Patients with lumbar disc herniation who failed conservative treatment undergoing surgical treatment through microdiscectomy.

Lumbar Intervertebral Disc, Flavum ligament, Multifidus muscle

Infection

Intervertebral Disc Herniation

Propionibacterium Infection

Spinal Diseases

Discitis

It will be an observational study without interventions. Subjects with diagnose of lumbar disc herniation undergoing open decompression surgery (microdiscectomy) will be included and analyzed. There will be no direct intervention to the patient proposed by the study.

Microdiscectomy

Hospital Israelita Albert Einstein

Subclinical Propionibacterium Acnes Infection Estimation in the Intervertebral Disc (SPInE-ID)

Subclinical Propionibacterium Acnes Infection Estimation in the Intervertebral Disc (SPInE-ID): a Prospective Cohort

The main objective of this study considers that the intervertebral disc is infected by any type of low virulence pathogen, which leads to Modic changes and chronic low back pain. Thus, calculation of the incidence of infection in lumbar disc herniations will be performed.
1. Incidence of infection rate (IIR) will be calculated as follows: IIR = (number of detected infections) (total number of included patients)

Intensity of low back pain and limitation for daily activities of patients with and without infection will be analyzed through the Numeric Rating Score (NRS) system applied at time of patient recruitment and 1, 3, 6 and 12 months after surgical procedure. Minimal clinically important difference will be considered as an increase of 30% of baseline lumbar pain at first postoperative month, due to possible bias of postoperative pain due to surgical manipulation as well as pain due to the disc herniation itself.

Quality of life at the end of one year for both infected and uninfected groups, with and without Modic changes, will be analyzed through the validated Portuguese version of the EuroQol (EQ-5D) questionnaire. This measurement tool will be applied at timing of patient recruitment, and 1, 3, 6 and 12 months after surgery.

Function will be quantified through the Portuguese version of the Oswestry Disability Index (ODI) for lumbar pain that will be applied at time of recruitment and 1, 3, 6 and 12 months after surgery.

Insurgent Modic changes in patients will be analyzed one year after surgery, as well as its relationship with presence or absence of infection.
Incidence of Modic (IM) changes will be calculated for the infection group (IM infec) and for the total group (IM total) as follows:
(number of Modic changes in infected IM infec = patients after 1 year) (total number of infections)
IM total = number of Modic changes at final 1 year follow-up total number of patients

Modic volume will be measured according to Wang et al(18). Three sagittal slices of the lumbar spine will be considered: midsagittal slice; left pedicle parasagittal slice; and right pedicle parasagittal slice. The parameters examined to quantify Modic changes will include measures of ratios of the region affected by Modic changes to the entire corresponding vertebral body, including maximal width ratio, maximal height ratio, and area ratio. Vertebral body changes will be classified accordingly to Modic changes type I, II, and III(1,2).

Fail of surgical treatment (recurrence, instability, need for reoperation, etc.); need for additional physical therapy sessions; superficial infection; drainage; deep venous thrombosis; and, any other possible adverse event that may show up will be included as well.

Data will be collected for presence of vertebral or disc edema, and presence of disc hydration or not.

Disc degeneration will be collected as: normal; degeneration with height preservation; and, degeneration with loss of height. Presence of disc hydration or not.

sciatica/треска

Subclinical Propionibacterium Acnes Infection Estimation in the Intervertebral Disc (SPInE-ID)

The Efficacy of Oral Steroids in the Treatment of Acute Sciatica

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