Improvement In VAS Scores Research Articles

Single-center, consecutive series study of the use of a novel platelet-rich fibrin matrix (PRFM) and beta-tricalcium phosphate in posterolateral lumbar fusion.

To evaluate the radiographic and clinical outcomes of the combination of platelet-rich fibrin matrix (PRFM) with beta-tricalcium phosphate (β-TCP) and bone marrow aspirate (BMA) as a graft alternative in posterolateral lumbar fusion procedures. Researchers evaluated 50 consecutive patients undergoing one-level to three-level posterolateral lumbar fusion procedures, resulting in a total of 66 operated levels. The primary outcome was evidence of radiographic fusion at 1-year follow-up, assessed by three independent evaluators using the Lenke scoring system. Secondary outcomes included back and leg VAS scores, incidence of reoperations and complications, return-to-work status, and opioid use. At 1-year follow-up, radiographic fusion was observed in 92.4% (61/66) of operated levels. There was significant improvement in VAS scores for both back and leg pain (p < 0.05). Compared to baseline figures, the number of patients using opioid analgesics at 12-months decreased by 38%. The majority (31/50) of patients were retired, yet 68% of employed patients (n = 19) were able to return to work. No surgical site infections were noted, and no revision surgery at the operated level was required. This is the first report to analyze the combination of PRFM with β-TCP and BMA for PLF procedures. Our results indicate a rate of fusion similar to those reported using iliac crest bone graft (ICBG), while avoiding donor site morbidity related to ICBG harvesting such as hematoma, pain, and infection. These slides can be retrieved under Electronic Supplementary Material.

Role of second high-intensity focused ultrasound (HIFU) treatment for unsatisfactory benign thyroid nodules after first treatment.

We aimed to assess the efficacy and safety of second high-intensity focused ultrasound (HIFU) ablation treatment in benign thyroid nodules that had failed to shrink by > 50% 6 months after the first treatment. Twenty-eight patients who did not achieve 50% volume reduction at 6 months after the first HIFU treatment underwent a second HIFU treatment. Nodule volume was measured on ultrasound at baseline, 3 months and 6 months. Extent of nodule shrinkage (by volume reduction ratio) (VRR) = [Baseline volume - volume at 6 months]/[Baseline volume] * 100. Treatment success was defined as VRR > 50%. Obstructive symptom score (by 0-10 visual analogue scale, VAS) was evaluated for 6 months after treatment. No complications occurred after the second treatment. The mean 6-month VRR was 21.78 ± 16.87% with a median (range) of 16.16 (1.63-54.07)%. At 6 months, only two (7.1%) patients achieved treatment success, while nine (32.1%) patients had VRR < 10%. However, relative to baseline (3.96 ± 1.04), the mean VAS significantly improved at 3 and 6 months (2.96 ± 1.43, p<0.001 and 2.58 ± 1.39, p<0.001, respectively). There was a significant correlation between VRR and improvement in VAS score at 6 months (ρ=0.438, p=0.025). Greater nodule volume before the second treatment (OR=1.169, 95% CI=1.004-1.361, p=0.045) was a significant factor for greater VRR after the second treatment. Although subjective obstructive symptoms continued to improve after the second treatment, the actual extent of nodule shrinkage was small. Larger-volume nodules tended to shrink more significantly than smaller-volume nodules in the second treatment. • Second treatment resulted in small shrinkage in unsatisfactory nodules after first treatment. • Obstructive symptoms tended to continue to improve after second treatment. • Larger-size nodules tended to respond better in the second treatment.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM What's New in MIS: 38. Retrospective analysis of Sacroiliac Joint (SIJ) fusions comparing the percutaneous transgluteal approach to the posterior oblique approach

BACKGROUND CONTEXT For many years, low back pain originating from the sacroiliac joint was either overlooked or misdiagnosed and therefore untreated. This is perhaps due to a number of factors. For example, spine surgeons were trained to look at the spine for sources of pain and not the sacroiliac joint. Additionally the diagnostic technique for identifying the sacroiliac joint as a pain generator were not refined. If the saroiliac joint was identified as the problem, orthopedic surgeons were reluctant to address the sacroiliac joint surgically due to its high morbidity rates. However, with a significant percentage of the patient population having the sacroiliac joint as the pain generator, it makes sense to try to alleviate this pain in a way that is as minimally invasive as possible. One such technique is a lateral transgluteal approach. Another technique for accessing the sacroiliac joint in a minimally invasive fashion is through the posterolateral approach. The author has experience with both approaches and device types. It was the author's intent to compare the two approaches to ascertain which achieved better outcomes. PURPOSE We want to compare the transgluteal approach with posterior oblique approach and look at the adverse events and complications related to these two different approaches. STUDY DESIGN/SETTING Retrospective analysis cohort of two groups of patients. One group underwent transgluteal approach with insertion of triangular SI bone implants and the other group underwent posterior oblique approach with insertion of cannulated Rialto screws packed with Grafton paste as a bone graft substitute. PATIENT SAMPLE Group A consisted of patients treated with a transgluteal approach receiving the SI- Bone iFuse Implant System. Group B consisted of patients treated posterolaterally with the Medtronic Rialto SI Fusion System. For the sake of this study, only patients receiving unilateral implants were enrolled. Only patients with a diagnosis of sacroilitis or SIJ disruption were enrolled. Patients with other SIJ pathologies were excluded. Revision SIJ fusions were likewise excluded. The following date was collected from 20 to 30 patients in both groups. OUTCOME MEASURES Data collected consisted of Pre-op VAS, Post-op VAS, Revision Rate, Complication Rate, Blood Loss and Surgical Time. METHODS Refer to Patient Sample and Outcome Measures section. RESULTS Eighty percent of patients receiving the transgluteal approach showed an improvement in VAS scores, with 45% showing significant VAS improvement. A total of 96.7% of patients receiving the posterolateral approach showed improvement in VAS scores with 65% showing significant improvement. The transgluteal group had a 20% adverse event rate versus 6.7% for the posterolateral group. Lastly, the average blood loss for the posterolateral group was 33cc versus 60cc for the transgluteal group. CONCLUSIONS The posterolateral approach appears to be the superior approach. It is the author's belief that the increased bleeding associated with the transgluteal approach increases the potential for a postoperative hematoma, thereby yielding the higher adverse event rate. It is the author's opinion that the higher rate of patients in the posterolateral group reporting significant VAS improvement is due to the lack of disruption of the gluteal muscles associated with the trajectory. Bypassing these muscles altogether enables the patient to return to weight-bearing sooner, subsequently ambulating sooner and ultimately return to normal activities sooner. One of the adverse events in the transgluteal approach was the result of the nerve insult due to a malpositioned implant. While potentially the result of implantation technique, impacted vs. screwed, it is important to note that the trajectory of the lateral transgluteal approach does place the sacral nerve roots at risk. It was beyond the scope of this study to look at the impact of the individual implant design differences and placement techniques on clinical outcomes. Rialto (Approved for this indication), Grafton Bone Paste (Investigational/Not approved) FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Failed Dermal Allograft Procedures in Irreparable Rotator Cuff Tears Can Still Improve Pain and Function. The “Biologic Tuberoplasty Effect”

Objectives:Massive rotator cuff tears (MRCT) are a challenging problem. Dermal allografts have been used in “bridging” procedures and superior capsule reconstruction (SCR). Both have led to clinical improvement, but without correlation with post-operative imaging. The purpose of this study is to examine graft integrity on MRI in patients who underwent an SCR or bridging procedure to determine if graft integrity correlates with functional outcome. We also propose a new classification of dermal allograft re-tear on MRI.Methods:This study was approved by our IRB. Between 2006 and 2016, 11 patients (12 shoulders) underwent a bridging procedure and 10 patients underwent an SCR for MRCT with a dermal allograft by a single surgeon. The grafts were secured to the tuberosity in a double-row, trans-osseous equivalent (DR-TOE) fashion. Pre- and post-operative VAS, acromiohumeral distance (AHD), and ASES scores, and pre-operative Hamada grade and Goutallier classification were prospectively collected and retrospectively reviewed. An MRI was obtained on all patients post-operatively to assess graft integrity. The status of the graft was divided into three types based on MRI findings: Type 1- Graft intact medially (rim of cuff or glenoid) AND laterally (greater tuberosity); Type 2- Graft intact laterally but torn medially; Type 3- Graft torn laterally. The shoulders were then grouped based on these types for further analysis.Results:The average age was 61 (range: 49-73). Average follow-up was 21.6 months (range: 8-80). Average length from surgery to MRI was 13.9 months (range: 6-80). There was a significant improvement in VAS (pre-8.1 to post-1.3) and ASES (pre-26.3 to post-84.6) in Type 1 (P<0.01) and in VAS (pre-7.0 to post-0.7) and ASES (pre-32.6 to post-91.2) in Type 2 (P<0.01). There was no difference in post-operative VAS (1.3 vs 0.7) and ASES (84.6 vs 91.2) between Type 1 and Type 2 (P=0.8). There was no improvement in VAS (pre-7.3 vs post-5.7) and ASES (pre-30.6 vs post-37.2) in Type 3. There was a significant difference in post-operative VAS (5.7 vs 1) and ASES (37.2 vs 88.1) between Type 3 versus Types 1+2, respectively (P<0.01). The AHD decreased in type 3 (pre-7.8 mm to post-3.2 mm, P=0.02) but did not change in Types 1+2 (pre-7.8 mm to post-8.0 mm, P=0.7).Conclusion:In patients who have SCR or “bridging” procedures for MRCT with a dermal allograft, there is significant improvement in VAS and ASES scores if the graft heals to the tuberosity, regardless if it is still intact to the glenoid (in SCR) or the rim of rotator cuff tendon (“bridging”). Individuals whose graft is torn from the tuberosity did not have improvement in VAS or ASES scores versus baseline. There was no significant difference in AHD in all groups. We believe that the dermal graft acts as a “biologic (interpositional) tuberoplasty,” preventing bone-to-bone contact between the tuberosity and the acromion, thus eliminating pain and improving function. We still recommend performing an SCR when indicated because it has been shown to restore the normal kinematics of the shoulder in a laboratory setting. However, careful attention should be paid to the repair of the graft to the tuberosity, so that in case the primary procedure fails medially, the graft can still improve pain and function.

Sport and physical activities in patients with Chronic Achilles tendon rupture reconstruction using flexor hallucis longus transfer

Category: Sports Introduction/Purpose: Neglected or chronic Achilles tendon ruptures can be significantly disabling to patients if the muscle-tendon unit is stretched beyond its normal passive limit. Chronic rupture of the Achilles tendon (delayed diagnosis of more than 4 weeks) can result in retraction of the tendon and inadequate healing. Direct repair may not be possible and clinical results may not be satisfactory especially if the distal stump is grossly tendinopathic and when the defect exceeds 5-6 cm. Methods: We evaluated 9 patients (mean age 63) who underwent flexor hallucis longus transfer for treatment of chronic Achilles tendinopathy between May 2014 and January 2017 at a 12 months follow-up. Our results were measured with the SF-12 survey, AOFAS Ankle-Hindfoot Scale and VAS. Activity levels were determined using the Halasi ankle activity scale and the UCLA score obtained preoperatively and 12 months after surgery. Wound complications and tip-toe stance were also assessed. Results: All patients had a significant improvement of AOFAS, VAS and SF-12 scores. The Halasi activity scale and UCLA score were 5.8 and 8.2 respectively 12 months after surgery. Patient reported outcome measures consistently demonstrated improvement in clinical putcomes at 12 months follow-up. The patients went back to full daily function, could single leg heel raise and were gradually returning to sport. No major complications were recorded. Conclusion: Reconstruction of chronic tears of the Achilles tendon with flexor hallucis longus transfer can achieve satisfactory improvements in clinical outcomes at 1 year follow-up.

Proximal Adductor Avulsion Injuries: Outcomes of Surgical Reattachment in Athletes.

Background:Sports-related groin injuries are common among athletes. However, traumatic proximal adductor avulsion injuries are relatively rare groin injuries in the athletic population, with limited case reports describing suture anchor repair.Purpose:To report on the outcomes of surgical reattachment of proximal adductor avulsion injuries in athletes utilizing a suture anchor repair technique.Study Design:Case series; Level of evidence, 4.Methods:Prospective data were collected on patients undergoing surgical reattachment of proximal adductor avulsion injuries from December 2012 to May 2015 by a single surgeon. Six athletes presented after a traumatic sports-related injury with disabling groin pain, adductor weakness, and magnetic resonance imaging confirmation of fibrocartilage avulsion of the proximal adductor with retraction. Patient-reported outcomes (Hip Outcome Score–Activities of Daily Living [HOS-ADL] and Hip Outcome Score–Sport Specific [SS] subscales, modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain) were collected preoperatively and at a minimum 2-year follow-up.Results:The latest follow-up of each patient averaged 33.4 months postoperatively (range, 25-42.5 months). All patients returned to sporting activities, with 1 minor wound complication that resolved. Paired-samples t tests indicated that the mean latest postoperative scores for all patients were significantly better than their mean preoperative scores (HOS-ADL: 99.0 vs 43.2, HOS-SS: 98.9 vs 8.3, and mHHS: 97.1 vs 44.6, respectively; P < .001 for all). Similarly, there was a significant improvement in mean postoperative VAS scores for all patients (from 89.2 to 2.2; P < .001).Conclusion:Patient-reported outcomes offer an objective measure of hip function and pain control. Surgical reattachment utilizing a multiple suture anchor technique is a successful procedure that allows for a safe return to athletic performance and a predictable return to sport.

Anterior subcutaneous transposition and simple decompression of the ulnar nerve at the elbow – the postoperative improvement in DASH score, VAS score and sonographic findings

Anterior subcutaneous transposition and simple decompression of the ulnar nerve at the elbow – the postoperative improvement in DASH score, VAS score and sonographic findings

Percutaneous Endoscopic Cervical Discectomy and Osteophytes Removal Via an Anterior Transforaminal Approach for Radiculopathy: Technical Notes and Review

BACKGROUND: Cervical radiculopathy can be treated by anterior endoscopic approach to access its target pathology decompressing spinal nerve roots without fusion. The transforaminal anterior percutaneous endoscopic cervical discectomy approach is easy way to transverse process and decompress and remove osteophytes. It preserves spinal motion, stability and reduces risk of vertebral injury. METHODS: A case selected had neck pain radiating toward right arm for 2 month but severe pain from 20 days, neck deformities, head tilted toward right side. Neurological examination showed decreased sensation, weakness over right sided trapezius, biceps and triceps muscles. Eaton sign and Spurling sign were positive. Preoperative dynamic X-ray showed degenerative changes, osteophtyes at C3-4, C5-6, CT -intervertebral foraminal stenosis at C3-4 and C5-6 level, MRI -disc protrusion severely compressing spinal cord at C3/4 level. We operated at most significant level as first successful newer approach for cervical radiculopathy with osteophytes removal, decompression and discectomy by PECD anterolateral (transforaminal approach) under general anesthesia. RESULTS: Blood loss 100 mL. Hospital Stay 3 days. Operative time was 80 minute. There was marked improvement of preoperative VAS score from 7/10 to 3/10. After surgery drain was fixed for 24 hour to collect some residual fluids and avoid hematomas. There were no significant post operative events or surgery-related complication. CONCLUSION: Under percutaneous endoscopic system is easy to visualize proper minute structure, drill, dissect and lessen the chance of iatrogenic injury, decrease risk of vertebral arteries. Anterior transformaminal endoscopic surgical approach can be further developed and trained for treatment of cervical radiculopathy in large population.

Role of anti-oxidant (vitamin-C) in post-operative pain relief in foot and ankle trauma surgery: A prospective randomized trial

BackgroundPost-operative pain may adversely affect a patient’s quality of life. Studies have shown that vitamin C, being an anti-oxidant and neuro-modulating agent, can help to reduce pain in a variety of clinical settings. The objective of this randomized controlled trial was to assess the effectiveness of vitamin C in reducing post-operative pain, analgesia requirements and improving functional outcome. MethodsPatients with isolated foot and ankle trauma, who had undergone surgery, were randomly assigned to receive either vitamin C 500mg or a placebo tablet twice a day. VAS score, analgesia requirement and functional outcome were assessed during their regular follow up. Results were compared and analyzed at the end of 3 months. ResultsThe group which received vitamin C, showed improvement in VAS score at the end of second and sixth week of follow up, reduced analgesia requirements and improved functional outcome as compared to the placebo group. ConclusionsThis study shows that the supplementation of vitamin C in patients undergoing surgery for foot and ankle trauma helps to reduce analgesic requirements, improve VAS scores and achieve better functional outcome.

Efficacy of platelet rich plasma in comparison to steroid for the management of chronic plantar fasciitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic plantar fasciitis is often a difficult to treat entity and platelet-rich plasma (PRP) is an upcoming modality instead of steroid in chronic cases of plantar fasciitis resistant to traditional non-operative management.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients with chronic plantar fasciitis were prospectively randomised into 2 groups and treated with either a single injection of 3 cc PRP or 40 mg DepoMedrol (Cortisone) injection and followed for a year. Immediately prior to PRP or cortisone injection American Orthopedic Foot and Ankle Society (AOFAS) hind foot scoring was done for all patients. These scores were repeated at 6 weeks, 6 months and 12 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Six weeks evaluation of AOFAS after PRP and corticosteroid administration, the mean visual analogue scale (VAS Score) showed a significant increase in corticosteroid group (4.2) as compared to PRP group (5.8). But, the PRP group (1.8) showed significant improvement in mean VAS scores as compared to Steroid group (3.4) after a year of the treatment. Similarly, the AOFAS score improved significantly in the steroid group (64.4) at 6wks as compared to the PRP group (52.2) but at 12 months however, the PRP group sustained its effect with a mean AOFAS score of 92.2 while in the steroid group, the score dropped to a mean of 78.4.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PRP was more effective than steroid for the long term treatment of chronic plantar fasciitis. Level of Evidence: Level I, prospective randomized comparative series.&lt;/p&gt;

Correction to: Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality

The second to last sentence in the Results section of the Abstract should be corrected to, "At 180-days follow-up, there was a significant improvement in total VAS scores."

Percutaneous Endoscopic Cervical Discectomy and Osteophytes Removal Via an Anterior Transforaminal Approach for Radiculopathy: Technical Notes and Review

BACKGROUND: Cervical radiculopathy can be treated by anterior endoscopic approach to access its target pathology decompressing spinal nerve roots without fusion. The transforaminal anterior percutaneous endoscopic cervical discectomy approach is easy way to transverse process and decompress and remove osteophytes. It preserves spinal motion, stability and reduces risk of vertebral injury. METHODS: A case selected had neck pain radiating toward right arm for 2 month but severe pain from 20 days, neck deformities, head tilted toward right side. Neurological examination showed decreased sensation, weakness over right sided trapezius, biceps and triceps muscles. Eaton sign and Spurling sign were positive. Preoperative dynamic X-ray showed degenerative changes, osteophtyes at C3-4, C5-6, CT -intervertebral foraminal stenosis at C3-4 and C5-6 level, MRI -disc protrusion severely compressing spinal cord at C3/4 level. We operated at most significant level as first successful newer approach for cervical radiculopathy with osteophytes removal, decompression and discectomy by PECD anterolateral (transforaminal approach) under general anesthesia. RESULTS: Blood loss 100 mL. Hospital Stay 3 days. Operative time was 80 minute. There was marked improvement of preoperative VAS score from 7/10 to 3/10. After surgery drain was fixed for 24 hour to collect some residual fluids and avoid hematomas. There were no significant post operative events or surgery-related complication. CONCLUSION: Under percutaneous endoscopic system is easy to visualize proper minute structure, drill, dissect and lessen the chance of iatrogenic injury, decrease risk of vertebral arteries. Anterior transformaminal endoscopic surgical approach can be further developed and trained for treatment of cervical radiculopathy in large population.

Outcome Following Platelet Rich Plasma Injection In Patients Of Chronic Lateral Epicondylitis

Introduction: Various modalities of management are available for lateral epicondylitis which is a common cause of pain around elbow. Many studies have suggested the use of prp (platelet rich plasma) as a safe and effective mode of therapy.Material and methods: purpose of this study was to assess the efficacy of prp injection in patients of chronic lateral epicondylitis.It was an interventional study of 70 cases with at least 6 months of symptoms and failed conventional therapy. PRP was prepared from 40 ml autologous venous blood by double centrifugation method.Patients were followed upto 6months. An analysis of result with regards to pain (vas score) was done.Results: Right elbow was predominantly affected in our sample. Mean age of patients was 41 years. Success was defined as reduction of pain (vas) without re-intervention after a follow up of 6 months. In all patients there was improvement in vas score .pre injection mean vas score of patients was 7.04 and at final follow-up it was 1.84. There was 74 % improvement in vas score. There was progressive improvement with no complications. Conclusion: Treatment of patients with tennis elbow with prp decreases pain and significantly increases function, even after a follow-up of 6 months.

SURGICAL TREATMENT OF THORACIC AND LUMBAR SPINE FRACTURES USING TRANSPEDICULAR VERTEBROPLASTY AND FIXATION

Objective. To analyze treatment results in patients with fractures of thoracic and lumbar vertebal bodies after transpedicular vertebroplasty and fixation through minimally invasive percutaneous and open approaches. Material and Methods . A total of 154 patients with uncomplicated type A2, A3 fractures of the thoracic and lumbar vertebral bodies were operated on. All patients were examined with X-ray densitometry, spondylography, and CT. Group 1 included 53 patients who underwent vertebroplasty with deproteinized bone graft and percutaneous transpedicular fixation. Patients of Group 2 (n = 41), Group 3 (n = 43) and Group 4 (n = 17) underwent open transpedicular fixation and vertebroplasty with deproteinized bone graft (Group 2) and titanium nikilide granules (Groups 3 and 4). Results . Intraoperative blood loss during open vertebroplasty combined with short-segment transpedicular fixation exceeded that during percutaneous vertebroplasty. Parameters of kyphotic deformity, the wedge index and the loss of correction did not differ significantly except for Group 4. Significant improvement in ODI and VAS scores was noted after percutaneous vertebroplasty as compared with control groups. Conclusion . Transpedicular verteboplasty and transpedicular fixation, both open and percutaneous, performed for the treatment of type A2 and A3 spinal fractures provide reliable stabilization of the injured spinal segments, allow vertebral body height restoration to a greater extent and correction of the kyphotic deformity.

S188 The role of repetitive transcranial magnetic stimulation in treatment of diabetic polyneuropathic resistant pain

Objective The objective of our study is to reduce resistant diabetic polyneuropathic pain using repetitive transcranial magnetic stimulation (rTMS). Diabetes mellitus is a clinical syndrome characterized by hyperglycemia caused by relative or absolute deficiency of insulin in the body. Painful neuropathy is a common complication in chronic diabetes. Although painful neuropathy responds to antidepressants, anticonvulsants and opioid agonists, these drugs proved to have different side effects and are sometimes not effective. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, safe and effective mechanism used in relieving neuropathic pain. According to pulses given, it can modulate cortical plasticity, consequently causing excitability or inhibition according to the rate of stimulation. Methods Twenty patients were randomly selected and divided into two groups: Insulin dependent (group A) and non-Insulin dependent (group B), each group contains10 patients. High frequency 10 Hz stimulation protocol is applied on both groups for 5 consecutive days, repetitive transcranial magnetic stimulation was applied over lower limbs’ motor cortex, VAS score and nerve conduction studies were compared before and after the sessions. Results and significance Highly significant improvement of VAS score and nerve conduction studies (p-value Discussion To the best of our knowledge, this study is one of the first studies to apply rTMS over lower limb motor cortex in treating patients suffering from diabetic neuropathic pain by activating pain control systems as well as improving their nerve conduction studies. Improvement of nerve conduction studies is a result of pyramidal tract excitation, accordingly spinal synaptic plasticity. Conclusion According to our study, we found that rTMS significantly reduced painful diabetic neuropathy. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems.

Functional outcomes of platelet rich plasma injections in plantar fascitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The study was conducted to analyse the clinical outcomes following a single injection of platelet rich plasma, produced using autologous blood by standard double centrifugation technique in patients with plantar fasciitis who have not had relief using conservative methods.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Between June 2013 and June 2015, 26 consecutive patients (Mean age 45.92) (11 males/15 females) who had symptoms for a minimum of 3 months and had failed conservative management options such as rest, anti-inflammatories and physiotherapy were given a single injection of PRP in the medial calcaneal tubercle.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The outcomes were measured using Visual analogue scale and Foot function index at pre injection, and at 1, 6 and 12 months post injection and results tabulated. All patients reported an improvement in VAS and FFI scores consistently. One superficial infection was encountered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Single injection of platelet rich plasma improves pain and function in the foot in patients suffering from plantar fasciitis when conservative management has failed. The synergism between various autologous growth factors may play a role in tendon healing. &lt;/p&gt;

Outcome of Anterior Lumbar Interbody Fusion: A Retrospective Study of Clinical and Radiologic Parameters.

This study critically evaluates the long-term results of standalone anterior lumbar interbody fusion (ALIF), without use of rhBMP-2, as a therapeutic option for symptomatic patients with degenerative disc disease (DDD). Furthermore, this study intends to identify predictive parameters for anterior lumbar interbody fusion outcome. A retrospective cohort study with additional telephone interview to obtain missing data was performed. All patients who underwent an L4-L5 or L5-S1 ALIF-procedure, or both, in the period between 2006 and 2011 were identified. The medical files of 123 patients with 154 fusion levels were reviewed. All patients were contacted by telephone to gather supplementary and missing information. Pain and functionality scores (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), radiologic (intervertebral disc height, Modic and Pfirrmann classifications), and different clinical parameters were gathered. The mean age of the population at surgery was 46.2 years. Overall, 59 female and 64 male patients were included in the study. The mean VAS score for back and leg pain improved significantly (P < 0.001) with 5 and 4.4 points respectively at 3-year follow-up. Modic-type I changes are associated with a better improvement in VAS score for back pain (P= 0.026), Pfirrmann-grades IV and V and an intervertebral disc height of less than 5 mm are associated with a better improvement in leg pain (respective P-values: 0.045 and 0.033). Overall, 89% of patients would reconsider the surgical intervention. The ALIF technique is a durable treatment option for patients with DDD. This study suggests different predictive parameters for treatment outcome.

Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis

Background ContextLaminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures. PurposeThis study aimed to compare the clinical and radiographic outcomes of bilateral decompression via a unilateral approach (BDUA) with transforaminal lumbar interbody fusion (TLIF) and laminectomy with PLIF in the treatment of degenerative lumbar spondylolisthesis (DLS) with stenosis. Study DesignThis is a prospective cohort study. Patient SampleThis study compared 43 patients undergoing BDUA+TLIF and 40 patients undergoing laminectomy+PLIF. Outcome MeasuresVisual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ) score. MethodsThe clinical outcomes were assessed, and intraoperative data and complications were collected. Radiographic outcomes included slippage of the vertebra, disc space height, segmental lordosis, and final fusion rate. This study was supported by a grant from The National Natural Science Foundation of China (81572168). ResultsThere were significant improvements in clinical and radiographic outcomes from before surgery to 3 months and 2 years after surgery within each group. Analysis of leg pain VAS and ZCQ scores showed no significant differences in improvement between groups at either follow-up. The mean improvements in low back pain VAS and ODI scores were significantly greater in the BDUA+TLIF group than in the laminectomy+PLIF group. No significant difference was found in the final fusion rate at 2-year follow-up. The BDUA+TLIF group had significantly less blood loss, shorter length of postoperative hospital stay, and lower complication rate compared with the laminectomy+PLIF group. ConclusionsWhen compared with the conventional laminectomy+PLIF procedure, the BDUA+TLIF procedure achieves similar and satisfactory effects of decompression and fusion for DLS with stenosis. The BDUA+TLIF procedure appears to be associated with less postoperative low back discomfort and quicker recovery.

Platelet rich plasma for the treatment of osteoarthrosis knee

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; New studies focused on modern therapeutic methods which stimulate cartilage healing and repair the damage, including the use of platelet-rich plasma (PRP) as a cocktail of growth factors. This study has the purpose to present the use of PRP in management of knee osteoarthrosis and its outcomes up to 6 month follow up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 58 patients with 100 knees (32 male, 26 female) with Kellgren Lawrence grade 1, 2,3 and 4, aged between 50 to 65 years between February 2015 to December 2015 treated with 4 ml of intra-articular PRP injections at 4 week interval in each affected knee and evaluated using WOMAC and VAS scores before injection and on follow up at end of the 1&lt;sup&gt;st&lt;/sup&gt;, 3&lt;sup&gt;rd&lt;/sup&gt;, and 6&lt;sup&gt;th&lt;/sup&gt; month.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age was 58.29 years. Improvement in WOMAC score for KL grade 1 (32.61%), grade 2 (31.12%), grade 3(26.54%) whereas only 13.68% in KL grade 4 at end of 6month follow up. Improvement in VAS score for KL grade 1 (41.30%), grade 2 (38.02%), grade 3 (47.68) whereas only 12.74% in grade 4 at the end of 6 month follow up. Results show statistically higher significant improvement seen in WOMAC and VAS for KL grade 1, 2, and 3 as compared to grade 4 at 6 months follow up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results of our study illustrated that the treatment with intra articular PRP injections is safe and effective in reducing pain and stiffness as well as improve knee function and quality of life in early stages of knee osteoarthrosis. &lt;/p&gt;

Arthroscopic Treatment of Focal Osteochondral Lesions of the First Metatarsophalangeal Joint

Background:This study aimed to assess the arthroscopic treatment, one of the surgical treatment options, for early grade focal osteochondral lesions of the first MTP joint, and to determine the impact of the arthroscopic microdrill hole surgery on foot function and daily life in a patient group with failed conservative treatment.Materials-Methods:This prospective study reviewed 27 patients having hallux rigidus with osteochondral injury of the first MTP joint who were operated with first MTP joint arthroscopy. Six patients had Coughlin-Shurnas grade 4 hallux rigidus and were excluded from the study; 5 patients were excluded due to having an arthroscopic kissing lesion, and 3 patients were excluded for not having attended regular follow-up after third month. After excluding the above patients, the study was completed with 14 patientsResults:The mean hallux vagus angle was 13.29⁰ (±1.93 SD) and the mean intermetatarsal angle was 9.14⁰ (±0.86 SD). Apart from joint arthroscopy, no soft tissue procedure and/or any procedure requiring osteotomy was intended in any patient. The median operative duration was 27.8 (19-56) minutes.The patients had mean preoperative VPS and AOFAS-Hallux scores of 8.14±0.86 SD and 48.64±4.27, respectively; the corresponding postoperative values of both scores were 1.86±0.66 SD and 87.00±3.70. Both VPS and AOFAS-Hallux scores changed significantly (p<0.01)Discussion:In this prospective study we explored the impact of arthroscopic microdrill hole surgery on foot functions and daily life activities in patients with focal osteochondral lesions of the first MTP joint. Our results indicated significant improvements in VAS and AOFAS scores with this treatment. The micro drill technique we applied in this study is based on the principle of opening 4-6-mm long tunnels to enable stem cells to migrate to the defected area and achieve cure by differentiation in full-thickness chondral injuries with exposed subchondral bone.In conclusion, arthroscopic microhole drill technique can be applied with impressive functional scores and without any complication in persons who failed conservative therapy for hallux rigidus with focal chordal injury, a common foot problem. There is a need for comparative studies with long follow-up period in this field.