Claudication Distance Research Articles

The Effect of High-intensity Interval Training on Initial Claudication and Absolute Walking Distance in Peripheral Artery Disease Patient: A Case Report

The Effect of High-intensity Interval Training on Initial Claudication and Absolute Walking Distance in Peripheral Artery Disease Patient: A Case Report

Benefits of Taurisolo in Diabetic Patients with Peripheral Artery Disease.

Trimethyl-N-oxide (TMAO) has been linked to peripheral artery disease (PAD). TaurisoloⓇ is a natural, balanced phytocomplex containing resveratrol, quercetin, catechins, procianidins, gallic acid, and caffeic acid. Numerous studies have shown that TaurisoloⓇ reduces the damage of TMAO and exerts a protective effect on endothelial cells (ECs). The aim of this randomized, double-blind, single-center study was to evaluate the effects of TaurisoloⓇ on claudication in patients with PAD (Rutheford grade I, category II, Fontaine Classification: Stage IIA, American Medical Association Whole Person Impairment Classification: Class 0-WPI 0%) in two parallel groups of 31 patients. The primary outcomes were an increase in the pain-free walking distance and the ankle/brachial pressure index at the beginning and at the end of the treatment with Taurisolo. The secondary endpoint was the serum TMAO changes. The claudication distance improved by 14.1% in the Taurisolo group and by 2.0% in the placebo group, while the maximal distance increased by 15.8% and 0.6% only, respectively (both p < 0.05). The TMAO plasma levels decreased from 3.97 ± 2.13 micromole/L to 0.87 ± 0.48 (p < 0.0001) in the treated group. All these changes were highly significant both in univariate mixed models as well as in the adjusted model. Ultimately, TaurisoloⓇ might be an effective intervention to ameliorate intermittent claudication.

Triglyceride-glucose index for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents.

To evaluate the triglyceride-glucose index (TyG index) for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents. Subjects with iliac artery stenosis, who underwent an iliac stent intervention and were followed up for at least 2 years were included in the study. Subjects were grouped according to TyG index (Group A, TyG index ≤8.848; Group B 8.849 ≤TyG index ≤9.382 and Group C TyG index ≥9.383). The subject's baseline characteristics, blood parameters, claudication distance, Transatlantic Intersociety Consensus classification, target lesion localization, stent direction, number of stents that were applied, and stent type were noted. Pre- and 1st and 2nd-year post-procedure Rutherford statuses, ankle-brachial index, and stenosis degree were recorded. To calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), Group B and Group C were combined and compared with Group A. In total, 255 subjects were evaluated (female, n=77-30.2%, male, n=178-69.8%). The mean age of the subjects was 66.00±10.00 years (range from 39 to 90 years). The pre-procedure Rutherford measurements were significantly different among the groups (p=0.001). The rates of mild claudication and resting pain in Group A were higher than those in Groups B and C. The rate of moderate claudication in Group C was higher than that in Groups A and B. The rate of severe claudication in Group B was higher than that in Groups A and C. One year after the procedure, there were more asymptomatic cases in Group A than in Groups B and C (p=0.001). The rate of mild claudication in Group C was lower than that in Groups A and B. The rate of moderate claudication in Group C was higher than that in Group A. The rate of severe claudication in Group C was higher than that in Groups A and B. Two years after the procedure, the Rutherford measurements and the rates of mild claudication in Groups A and B were higher than those in Group C. The rate of severe claudication in Group C was higher than that in Groups A and B (p=0.001). One year after the procedure, the computed tomography angiography (CTA) measurements and the rate of full patency in Group A were higher than that in Groups B and C. The rate of 0-50% stenosis in Group B was higher than that in Groups A and C. The rate of 50-70% stenosis in Group C was higher than that in Group A. Two years after the procedure, the CTA measurements and the rates of 70-99% stenosis and 100% occlusion in Group C were higher than those in Groups A and B. The TyG index has high specificity and NPV. However, specificity and PPV levels were found to be quite low. The TyG index was found to be an easy-to-use marker for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents.

Rejuvenating Mobility: Impact of Concurrent Exercise on Functional Claudication Distance and Vascular Health among Patients with T2DM-Associated PAD

Rejuvenating Mobility: Impact of Concurrent Exercise on Functional Claudication Distance and Vascular Health among Patients with T2DM-Associated PAD

Effect of a standalone rehabilitation programme for patients with peripheral arterial disease on claudication, cardiovascular risk factors and quality of life

Background/Aims There have been calls to make rehabilitation programmes more accessible to patients with peripheral arterial disease. This study aimed to evaluate the effectiveness of a standalone peripheral arterial disease rehabilitation programme on walking outcomes, quality of life and cardiovascular risk factors as primary outcomes. Secondary outcomes relating to the characteristics that may have influenced change in walking outcomes and reasons for non-attendance or non-completion were also explored. Methods In this prospective, observational, one-site study, new patients were offered a 10-week programme, consisting of exercise, education and intervention for uncontrolled cardiovascular risk factors, in line with international peripheral arterial disease guidelines. Claudication times were measured using the Gardner-Skinner protocol and quality of life was measured using VascuQol. Pre- and post-intervention data were analysed using the SPSS version 23, with Pearson's Rho, Spearman's Rho and t tests being performed as appropriate. Statistical significance was set at P&lt;0.05. Results Of the 160 referrals received, 114 patients were enrolled in the programme and 89 (78%) completed it. Reasons for non-completion were mainly either logistical (domestic commitments or return to work) or perceptions of insuitability relating to age, infirmity or severity of peripheral arterial disease. Of those who completed the programme, the median age was 66 years, 81% were men, 71% had a history of hypertension, 25% had diabetes and 37% smoked. There were significant pre–post improvements (P&lt;0.05) in initial and maximum claudication time and distance, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein and quality of life scores. Improvements in maximum claudication times were associated with lower baseline initial claudication times, lower body mass index, some quality of life scores and male gender. Conclusions The peripheral arterial disease rehabilitation programme was effective in improving functional capacity, quality of life and some cardiovascular risk factors. Factors found to influence improvements in claudication times could be discussed with patients before and during the programme to address misperceptions, provide encouragement and improve compliance and recruitment. The safe environment of supervised exercise may have contributed to these results, prompting efforts to make exercise accessible to all patients with peripheral arterial disease.

Comparative Study of the Outcomes of Endoscopic Unilateral Laminotomy for Bilateral Decompression (ULBD) With Destandau Technique and Microscopic ULBD: A Randomized Double-Blinded Study of 685 Patients

Objective: Lumbar canal stenosis is a common finding amongst elderly patients visiting spine surgeons for back pain. Uniportal unilateral laminotomy for bilateral decompression (ULBD) is an emerging minimally invasive procedure for lumbar canal stenosis. This study compared the clinical outcomes of endoscopic ULBD with Destandau technique and microscopic lumbar canal decompression.Methods: A prospective multicenter study on 685 patients undergoing single-level spinal canal decompression. Patients with axial back pain, lumbar radiculopathy, lumbar canal stenosis &amp; claudication distance &lt;1,000 m were included. Parameters assessed were Dura expansion, thecal sac’s cross-sectional area, horizontal displacement, blood loss, operation time, hospital stay, modified MacNab score, visual analogue score (VAS), side changing (self) status, Oswestry Disability Index (ODI), and the Short-Form 36 for quality of life (QoL).Results: Group 1 (endoscopic ULBD with Destandau technique) had 343 patients and group 2 (microscopic ULBD) had 342 patients. Group 1 had lower horizontal displacement (0.34%±0.21%, p&lt;0.001) and significant improvement of VAS (42.28%±3.20%, p&lt;0.001) at 1-week postsurgery with shorter hospital stay (1±0.2 days vs. 1.8±0.8 days, p&lt;0.01) and significant improvements of ODI and MacNab scores (42.28±3.20 and 85.30%, p&lt;0.001). The 30-second chair test (3.4±0.13 vs. 5.6±2.41, p&lt;0.001), 10-meter walk test (1.0±2.15 vs. 0.55±3.23, p&lt;0.001), and SF-36 physical health component score (48.20±8.46 vs. 74.48±0.54, p&lt;0.001) improved significantly as well. Furthermore, 92% of patients were able to change sides while in bed at 1-week postsurgery. Claudication distance improved significantly in both groups.Conclusion: Group 1 patients had better clinical and functional outcomes within 3 months of surgery than group 2 patients, with improved QoL, shorter hospital stays, claudication distance, and self-side changing ability.

Application of 3D Printing Insole by Hemodynamics in Older Patients with Critical Limb Ischemia: Protocol for a Randomized Clinical Trial.

Critical limb ischemia (CLI) is a severe condition characterized by inadequate blood flow to the lower extremities, often leading to tissue damage and amputation. CLI is characterized by microcirculatory dysfunction, muscle tissue necrosis, and inflammation. Patients may suffer from the traumatic pain and the increase of plantar pressure, and foot care for patients with CLI has become the "last mile" to improve their life quality. Traditional shoe insoles often lack individual customization, failing to address the unique anatomical needs and hemodynamic characteristics of patients. The study aims to investigate the effects of this innovative intervention on improving the clinical outcomes, and quality of life in CLI patients. This Critical Limb Ischemia Hemodynamic Insole Study is a randomized controlled study performed to explore the effect of a 3D printing insole on foot care of CLI patients. This study recruitment began on November 1, 2021. Patients with CLI confirmed by clinical symptoms and imaging were recruited as the research objects. Participants will be randomly assigned to either the experimental group, which will receive 3D-printed insoles customized based on their hemodynamics, or the control group, which will receive traditionally manufactured insoles. Both groups were followed up for up to 24 months after surgery, including claudication distance, claudication time, pain score, rehospitalization, etc. ChiCTR2100051857.

Smoking and Diabetes Attenuate Number of CD34+ Haematopoietic Stem Cells in Peripheral Blood of Patients with Advanced Peripheral Artery Disease.

Peripheral artery disease (PAD) is a globally prevalent problem with limited treatment options, leaving up to a fifth of patients remediless. The emergence of new studies on cell therapy in recent years offers a new promising option for their treatment. Our aim was to explore how the number of CD34+ hematopoietic cells in the peripheral blood of PAD patients is associated with patients' functional as well as atherogenic factors. We selected 30 patients with advanced PAD, recorded their performance in a walking test in standard conditions and sampled their blood for further analysis with an emphasis on CD34+ cell selection and counting. No correlation of the CD34+ cell number was confirmed with any of the observed laboratory parameters. There was an association between the claudication distance and the number of CD34+ cells (r = -0.403, p = 0.046). The number of CD34+ cells differed between patients with and without type II diabetes (p = 0.071) and between active smokers, past smokers, and non-smokers (p = 0.035; p = 0.068, p = 0.051, respectively), with both smoking and presence of diabetes type II having a negative effect on the number of CD34+ cells. Our study demonstrated a dependence of the CD34+ cell number on the patient's characteristics.

Neuromuscular Electrical Stimulation for Intermittent Claudication (NESIC): multicentre, randomized controlled trial.

This was an open, multicentre, randomized controlled trial. Patients with intermittent claudication attending vascular surgery outpatient clinics were randomized (1:1) to receive either neuromuscular electrical stimulation (NMES) or not in addition to local standard care available at study centres (best medical therapy alone or plus supervised exercise therapy (SET)). The objective of this trial was to investigate the clinical efficacy of an NMES device in addition to local standard care in improving walking distances in patients with claudication. The primary outcome was change in absolute walking distance, measured by a standardized treadmill test at 3 months. Secondary outcomes included intermittent claudication (IC) distance, adherence, quality of life, and haemodynamic changes. Of 200 participants randomized, 160 were included in the primary analysis (intention to treat, Tobit regression model). The square root of absolute walking distance was analysed (due to a right-skewed distribution) and, although adjunctive NMES improved it at 3 months, no statistically significant effect was observed. SET as local standard care seemed to improve distance compared to best medical therapy at 3 months (3.29 units; 95 per cent c.i., 1.77 to 4.82; P < 0.001). Adjunctive NMES improved distance in mild claudication (2.88 units; 95 per cent c.i., 0.51 to 5.25; P = 0.02) compared to local standard care at 3 months. No serious adverse events relating to the device were reported. Supervised exercise therapy is effective and NMES may provide further benefit in mild IC.This trial was supported by a grant from the Efficacy and Mechanism Evaluation Program, a Medical Research Council and National Institute for Health and Care Research partnership. Trial registration: ISRCTN18242823.

Enhancing Functional Efficiency and Quality of Life through Revascularization Surgery in Peripheral Arterial Disease: A Comparative Analysis of Objective and Subjective Indicators.

BACKGROUND This study aimed to compare the ankle-brachial index (ABI), maximal claudication distance (MCD), pain-free walking distance (PFWD), claudication pain, and quality of life (intermittent claudication questionnaire [ICQ]) before and 3 months after revascularization surgery in 98 patients diagnosed with peripheral arterial disease (PAD) at a single center in Poland. MATERIAL AND METHODS Ninety-eight patients were examined (77% men, 23% women, 65.65±7.27 years old), diagnosed with PAD, and qualified for revascularization. The diagnosis of PAD was made on the basis of ABI ≤0.9 and medical records. The patients underwent a noninvasive examination, including measurement of ABI (by Doppler with the EZ8 probe), assessment of the quality of life by ICQ, distance of intermittent claudication on a treadmill using the Gardner-Skinner protocol (including PFWD and MCD), and pain intensity during walking (numeric rating scale [NRS11]). The assessment was carried out twice: 1 to 5 days before surgery and 3 months after surgery. RESULTS There was an increase of ABI (0.4 vs 0.62, P<0.001), PFWD (26.64 vs 80.21, P<0.001), MCD (60.08 vs 181.85, P<0.001), and ICQ (79.92 vs 60.23, P<0.001) and reduction of PFWD pain (7.26 vs 6.05, P<0.001) and MCD pain (9.24 vs 8.11, P<0.001). CONCLUSIONS Revascularization surgery improved the ABI and patients functional efficiency expressed in the improvement of subjective indicators PFWD, MCD, NRS11, and ICQ. Patients who had a longer duration of disease had worse outcomes after revascularization. More attention should be paid to increasing access to preventive examinations aimed at early detection of PAD and the possibility of implementing conservative treatment.

Neuromuscular electrical stimulation as an adjunct to standard care in improving walking distances in intermittent claudication patients: the NESIC RCT

Background Peripheral arterial disease is common and associated with increased cardiovascular morbidity and mortality. While patients with peripheral arterial disease are known to benefit from supervised exercise therapy, it is not always available. Neuromuscular electrical stimulation devices may offer a similar benefit. A randomised controlled trial was required to ascertain whether such devices can benefit patients who receive supervised exercise therapy and those who do not. Objective(s) The primary objective was to assess the mean difference in absolute walking distance at 3 months in intermittent claudication patients receiving either a neuromuscular electrical stimulation device and local standard care (intervention), or local standard care alone (control). Design A pragmatic, multicentre, randomised controlled trial stratified by centre. Setting Secondary-care National Health Service hospitals in the United Kingdom. Participants Patients aged ≥18 years, with a diagnosis of intermittent claudication according to the Edinburgh Claudication Questionnaire and ankle–brachial pressure index (or stress test), without contraindications to neuromuscular electrical stimulation were deemed eligible to partake. Interventions Participants were randomised 1 : 1 to either local standard care or local standard care and neuromuscular electrical stimulation. Due to the nature of the intervention, it was unfeasible to blind the research nurse or participant to the study allocation. Main outcome measures The primary outcome measure was absolute walking distance measured by treadmill testing at 3 months. Secondary outcomes included change in initial claudication distance, quality of life, compliance with interventions and haemodynamic assessments. Results Two hundred patients underwent randomisation, with 160 patients having analysable primary outcome data for the intention-to-treat analysis intervention (n = 80); control (n = 80). As the data were right-censored, a Tobit regression model was used to analyse the primary outcome, utilising the square root of the absolute walking distance to accommodate the skewed data. However, as this made the data difficult to interpret, a Tobit regression model using raw absolute walking distance data was used as well. Neuromuscular electrical stimulation improved the difference in absolute walking distance at 3 months but this was not statistically significant (square root of absolute walking distance: 0.835 units, 95% confidence interval −0.67 to 2.34 units; p = 0.28/absolute walking distance raw data: 27.18 m, 95% confidence interval −26.92 to 81.28 m; p = 0.323). Supervised exercise therapy participants showed a markedly improved absolute walking distance compared with patients receiving best medical therapy only at 3 months (square root of absolute walking distance: 3.295 units 95% confidence interval 1.77 to 4.82; p &lt; 0.001/absolute walking distance raw data: 121.71 m, 95% confidence interval 67.32 to 176.10; p ≤ 0.001). Neuromuscular electrical stimulation significantly improved absolute walking distance at 3 months for mild claudicants (square root of absolute walking distance: 2.877 units, 95% confidence interval 0.51 to 5.25; p = 0.019/absolute walking distance raw data: 120.55 m, 95% confidence interval 16.03 to 225.06; p = 0.03) compared to the control arm. This was an unplanned (post hoc) analysis. There were no clear differences in mechanistic measurements between the two treatment groups over the follow-up period. Serious adverse events were evenly reported between the two groups; all being classified as either not related or unlikely to be related to the study device. Limitations Absolute walking distance was used as the primary outcome measure; there was a large range of baseline distances in both groups with right-skewed distribution. We did not stratify by baseline absolute walking distance for the primary outcome analysis. Additionally, only 160 patients had analysable primary outcome data due to missing treadmill data. Conclusions Supervised exercise therapy is an effective treatment for intermittent claudication. Neuromuscular electrical stimulation appears to be beneficial as an adjunct to supervised exercise therapy and on its own in mild claudicants. Future work Further studies are needed to confirm the effectiveness of neuromuscular electrical stimulation in combination with supervised exercise therapy, and in mild to moderate claudicants in a larger sample size. Study registration This trial is registered as ISRCTN18242823. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR) partnership (project number 15/180/68). This will be published in full in Efficacy and Mechanism Evaluation; Vol. 10, No. 2. See the NIHR Journals Library website for further project information. Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC) (with others, e.g. NIHR Imperial CRF, Imperial College ECMC, NIHR Imperial PSTRC, NIHR London MIC, etc.).

Lumbar paraspinal muscle morphology is associated with spinal degeneration in patients with lumbar spinal stenosis

BACKGROUND CONTEXTLumbar spinal stenosis (LSS) has been reported to induce changes in paraspinal muscle morphology, but objective physical function and degenerative spine conditions are rarely assessed. PURPOSETo identify factors associated with paraspinal muscle morphology using objective physical and degenerative spine assessments in patients with LSS. STUDY DESIGN/SETTINGCross-sectional design. PATIENT SAMPLESeventy patients with neurogenic claudication caused by LSS, receiving outpatient physical therapy. OUTCOME MEASURESCross-sectional area (CSA) and functional CSA (FCSA) of the multifidus, erector spinae, and psoas muscles, the severity of stenosis, disc degeneration, and endplate abnormalities were evaluated by magnetic resonance imaging, as well as sagittal spinopelvic alignment by X-ray. Objective physical assessments included pedometry and claudication distance. Patient-reported outcomes included the numerical rating scale of low back pain, leg pain, and leg numbness, and the Zurich Claudication Questionnaire. METHODSTo assess the impact of LSS on paraspinal muscles, FCSA and FCSA/CSA were compared between the dominant and nondominant sides based on the patients’ neurogenic symptoms, and multivariable regression analyses adjusted for age, sex, height, and weight were performed; p<.05 was considered significant. RESULTSSeventy patients were analyzed. At one level below the maximum stenotic level, erector spinae FCSA on the dominant side was significantly lower than that on the nondominant side. In the multivariable regression analyses, at one level below the symptomatic level, disc degeneration, endplate abnormalities, and lumbar spinopelvic alignment, such as decreased lumbar lordosis and increased pelvic tilt, were negatively associated with multifidus FCSA and FCSA/CSA ratio. A significant association was observed between dural sac CSA and erector spinae FCSA. Throughout L1/2 to L5/S, disc degeneration, endplate abnormalities, and lumbar spinopelvic alignment were negatively associated with multifidus and erector spinae FCSA or FCSA/CSA. CONCLUSIONSLumbar paraspinal muscle asymmetry caused by LSS was observed only in erector spinae. Disc degeneration, endplate abnormalities, and lumbar spinopelvic alignment, rather than spinal stenosis and LSS symptoms, were more associated with paraspinal muscle atrophy or fat infiltration.

Effect of Dietary Supplements Which Upregulate Nitric Oxide on Walking and Quality of Life in Patients with Peripheral Artery Disease: A Meta-Analysis.

This systematic review pooled evidence from randomised controlled trials (RCTs) on the effectiveness of dietary upregulators of nitric oxide (NO) in improving the walking and quality of life of patients with peripheral artery disease (PAD). RCTs examining the effect of dietary upregulators of NO in patients with PAD were included. The primary outcome was the maximum walking distance. Secondary outcomes were the initial claudication distance, the six-minute walking distance, quality of life, the ankle-brachial pressure index (ABI), adverse events and risk of mortality, revascularisation or amputation. Meta-analyses were performed using random effects models. The risk of bias was assessed using Cochrane's ROB-2 tool. Leave-one-out and subgroup analyses were conducted to assess the effect of individual studies, the risk of bias and intervention type on pooled estimates. Thirty-four RCTs involving 3472 participants were included. Seven trials tested NO donors, nineteen tested antioxidants, three tested NO synthase inducers and five tested enhancers of NO availability. Overall, the dietary supplements significantly improved the initial claudication (SMD 0.34; 95%CI 0.04, 0.64; p = 0.03) but not maximum walking (SMD 0.13; 95%CI -0.17, 0.43; p = 0.39) distances. Antioxidant supplements significantly increased both the maximum walking (SMD 0.36; 95%CI 0.14, 0.59; p = 0.001) and initial claudication (SMD 0.58; 95%CI 0.26, 0.90; p < 0.001) distances. The dietary interventions did not improve the physical function domain of the Short Form-36 (SMD -0.16; 95%CI -0.32, 0.00; p = 0.38), ABI or risk of adverse events, mortality, revascularisation or amputation. Dietary NO upregulators, especially antioxidants, appear to improve the initial claudication distance in patients with PAD. Larger high-quality RCTs are needed to fully examine the benefits and risks of these treatments. PROSPERO Registration: CRD42022256653.

Narrative Review: Peripheral Arterial Disease in Patients with Hyperuricemia and Gout.

To discuss what is currently known about the association and potential mechanistic interactions of hyperuricemia and gout with peripheral arterial disease (PAD). Gout patients are at increased risk for coronary artery disease, but less is known about their risk for PAD. Studies suggest that the presence of gout and hyperuricemia are associated with PAD independent of known established risk factors. Moreover, higher SU was found to be associated with greater odds of having PAD and was independently associated with decreased absolute claudication distance. Urate's role in free radical formation, platelet aggregation, vascular smooth muscle proliferation, and impaired endothelial vasodilation may promote atherosclerotic progression. Studies suggest that patients with hyperuricemia or gout are at higher risk for developing PAD. Evidence is stronger for the relationship between elevated SU and PAD than for gout and PAD, but more data is needed. Whether elevated SU serves as a marker or cause of PAD remains to be investigated.

Does daily physical activity reflect claudication distance measured on a treadmill and in a community outdoor setting?

Low physical activity in patients with claudication is associated with lower walking abilities as assessed by the treadmill test. The impact of physical activity on the ability to walk in a natural environment is unknown. The study aimed to assess the level of daily physical activity among patients with claudication, as well as the relationship between the level of daily physical activity and claudication distance measured during the outdoor walking and treadmill tests. The study included 37 patients (24 males), aged 70.03±5.9, with intermittent claudication. Daily step count was assessed using the Garmin Vivofit activity monitor, worn on the non-dominant wrist for 7 consecutive days. Pain-free walking distance (PFWDTT) and maximal walking distance (MWDTT) were measured via the treadmill test. During 60-minute outdoor walking, the maximal walking distance (MWDGPS), total walking distance (TWDGPS), walking speed (WSGPS), number of stops (NSGPS) and stop durations (SDGPS) were assessed. Mean daily step count - 7,102±3,433. A significant correlation was observed between daily step count and MWDTT, TWDGPS (R=0.33, R=0.37, respectively (p<0.05). Furthermore, 51% of patients reached less than 7,500 steps/day and presented significantly shorter MWDTT, MWDGPS and TWDGPS, compared to the participants covering ≥7,500 steps (p<0.05). The daily step count reflects claudication distance measured on a treadmill and only partially in a community outdoor setting. The minimal daily step count that should be recommended for patients with claudication, allowing achievement of significantly better results with regard to walking abilities, both on the treadmill and in outdoor settings, is at least 7,500 steps per day.

The Outcome of Laminectomy versus Laminoforaminotomy in Terms of Claudication Distance in Lumbar Spinal Stenosis

Objectives: The study aimed to compare the surgical outcome of two different procedures for lumbar spinal stenosis. It helped us in the decision-making to go for less invasive procedures, as compared to conventional laminectomy in lumbar spinal stenosis patient patients.&#x0D; Materials and Methods: An interventional randomized controlled trial was conducted in the department of neurosurgery, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS Islamabad. A total of 158 adult patients aged between 35 to 55 years with an established diagnosis of lumbar stenosis and claudication distance of fewer than 100 meters were enrolled. Patients were randomly included into two equal groups via the computerized method. In Group A laminectomy was done and in Group Blaminoforaminotomy was adopted. The outcome was measured in terms of claudication distance at 4 weeks after the procedure, and compared in both groups.&#x0D; Results: The mean age of the patients was 44.92 ± 6.28 years. Poor outcome was significantly lower in the Laminoforaminotomy group as compared to the Laminectomy group, at 4 weeks after the procedure. The frequency of claudication distance &gt; 500m (good) at 4 weeks was found to be 62 (78.5%) in the Laminectomy group and it was found in 74 (93.7%) patients in the Laminoforaminotomy group (p = 0.022).&#x0D; Conclusions: The study concluded that the laminoforaminotomy is superior to laminectomy, in terms of claudication distance at four weeks after the procedure.

Clinical Efficacy of Neurotropin for Lumbar Spinal Stenosis with Low Back Pain.

We compared the clinical effects of Neurotropin, limaprost alfadex, and a combination of both drugs for lumbar spinal stenosis (LSS) with low back pain (LBP). We conducted a multicenter, randomized, active-controlled, open-label trial from March 2021 to May 2022. Participants were patients diagnosed with LSS by MRI and were randomly assigned to three groups: Neurotropin/limaprost combination (NL group), Neurotropin (N group), and limaprost group (L group). Participants received the drugs administered orally for 12weeks, and each examination and observation was performed before any drug administration and every 2weeks thereafter. We recorded age, sex, height, weight, duration of symptoms, intermittent claudication distance, level of stenosis in MRI, and concomitant analgesics as examination items in the trial period. Items measured during the trial were visual analog scale (VAS) score (mm) for LBP, leg pain and numbness, walking activity (walking speed, stride length), standing balance (3m Timed Up-and-Go (TUG) Test results, Five Times Sit-to-Stand Test (FTSST) results), LBP/Quality of Life (QOL)-related scores (Oswestry Disability Index (ODI), Euro QOL 5-Dimensions 5-Level (EQ-5D-5L), Roland-Morris Disability Questionnaire (RDQ)), psychological factors (Pain catastrophizing scale (PCS) and Pain Self-Efficacy Questionnaire (PSEQ) scores), and adverse events. Each item was evaluated using changes at each visit (weeks 2-12) from baseline value before drug administration (week 0), and changes were considered significant when p < 0.05. We included results from 64 patients in the present study; 24 were assigned to the NL group (mean age 71.2years), 20 to the N group (mean age 76.2years), and 20 to the L group (mean age 74.4years). There were no significant differences between the three groups in patient characteristics, concomitant analgesics, or baseline VAS score, gait balance, or QOL-related scores (p ≥ 0.05). The VAS and leg pain scores were significantly improved in Group L, and LBP was improved significantly in Group N. QOL and ODI scores improved significantly in the NL and L groups, EQ-5D score improved significantly in the L group, and RDQ score improved significantly in all groups (p < 0.05). Psychological factor and PCS scores improved significantly in the NL and L groups (p < 0.05). Walking speed and stride length were improved significantly in the NL and N groups (p < 0.05). TUG/FTSST scores were improved significantly in all groups (p < 0.05). Leg pain VAS score was improved significantly (p < 0.05) in the L group compared with the NL group after 6 and 12weeks of administration, and LBP VAS was improved significantly in the N group after 6weeks compared with the NL group (p < 0.05). Walking speed was significantly improved in the NL group after 2weeks compared with the N group and improved significantly in the NL group after 6weeks (p < 0.05) compared with the L group. RDQ was decreased significantly in the L group compared with the NL group after 8weeks (p < 0.05). Combined use of Neurotropin and limaprost showed an additional effect on walking speed compared with single drug administration. Neurotropin may contribute to the improvement of low back pain, walking speed/stride length, and standing balance. Japan Registry of Clinical Trials (jRCTs031200282).

The serpentine pattern on MRI as an early prognostic factor after fusion for lumbar spinal stenosis.

This study aimed to determine the relationship between the serpentine pattern nerve roots (SNR) and prognosis after lumbar fusion for lumbar spinal stenosis (LSS) by comparing clinical outcomes in patients with or without a serpentine pattern. LSS patients with neurological symptoms often present with SNRs. Several studies have shown that LLS symptoms are worse in patients with SNRs. However, the relationship between SNR and outcome after spinal fusion surgery has not yet been established. A total of 332 patients who underwent spinal fusion surgery between January 1, 2010, and December 31, 2019, were enrolled. Patients were divided into those with a serpentine pattern (S group) and those without a serpentine pattern (N group). The prognosis of the 2 groups was compared using visual analog scale (VAS), Oswestry disability index, claudication distance, medication dose for leg dysesthesia, and glucose tolerance. A total of 113 patients had a serpentine pattern, while the remaining 219 did not. Symptom duration and presence of diabetes mellitus were significantly different between the 2 groups (N = 25.4, S = 32.6, P < .05). Changes in the VAS score for lower extremity pain between the 2 groups at 1 year after surgery showed that patients without a serpentine pattern had significantly better outcomes than those with a serpentine pattern (N: 2.7 ± 1.1 vs S: 4.1 ± 1.3; P < .001), despite the score change at 1 month showing no difference (N: 3.5 ± 0.9 vs S: 3.8 ± 1.0; P = .09). SNRs on MRI are more prevalent in diabetic patients and are a negative prognostic factor in lumbar fusion surgery for LSS. Our insights may help physicians decide the optimal surgical plan and predict the postoperative prognosis of patients with LSS.

Clinical and radiological predictors of response to lumbar transforaminal epidural steroid injection at 3 months: A retrospective study

BackgroundTransforaminal epidural steroid injection (TFESI)1 is commonly used to relieve pain due to intervertebral disc displacements (IDD).2 Poorly defined selection criteria lead to post procedure dissatisfaction among patients. We aimed to find clinical and magnetic resonance imaging (MRI)3 predictors for pain relief at 3 months following a TFESI. Poorly defined selection criteria lead to post procedure dissatisfaction among patients. MethodsA retrospective study of 116 patients who had undergone TFESI. Predictors used were - age, duration of symptoms, body mass index, neuropathic character of pain, dermatomal distribution of pain, claudication distance, response to anti-neuropathic medication and extent of nerve root compromise in MRI as per Pfirmann criteria. A relief of 50% or more at the end of 3 months was considered the criterion for significant pain relief from TFESI. ResultsAt 3 months, 72% (84/116) had significant pain relief. Dermatomal distribution of pain (73%) and neurogenic claudication (71%) were the most prevalent clinical features. Dermatomal distribution of leg pain, responsiveness to anti-neuropathic medications and a Pfirmann grade 2/3 in MRI were the most important predictors with an odds ratio (OR)4 of 12.1, P ​< ​0.001, OR 6.4, P ​= ​0.002 and OR 3.1, P ​= ​0.056, respectively. The model was statistically significant χ2 (3, N ​= ​116) ​= ​43.43,P ​< 0.001 and explained 52% variance in the outcome. The model correctly predicted the outcome 85% times. ConclusionsIf a patient has leg pain which is dermatomal in distribution, responds to anti-neuropathic medications and has Pfirmann grade 2/3 in MRI, then chances of more than 50% relief persisting at 3 months after TFESI are significantly better.

Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results.

Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation. This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications. Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m2 (mean BMI of 27.5 kg/m2 ). The preoperative claudication distance was 160.00 ± 68.96 m (range 70-250 m), which was significantly extended on the 3-month and 1-year follow-up (1020.00 ± 407.70 m and 1040.00 ± 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 ± 0.97 (range 4-7) and 6.40 ± 0.97 (range 5-8). The score on postoperative month 3 was 1.60 ± 0.52 (range 1-2) and 1.20 ± 0.79 (range 0-2), and the 1-year follow-up score was 1.90 ± 0.74 (range 1-3) and 1.60 ± 0.70 (range 1-3), respectively. The preoperative ODI was 72.23 ± 6.30 (range 64.4-82.2), the 3-month follow-up ODI was 31.12 ± 4.20 (range 24.4-35.6), and the 1-year follow-up ODI was 29.33 ± 5.92 (range 20.0-37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 ± 32.5min vs. 214.9 ± 60.0 min) but the amount of blood loss decreased significantly (113.3 ± 26.7ml vs. 366.8 ± 298.2ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1-year follow-up. OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice.