A significant number of patients with degenerative lumbar spine disease (DSD) require decompressive surgery. Disparities in surgical care exist between different countries and regions. This study reports on the clinical and safety outcomes of lumbar decompressive surgery performed in the Gaza Strip, a poor and underserved area with a fragile healthcare system.

Patients with DSD were prospectively followed up after undergoing lumbar decompressive surgery at two major governmental hospitals in the Gaza Strip between October 2019 and March 2020. Outcomes were assessed using the Core Outcome Measure Index (COMI-back) and the Oswestry Disability Index (ODI), measured both before and three months after surgery. Surgical complication rates were also evaluated. A paired t-test was performed to explore the significance of differences in the mean pre- and postoperative scores for each COMI variable and the ODI item.

Sixty-six patients were included, consisting of 41 (62.1 %) males and 25 (37.9 %) females, with a mean age of 61.02 ± 11.4 years. The total COMI-back score decreased from 27.3 ± 6 to 10.3 ± 10 postoperatively (p < 0.0001). A decrease of 15.15 points was also noted between the mean ODI scores before and after surgery (p < 0.0001). Similar significant decreases were observed across all COMI-back and ODI items. The three-month global outcome indicated that the operation benefited 47 patients (71.2 %). Likewise, 39 (59 %) and 19 (28.7 %) reported being "highly satisfied" or "satisfied" with the overall state of their back/leg symptoms, respectively. Eight (12.1 %) patients experienced a postoperative complication: six (9.5 %) had wound infections, one (1.5 %) sustained a dural tear, one (1.5 %) experienced a CSF leak, and one (1.5 %) needed reoperation. The mean hospital stay was 2 days ± 1.3 days.

The study shows a significant improvement across all outcome parameters from baseline to the three-month postoperative follow-up, with rates of surgical complications and hospital stays comparable to global averages.

Lumbar disc herniation (LDH) is one of the most common conditions associated with functional disability, affecting patients' quality of life (QOL). Disability can be affected by cognitive factors, such as pain catastrophizing. Similarly, unfulfilled basic psychological needs (i.e., autonomy, competence, relatedness) are associated with biases in pain perception and QOL. Using the fear-avoidance model and the self-determination theory, this study investigates: (1) the separate contribution of pain-related variables and basic psychological needs satisfaction in predicting QOL in patients proposed for LDH surgery; (2) pre- and post-surgical differences in pain catastrophizing and basic psychological needs satisfaction.

First, we used hierarchical regression on 193 patients (M_age = 46.10, SD_age = 11.40) to identify predictors of QOL. Second, we performed paired t-tests on 55 patients to investigate pre- and post-surgical differences in pain catastrophizing and basic psychological needs satisfaction.

Hierarchical regression showed that the model predicts 27% of the variance in QOL; medium pain level, age, pain catastrophizing, and basic psychological needs satisfaction were significant predictors. Also, pain catastrophizing significantly decreased after surgery [t (54) = 6.07, p < 0.001, Cohen's d = 0.81], but basic psychological needs satisfaction did not modify significantly.

This research confirms the importance of pain perception and pain catastrophizing for LDH patients' QOL and broadens the applicability of the self-determination theory for spinal patients.

A survey study was conducted in Korean medicine doctors who provide nonsurgical integrative treatment for cervical disc herniation (CDH) at spine-specialty hospitals to assess usual treatment practices, diagnosis and treatment methods, and related adverse events for CDH. The questionnaire was jointly developed by clinical experts and methodology experts and was administered to 197 Korean medicine doctors (response rate: 84.9% (n = 197/232)) practicing at spine-specialty Korean medicine hospitals for analysis of general sociodemographic information, practice patterns of CDH including diagnosis and treatment strategies, CDH prognosis, and treatment safety. The average clinical experience of respondents was 9.3±6.4 years, and 4.0±1.8 weeks were regarded to be needed for CDH pain to decrease by 50% and 9.1±3.4 weeks to decrease by 80%. Eight-Principle Pattern and Meridian System Identification were the most commonly used Korean medicine syndrome differentiation methods, and CDH was most often considered to be a result of Qi stagnation and Blood coagulation. The Spurling test was reported to be important in physical examination, and magnetic resonance (MR) images were mostly used for diagnosis and treatment of CDH of various diagnostic tools. Treatment mainly consisted of a nonsurgical, integrative multimodal approach comprising acupuncture, pharmacopuncture, herbal medicine, and Chuna manual therapy. Shinbaro pharmacopuncture and Chungpa-jun, which are well-established herbal treatments supported by evidence, were considered to be of high importance in CDH treatment. With regard to safety, acupuncture was considered to be the safest, while bee venom pharmacopuncture was of highest concern due to potential hypersensitivity. This study is the first report to investigate current practice patterns and approach of Korean medicine doctors to CDH treatment. This data may be of significance to Korean medicine doctors in drawing clinical guidelines and conducting randomized controlled trials (RCTs) to generate high-level evidence on the effectiveness of nonsurgical integrative medicine treatments for CDH.

Pain relief has been shown to be the most frequently reported goal by patients undergoing lumbar disc surgery. There is a lack of systematic research investigating the course of postsurgical pain intensity and factors associated with postsurgical pain. This systematic review focuses on pain, the most prevalent symptom of a herniated disc as the primary outcome parameter. The aims of this review were (1) to examine how pain intensity changes over time in patients undergoing surgery for a lumbar herniated disc and (2) to identify socio-demographic, medical, occupational and psychological factors associated with pain intensity.

Selection criteria were developed and search terms defined. The initial literature search was conducted in April 2015 and involved the following databases: Web of Science, Pubmed, PsycInfo and Pubpsych. The course of pain intensity and associated factors were analysed over the short-term (≤ 3 months after surgery), medium-term (> 3 months and < 12 months after surgery) and long-term (≥ 12 months after surgery).

From 371 abstracts, 85 full-text articles were reviewed, of which 21 studies were included. Visual analogue scales indicated that surgery helped the majority of patients experience significantly less pain. Recovery from disc surgery mainly occurred within the short-term period and later changes of pain intensity were minor. Postsurgical back and leg pain was predominantly associated with depression and disability. Preliminary positive evidence was found for somatization and mental well-being.

Patients scheduled for lumbar disc surgery should be selected carefully and need to be treated in a multimodal setting including psychological support.