Lumbar disc herniation with contralateral radiculopathy: a systematic review on pathophysiology and surgical strategies

Ruschel, Leonardo Gilmone; Agnoletto, Guilherme José; Aragão, Afonso Henrique de; Duarte, Joel Sanabria; Oliveira, Matheus Fernandes de; Teles, Alisson Roberto

doi:10.1007/s10143-020-01294-3

“…Lumbar intervertebral disc herniation is a common disease in orthopaedics, most of which are ipsilateral radiculopathy caused by ipsilateral intervertebral disc herniation, and some patients may also have symptoms of contralateral radiculopathy. 50 In TCM, it belongs to the categories of "Bi syndrome," "lower back pain," and "tendon injury." 51,52 According to the discussion in Bi Syndrome of Plain Conversation, "The interaction of wind, cold, and dampness causes Bi (stagnation or obstruction)."…”

Section: Lumbar Intervertebral Disc Herniationmentioning

confidence: 99%

“…Lumbar intervertebral disc herniation is a common disease in orthopaedics, most of which are ipsilateral radiculopathy caused by ipsilateral intervertebral disc herniation, and some patients may also have symptoms of contralateral radiculopathy. 50 In TCM, it belongs to the categories of “Bi syndrome,” “lower back pain,” and “tendon injury.” 51 52 According to the discussion in Bi Syndrome of Plain Conversation, “The interaction of wind, cold, and dampness causes Bi (stagnation or obstruction).” In the discussion in Treatment of Lumbago with Acupuncture of Plain Conversation, it says “Lumbago due to disorder of the channel in the muscles makes the patient unable to cough and causes spasm when the patient coughs.” The disease is deficient in root and excess in superficial, and it takes “deficiency of the liver and kidney, insufficiency of qi and blood, and weakness of defensive Yang” as the root causes and “invasion of wind, cold, and dampness, obstruction of qi movement, retention of blood stasis” as the superficial causes. 53 54 In recent years, the number of patients with lumbar disc herniation has increased year by year, and they tend to be younger.…”

Section: Clinical Application Of Huangqi Guizhi Wuwu Decoction In Ort...mentioning

confidence: 99%

Application of Huangqi Guizhi Wuwu Decoction in Orthopaedics and Traumatology

Xu

¹

,

Tan

²

,

Wang

³

et al. 2022

Chinese medicine and natural products

0

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The Huangqi Guizhi Wuwu Decoction(HQGZWWT) is composed of Huangqi (Astragali Radix), Shaoyao (Paeoniae Radix Alba), Guizhi (Cinnamomi Ramulus), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus) which has various pharmacological anti-inflammatory, analgesic, antioxidant, antitumor, lipid-lowering, and immunity-regulating activities. It has certain advantages in the treatment of orthopaedic diseases, such as cervical spondylosis, scapulohumeral periarthritis, lumbar disc herniation, knee osteoarthritis, rheumatoid arthritis, myofascial pain syndrome, etc., with outstanding clinical efficacy, few adverse reactions, and high patient compliance. However, modern pharmacological researches on the whole prescription of HQGZWWT are insufficient and the therapeutic targets are not clear which needs further exploration. Besides, this prescription cannot treat all orthopaedic diseases, so we should adhere to the thinking of four diagnostics in traditional Chinese medicine (TCM), select prescriptions based on syndrome differentiation, closely follow the pathogenesis, innovate and expand its scope of application, reflect the application advantages of this prescription in orthopaedics and traumatology and improve the total clinical efficiency.

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“…Lumbar disc herniation (LDH), as the most common cause of low back and leg pain [ 1 ], was diagnosed in 60% to 80% of people at different ages [ 2 ]. The LDH is common in people aged 25 to 55 spending large percent of times sitting or standing with heavy workload.…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis

Wang

¹

,

Long

²

,

Wu

³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. This study is aimed at exploring the clinical effect of mechanical traction on lumbar disc herniation (LDH). Methods. Related literatures were retrieved from PubMed, Medline, Embase, CENTRAL, and CNKI databases. Inclusion of literature topic was comparison of mechanical traction and conventional physical therapy for lumbar disc herniation. Jadad scale was used to evaluate the quality of the included RCT studies. The Chi-square test was used for the heterogeneity test, and a random effect model was used with heterogeneity. Subgroup analysis and sensitivity analysis were used to explore the causes of heterogeneity. If there was no heterogeneity, the fixed effect model was used, and funnel plots were used to test publication bias. Results. Visual analog scale (VAS) in the mechanical traction group was lower than that in the conventional physical therapy group ( MD = − 1.39 (95% CI (-1.81, -0.98)), Z = 6.56 , and P < 0.00001 ). There was no heterogeneity among studies ( Ch i 2 = 6.62 , P = 0.25 , and I 2 = 24 %) and no publication bias. Oswestry disability index (ODI) in the mechanical traction group was lower than that in the conventional physical therapy group ( MD = − 6.34 (95% CI (-10.28, -2.39)), Z = 3.15 , and P = 0.002 ). There was no heterogeneity between studies ( Ch i 2 = 6.27 , P = 0.18 , and I 2 = 36 %) and no publication bias. There was no significant difference in Schober test scores between the mechanical traction group and the conventional physical therapy group ( MD = − 0.40 (95% CI (-1.07, 0.28)), Z = 1.16 , and P = 0.25 ). There was no heterogeneity among studies ( Ch i 2 = 1.61 , P = 0.66 , and I 2 = 0 %) and no publication bias. Conclusion. Mechanical traction can effectively relieve lumbar and leg pain and improve ODI in patients with lumbar disc herniation but has no significant effect on spinal motion. The therapeutic effect of mechanical traction was significantly better than that of conventional physical therapy. Lumbar traction can be used in conjunction with other traditional physical therapy.

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“…A herniated lumbar disc (HLD) refers to the displacement of the disc material beyond the intervertebral disc space. 1 It is one of the most common causes of musculoskeletal pain 2,3 ; the prevalence of a symptomatic HLD in the general population is 1%-3%. 1 The HLD causes lumbosacral radicular pain, and its mechanisms are direct mechanical compression of the nerve root and chemical inflammation around the nerve root.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of transforaminal epidural steroid injection in patients with lumbosacral radicular pain according to the location, type, and size of herniated lumbar disc

Kwak

¹

,

Jang

²

,

Lee

³

2021

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Objectives: Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbosacral radicular pain due to herniated lumbar disc (HLD). Objectives:We evaluated the long-term outcomes of TFESI in patients with lumbosacral radicular pain due to an HLD by the location, type, and size of the HLD. Methods:In total, 114 patients who received the initial TFESI at least 4 years ago completed a telephone interview. We investigated the presence of radicular pain, degree of current pain, current pain medications and TFESIs, additional TFESIs, progression to surgery, and trouble in performing daily life activities and occupational job duties. We classified the included patients by the location, type, and size of the HLD, and evaluated whether these factors affected the long-term outcomes of TFESI.Results: At least 4 years after the initial TFESI, radicular pain was completely resolved in 45% of the patients. However, 30% patients were on oral painkillers or repetitive TFESIs or had undergone surgery and 15% had difficulty in performing daily life activities and occupational job duties. A larger number of patients with extruded lumbar disc herniation required additional TFESIs than those with protruded lumbar disc herniation. Apart from this, the outcomes did not significantly differ by the location, type, and size of the HLD. Conclusions:Our findings provide useful information to clinicians managing radicular pain due to HLD.

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Lumbar disc herniation with contralateral radiculopathy: a systematic review on pathophysiology and surgical strategies

Cited by 26 publications

References 27 publications

Application of Huangqi Guizhi Wuwu Decoction in Orthopaedics and Traumatology

Application of Huangqi Guizhi Wuwu Decoction in Orthopaedics and Traumatology

Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis

Long‐term outcomes of transforaminal epidural steroid injection in patients with lumbosacral radicular pain according to the location, type, and size of herniated lumbar disc

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