Background and Objectives: Postoperative pain after endoscopic discectomy may reflect acute surgical nociception superimposed on pre-existing radicular symptoms. Molecular hydrogen (H2) has antioxidant and anti-inflammatory properties, but clinical evidence for perioperative analgesia is limited. We evaluated the association between perioperative H2 inhalation and postoperative pain and analgesic requirements. Materials and Methods: This open-label, non-randomized pilot study enrolled 37 patients in two consecutive periods (H2, n = 25; control, n = 12). Because original outcome records for 12 H2-period participants could no longer be retrieved at the time of manuscript preparation, the complete-case clinical analysis included 25 source-verifiable participants (H2, n = 13; control, n = 12). H2 was delivered via nasal cannula as a 66.7% H2/33.3% O2 source gas at 2 L/min (estimated inspired H2 approximately 4%). Pain was evaluated with a numerical rating scale (NRS) preoperatively, at post-anesthesia care unit (PACU) arrival, at 1, 6, 12, and 24 h, and at 1 month. Longitudinal scores were analyzed using generalized estimating equations with Holm-adjusted comparisons. A parallel exploratory murine chronic constriction injury (CCI) experiment (n = 6/group) assessed mechanical allodynia over 14 days of daily H2 inhalation. Results: The group-by-time interaction was significant (Wald χ[2](6) = 56.68, p < 0.001). After Holm adjustment, pain scores were lower with H2 at PACU arrival (difference, -3.21; adjusted p = 0.002), 1 h (-2.42; adjusted p = 0.004), and 1 month (-3.45; adjusted p < 0.001). Intraoperative fentanyl use and rescue analgesic use were also lower in the H2 group; no adverse events were documented in the analyzed cohort. In the murine CCI experiment, H2-treated mice showed higher ipsilateral paw withdrawal thresholds than air-exposed controls. Conclusions: Perioperative H2 inhalation was associated with lower pain scores at selected time points and reduced analgesic requirements. These preliminary findings require confirmation in randomized trials. Trial registration: ClinicalTrials.gov NCT05476575.

The occurrence of lumbar spinal chondromas is exceptionally rare, with fewer than 30 cases reported. Due to their rarity and similar presentation to more common spinal pathologies, lumbar spinal chondromas often pose diagnostic challenges. A 19-year-old patient was diagnosed with lumbar spinal chondroma at the L5-S1 level. The tumor was initially misinterpreted as a case of lumbar disc prolapse, and surgical decompression was planned. During surgery, a whitish firm, cartilaginous tumor compressing the S1 nerve root was discovered and excised. A narrative review of the literature was conducted, analyzing case reports and series of lumbar spinal chondromas published between 1900 and October 2025. A total of 25 cases were included, with a focus on clinical presentation, imaging findings, surgical management, and outcomes. The most common symptoms of lumbar spinal chondromas are low back pain (44%) and sciatica (40%). Neurological deficits, such as conus medullaris syndrome, cauda equina syndrome, or paraparesis, were observed in 8% of cases. Lumbar spinal chondromas, although rare, should be considered in the differential diagnosis of lumbar radiculopathy or back pain. In this nearly doubled cohort relative to the prior systematic review, peripheral rim enhancement on magnetic resonance imaging, previously considered the most characteristic discriminating feature, was present in fewer than a third of cases, highlighting the persistent diagnostic difficulty of this entity. The surgical approach and anatomical location significantly influence recovery, with most cases showing positive postsurgical results.

Intervertebral disc disease (IVDD) leads to chronic lumbosacral radiculopathy (LSR) with nerve root compression resulting in numbness and low back pain. The aim was to evaluate therapeutic and immunomodulatory potential of multi-protein platelet and plasma-derived biologic (C-1101) to alter inflammatory mediators and gene expression in IVDD.

Study DesignLiterature review with consensus clinical recommendations.ObjectiveTo review key studies on surgical vs. non-operative treatment for lumbar disc herniation (LDH) and present recommendations for how the practicing clinician should use this evidence.MethodsTwo randomized controlled trials (RCTs), two RCTs with concomitant observational cohorts, one prospective study, and one retrospective study were summarized, methodologically assessed, and assigned an expert clinical recommendation.ResultsKim et al. demonstrated that selected surgical candidates who prefer to avoid surgery can achieve similar long-term outcomes with non-surgical management, although with slower recovery. Lurie et al. demonstrated surgical superiority in as-treated analyses across pain and disability up to 8 years, but substantial crossover limited intention-to-treat findings. Peul et al. showed that early surgery versus prolonged conservative management yields equivalent 1-year outcomes, with the primary benefit of faster pain relief. Bailey et al. demonstrated that for persistent sciatica (4-12 months), microdiscectomy outperforms conservative care at 6 months. Petr et al. found that in the case of acute motor deficit, surgery within 48 hours yields faster neurological recovery. Thomé et al. identified 3 days as the critical cutoff for complete recovery in moderate-to-severe deficits, with 8 days applicable for mild deficits.ConclusionsThe evidence suggests that, for patients without motor deficits, symptom duration, severity, and patient preference should drive treatment selection, with increasing benefit of surgery as symptom duration grows. For patients with motor deficits, decompression within 3 days should be the goal for moderate-to-severe paresis to maximize the likelihood of complete neurological recovery.

Low back pain (LBP) is one of the leading causes of disability worldwide, affecting hundreds of millions of people globally. Scientific literature continues to highlight key issues in managing these patients, including accuracy of diagnostic terminology, identification of the specific pain mechanisms, and lack of effective licensed treatment options. Using published clinical trials of gabapentinoids to provide insights, we discuss key methodological and clinical factors, such as the accurate use of terminology, appropriate patient selection, effective application of screening tools, and mechanism-based selection of medicines at therapeutic doses. It is important to select a patient population appropriately for the specific pain mechanism treated by the medicine under assessment. Current evidence suggests that identification of a neuropathic component in clinical trials is often inadequate, with many studies either failing to use available validated screening tools or applying them without sufficient methodological rigor. Alongside this, spontaneous resolution of acute pain in low back patients remains an important confounder that is often not thoroughly accounted for. Patients with LBP represent a highly heterogeneous group, and the potential disconnect between diagnosis and mechanism is not helped by older nonspecific terminology. The clinical community continues to improve the terminology, such as the recent International Association for the Study of Pain (IASP) definition of "spine-related leg pain" updating the older diagnosis of "sciatica." Defining or further stratifying a patient population (for example, using neuropathic screening tool scores) and then evaluating multiple treatments effective for nociceptive or neuropathic pain may improve a study's discriminatory power while reducing the number of patients required. Once initial drug efficacy has been established in randomized, placebo-controlled trials, additional study designs targeting specific patient populations can still provide valuable insight into key clinical questions, often requiring substantially fewer resources.

Lumbar epidural steroid injections (LESIs) are minimally invasive, image-guided procedures used to treat lumbosacral radicular pain by depositing corticosteroid, with or without local anesthetic, into the epidural space. Radicular pain results from inflammation, irritation, or compression of a lumbar or sacral nerve root. This pain commonly presents in the low back and radiates into the buttock or lower extremity in a dermatomal distribution. Lumbar disc herniation is the most common cause; degenerative lateral recess or foraminal stenosis, spondylolisthesis, postoperative epidural fibrosis, and facet synovial cysts may also produce radicular symptoms. LESIs are not routinely indicated for isolated axial low back pain without radicular features. LESIs occupy an intermediate role between noninterventional treatment and surgical decompression. In appropriately selected patients with persistent, function-limiting radicular pain despite conservative measures, an injection may provide sufficient symptom relief to facilitate physical therapy, maintenance of daily activity, and reduction of analgesic requirements. LESIs do not correct the underlying structural pathology and should not delay urgent evaluation of cauda equina syndrome, progressive motor deficit, suspected infection, fracture, or malignancy. Three lumbar epidural approaches are used: interlaminar, transforaminal, and caudal. The transforaminal approach permits selective delivery near the affected nerve root and ventral epidural space. In contrast, interlaminar and caudal approaches generally provide broader epidural distribution and may be useful for multilevel symptoms, bilateral disease, or altered postsurgical anatomy. Approach selection should be individualized according to clinical presentation, imaging findings, prior surgery, and procedural risk. Fluoroscopic guidance with contrast confirmation is routinely used to optimize needle placement and assess injectate spread. Evidence supports realistic, time-limited expectations. A 2025 systematic review from the American Academy of Neurology concluded that epidural steroid injections probably reduce short-term pain and disability in cervical and lumbar radiculopathy, while evidence remains insufficient to establish durable long-term pain relief. Similarly, a 2024 systematic review and meta-analysis found short- to medium-term pain benefit for sciatica caused by lumbar disc herniation but no clear improvement in functional recovery. Although serious complications are uncommon, they can be consequential. Careful patient selection, image-guided technique, appropriate use of contrast, and vigilance for intravascular or intrathecal injection are essential components of safe practice. LESIs should therefore be incorporated into a multimodal, patient-centered treatment plan rather than used as a stand-alone or indefinitely repeated intervention.