Systematic Review of Outcomes Following 10-Year Mark of Spine Patient Outcomes Research Trial for Intervertebral Disc Herniation

Oster, Brittany A.; Kikanloo, Sina Rashidi; Levine, Nicole L.; Lian, Jayson; Cho, Woojin

doi:10.1097/brs.0000000000003400

Cited by 10 publications

(8 citation statements)

References 36 publications

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“…The lack of symptoms may be a consequence of the nature of the tear, location, and severity of the injury. Symptomatic lumbar disc herniations that do not resolve with initial appropriate nonoperative management are often managed surgically 71 . While surgical intervention decompresses neural elements and removes the herniated component of the disc, there is no successful method to clinically repair the AF.…”

Section: Annulus Fibrosus Injurymentioning

confidence: 99%

A challenging playing field: Identifying the endogenous impediments to annulus fibrosus repair

et al. 2021

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Intervertebral disc (IVD) herniations, caused by annulus fibrosus (AF) tears that enable disc tissue extrusion beyond the disc space, are very prevalent, especially among adults in the third to fifth decade of life. Symptomatic herniations, in which the extruded tissue compresses surrounding nerves, are characterized by back pain, numbness, and tingling and can cause extreme physical disability. Patients whose symptoms persist after nonoperative intervention may undergo surgical removal of the herniated tissue via microdiscectomy surgery. The AF, however, which has a poor endogenous healing ability, is left unrepaired increasing the risk for re-herniation and pre-disposing the IVD to degenerative disc disease. The lack of understanding of the mechanisms involved in native AF repair limits the design of repair systems that overcome the impediments to successful AF restoration. Moreover, the complexity of the AF structure and the challenging anatomy of the repair environment represents a significant challenge for the design of new repair devices. While progress has been made towards the development of an effective AF repair technique, these methods have yet to demonstrate long-term repair and recovery of IVD biomechanics. In this review, the limitations of endogenous AF healing are discussed and key cellular events and factors involved are highlighted to identify potential therapeutic targets that can be integrated into AF repair methods. Clinical repair strategies and their limitations are described to further guide the design of repair approaches that effectively restore native tissue structure and function.

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Section: Annulus Fibrosus Injurymentioning

confidence: 99%

A challenging playing field: Identifying the endogenous impediments to annulus fibrosus repair

et al. 2021

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“…Having intractable pain and failing ambulatory conservative treatment essentially means that all of this patient subset consists of potential surgical candidates, meeting similar inclusion criteriae to the patients randomized in previous studies comparing conservative to surgical treatment 2 , 4 , 5 , 10 , 18 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of intra-venous steroids for preventing surgery for lumbo-sacral radiculopathy secondary to intervertebral disc herniation: a retrospective study of 213 patients

Kovarsky

Shani

Rod

et al. 2022

Sci Rep

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The natural history of lumbar disc herniation with radiculopathy is favorable, with 95% of patients expected to be pain-free within 6 months of onset. Despite the favorable prognosis, operative treatment is often chosen by patients unable to “ride out” the radicular episode. Prospective studies comparing surgical with non-surgical treatment have demonstrated similar long-term results. We conducted a retrospective case-series study of patients with a lumbar disc herniation and intractable radicular pain without significant neurological deficits treated with intra-venous dexamethasone. The primary outcome measure was whether the patient had undergone operative treatment within 1 year of receiving the intravenous steroid treatment. 213 patients met our inclusion criteria. 30 were lost to follow-up and 2 had died before completing 1 year of follow-up. Of the remaining 181 patients, 133 (73.48%) had not undergone surgery within 1 year of receiving intra-venous steroid treatment while 48 (26.51%) had undergone surgery. 6 (3.31%) of the patients had undergone surgery more than 1 year of receiving IV steroid treatment. Intravenous steroid treatment in our retrospective series was approximately 30% better at preventing the need for surgery than the reported outcomes of conservative treatment in randomized controlled trials previously published.

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“…The mechanism of radicular pain in disc herniation may relate to mechanical compression or inflammation [ 1 , 7 - 10 ]. While surgical interventions are considered the mainstay of treatment for lumbar disc herniation or radiculopathy [ 11 ], multiple studies have shown epidural injections to be effective [ 1 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

et al. 2021

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Background: Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. Methods: An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). Results: This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. Conclusions: Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

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Systematic Review of Outcomes Following 10-Year Mark of Spine Patient Outcomes Research Trial for Intervertebral Disc Herniation

Cited by 10 publications

References 36 publications

A challenging playing field: Identifying the endogenous impediments to annulus fibrosus repair

A challenging playing field: Identifying the endogenous impediments to annulus fibrosus repair

Effectiveness of intra-venous steroids for preventing surgery for lumbo-sacral radiculopathy secondary to intervertebral disc herniation: a retrospective study of 213 patients

The role of percutaneous neurolysis in lumbar disc herniation: systematic review and meta-analysis

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