Targeting dual pathways in refractory coccydynia: A comparative study of ganglion impar block alone versus combined with pericoccygeal injection.

To explore the predictive value of the Neutrophil-to-Lymphocyte Ratio (NLR) in the prognosis of patients with Lumbar Disc Herniation (LDH) undergoing Percutaneous Intradiscal Radiofrequency Thermocoagulation (PIRFT). A total of 121 patients with LDH undergoing PIRFT treatment were selected, ranging in age from 35 to 65 years old, with no gender restrictions. Blood samples were collected in the morning after admission while fasting, and the absolute neutrophil and lymphocyte counts in the blood were detected using the enzyme-linked immunosorbent assay (ELISA) method to calculate the Neutrophil-to-Lymphocyte Ratio (NLR). Patients were divided into two groups according to the modified Macnab criteria: the Effective group (E group) and the Invalid group (I group). The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores were used to assess the pain level and activity ability of the patients before treatment and at 90 days and 180 days post-treatment. The correlation between NLR and ODI, JOA scores was analyzed using rank correlation analysis, and the predictive value of NLR for the therapeutic effect of PIRFT was analyzed using the Receiver Operating Characteristic (ROC) curve. A total of 121 patients were ultimately enrolled. Based on the follow-up results at 90 days post-surgery, there were 110 cases in the effective group (E group) and 11 in the ineffective group (I group). The results showed that before treatment, the NLR levels in the E group were significantly lower than those in the I group (P < 0.05), and there were no significant differences in ODI and JOA scores between the two groups (P > 0.05). Ninety days after treatment, the NLR levels in the I group remained significantly higher than those in the E group (P < 0.05), and the E group's ODI and JOA scores showed significant improvement compared to before treatment (P < 0.05). In contrast, the I group only showed improvement in ODI scores (P < 0.05), with no significant change in JOA scores (P > 0.05). Additionally, the I group's ODI scores were significantly higher than those of the E group (P < 0.05), and their JOA scores were significantly lower than those of the E group (P < 0.05). All patients in the I group underwent a second radiofrequency ablation treatment. A comparison was made again after 180 days of treatment, and there were no significant differences in NLR levels between the two groups (P > 0.05). Both groups showed improvement in ODI and JOA scores compared to before treatment (P < 0.05), with no significant differences between the groups (P > 0.05). Rank correlation analysis showed that preoperative NLR levels were positively correlated with ODI scores at 90 days after PIRFT treatment (r = 0.386, P < 0.01) and negatively correlated with JOA scores (r = -0.326, P = 0.003). The results of the ROC curve analysis showed that the area under the ROC curve (AUC) was 0.803, the optimal diagnostic cutoff point was 1.975, the correct diagnosis index was 0.518, 95% CI: 0.650-0.955, P < 0.001. Preoperative inflammatory levels are one of the factors affecting the treatment of lumbar disc herniation with percutaneous radiofrequency ablation, and the Neutrophil-to-Lymphocyte Ratio (NLR) helps to predict the effectiveness of percutaneous disc radiofrequency ablation in treating lumbar disc herniation.

BackgroundWe aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS).MethodsThe study was an additional analysis in the NORDSTEN Spinal Stenosis Trial. In total, 230 men and 207 women (mean age 66.8 (SD 8.3)) were included. All patients underwent an MRI including T1- and T2-weighted sequences. Grade of foraminal stenosis was dichotomized into none to moderate (0–1) and severe (2–3) category using Lee’s classification system. The Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and numeric rating scale (NRS) for back and leg pain were collected at baseline and at 2-year follow-up. Primary outcome was a reduction of 30% or more on the ODI score. Secondary outcomes included the mean improvement on the ODI, ZCQ, and NRS scores. We performed multivariable regression analyses with the radiological variates foraminal stenosis, Pfirrmann grade, Schizas score, dural sac cross-sectional area, and the possible plausible confounders: patients’ gender, age, smoking status, and BMI.ResultsThe cohort of 437 patients presented a high degree of degenerative changes at baseline. Of 414 patients with adequate imaging of potential foraminal stenosis, 402 were labeled in the none to moderate category and 12 in the severe category. Of the patients with none to moderate foraminal stenosis, 71% achieved at least 30% improvement in ODI. Among the patients with severe foraminal stenosis, 36% achieved at least 30% improvement in ODI. A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. When investigating outcome as continuous variables, a similar association between severe foraminal stenosis and less improved ODI with a mean difference of 9.28 points (95%CI 0.47, 18.09; p=0.04) was found. Significant association between severe foraminal stenosis and less improved NRS pain in the lumbar region was also detected with a mean difference of 1.89 (95% CI 0.30, 3.49; p=0.02). No significant association was suggested between severe foraminal stenosis and ZCQ or NRS leg pain.ConclusionIn patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI.Trial registrationThe study is registered at ClinicalTrials.gov (22.11.2013) under the identifier NCT02007083.

BackgroundLumbosacral transforaminal epidural steroid injection (LTFESI) is a commonly performed intervention for treating radicular pain. While factors that predict pain improvement after LTFESI have been evaluated, minimal literature exists regarding predictors of functional improvement. PurposeTo identify factors that are associated with functional improvement at short-term follow-up after LTFESI. Study designRetrospective review of prospectively collected registry data. Patient samplePatients undergoing LTFESI at an academic spine center who completed an Oswestry Disability Index (ODI) questionnaire both pre-procedure and one to three weeks post-procedure. Outcome measuresThe outcomes of interest were the proportions of patients who experienced a minimal clinically important difference (MCID) in function defined as ​≥ ​30% improvement in ODI score, as well as ​≥ ​10-point and ≥15-point improvement in ODI score. MethodsLogistic regression analysis was performed to examine the associations of predictor variables to the ODI responder/non-responder outcome variable. The predictor variables for the analysis included: age, baseline ODI score, Charleston Comorbidity Index (CCI), payer type, prior lumbosacral spine surgery, pre-injection opioid use, two-level injections, bilateral injections, repeat injection, trainee presence during injection, immediate numerical rating scale (NRS) change post-injection. An odds ratio (OR) and its 95% confidence intervals (CIs) were calculated. ResultsA total of 606 patients were included in the analysis. More than half of the patients (56.8%) reported a ≥7.1% improvement in ODI score, and about 30% reported a ≥30% improvement in ODI score. Approximately 36% and 20% of the patients reported ≥10-point and ≥15-point reductions in ODI score, respectively. Medicaid and Medicare payer type and pre-injection opioid use were significantly associated with a lower likelihood of ≥30%, and ≥15-point improvements in ODI, after adjusting for the other factors (p ​< ​0.05). ConclusionsWhen using various common definitions of MCID for ODI score improvement, Medicaid, Medicare, and pre-injection opioid use were identified as factors that are negatively associated with functional improvement at short-term follow-up after LTFESIs.

The objective of this study was to evaluate predictors of patient satisfaction following surgical treatment of Meyerding grade 2 lumbar spondylolisthesis. The authors hypothesized that postoperative improvements in patient-reported outcomes (PROs) would be the primary determinants of satisfaction. Patients with grade 2 lumbar spondylolisthesis were identified from the Spine CORe™ study group of the Quality Outcomes Database, a multicenter consortium of 14 participating sites. This cohort comprises 328 patients with a 60-month follow-up rate of 81%. Demographic, clinical, and surgical characteristics were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back (NRS-BP) and leg pain (NRS-LP), and EQ-5D, measured at baseline and at 60 months. The primary outcome was satisfaction at 60 months, assessed using the North American Spine Society patient satisfaction index. Satisfaction was defined as a score of 1 ("surgery met my expectations") or 2 ("I did not improve as much as I had hoped, but I would undergo the same surgery again"). Minimal clinically important difference (MCID) thresholds were ≥ 14.3 for the ODI, ≥ 0.2 for the EQ-5D, ≥ 1.7 for the NRS-LP, and ≥ 1.6 for the NRS-BP. Univariate comparisons and logistic regression were performed to identify predictors of satisfaction. A total of 328 patients underwent surgery for grade 2 spondylolisthesis. At 5 years, follow-up data was complete in 266 patients (81%). Of these patients, 25 died within 5 years of surgery of unrelated causes and 241 had complete satisfaction scores at 5 years. At 60 months, 208 of the 241 patients were satisfied with surgery. Baseline demographic, comorbidity, and operative characteristics were similar between groups. Lower rates of 90-day readmissions were observed in satisfied patients (1.6% vs 19.4% p < 0.001). At 60 months, satisfied patients reported lower mean NRS-BP (2.6 vs 5.3, p < 0.001), NRS-LP (2.3 vs 5.2, p < 0.001), and ODI scores (8.9 vs 19.5, p < 0.001). MCID achievement was higher in satisfied patients for NRS-BP (78.3% vs 54.5%, p = 0.008), NRS-LP (79.8% vs 54.5%, p = 0.003), ODI (53.4% vs 15.2%, p < 0.001), and EQ-5D (30.0% vs 3.0%, p < 0.001) scores. In multivariable analysis, greater 5-year improvements in ODI (OR 0.88, p = 0.010) and NRS-LP (OR 0.74, p = 0.010) scores, as well as lower baseline NRS-LP scores (OR 0.54, p = 0.001) were independently associated with higher odds of satisfaction. No baseline demographic, comorbidity, or surgical factor predicted satisfaction. Eighty-six percent of patients with grade 2 lumbar spondylolisthesis were satisfied with results 5 years after surgery. Satisfaction was primarily associated with improvements in disability (ODI), while baseline and perioperative characteristics were not predictive.

Introduction:Coccydynia refers to pain in the terminal segment of the spinecaused by abnormal sitting and standing posture. Coccydynia is usually managed conservatively, however in nonresponsive patients, ganglion impar block is used as a good alternate modality for pain relief. This article studies the effect of ganglion impar block in coccydynia patients who were not relieved by conservative management.Materials and Methods:The study was carried out at the pain clinic in the departments of Physical Medicine and Rehabilitation and Radiology in a tertiary centre in India. It was a prospective hospital-based study, in which 35 patients with coccydynia were considered for fluoroscopy-guided trans-sacro-coccygeal ganglion impar block. The outcome assessment was done using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) scores for a follow-up period of 6 months. Of the 35 patients, 4 were lost to follow-up. Analysis was done usingthe data from the remaining 31 patients.Results:The mean age of the patients suffering from chronic coccydynia was 42.9 ± 8.39 years, and patients' age range was 28–57 years. The mean score of NRS and ODI before the procedure was 7.90 ± 0.16 and 48.97 ± 1.05, respectively. The interquartile range (IQR) of NRS score remained almost unchanged during pre and postprocedure, however, IQR of ODI varied during the pre and post procedural events. The NRS and ODI scores immediately after the procedure decreased drastically showing significant pain relief in patients, and the difference of scores till the end of study was statistically significant.Conclusion:This study recommends the trans-sacro-coccygeal “needle inside needle” technique for local anesthetic block of the ganglion impar for pain relief in patients with coccydynia. This should be integrated with rehabilitative measures including ergonomical modification for prolonging pain free period.

Background The occurrence of incidental durotomies (IDs) following spinal operations is a widely recognized issue. Complications such as poor outcomes, extended hospitalization, prolonged immobilization, infections, and revision surgeries are all potential consequences of inadequate durotomy management during the initial surgery. This study aims to describe the outcomes of ID repair in thoracolumbar spine surgery in terms of the Oswestry Disability Index (ODI) score and visual analog scale (VAS) when performed with the active involvement of orthopedic residents in the surgical procedure. Methodology Between April 2021 and April 2023, a hospital-based observational study was conducted among 110 patients hospitalized in the orthopedic ward at R.L. Jalappa Hospital and Research Center in Kolar, Karnataka, who required IDs due to an accidental dural tear or a postoperative CSF fluid leak following thoracolumbar spine procedures. Patients with a previous history of thoracolumbar spine surgery, vertebral tumors, spinal metastasis, infections, e.g., spondylodiscitis, or Pott's spine were excluded. The ODI score and VAS score were calculated on the postoperative day, one month, and three months following surgery. Results The mean age of the study participants was 62.81 + 10.49 years, with a male preponderance of 67.2% among the study participants. The mean BMI of study participants was 23.77 kg/m2. Approximately 24.5% of participants had a prior history of spinal surgery. Among 110 patients, 32 had postoperative complications. Six patients reported experiencing urinary retention, followed by five with CSF leakage and one with a postural headache(five cases). Based on the ODI score, mild disability was seen in 32.7% of the study samples at three months of follow-up. Based on the VAS score, moderate pain was seen among all the study samples at three months of follow-up. The ANOVA test revealed statistically significant differences in ODI and VAS score reductions between the immediate postoperative period and the one-month and three-month follow-up periods (p = 0.001 and p = 0.0247, respectively). Conclusion Less than one-third of the samples had postoperative complications. At three months, ODI scores showed mild disability in one-third of the study samples. At three months, all study samples had moderate VAS pain. The improvement in ODI and VAS scores from the day after surgery through the one-month and three-month follow-up periods was statistically significant.

This retrospective study aimed to determine the efficacy of an integrated active, rehabilitation protocol in patients ≥ 65years of age with chronic mechanical low back pain and compare the results in similar patients in 50-64years age group. Pre- and post-treatment mean numerical pain rating scale (NPRS) score, mean Oswestry disability index (ODI) score, treatment outcome category and minimal clinically important difference (MCID) thresholds achieved for NPRS and ODI scores post-treatment were compared among 697 patients in the 50-64years and 495 patients in the ≥ 65years age groups. At a mean treatment duration of 57days (range, 30-90days), both mean NPRS score (p < 0.0001) and mean ODI score (p < 0.0001) were significantly higher in the ≥ 65years age group when compared to the 50-64years age group. However, post-treatment outcome categories (p = 0.17) and percentage of patients who achieved MCID thresholds for NPRS score (p = 0.13) and ODI score (p = 0.18) were not significantly different between the two groups. There was a significant correlation between post-treatment NPRS score and patient age and pre-treatment NPRS score and between post-treatment ODI score and incidence of osteoporosis and pre-treatment ODI score. Although mean NPRS and ODI scores achieved were significantly better in patients of 50-64years of age, our integrated active, rehabilitation protocol helped achieve significant improvement in NPRS score, MCID thresholds for NPRS and ODI scores and treatment outcomes in patients ≥ 65years of age, similar to patients in the 50-64years of age group, at the end of 3months of treatment. These slides can be retrieved under Electronic Supplementary Material.

To evaluate the surgical outcome in terms of functional and subjective recovery, patients who needed discectomies at L1-L2, L2-L3 and L3-L4 levels were compared with an age and sex-matched group of patients who required L4-L5 and L5-S1 discectomies. We prospectively enrolled 50 consecutive patients, referred to our center, who had L1-L2, L2-L3 and L3-L4 herniations and required surgical intervention. Likewise, a comparative group of 50 consecutive patients with herniations at L4-L5 and L5-S1 were selected. All 100 patients were treated and followed for a 1 year period. Physical examination findings as well as Oswestry Disability Questionnaire before surgery were recorded. After 1 year, patients were requested to fill the same questionnaire. Significant decline in the Oswestry Disability Index (ODI) scores was considered to be a measure of functional improvement and recovery. The mean age of patients with upper lumbar disc herniation (L1-L2, L2-L3, L3-L4) was 45.7 years and patients with lower lumbar disc herniation (L4-L5, L5-S1) had a mean age of 41.2 years. There was no statistically significant difference in age between the two groups. The preoperative Oswestry Disability (ODI) Index score had a statistically significant impact on ODI score improvement after surgery in both lower and upper lumbar disc groups. All 100 patients with either lower or upper lumbar disc herniation had statistically significant ODI change after surgical intervention (P < 0.0001 for both groups). However, patients with upper disc herniations and moderate preoperative disability (ODI of 21-40%) did not show significant improvement, while patients with ODI greater than 40% had significant reduction (P = 0.018). Surprisingly, as many as 25% of the former had even an increase in ODI scores after surgery. Gender was also a conspicuous factor in determining the surgical outcome of patients with upper lumbar disc herniation, and male patients had more reduction in ODI score than female patients (P = 0.007). Since the functional recovery in patients with herniated lumbar disc, especially upper lumbar herniation, is influenced by preoperative ODI scores, the use of ODI or any other standard pain assessment tool is a sensible consideration as an inherent investigative method to preclude unfavorable surgical outcome.

Introduction: Facet joint injection (FJI) combined with steroids is known to be effective for lumbar facet joint arthropathy (FJA). This study evaluates its impact using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) to measure function and pain, respectively, before and six months after treatment. Additionally, the study examined the relationship between body mass index (BMI), vitamin D levels, and functional outcomes as indicated by ODI scores. Materials and methods: Thirty-six patients underwent lumbar FJI at the L3/L4, L4/L5, and L5/S1 levels. Changes in ODI and VAS scores were analysed using paired T-tests. To examine the mean differences in ODI scores before and six months after treatment, a One-way ANOVA was conducted, with post-hoc analysis using the Dunnett T3 test for significant results. A p-value &lt; 0.05 was considered statistically significant. Results: Significant improvements in functionality and pain were observed, as indicated by ODI and VAS scores. Notably, patients with a normal BMI showed marked functional improvement. The One-way ANOVA revealed a positive correlation between vitamin D levels and ODI scores, with the post-hoc analysis indicating that patients with optimal vitamin D status had the best outcomes. Conclusion: Patients with lumbar FJA who have a normal BMI and optimal vitamin D levels demonstrated significantly improved clinical outcomes at six months.

Association of catechol- O-methyltransferase genetic variants with outcome in patients undergoing surgical treatment for lumbar degenerative disc disease

Poster 107: Gabapentin’s effect on functional outcome after epidural spinal injections for lumbar radiculopathy.

Cross-sectional study. To evaluate the response behavior of EuroQOL-5D (EQ-5D) compared with the Oswestry Disability Index (ODI), and back and leg pain scores. Recent changes in policies have highlighted the need for demonstration of both quality and cost effectiveness. In an effort to meet these requirements, surgeons are collecting health-related quality of life and utility data. Unfortunately, the burden of extensive data collection on both physician and patient is considerable. The EQ-5D is a commonly used, easily administered, brief utility measure that can provide both clinical and utility data. The EQ-5D has not yet been validated in spine patients in comparison with established outcome measures. EQ-5D, ODI, back and leg pain (0-10) scores were collected as part of standard clinical practice. Spearman rank correlations between the ODI, back and leg pain scores, and the EQ-5D were determined. A subanalysis to determine dimension-specific effects was done. Data were categorized by level of low back disability and level of back and leg pain. Data from 8385 patients (5046 females, 3339 males), mean age 52 (range, 18-96) were analyzed. There was a strong correlation between EQ-5D and ODI (r = -0.776) and between EQ-5D and back pain (r = -0.648); and moderate correlation between EQ-5D and leg pain scores (r = -0.538). Increasing disability, as measured by ODI, lead to lower EQ-5D scores, with similar response behavior for both back and leg pain scores. All correlations were statistically significant at P < 0.0001. The EQ-5D correlated well with established spine outcome measures, including ODI, and back and leg pain scores. EQ-5D correlated best with ODI scores. Correlation with back pain was stronger than leg pain, but all correlations were relatively strong. The EQ-5D can serve spine surgeons as an effective measure of clinical outcome and health utility for economic analysis.

This study aimed to examine the changes in the Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), and Roland Morris Disability Questionnaire (RMDQ) scores before and after epidural steroid injection (ESI) in patients with lower back pain, and the correlation between the three scales in patients with reduced scores on these scales. Patients completed the NRS, ODI, and RMDQ before and after receiving ESI. A paired t-test was performed to compare the mean scores obtained before and after ESI. The correlations between the scores were estimated by calculating the difference between the baseline and follow-up scores. Of the 49 patients, 37 completed both questionnaire assessments. Among them, 26 patients (70%) presented a post-ESI decrease in scores obtained on all three scales. The NRS score decreased from 6.81±1.91 points at baseline to 3.66±2.22 points at follow-up (p&lt;0.0001); similarly, the ODI score decreased from 41.65±14.76 to 30.38±16.16 points (p=0.0025); and the RMDQ score decreased from 11.11±5.68 to 7.64±5.74 points (p=0.011). Of the 37 patients who completed the two questionnaires, 26 had reduced NRS, ODI, and RMDQ scores. The intraclass correlation coefficients between the NRS and ODI, NRS and RMDQ, and ODI and RMDQ scores were 0.7943, 0.6615, and 0.7182, respectively. The concordance correlation coefficients between the NRS and ODI, NRS and RMDQ, and ODI and RMDQ scores were 0.6020, 0.4938, and 0.5202, respectively. Among the measurements, the correlation between the NRS and ODI scores was the highest, and a moderate correlation was found between the scores obtained using the other instruments.

The disaggregation of the oswestry disability index in patients undergoing lumbar surgery for degenerative lumbar spondylolisthesis

To evaluate effectiveness of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel in improving clinical outcomes after the first-time lumbar discectomy. Ninety-three patients with herniated lumbar disc at L4-L5 or L5-S1 were enrolled and randomized into two groups: CMC/PEO gel treatment group and control group. All the patients underwent laminotomy and discectomy by posterior approach. The preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores for lower-back pain and leg pain were analyzed and compared between two groups at 30- and 60-day time points. No patient presented with any clinically measurable adverse event during surgery. There were no significant differences between the treated group and the control group on the preoperative ODI and VAS scores. In general, the ODI and VAS scores decreased in both groups at all the time points. At the 30-day time point, the VAS scores for back pain and leg pain and the ODI scores in treatment group were lower by 9.9% (P=0.0302), 27.0% (P=0.0002) and 16.3% (P=0.0007) than those in control group. And at the 60-day time point, the ODI and VAS scores further decreased in both groups. The VAS scores for leg pain in treatment group were lower by 4.5% than that in the control group (P=0.0149). However, no significant difference was detected between two groups on the ODI and VAS scores for back pain. The results demonstrated that CMC/PEO gel is effective in reducing posterior dural adhesions in the spine with no apparent safety issues. It can improve patients' postoperative clinical outcome.