Improvement In VAS Scores Research Articles

SAT0117 Sarilumab, a Subcutaneously-Administered, Fully-Human Monoclonal Antibody Inhibitor of The IL-6 Receptor: Relationship Between Eular Responses and Change from Baseline of Selected Clinical Parameters

BackgroundModification of signs and symptoms and improvement in quality of life are key goals for clinical management of RA patients (pts). Sarilumab (SAR) is the first fully human monoclonal antibody...

Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials

PurposeTo compare the efficacy and safety of TDR to that of the fusion for the treatment of lumbar degenerative disc disease (LDDD).MethodsRandomized controlled trials comparing TDR with any other intervention for LDDD were acquired by a comprehensive search in PubMedCentral, MEDLINE, EMBASE, BIOSIS, ClinicalTrials.gov, and the FDA trials register. Methodologic quality was assessed and relevant data were retrieved, and appropriate meta-analysis was performed. Two review authors independently selected studies, extracted data, and assessed risk of bias. Results and upper bounds of confidence intervals were compared with predefined clinically relevant differences.ResultsSix relevant randomized controlled trials (RCTs) involving 1,603 patients were identified and reported two year follow-up results. Patients in TDR group compared with lumbar fusion group demonstrated significant improvements in ODI, VAS scores and complication rates at the two year follow-up. Meanwhile, except for operating time in anterior group, intra-operative blood loss, operating time in posterior group, and reoperation rate were without clinical significance between the two groups. In addition, the range of motion (ROM) was maintained within normal ranges after TDR.ConclusionsThe results showed the TDR has significant safety and efficacy comparable to lumbar fusion at two year follow-up. Although superiority compared to fusion could not be proved, by comparing clinical symptoms relieved, motion preserved, and the low reoperation rate during long-term follow-up on TDR, TDR was considered safe and effective. Therefore, the authors suggest adopting TDR on a large scale; with failure of TDR, interbody fusion would be performed.

An oral TRPV1 antagonist attenuates laser radiant-heat-evoked potentials and pain ratings from UV(B)-inflamed and normal skin.

Laser (radiant-heat) evoked potentials (LEPs) from vertex-EEG peak-to-peak (PtP) amplitude were used to determine acute antinociceptive/antihyperalgesic efficacy of ABT-102, a novel TRPV1 antagonist efficacious in preclinical pain models, compared with active controls and placebo in normal and UV(B)-inflamed skin. This was a randomized, placebo- and active-controlled, double-blind, intra-individual, crossover trial. Twenty-four healthy subjects received six sequences of single doses of ABT-102 (0.5, 2, 6 mg), etoricoxib 90 mg, tramadol 100 mg and placebo. Painful stimuli were induced by CO(2) -laser on normal and UV(B) -inflamed skin. LEPs and visual analogue scale (VAS-pain) ratings were taken at baseline and hourly up to 8 h post-dose from both skin types. Compared with placebo, significant mean decreases in the primary variable of LEP PtP-amplitude from UV(B)-inflamed skin were observed with ABT-102 6 mg (P < 0.001), ABT-102 2 mg (P = 0.002), tramadol 100 mg (P < 0.001), and etoricoxib 90 mg (P = 0.001) over the 8 h period; ABT-102 0.5 mg was similar to placebo. ABT-102 6 mg was superior to active controls over the 8 h period (P < 0.05) whereas ABT-102 2 mg was comparable. Improvements in VAS scores compared with placebo were observed with ABT-102 6 mg (P < 0.001) and ABT-102 2 mg (P = 0.002). ABT-102 average plasma concentrations were 1.3, 4.4 and 9.4 ng ml(-1) for the 0.5, 2 and 6 mg doses, respectively. There were no clinically significant safety findings. TRPV-1 antagonism appears promising in the management of clinical pain, but requires further investigation.

Evaluation of temporomandibular joint disc-repositioning surgery with Mitek mini anchors

Purpose:The aim of this study is to evaluate outcome of Mitek mini anchors (DePuy Mitek, Raynham, MA) in TMJ discopexy and assess patient satisfaction based on MRI findings.Patients and Methods:7 patients suffered from significant pain and dysfunction diagnosed on MRI findings as anterior disc displacement without reduction selected for this study. Anchor stability, assessment of positional changes and roofing were evaluated by postop MRI and OPTGs. Satisfaction was assessed with VAS. Preop and postop maximum interincisal opening measurements were compared.Results:There was significant difference between preop and posto P values of MIO and VAS. All 7 patients noted complete absence of pain at the postop 1-year follow-up. Only 1 patient had postop clicking but showed remarkable improvement of jaw functions (MIO). The articular disk was observed at its normal position in 6 patients except one patient whom MRI confirmed postop partial roofing. OPTGs reveal neither radiologic changes around the mini anchors in the condylar head nor any positional shifts.Conclusion:Disc repositioning with Mitek mini anchors represent improvement in post-op VAS scores and clinical findings (MIO) based on comparison preop and postop MRI scans and panoramic films. However, our study group consists of limited number of patients, further studies with more number of cases are required to evaluate the outcomes

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

It is well known that arthrodesis is associated with adjacent segment degeneration (ASD). However, previous studies were performed with simple radiography or CT. MRI is most sensitive in assessing the degenerative change of a disc, and this is the first study about ASD by radiography, CT and MRI. We sought to factors related to ASD at cervical spine by an MRI and CT, after anterior cervical spine surgery. This is a retrospective cross-sectional study of cervical disc herniation. Patients of cervical disc herniation with only radiculopathy were treated with either arthroplasty (22 patients) or ACDF with cage alone (21 patients). These patients were required to undergo MRI, CT and radiography preoperatively, as well as radiography follow-up for 3 months and 1 year, and we conducted a cross-sectional study by MRI, CT and radiography including clinical evaluations 5 years after. Clinical outcomes were assessed using VAS and NDI. The fusion rate and ASD rate, and radiologic parameters (cervical lordosis, operated segmental height, C2-7 ROM, operated segmental ROM, upper segmental ROM and lower segmental ROM) were measured. The study groups were demographically similar, and substantial improvements in VAS (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2% in the fusion group and 4.5% in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9 and 50%, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences between groups. The ASD rate of 46.5% after ACDF or arthroplasty, and arthroplasty did not significantly lower the rate of ASD. ASD occurred in patients who had preexisting ASD and in patients who also had other segment degeneration. ASD may be associated with a natural history of cervical spondylosis rather than arthrodesis.

Quality of life following a major lower limb ampu tation in Johann esburg, South Africa.

To determine the impact of lower limb amputation on qualityof life in people in the Johannesburg metropolitan area of South Africa, duringtheir reintegration to their society/community of origin.A longitudinal pre- test- post test design was utilized. Consecutive samplingwas used to recruit and interview participants (n=73) who met the inclusioncriteria. Ethical clearance was obtained. The hospitals and participants gaveinformed consent.The EQ-5D, Barthel Index, and Modified Household Economic andSocial Status Index were used to collect data. Participants were interviewed preoperatively and then followed upthree months post-operatively. Data were analysed using STATA version 10. Categorical data were analysedusing Chi-square/Fischer’s exact test and continuous data were analysed using Wilcoxon signed rank and medianregression.Most (n=21, 52.5 %) participants had no income. One participant was homeless, 17.5% (n=7) lived in shacks.The preoperative and postoperative median VAS of the EQ-5D was 60 and 70 respectively showing no significantimprovement in QOL (median EQ-5D VAS). The preoperative and postoperative median total BI score was 20 and 19respectively, showing a significant reduction in function (median total BI) three months postoperatively (p&lt;0.001).Preoperative mobility was a predictor of postoperative quality of life. Being female was a predictor of higher qualityof life.The average EQ-5D VAS score and overall function (total BI) were generally scored high both preoperativelyand postoperatively but there was no significant improvement in EQ-5D VAS score and there was a significant reductionin function after three months. Higher scores in mobility preoperatively is a predictor of higher quality of lifepostoperatively.

Comparative analysis on curative effects of percutaneous vertebroplesty and kyphoplasty in the treat-ment for thoracolumbar vertebral compression fracture

[Objective]To explore and compare the clinical efficacy of treatment of thoracolumbar vertebral compression fracture by percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP).[Methods]46 cases of thoracolumbar vertebral compression fractures in patients with surgical Methods were divided into vertebral angioplasty group and kyphoplasty group,intraoperative blood loss of two groups,operative time,the bone cement injected volume,bone cement leakagerate and clinical efficacy before and after surgery were compared in two groups.Resrlts Patients were successfully completed with surgery,infection,complications of hematoma,nerve root injury,and vertebral body fractures.There was no statistical significant difference in operative time and blood loss in two groups(P＞ 0.05).But there was significant differences in the injection volume of hone cement,bone cement leakage rate between the two groups (P＜0.05).Two groups' restoring vertebral height extent had significant improvement in VAS score than the preoperative group,difference was statistically significant (P＜ 0.05) but no significant difference found between two groups (P＞ 0.05).Mter 2weeks in PVP group,and the PKP group,1 year after the efficiency difference was not significant (P＞ 0.05).[Conclusion]s PVP and PKP treatment of thoracic and lumbar vertebral compression fracture may derive significant clinical efficacy,with less trauma,shorter operative time,less bleeding,fewer complications,minimally invasive characteristics.PKP can effectively correct the kyphosis,greatly reduce the occurrence of bone cement leakage than PVP increased security,hut the cost is higher; PVP operation is relatively simple,inexpensive,hut the bone cement leakage rate is relatively high.It should be combined with a vasiety of factors to select the appropriate surgical clinical. Key words: Percutaneous vertebroplasty(PVP); Percutaneous kyphoplasty(PKP); Compression fracture; Osteoporosis; Bone cement; Curative effect

Langzeitwirksamkeit und Sicherheit der Ballon-Kyphoplastie zur Behandlung osteoporotischer Wirbelkörperfrakturen

The aim of the evaluation of treatment protocols was an extension of the documentation regarding efficacy, duration of action and safety of balloon kyphoplasty. In addition, the data analysis should be used to clarify whether differences arise concerning the treatment success, depending on the number and/or position of the augmented vertebral bodies. The data of all patients who were admitted and operated on for vertebral body fractures between 2004 and 2009 were collected and evaluated for this study. The patients were examined pre-operatively and during the control visits clinically and radiologically. The intensity of pain was recorded on a visual analogue scale (VAS: 0-100 mm). To determine the functional limitations the Oswestry questionnaire was used. In addition, the middle and anterior heights of the vertebral body and the kyphosis angle were measured. To perform the balloon kyphoplasty the Kyphon® system was applied. The findings of all patients were documented in order to evaluate the efficacy and safety of balloon kyphoplasty for up to 3 years and to compare them with regard to the differences depending on the number and/or location of vertebral fractures (T = 1, T > 1, L = 1, L > 1, T + L). The overall evaluation of all patients (n = 464) in whom a balloon kyphoplasty was carried out showed an average improvement in VAS scores by 53 mm and the Oswestry scores by 47 percentage points. It was possible to demonstrate a significant improvement of the vertebral body height (mean 1.6 mm) and the kyphosis angle (1.3 degrees) in long-term controls up to 3 years. When comparing the findings in the groups that had been operated on a different number of vertebrae and/or at different positions in the spinal region (n = 466) it could be proven that the average decrease in pain intensity did not differ in all 5 groups (> 50 mm). Also for the Oswestry scores the reduction was almost comparable in all 5 groups. The radiological findings did not show striking differences between the 5 groups. Balloon kyphoplasty was proven to be a safe and effective procedure. Thus, the balloon kyphoplasty in carefully selected patients can yield better results than a non-invasive conservative treatment. It contributes decisively a better quality of life for the operated patients and diminishes the risks of long-lasting treatment with drugs.

Prospective comparative study between two different fixation techniques in meniscal allograft transplantation

To compare the functional and radiographic results between two different horn fixation techniques for meniscal allograft transplant. This is a prospective study of 88 meniscal allograft transplants with a mean 5-year follow-up. Forty transplants were performed on the medial compartment and 48 on the lateral compartment. The same surgeon performed all surgeries. Thirty-three grafts were fixed only with sutures (Group A) and 55 only with bony fixation (Group B). Both groups were comparable in terms of age, laterality, time since meniscectomy and preoperative functional and radiographic status. Functional assessment was done with Lysholm and Tegner scores and the Visual Analogical Scale for pain. Joint space narrowing was evaluated in the Rosenberg view. There was a significant improvement in Lysholm, Tegner and VAS scores without differences between Group A and Group B (n.s.). Radiographic evaluation did not show any joint space narrowing (n.s.). No differences in the comparison of all the variables of the two compartments were found. There were complications in 33.3 % of patients in Group A that including 7 graft tears (21.4 %) and in which there was an allograft failure rate of 9 %. Group B showed complications in 16.4 % of the patients and included 4 graft tears (7.3 %, n.s.) with an allograft failure rate of 3.6 %. Meniscal allograft transplantation with either technique provided good functional and radiographic results at mid-term follow-up. Both graft fixation methods showed no differences relative to functional and radiographic results. There was a considerably higher rate of complications in transplantations performed with the only-suture technique than those with bony fixation, although the difference was not statistically significant with the numbers available. The results suggest that similar functional results should be expected whether the meniscal graft includes bone plugs or not. However, graft tears seem to happen more frequently if the MAT is performed without bony fixation. Prospective comparative study, Level II.

Transforaminal Lumbar Interbody Fusion (TLIF) for Revision of Failed Posterolateral Spinal Fusion

Introduction: Posterolateral fusion is commonly used for managing many degenerative spinal problems. Reported pseudarthrosis rate varies between 5-56%. Several approaches have been used for revision, including re-grafting, ALIF, PLIF, and TLIF. Purpose: The aim of this work is to evaluate the radiographic and functional results of TLIF for the management of symptomatic lumbar pseudarthrosis and to compare between revising posterolateral fusion by re-grafting and by TLIF using autogenous iliac bone graft. Study Design: This is prospective comparative study Methods: Forty-three patients with symptomatic pseudarthrosis after previous posterolateral fusion were revised using TLIF technique and were prospectively evaluated and followed for a minimum of 2 years (Range=2-5.6 years). The clinical and radiological outcomes were recorded and compared to a different group of another 21 patients treated earlier with refreshing the same fusion bed and re-grafting. Only autogenous iliac grafts were used in all cases. VAS and Oswestry Disability Index (ODI) were used for the clinical assessment. Radiographs were obtained at 2, 6, 12 and 24 months.Results: There was no significant difference in the mean amount of blood loss between both groups. However, the mean operative time for TLIF was significantly shorter than the revision PLF. At 2 years follow-up, the TLIF group showed significantly better improvement in the mean VAS score and ODI scores (42 and 43 in TLIF group versus 8 and 21 in the PLF group) and the fusion rate was also significantly higher. Complications included incidental dural tear (2 patients) in the TLIF group that was recognized intraoperatively and successfully repaired, superficial infection (1 patient)in the posterolateral group, and donor site discomfort (2 patients in each group). Conclusion: The significantly higher success of TLIF for revising pseudarthrosis after posterolateral fusion is attributed to the fact of placing the graft in a wide fresh bed under compression. The approach is relatively easy and safe for the neural tissue because it avoids any fibrosis from previous surgery and its use is therefore encouraged. (2012ESJ014)

Good Functional Outcome and Adjacent Segment Disc Quality 10 Years after Single-Level Anterior Lumbar Interbody Fusion with Posterior Fixation

We reviewed the records of a prospective consecutive cohort to evaluate the clinical performance of anterior lumbar interbody fusion with a titanium box cage and posterior fixation, with emphasis on long-term functional outcome. Thirty-two patients with chronic low back pain underwent anterior lumbar interbody fusion and posterior fixation. Radiological and functional results (visual analogue scale [VAS] and Oswestry score) were evaluated. Adjacent segment degeneration (ASD) was evaluated radiologically and by magnetic resonance imaging (MRI). Twenty-five patients (78%) were available for follow-up. Functional scores showed significant improvement in pain and function up to the 2-year follow-up observation. At 4 years, there was some deterioration of the clinical results. At 10-year follow-up, results remained stable compared with 4-year results. MRI showed ASD in 3/25 (12%) above and 2/10 (20%) below index level (compared with absent preoperatively). ASD could not be related to clinical outcome in this study. Anterior lumbar interbody fusion and posterior fixation is safe and effective. Initial improvement in VAS and Oswestry scores is partly lost at the 4-year follow-up. Good clinical results are maintained at 10-year follow-up and are not related to adjacent segment degeneration.

Abstract No. 183: Radiofrequency targeted vertebral augmentation (RF-TVA) for osteoporotic compression fractures

RF-TVA employs a novel system containing a steerable osteotome for site-specific cavity creation and radiofrequency (RF) modulation of cement viscosity delivered using a hydraulic delivery system. We report a prospective study of patients with acute osteoporotic vertebral compression fractures (VCF) with this system. Between May 2009 and January 2011, 20 patients with 1-3 painful VCFs (confirmed by MRI and pain concordant with index level) who were to receive kyphoplasty treatment were enrolled. Inclusion criteria included age between 50-90, Visual Analogue Pain (VAS) score >4, a moderate (21-40%) or greater Oswestry Disability Index (ODI) score, and 20-90% vertebral compression. VAS and ODI scores were recorded pre-procedure, at discharge, one week, one month, and three months after the procedure. ODI scores were recorded at the same time points except at discharge. Each procedure was performed using this Vertebral Augmentation System. A trocar was placed via a unipedicular approach. . Using a remotely controlled delivery system RF energy was applied tothe PMMA cement as it passed into the delivery cannula. Average patient age was 79.7 ±9.85 years. The mean percentage of collapse was 28 ±13. %. A majority of patients had associated diseases, the most common ones being hypertension (N=14) and coronary artery diseases (N=9). All surgeries were performed within 42 days (av. 13 days) of the patient's reported date of injury. The average procedure time was 18.6 ± 8.95 minutes. No procedure related complications were encountered. No patients required bilateral procedures. The improvement in mean VAS scores from pre-procedure to discharge was 3.4 (p<0.0001). At 1 week, 1 month and 3 months, the improvement in mean VAS score was 3. After three months, the improvement in average ODI scores was significant (34.14%, p < 0.0001). Radiofrequency targeted vertebral augmentation (RF-TVA) is a safe and effective method for treatment of vertebral compression fractures. The use of RF energy, to warm cement immediately prior to entering the patient, results in the unique combination of consistently high viscosity cement useable over an extended working time.

Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: A 12-month randomized follow-up, controlled trial

Uncertainty regarding the benefits of vertebroplasty (VP) for the treatment of acute osteoporotic vertebral fractures has recently arisen. A prospective, controlled, randomized single-center trial (ClinicalTrials.gov registration number NCT00994032) was designed to compare the effects of VP versus conservative treatment on the quality of life and pain in patients with painful osteoporotic vertebral fractures, new fractures and secondary adverse effects were also analyzed during a 12-month follow-up period. A total of 125 patients were randomly assigned to receive conservative treatment or VP. The primary end point was to compare the evolution of the quality of life (Quality of Life Questionnaire of the European Foundation for Osteoporosis [Qualeffo-41] and pain (Visual Analogue Scale [VAS]) during a 12 month follow-up. Secondary outcomes included comparison of analgesic consumption, clinical complications, and radiological vertebral fractures at the same time points. Both arms showed significant improvement in VAS scores at all time points, with greater improvement (p = 0.035) in the VP group at the 2-month follow-up. Significant improvement in Qualeffo total score was seen in the VP group throughout the study, whereas this was not seen in the conservative treatment arm until the 6-month follow-up. VP treatment was associated with a significantly increased incidence of vertebral fractures (odds ratio [OR], 2 · 78; 95% confidence interval [CI], 1.02-7.62, p = 0.0462). VP and conservative treatment are both associated with significant improvement in pain and quality of life in patients with painful osteoporotic vertebral fractures over a 1-year follow-up period. VP achieved faster pain relief with significant improvement in the pain score at the 2-month follow-up but was associated with a higher incidence in vertebral fractures.

Clinical outcome and influencing factor for repeat lumbar discectomy for ipsilateral recurrent lumbar disc herniation.

ObjectiveRecurrent herniation following disc excision has been reported in 5-15% of patients. There have been numerous studies of recurrent disc herniation, but these have analyzed mixed patient populations. We designed this study to analyze the factors that influencing the clinical results, and efficiency of repeat discectomy for recurrent lumbar disc herniation occurring at the same level and on the same side after primary discectomy.MethodsBetween 1990 and 2011, a total of 52 patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Clinical outcomes were measured with Macnab criteria and visual analog scale (VAS score). Clinical parameters were also analyzed for influencing factors for outcome.ResultsBased on Macnab criteria, an excellent surgical outcome was achieved in 28 cases (54%), a good outcome in 22 cases (42%), a fair outcome in 1 case (2%), and a poor outcome in 1 case (2%). Based on VAS score, 47 of 52 patients (90%) showed more than 4 score improvement. Age, sex, diabetes mellitus, smoking, time interval between repeat and primary discectomy, duration of recurrent symptoms, and extent of disc herniation did not significantly affect Macnab criteria and VAS score. However, a traumatic event showed less VAS score improvement whereas not affecting on Macnab criteria.ConclusionConventional open lumbar discectomy performed as repeat surgery for recurrent herniation showed satisfactory results. Based on the results of this study, repeat discectomy can be recommended for the management of recurrent lumbar disc herniation. Further study is needed to evaluate factors related to the outcomes of repeat discectomy.

POSTOPERATIVE OUTCOMES OF ARTHROSCOPIC SUBACROMIAL DECOMPRESSION FOR ROTATOR CUFF TEAR WITH SHOULDER STIFFNESS

Some patients with rotator cuff tear have shoulder stiffness preoperatively. Concomitant preoperative shoulder stiffness may affect postoperative outcomes of arthroscopic subacromial decompression (ASD) for rotator cuff tear. The purpose of this study was to compare postoperative outcomes for ASD between rotator cuff tear patients with and without preoperative shoulder stiffness and to analyze the serial change in functional scores, range of motion (ROM), and pain intensity of the 2 groups after operation. 60 shoulders of 58 patients who underwent ASD for rotator cuff tear were studied. Arthroscopic release was performed for the stiffness group. The results were assessed before surgery and 1, 3, 6, 12 and 24 months after surgery, and the results in the stiffness group and non-stiffness group were compared. No differences in serial changes for postoperative outcomes of ASD were seen in terms of the Japanese Orthopaedic Association shoulder scoring system (JOA scores) and the visual analog scale (VAS scores) for pain at night and pain during motion between the stiffness group and non-stiffness group. However, compared to the non-stiffness group, forward flexion and abduction angles were significantly smaller for the stiffness group at 1 and 3 months after surgery. External rotation and internal rotation angles were significantly smaller at 1 month after surgery for the stiffness group than for the non-stiffness group. Preoperative shoulder stiffness does not affect improvement of postoperative JOA scores and VAS scores of ASD. When measured 6 months after surgery, ROM in the stiffness group and the non-stiffness group was similar.

Early Outcomes of Minimally Invasive Anterior Longitudinal Ligament Release for Correction of Sagittal Imbalance in Patients with Adult Spinal Deformity

The object of this study was to evaluate a novel surgical technique in the treatment of adult degenerative scoliosis and present our early experience with the minimally invasive lateral approach for anterior longitudinal ligament release to provide lumbar lordosis and examine its impact on sagittal balance. Methods. All patients with adult spinal deformity (ASD) treated with the minimally invasive lateral retroperitoneal transpsoas interbody fusion (MIS LIF) for release of the anterior longitudinal ligament were examined. Patient demographics, clinical data, spinopelvic parameters, and outcome measures were recorded. Results. Seven patients underwent release of the anterior longitudinal ligament (ALR) to improve sagittal imbalance. All cases were split into anterior and posterior stages, with mean estimated blood loss of 125 cc and 530 cc, respectively. Average hospital stay was 8.3 days, and mean follow-up time was 9.1 months. Comparing pre- and postoperative 36′′ standing X-rays, the authors discovered a mean increase in global lumbar lordosis of 24 degrees, increase in segmental lumbar lordosis of 17 degrees per level of ALL released, decrease in pelvic tilt of 7 degrees, and decrease in sagittal vertical axis of 4.9 cm. At the last followup, there was a mean improvement in VAS and ODI scores of 26.2% and 18.3%. Conclusions. In the authors' early experience, release of the anterior longitudinal ligament using the minimally invasive lateral retroperitoneal transpsoas approach may be a feasible alternative in correcting sagittal deformity.

Spinal Anesthesia and Minimal Invasive Laminotomy for Paddle Electrode Placement in Spinal Cord Stimulation: Technical Report and Clinical Results at Long-Term Followup

Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.

Posterolateral versus circumferential instrumented fusion for monosegmental lumbar degenerative disc disease using an expandable cage.

Theoretically, 360° instrumented fusion has been considered to offer better radiological correction than PLF. Despite numerous publications, this correlation is still weak with several controversies in the relative literature. This prospective randomized study was designed to compare the radiological segmental results, complications and outcome of 360° instrumented fusion with the use of a single diagonal expandable PLIF device versus posterolateral pedicle screw fixation in monosegmental lumbar DDD and to show that the use of an novel expandable cage is associated with low PLIF-related complication rate compared to conventional cages reported previously. Prospective randomized controlled clinical and radiological study. Adults who suffered from monosegmental DDD were eligible for enrolment in this trial. We randomly assigned 150 patients to receive either 360° instrumented fusion (group A) with expandable cage or PLF (group B). Differences between the two groups regarding clinical parameters and radiographic sagittal measurements after 36months of follow-up. The record included global [T12-S1 lordosis, sagittal global spinal balance (SB) (C7-mid-femoral axis)] and segmental [segmental disc wedging (SDW), anterior (ADHr) and posterior (PDHr) disc height ratio] radiological measurements at the instrumented segment. Additionally, clinical outcome was evaluated with VAS, SF-36 (Physical function and Bodily Pain) and ODI questionnaires. Fusion was evaluated with the use of Christiansen method. In 73 and 72 participants of group A and B, respectively, who completed follow-up to 36months, there were no differences with respect to the rate of improvement in SF-36, ODI and VAS scores. However, in the spines of group A, there was a significant increase in anterior disc height ratio (P=0.0057), posterior disc height (P=0.016) and segmental disc wedging (P=0.00021) without subsequent loss of correction. Fusion rate was radiologically shown in 94.5% and 87% spines of group A and B, respectively (P>0.2). Four and 9 spines in group A and B, respectively, showed non-union at the final observation. Our findings suggest that 360° fusion offers better sagittal radiological restoration associated with circumferential fusion. However, this difference seemed not to have any medium-term clinical impact. The use of expandable cage was associated with low PLIF-related complications compared to conventional cages.

Suspension Sutures in Management of Nasal Valve Collapse

Objective: Assess the efficacy of ala suspension sutures in the management of nasal valve collapse causing nasal obstruction. Method: Retrospective study of patients with ala suspension sutures inserted for nasal valve collapse in Doncaster Royal Infirmary from January 2009 to December 2010. Subjective nasal congestion was measured using visual analogue scale (VAS 0-10), and objective measurement using Peak inspiratory flow rate (PIFR) before and after the operation was performed. Results: Twenty-six patients with ala suspension sutures inserted were identified. Five patients who had concurrent procedures carried out on septum and turbinates were excluded. Twenty-one patients were included in our study. Ninety percent of patients were satisfied with the surgery, supported by significant improvement in the VAS (0 - 10) for nasal congestion and PIFR scores. The average VAS score improvement was 4.6 points, and PIFR increased by 23.3L/min. Of the 21 patients, 4 required revision procedures to achieve satisfactory outcome. Two out of these 4 developed neuralgia, which was controlled with Amitriptyline. Conclusion: The result of our study shows a significant improvement in patient symptoms following insertion of ala suspension suture for nasal valve collapse causing nasal obstruction. This is a short and well tolerated procedure with minimal side effects.

Assessment of Clinical Effect of Therapy Combining Disease with Syndrome on Rheumatoid Arthritis

To observe the effectiveness and safety of a therapy combining disease with syndrome on rheumatoid arthritis. Eighty patients with rheumatoid arthritis belonging to syndrome of damp-heat obstruction were randomly divided into a treatment group and a control group according to stratified blocked randomization method. Forty cases in the control group orally took Loxoprofen Sodium Tablet and Leifumite Tablet and the other 40 cases in the treatment group orally took a Chinese medicine for 12 weeks as a course of treatment. ACR therapeutic effect was used as the standard for evaluating the total therapeutic effect. After 12 weeks of treatment, there was a statistical difference (P < 0.01) in the improvement of VAS score, morning stiffness time, number of swelling joints, index of swelling joints, number of joints with tenderness, index of joints with tenderness, average grip strength of both hands, DSA28 score, HAQ, patient's assessment, physician's assessment, ESR, CRP and RF in both groups. The improvement of morning stiffness time, number of swelling joints, index of swelling joints, grip strength, HAQ and patient's assessment in the treatment group was much better than that in the control groups with statistical difference (P < 0.05). ACR20, ACR50 and ACR70 was 27.5% (11/40), 37.5% (15/40) and 22.5% (9/40) respectively in the treatment group and 40% (16/40), 27.5% (11/42) and 10.0% (4/40) respectively in the control group with statistical difference (P < 0.05) in the superiority of the treatment group over the control group. The incidence of adverse reaction in the control group was higher than that in the treatment group (P < 0.05). Definite therapeutic effect and high safety can be achieved in using the therapy combining disease with syndrome to treat rheumatoid arthritis belonging to syndrome of damp-heat obstruction.