Materiały źródłowe

• #1 Herniated Disk (Bulging Disk): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/12768-herniated-disk

  For the majority of people, herniated disk pain gets better on its own or with simple medical care. You’ll probably feel better within a month. If you don’t, you should see a healthcare provider. Some people need more aggressive medical measures, like spinal injections or herniated disk surgery. […] An untreated herniated disk can get worse. That’s especially true if you continue the activities that caused it for instance, if it developed because of your work. A worsening ruptured disk may cause chronic (ongoing) pain and loss of control or sensation in the affected area. See a healthcare provider if you still have symptoms after four to six weeks of conservative care.

• #1 Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial | BMJ Open

  https://bmjopen.bmj.com/content/3/5/e002534

  The primary aim of the present study was to compare the pain and disability scores at 5years follow-up between patients in the Sciatica Trial randomised for surgery or randomised for prolonged conservative treatment. […] In the long term, 8% of the patients with sciatica never showed any recovery and in at least 23%, sciatica appears to result in ongoing complaints, which fluctuate over time, irrespective of treatment. […] Age above 40years, severe leg pain at baseline and a higher affective Mc Gill pain score were predictors for unsatisfactory recovery. […] Twenty-one per cent of patients experienced unsatisfactory recovery at 5years, while 31% of the patients with complete data at 1, 2 and 5years of follow-up noted at least once an unsatisfactory recovery during this 5years follow-up period, irrespective of their allocated group.

• #1 Systematic review and meta-analysis of predictive factors for spontaneous regression in lumbar disc herniation in: Journal of Neurosurgery: Spine Volume 39 Issue 4 (2023) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/39/4/article-p471.xml

  Sixteen articles describing 360 cases of LDH were identified. […] The probabilities of spontaneous regression with bulging, protruded, extruded, and sequestered discs were 13.3%, 52.5%, 70.4%, and 93.0%, respectively (2 = 126.01, p 0.001). […] Extruded and sequestered discs were also significantly more likely to completely regress than smaller morphologies. […] This study shows further evidence of the influence of disc morphology on predicting LDH regression as well as provides the first meta-analysis of data indicating additional predictive factors. […] Further investigation of predictive factors for early ( 6 months) LDH regression is suggested to optimize clinical use. […] Researchers examined the entire literature to date to assess quantitative predictors for spontaneous regression of primary symptomatic herniated lumbar discs.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6396874/

  The aim of this study was to assess the predictive value of T2 mapping at baseline with regard to the development of disk herniation and clinical outcome at a 5-year follow-up in patients with low back pain. […] Using the baseline NPAF ratio, follow-up development of herniation was predicted with an area under the curve (AUC) of 0.893 in a receiver operating characteristic curve. The same was done using the baseline nucleus pulposus T2, resulting in an AUC of 0.901. […] Quantitative T2 mapping may serve as a clinically feasible, noninvasive imaging biomarker that can indicate disks at risk for herniation and correlates with clinical outcome and subjective patient burden in a representative cohort of patients with low back pain. […] The main finding of the assessed data shows that disks with herniation and worsened clinical outcome can be significantly differentiated from the rest via prediction based on quantitative baseline T2 mapping data. The NPAF ratio and NP T2 differed significantly between disks with and without new herniation at follow-up.

• #1 The outcome predicted value of enhanced MRI for prolapsed or sequestrated lumbar disc herniation | Chinese Journal of Orthopaedics;(12): 1350-1360, 2021. | WPRIM

  https://pesquisa.bvsalud.org/portal/resource/pt/wpr-910722

  The outcome predicted value of enhanced MRI for prolapsed or sequestrated lumbar disc herniation […] Objective: To analyze the predictive value of enhanced MRI in the outcome of prolapsed and sequestrated lumbar disc herniation through a retrospective analysis. […] Conclusion: Under close clinical observation, parts of the prolapsed or sequestrated lumbar disc herniations can be conservatively treated, and the herniated disc can be resorption in many people and the clinical symptoms were alleviated. Rim-enhancement signal differentiation by enhanced MR has a better predictive value for the outcome of the herniation, type I is more prone to resorption, preferred conservative treatment, type II is not easy to resorption, preferred surgery treatment, and the higher thickness of rim enhancement, the greater extend the rim-enhancement, the more prone to resorption phenomenon.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921966/

  In patients with a herniated disc confirmed by imaging and leg symptoms persisting for at least 6 weeks, surgery was superior to non-operative treatment in relieving symptoms and improving function. […] In the longitudinal intention-to-treat analysis, all the outcomes showed small advantages for surgery, but only the secondary outcomes of sciatica bothersomeness, satisfaction with symptoms, and self-rated improvement were statistically significant. […] The as-treated analysis combining the randomized and observational cohorts, which carefully controlled for potentially confounding baseline factors, showed significantly greater improvement in pain, function, satisfaction, and self-rated progress over 8 years compared to patients treated non-operatively. […] The non-operative group, however, also showed substantial improvements over time, with 54% reporting being satisfied with their symptoms and 73% satisfied with their care after 8 years.

• #1 Legacy Research Page: ChiroGeek.com

  https://www.chirogeek.com/Research-Legacy-9-8-18/002_Carragee-HNP-Classifications.htm

  The Fragment-contained and the Fragment-Fissure groups did the best with surgery as measured by the average Oswestry Disability and Stanford scores. The 80% improvement of the fragment-contained group was quite impressive. […] The Fragment-Defect group, which had the large gaping 6 millimeter + channel in their anulus (6mm), did not do so well. That large channel or defect in the anulus, seemed to make the disc prone to 'recurrent herniation’, as evident by the 27% re-herniation rate! […] Carragee notes that the 89 „Patients who had extruded disc herniation’s with largely intact anuli (Fragment-Fissure herniation) did exceptionally well, with only one recurrence (1.1%) after five full years of observation! In contract, patients who had extruded fragments with large or massive anular defects (Fragment-Defect herniations) accounted for most of the clinically important reherniations and reoperations over time.” […] Carragee stated this: „The treatment of anular prolapses with no discrete fragments (No Fragment-Contained herniation group) by means of conventional anulotomy and limited discectomy was unsatisfactory.”

• #1

  https://link.springer.com/article/10.1007/s00701-021-04859-3

  To develop a prognostic model for failure and worsening 1 year after surgery for lumbar disc herniation. […] The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. […] We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery. […] The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. […] The combination of the presence (yes) or absence (no) of each prognostic factor, as well as their respective odds ratios yield an overall probability for failure or worsening in each of the three ODI baseline groups.

• #1 Study shows how AI can predict prognosis after lumbar disk herniation surgery

  https://medicalxpress.com/news/2024-02-ai-prognosis-lumbar-disk-herniation.html

  Machine learning models can inform patients and clinicians about prognosis after lumbar disk herniation surgery, according to a study published online Feb. 7 in JAMA Network Open. […] The researchers found that the proportion of cases experiencing treatment non-success were 33, 27, and 31 percent based on improvement in the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) back pain, and NRS leg pain, respectively. […] „The models were based on routinely available preoperative predictors, making them readily amenable to further external validation in other spine registries and potentially implementable in electronic medical records systems to inform about individual prognosis and aid in surgical decision-making,” the authors write.

• #1 Surgery for Lumbar Disc Herniation and Future Risk for Long-Term Sick Leave: A Two-Year Prospective Swedish Cohort Study of 5842 Patients of Working Age

  https://www.clinmedjournals.org/articles/iaos/international-archives-of-orthopaedic-surgery-iaos-6-030.php?jid=iaos

  Even if lumbar disc-herniation (LDH)-surgery is rather common, there is little knowledge on future sick leave. […] The results show that patients with > 90 sick-leave days before surgery, female sex, and being born outside of Sweden have a statistically significant higher risk of > 180 sick-leave days in the first and second year following LDH-surgery date. […] The majority of patients surgically treated for LDH had fewer than 180 sick-leave days during the first year following the procedure. However, the risk of having > 180 sick-leave days the first year after surgery was significantly higher for those who had been on sick leave > 90 days in the year before surgery, this higher risk was also persistent in the second year following the surgery. Female sex and born outside of Sweden were also associated with a higher risk for > 180 sick-leave days. Age and educational level displayed significantly weaker associations with sick leave after surgery. The results of this first explorative study indicate that further studies on risk factors for long-term sick leave following LDH surgery are warranted-especially as long-term sick leave sometimes is an indicator for performing such surgery.

• #1 Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0474-9

  Lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. Specifically, lower age and low fear avoidance predict a better functional outcome and less back pain, while higher education and working full-time predict less leg pain. […] Identification of prognostic factors predicting persistent pain and disability is important for better understanding of the clinical course information that can be provided to patients and physicians and decision-making in treatment and guidance of patients with radiculopathy. We identified higher age and reflex impairment as prognostic factors for non-success, and higher education, working full-time and low fear avoidance as prognostic factors for a successful outcome. These prognostic factors may be used by clinicians to inform patients about the one-year prognosis of chronic unilateral lumbar radiculopathy.

• #1

  https://link.springer.com/article/10.1007/s00586-023-07528-4

  There is little, and low quality, evidence to guide practice in terms of factors that predict outcomes in patients following ESI for disc-related sciatica. […] The review found 15 eligible studies, which explored 42 potential prognostic factors assessed before the ESI. Our review showed that no prognostic factor is consistently associated with patient outcomes, most studies found no association or conflicting results. […] Considering the frequent use of ESIs in clinical practice, the search results are surprising. It was anticipated that there would be more high-quality prognosis studies of this nature. […] This systematic review highlights the continued uncertainty about prognostic factors in patients having ESI for sciatica. There is a clear need for a suitably powered, low risk of bias, prospective cohort to more carefully investigate factors that predict outcome following ESI.

• #1 The Course of Pain Intensity in Patients Undergoing Herniated Disc Surgery: A 5-Year Longitudinal Observational Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156647

  Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi = 25.97, p0.001). […] In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. […] The most important risk factors for postsurgical pain were a negative SPE and depression. The results promote a multimodal treatment setting including psychological and vocational support for patients at risk of pain chronification.

• #2 The Course of Pain Intensity in Patients Undergoing Herniated Disc Surgery: A 5-Year Longitudinal Observational Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156647

  Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi = 25.97, p0.001). […] In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. […] The most important risk factors for postsurgical pain were a negative SPE and depression. The results promote a multimodal treatment setting including psychological and vocational support for patients at risk of pain chronification.

• #2 Systematic review and meta-analysis of predictive factors for spontaneous regression in lumbar disc herniation in: Journal of Neurosurgery: Spine Volume 39 Issue 4 (2023) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/39/4/article-p471.xml

  Transligamentous rupture and increasing size of herniated disc in terms of both morphology and baseline volume were significantly associated with regression. […] This finding aids in the operative decision-making for this cohort; however, predictors of regression should be assessed over a shorter time frame (e.g., 6 months) to ensure optimal clinical use in the future.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6396874/

  This study is, to the best of our knowledge, the first study to longitudinally investigate the prognostic potential of T2 mapping to predict future disk herniation in a 5-year follow-up. […] We conclude that T2 mapping may quantitatively indicate the risk of lumbar disk herniation and significantly correlate with individual disease burden, as reported by patients in this 5-year follow-up study.

• #2

  https://link.springer.com/article/10.1007/s00701-021-04859-3

  The model can identify patients with a high and low baseline probability for those outcomes. […] The estimated preoperative probabilities in our study population ranged from 3% to 94% for failure and from 1% to 72% for worsening, exemplified by three cases. […] We have developed a prognostic model to identify patients at risk of unfavorable outcomes after lumbar microdiscectomy, which could assist physicians and patients in clinical decision-making prior to surgery in cases where the indication for surgery is not clear cut.

• #2 Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial | BMJ Open

  https://bmjopen.bmj.com/content/3/5/e002534

  In our study, we could not estimate the effect of early versus late surgery, or surgery versus conservative treatment in an unbiased way since that would require a per protocol analysis. […] In this 5-year analysis the independent prognostic factors for an unsatisfactory outcome were a high McGill affective score, a high amount of leg pain and age over 40years at baseline. […] Signs of pain quality associated with depression and a more anxious mood, the age of the patient and the severity of leg pain at baseline were predictive of an unsatisfactory outcome. […] Furthermore, although the total number of disabled patients without pain free periods in this study seems to be low, in almost one-fourth of the patients, sciatica appears to be an ongoing disease with variable complaints in time, irrespective of treatment.

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