Improvement In Visual Analog Scale Research Articles

Pain Interference Influence on Postoperative Clinical Trajectory in Patients Undergoing Lumbar Decompression

Newer Patient-Reported Outcomes (PROs) may offer benefits over legacy PROs in ease of administration and interpretation. We aim to study the influence of preoperative pain interference (PI) using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PROMIS-PI) on postoperative clinical outcomes in patients undergoing lumbar decompression. Patients undergoing lumbar decompression without fusion were separated into 2 cohorts: PROMIS-PI < 64 (lesser PI) and PROMIS-PI ≥ 64 (greater PI). PROs included PROMIS physical function, PROMIS anxiety (PROMIS-A), PROMIS sleep disturbance (PROMIS-SD), PROMIS-PI, Patient Health Questionnaire-9, Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) and were collected at preoperative and postoperative time points. Demographics, perioperative characteristics, PROs, and Minimum Clinically Important Difference (MCID) were compared among groups through non-parametric inferential statistics. One-hundred and seven patients were identified. Independent of preoperative PI, patients reported significant postoperative improvement in PROMIS physical function, PROMIS-A, PROMIS-PI, VAS back, VAS leg, and ODI. The greater PI cohort reported significant postoperative improvement in Patient Health Questionnaire-9 and PROMIS-SD. The lesser PI cohort reported superior preoperative PROs in all domains. Postoperatively, the lesser PI cohort reported superior 6-week PROMIS-A and PROMIS-SD. MCID achievement rates were higher in the greater PI cohort for PROMIS-PI, VAS back, VAS leg, and ODI. Patients with lower preoperative PI reported superior postoperative anxiety and sleep disturbance. Patients with greater preoperative PI had higher MCID achievement rates in PI, pain, and disability. Patients with greater preoperative PI undergoing lumbar decompression may demonstrate higher rates of clinically tangible improvement.

Comparative study of unilateral biportal endoscopy and coaxial large channel endoscopy for lumbar spinal stenosis

Objective: To compare the efficacy of unilateral biportal endoscopy (UBE) and coaxial large channel endoscopy for lumbar spinal stenosis. Methods: A total of 176 patients with lumbar spinal stenosis treated in Tianjin Hospital from March 2015 to October 2021 were included in this study. Of the patients, 110 cases were treated with UBE, including 52 males and 58 females, with a mean age of (75.1±10.4) years; while 66 cases were treated with coaxial large channel endoscopy, including 31 males and 35 females, with an average age of (77.2±13.1) years. The visual analogue scale (VAS) score of pain and Oswestry disability index (ODI) were compared before and after surgery between the two groups, with the improvement rate calculated. The operation time, intraoperative blood loss, perioperative conditions and complications were compared. The operation efficacy was evaluated according to MacNab scale and was compared between the two groups. Results: There was no significant differences in age, gender, disease course, VAS of pain, ODI and index levels between the two groups before operation (all P>0.05). The operation time and postoperative drainage in UBE group and coaxial large channel endoscopy group were comparable [(60.1±12.4)min, (62.5±13.2)min and (103.8±20.7)ml, (98.5±22.1)ml, respectively, both P>0.05]. After the operation, the VAS score of low back pain, VAS score of leg pain and ODI of the two groups were all lower than those before operation, and decreased continuously during follow-up; and under the repeated measures analysis of variance, significant differences were found between different time points (all P<0.05), no significant difference was found between the two groups (all P>0.05), nor interaction between groups and time points was detected (all P>0.05). The patients were followed-up for (18.0±4.2) months (6 to 30 months). There was no significant difference in VAS and ODI improvement rates and excellent rate of efficacy between the two groups at the last follow-up (all P>0.05). Conclusions: Both UBE and coaxial large channel endoscopy can provide excellent results for lumbar spinal stenosis. UBE has sufficient decompression and is convenient to explore and remove the herniated disc.

Combined Bifrontal Transcranial Direct Current Stimulation and Auditory Stroop Training in Chronic Tinnitus.

Patients with tinnitus experience difficulties in cognitive control and executive functions. Many of which are regarded as the cause of tinnitus rather than its complications. Methods for the improvement of inhibitory and cognitive control seem to be effective in the control of tinnitus. In this study, transcranial direct current stimulation and auditory Stroop exercise were have been to improve inhibitory control and the ability to ignore tinnitus in patients suffering from chronic tinnitus. 34 patients with chronic tinnitus (> 6months) were randomly divided into two groups. The first group consist of 17 patients who received 6 sessions of tDCS followed by 6 sessions of auditory Stroop training. The second group received 6 sessions of sham tDCS followed by 6 sessions of auditory Stroop training. The initial evaluations including pure tone audiometry, psychoacoustic measurements, tinnitus handicap inventory (THI) survey and visual analog scale (VAS) of annoyance and loudness were performed before, immediately after, and one month after the tDCS, sham, and Stroop training. The results of this study revealed a significant reduction in THI score, VAS of loudness, and annoyance of tinnitus. A significant correlation was detected between the reaction time of incongruent words in the Stroop task and improvement of THI score and VAS of annoyance. Combined tDCS and Stroop training efficiently improve chronic tinnitus.

Global realignment after posterior vertebral column resection in severe thoracolumbar post-tubercular kyphosis: correlation with patient-reported outcomes.

To investigate spinal realignment in patients with severe post-tubercular kyphosis (PTK) who underwent posterior vertebral column resection (PVCR) and its correlation with patient-reported outcomes (PROs). Eighty-two patients were included in this study. Spinopelvic parameters (focal scoliosis (FS), coronal balance (CB), sagittal vertical axis (SVA), focal kyphosis (FK), C2-7 lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and pelvic incidence minus lumbar lordosis (PI-LL)) and PROs (Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)) were analyzed. The correlation between spinopelvic parameters and PROs was evaluated. FK, FS, CL, TK, LL, and PI-LL significantly changed after surgery. FK decreased from pre-operative 108.5 ± 16.4° to 31.8 ± 4.5° at threemonths after surgery and increased to 38.7 ± 6.6° at final follow-up (P < 0.001). FS decreased from pre-operative 20.9 ± 2.2° to 5.1 ± 2.2° at final follow-up (P < 0.001). CL decreased from pre-operative 7.2 ± 7.3° to 3.3 ± 8.3° at final follow-up (P = 0.002). TK improved from pre-operative - 5.6 ± 7.1° to 12.9 ± 8.2° at final follow-up (P < 0.001). LL decreased from pre-operative 75.5 ± 12.6° to 45.5 ± 7.9° at final follow-up (P < 0.001). PI-LL improved from pre-operative - 24.8 ± 13.4° to 4.8 ± 9.9° at final follow-up (P < 0.001). The improvement of PROs was found to be significantly correlated with the variations of FK, CL, TK, LL, and PI-LL. The multiple regression analysis revealed that FK was an independent predictor for the improvement of VAS and ODI. PVCR is effective in treating severe PTK, which can significantly improve patients' clinical and radiographic outcomes. Spine surgeons should pay more attention to reducing the residual kyphosis.

The Use of Iloprost in the Treatment of Bone Marrow Edema Syndrome of the Proximal Femur: A Review and Meta-Analysis.

The aim of this meta-analysis was to investigate the impact of intravenous iloprost therapy on pain, function, edema changes, and follow-up surgery in bone marrow edema syndrome of the proximal femur. A systematic literature search up to May 2022 was performed to find relevant papers that made a statement about the outcome of intravenous iloprost therapy alone. Factors such as the Visual Analog Scale (VAS), Harris Hip Score (HHS), edema reduction, and follow-up interventions were considered. These were compared using Forest plots. In 11 studies, 190 proximal femora with bone marrow edema syndrome that received intravenous iloprost therapy without further therapeutic intravenous or surgical intervention such as core decompression were studied. There was a significant mean improvement in VAS by 3.3 cm (2.07-4.5 cm) (p &lt; 0.001) and HHS by 24.36 points (18.23-30.49) (p &lt; 0.001) 3-6 months after receiving iloprost therapy. Only in 9.3% of cases (1.1-24.3%) did no clinical or radiological improvement occur. It could be shown that the existing publications support intravenous therapy with iloprost in patients with bone marrow edema syndrome and result in good clinical outcomes.

Comparison of Posterior Pedicle Screw Fixation and Lateral Fixation in the Extreme Lateral Interbody Fusion in Lumbar Degenerative Disease Patients with Osteopenia or Osteoporosis.

Nowadays, with the increasing proportion of osteoporosis in patients with lumbar degenerative diseases, doctors are facing the choice of intraoperative internal fixation methods. The purpose of this study was to compare and assess the clinical results of posterior bilateral pedicle screw fixation and lateral fixation in the extreme lateral interbody fusion (XLIF) in patients with osteopenia or osteoporosis. The retrospective review was performed on 67 degenerative lumbar diseases patients with osteopenia or osteoporosis who underwent XLIF in our hospital from January 2018 to July 2021. Patients in this study were classified into lateral screw (LS) group, lateral self-locking plate (LP) group, and bilateral pedicle screw (BPS) group. The functional evaluation factors containing Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) of leg pain, and VAS of low back pain, radiological factors such as disc height (DH), lumbar lordotic (LL) angle, segmental lordotic (SL) angle, cage subsidence degree and interbody fusion degree were compared. Primary outcomes: no differences were observed with regards to the incidence of complications among LS, LP and BS group (P < 0.05). The JOA and leg pain VAS were significantly improved after operation (P < 0.05) and all groups demonstrated similar improvements in the leg pain VAS and JOA score (P > 0.05). When comparing VAS of leg pain and JOA scores, no differences were identified among LS, LP and BPS groups (P > 0.05). There are four thigh sensory complaint, one hip flexor weakness and one thigh pain occurred and no death was observed. There were significantly better DH, LL angle, SL angle, cage subsidence degree and interbody fusion degree in the BPS group than in LS and LP groups 1 year after surgery (P < 0.05). The DH loss ratio, LL angle loss ratio, SL angle loss ratio in the BPS group was significantly lower than in the LP and LS groups (P < 0.05). The 12-month SL angle improvement rate in the BPS group was significantly higher than in the LP and LS groups (20.20± 14.69, 0.73 ± 4.68, 6.20 ± 12.31, P < 0.05). the BPS patients had significantly worse intraoperative blood loss and operation time than LS and LP patients (P < 0.05). In lumbar diseases patients with osteopenia or osteoporosis, the bilateral pedicle screw fixation has better orthopedic effect than lateral internal fixation, and can better maintain the stability of the spine in the long-term follow-up, which is a better choice in XLIF surgery.

The potential therapeutic effect of platelet-rich plasma in the treatment of post-COVID-19 parosmia

BackgroundCOVID-19-related olfactory dysfunction is an emerging problem with a significant impact on the quality of life of affected individuals. Different lines of treatment have been used with varying results. This study aimed to assess the potential therapeutic effect of PRP in the treatment of post-COVID olfactory dysfunction. This work aimed to assess the potential therapeutic effect of platelet-rich plasma (PRP) in treating post-COVID-19 parosmia. A pilot study was conducted on 60 patients with post-COVID parosmia without responding to a 3-month course of olfactory training, topical corticosteroids, omega-three, vitamin B12, and zinc supplementation. The patients were distributed randomly and equally among 2 groups. The case group was subjected to three PRP injections in the olfactory cleft at 3 weeks intervals. The control group continued the pre-study treatment protocol for 6 weeks. The degree of parosmia was assessed before and after treatment subjectively using a visual analog scale (VAS) from 0 to 10. Reaching 0–1 on the visual analog scale was a complete improvement. The primary outcome was assessing the post-treatment score for parosmia 1 month after the third injection in the case group. The second outcome was the comparison between both groups regarding the degree of improvement 1 month after cessation of treatment.ResultsThere was a highly significant improvement in VAS for parosmia (p < 0.00001) in the case group and a significant improvement in VAS for parosmia in the control group (p = P = 0.00148). There was a significant difference between both groups regarding the degree of improvement favoring the case group (p = 0.002).ConclusionPlatelet-rich plasma injection in the olfactory cleft offers a therapeutic option for treating patients with post-COVID-19 olfactory parosmia who failed to respond to traditional conservative treatment.

PLANTAR FASCIITIS TREATMENT WITH PLATELET-RICH PLASMA INJECTION VERSUS STEROID INJECTION

Objective: Plantar fasciitis is characterized by heel pain that worsens when you bear weight after a long period of rest. Injections of steroids are one of the numerous therapeutic techniques that are frequently used to control plantar fasciitis. Numerous studies demonstrate that short-term pain alleviation with steroid injections is not long-lasting. According to recent studies, autologous platelet-rich plasma (PRP) injections encourage healing, which improves both short- and long-term pain alleviation. To compare the effects of local PRP injection and corticosteroid in the management of chronic plantar fasciitis, the current study was conducted. Methods: Sixty patients who met the criteria for this prospective double-blind trial were randomly assigned to one of two groups. Patients in Group I received an injection of steroid, whereas those in Group II received an injection of PRPs. The PNS numerical pain score (NPS) and a visual analog scale (VAS) were used to evaluate the patients. An evaluation was conducted before the injection as well as at 6 weeks, 3 months, and 6 months after the injection. Results: The mean VAS in Group I reduced from 7.00 before injection to 2.31 and that in Group II decreased from 7.81 before injection to 1.12. At the 6-month follow-up, the mean NPS score in Group I increased from 7.05 to 1.41 and in Group II from 7.86 to 1.02. The VAS and NPS improvements were statistically significant. In both groups, the plantar fascia thickness had decreased at the conclusion of the 6-month follow-up period (5.88 mm in Group I to 4.03 mm and 5.96 mm to 3.27mm in Group II), and the difference was statistically significant. Conclusion: When compared to steroid injection, local PRP injection is an excellent therapeutic option for persistent plantar fasciitis with long-lasting positive effects.

Posterior Injured Vertebra Column Resection and Spinal Shortening for Thoracolumbar Fracture Associated with Severe Spinal Cord Injury: A Retrospective Case-Control Observational Study.

Background Thoracolumbar spinal fracture associated with severe spinal cord injury (sSCI) is a kind of severe traumatic spine injury. Although various approaches are currently used to treat sSCI-related thoracolumbar fractures, the neurological function of patients has not been significantly improved by surgery. Objective To evaluate the therapeutic effects of the new procedure of posterior injured vertebra column resection (PIVCR) and spinal shortening for the treatment of thoracolumbar fracture associated with sSCI. Methods In this retrospective case-control observational study, we included 66 patients with thoracolumbar fractures associated with sSCI in our institution from January 2015 to December 2017. According to the different surgical approaches, the patients were allocated to group A (n = 32, received simple posterior decompression and fixation) and group B (n = 34, received PIVCR and spinal shortening). All patients' clinical and radiologic outcomes were collected to evaluate retrospectively. The clinical outcomes were gathered, including the intraoperative blood loss, operative time, visual analog scale (VAS) score, and American Spinal Injury Association (ASIA) impairment scale. The radiologic outcomes were collected involving the range of spinal shortening, canal encroachment, heights of the anterior edge of the vertebral body, and the Cobb angle. Results There was no significant difference in the two groups regarding preoperative demographic data, VAS scores, segmental kyphosis Cobb, canal encroachment, and neurological status. The range of spinal shortening in group B was an average 1.57 ± 0.40 cm and 36.45 ± 6.56% of the height of the single spinal motion segment. Due to the characteristics of the surgical procedure, group B got complete decompression of the spinal cord and better postoperative canal decompression than group A. Thus, better clinical outcomes, including neurological improvement, loss of corrective Cobb angle, and VAS improvement, were shown in group B at the follow-up investigation than those in group A (P < 0.05). Conclusion PIVCR and spinal shortening surgical procedure is a safe, reliable, and effective approach to treating thoracolumbar fracture associated with sSCI.

A Novel Technique of Minimally Invasive Calcaneal Osteotomy for Intractable Insertional Achilles Tendinopathy Associated with Haglund Deformity

Category: Hindfoot Introduction/Purpose: To date, minimally invasive surgery (MIS) involving calcaneal osteotomy for Haglund deformity associated with intractable insertional Achilles tendinopathy has not been reported. This study presents the radiographic and clinical outcomes of our novel MIS-dorsal closing wedge calcaneal osteotomy (DCWCO) technique compared to open Haglund resection. We hypothesized that earlier clinical improvement after MIS-DCWCO could be achieved by leaving the Achilles tendon insertion site untouched. Methods: We retrospectively reviewed and compared the clinical and radiographic parameters of patients who underwent MIS- DCWCO (11 cases) or open Haglund resection (14 cases) between January 2012 and June 2019. The minimum duration of follow-up for inclusion was 18 months. We measured the calcaneal pitch, Meary's, Fowler-Philip, and Böhler's angles. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores measured preoperatively and at 3, 6, 9, 12, and &gt;=18 months, postoperatively. Results: In both groups, the Meary's and calcaneal pitch angles did not change significantly, whereas the Fowler-Philip and Böhler's angles were significantly changed postoperatively. Significant improvements in VAS and VISA-A scores were observed in both groups (P &lt; .001). The extent of correction of the four radiographic and two clinical parameters were not significantly different between the two groups. However, VAS and VISA-A scores at postoperative 6 months were significantly different, whereas these parameters were not significantly different at all other time points. Conclusion: Both techniques provided similar postoperative clinical and radiographic improvement. However, MIS-DCWCO achieved earlier clinical improvement than open Haglund resection.

Treatment of Hallux Rigidus: Comparison of Hemiarthroplasty with Cartiva Implant, Allograft Interpositional Arthroplasty, and Arthrodesis

Category: Midfoot/Forefoot; Other Introduction/Purpose: Hallux Rigidus (HR) can cause pain with motion, enlarged joint, decreased joint space, subchondral sclerosis, osteophyte formation and restricted joint mobility, limiting patient physical activity. A modern technique for the treatment of HR is 1st MTP hemiarthroplasty with the use of a Cartiva synthetic cartilage implant. The Cartiva implant is designed to imitate natural cartilage; this allows patients to maintain motion in the 1st MTP joint. Current scientific literature reporting early outcomes of the procedure is sparse and mixed. This discrepancy and the overall scarcity of data indicates the need for further analysis. The purpose of this study is to compare improvement in VAS with 1st MTP hemiarthroplasty with the Cartiva implant, allograft interposition arthroplasty and fusion in patients who failed conservative management or cheilectomy. Methods: This study evaluated subjects who underwent interpositional arthroplasty, arthrodesis, or hemiarthroplasty with the Cartiva implant from January 2008 to April 2020, with a minimum of one year documented follow-up. All subjects were 18 years of age and older, diagnosed Hallux rigidus with pain, had a decrease in 1st MTP motion, and had X-ray findings consistent with decreased joint space. Patient data collected includes age, gender, ethnicity, occupation, height, weight, BMI, diabetes status, rheumatoid arthritis status, smoking, co-morbid conditions, medication, activity of choice, duration of symptoms, and operative data. Pre-operative and post- operative Visual Analog Scale (VAS) pain scores were compared between groups. Pain, function, and alignment between groups were also evaluated, pre-operatively and post- operatively, using the AOFAS Midfoot Scale. Secondary objectives evaluated include surgical complications, surgical revision, and X-rays. Results: One hundred patients with 12 months of post-operative follow-up were included in this study: 52 hemiarthroplasty with Cartiva implant patients (Group A), 24 arthrodesis patients (Group B), and 24 interpositional arthroplasty patients (Group C). The mean age of patients was 57.12 years (range 35-95). Average VAS pain scores for Group A was 3.78 (0-9), for Group B was 2.71 (0-10), and Group C was 3.67 (0-8). The average AOFAS score for Group A was 63.36 (30-95), for Group B was 60.98 (32- 83), and Group C was 60.13 (31-83). Pre-operative average VAS pain scores were 4.86 (Group A), 2.32 (Group B), and 5.58 (Group C). Post-operative average VAS pain scores were 2.69 (Group A), 0.91 (Group B), and 1.75 (Group C). Pre-operative average AOFAS scores were 59.52 (Group A), 48 (Group B), and 47.25 (Group C). Post-operative average AOFAS scores were 67.20 (Group A), 73.96 (Group B), and 73 (Group C). Conclusion: Preliminary data shows the greatest reduction in VAS pain scores in the interpositional arthroplasty group. The greatest improvement in derived AOFAS score was seen in the arthrodesis and interpositional arthroplasty groups, indicating a better overall combination of post-operative pain, function, and alignment when compared to patients who underwent hemiarthroplasty with Cartiva implant. While this study is not yet complete, it appears that hemiarthroplasty with Cartiva implant may allow patients to maintain motion in the 1st MTP joint, but at the cost of increased post-operative pain.

Polyvinyl Alcohol Hydrogel Hemiarthroplasty of First Metatarsophalangeal Joint Hallux Rigidus: Single Surgeon Five-Year Experience

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is the most common arthritic condition of a foot with a prevalence of up to 45% in people aged &gt;75 years-old. First metatarsophalangeal joint (MTPJ) arthrodesis has been the historical gold standard treatment for late-stage HR. Polyvinyl alcohol (PVA) hydrogel implants have similar biomechanical properties as native cartilage, and thus have gained popularity as a joint-sparing technique that provides preservation of MTPJ motion. Initial literature demonstrated pain relief and functional outcomes equivalent to first MTPJ arthrodesis and excellent five-year survivorship. However, recent studies report variable failure rates on PVA hydrogel implants for HR. The purpose of this study was to report the five-year experience and outcomes of PVA hydrogel implants for the treatment of HR performed by a single surgeon. Methods: Electronic health records were queried from August 2016 to August 2021 for patients who underwent primary PVA hydrogel implant hemiarthroplasty (Cartiva Synthetic Cartilage Implant; Cartiva Inc, Alpharetta, GA) for symptomatic late-stage HR. All patients were treated by a single foot and ankle fellowship trained orthopaedic surgeon. A minimum of six months follow- up was required. Patient demographics and perioperative data were collected. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and radiographs were evaluated. Complications and the overall implant survivorship were reported. A Kaplan-Meier analysis was used to evaluate implant survival. Descriptive and univariate statistics were used to analyze data. A total of 196 primary PVA hydrogel implant procedures were performed of which 146 had a minimum six-month follow-up and were included. The mean follow-up was 14.5 (+- 11.9) months. Results: The majority of patients were female (n=103, 70.5%) with a mean age of 58.1 (+-10.1) years-old, BMI of 27.3 (+-5.2) Kg/m2, and an ASA score &lt; 3 (n=131, 89.7%). The majority of patients had stage II or III disease (n=115, 78.8%). Patients experienced significant improvement in VAS (p&lt;0.0001) and hallux dorsiflexion (p=0.0005) postoperatively. There was a total of 22 (15.1%) complications including implant subsidence (n=15, 10.3%), deep infection (n=6, 4.1%), and hypertrophic ossification (n=1, 0.7%). Revision surgeries were required in 12.3% (n=18) of patients at an average of 9.4 (+- 9.2) months postoperatively. This included 9 (6.2%) revision PVA hydrogel implant procedures and 9 (6.2%) first MTJP arthrodesis. The one-and two-year survival to any revision surgery (n=18) were 89.1% and 80.5%, respectively. The one- and two-year survival to MTPJ arthrodesis (n=9) were 95.9% and 86.3%, respectively (Table 1). Conclusion: In the largest single-surgeon series reported, first MTPJ hemiarthroplasty with a PVA hydrogel implant resulted in significantly improved pain and hallux dorsiflexion at an average of 15 months postoperatively. There was a high two-year survivorship of 86.3% until failure with required first MTPJ arthrodesis. Future prospective studies should be performed to refine the indications for PVA hydrogel implants and identification of risk factors for failure.

Calcaneal Malunions Management and Types of Surgical Correction

Category: Hindfoot; Ankle Introduction/Purpose: Number of fractures of the calcaneus amounts to 1-5.7% of all fractures of skeleton bones according to various authors. Moreover, these figures correspond to 50% of all fractures of feet bones. Consequences of calcaneus malunion leads to early disability, arthrosis, pain syndrome, disorder of the entire low extremity axis of motion alongside cosmetic defects and shoe wearing discomfort. Purpose of the study: classification of calcaneal malunions based on a geometrically normal position and dimensions of hindfoot in order to develop optimal type of treatment for multicomponent calcaneal deformity. Methods: Twelve patients with post traumatic deformed hindfoot after malunited calcaneal fractures and as a result varus and valgus deformity, subtalar arthritis, pain syndrome, shoe wear discomfort at different stages after trauma (from 1 to 10 years) were examined, underwent surgical alignment of calcaneus and were followed up for 24 months. All cases were assessed clinically using the American Orthopaedic Foot &amp; Ankle Society (AOFAS) and visual analog scale (VAS); radiologically by measuring hindfoot varus/valgus, talus tilt, Meary's angle, and hight of calcaneal. Results: It was found a significant improvement in AOFAS (55.2 preoperatively to 78.8 after 24 months) and VAS (65 preoperatively to 30.1). Moreover, our study revealed a significant improvement in the radiographic measurements including hindfoot varus/valgus, the talar inclination, Meary's angle, and hight of calcaneus. Conclusion: The elimination of angular hindfoot varus or valgus deformation, exostectomy of the lateral wall and subtalar fusion, as well as the use of a tricortical autograft for distarction arthrodesis at III-V type Zwipp and Rammelt classification, resulted in reduced pain, improved function, cosmetic results and shoe wearing.

Successful Treatment of Recalcitrant Plantar Fasciitis and Achilles Tendonitis using Platelet-Rich Plasma (PRP) Injection, Short and Intermediate Results

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: PURPOSE: To identify is PRP is an effective alternative to surgery to decrease pain and increase activities for patients with recalitrant plantar faciiitis and Achilles tendonitis/tendonosis after failing greater than 6 months of appropriate conservative treatment. INTRODUCTION: PRP is thought to stimulate the body's natural mechanism of growth factors to promote healing of tissues. This is thought to occur through PRP transforming a chronic inflammatory degenerative process into a 'fresh' inflammatory process. Patients who undergo surgery for recalcitrant plantar fasciitis and Achilles tendonitis/tendonosis often have extended recovery time which can adversely affect employment status and lifestyle activities. The senior author began to use PRP is his orthopedic practice in 2015 as an alternative to surgery for patients with recalcitrant plantar fasciitis and Achilles tendonitis. Methods: From 2015 to 2020, patients with recalcitrant plantar fasciitis or Achilles tendonitis (symptoms &gt;6 months and who had failed appropriate conservative measures) were given the choice to proceed with continued non-operative care vs. surgical intervention vs. a one-time PRP injection. All patients reported substantial pain affecting ADLs and recreational activities. All patients underwent preoperative MRI. Only patients with degenerative changes in the painful area on MRI were considered elegible for study inclusion. Informed consent was obtained for all participants prior to PRP injection. Subjects underwent a single PRP injection using a commercially avaialble FDA approved office based PRP centrifuge system. All PRP injections were performed by the senior author without ultrasound guidance using anatomical landmarks and the patient's maximum area of tenderness. Patient subjective assessments of success/failure of the injection and percentage of pain relief using VAS were recorded at 6-8 weeks and &gt; 1 year post injection. Results: 89 PRP injections were performed on 88 patients (33 male/56 female). The Visual Analog Scale (VAS) was used to evaluate the treatment effectiveness along with the patient's subjective description of their improvement. Initial success was defined as &gt;=50% pain decreased at 6-8 weeks post-injection. 55/89 subjects experienced relief &gt;=50% at 6-8 weeks (overall 62% success rate). The average VAS improvement at 6-8 weeks was 67% for Achilles and 72% for plantar fasciitis (PF). 70 patients were available for intermediate follow-up (either in person or telephone) at an average of 27 months post-injection (range 13 - 41 months). For patients reporting &gt;=50% continued pain relief, average VAS improvement was 83% for Achilles and 89% for PF. No patients with initial relief &gt;=50% at 6-8 weeks had recurrent/worsened symptoms at intermediate follow-up. Patients with &gt;=50% relief at 6-8 weeks trended toward further decreased pain over the next 12-24 months. Conclusion: This prospective case series study shows promising support of the short-term and intermediate-term effectiveness of PRP injection as a non-surgical treatment option for patients experiencing chronic recalcitrant plantar fasciitis and Achilles tendonitis. These results not only show a significant percentage of patients were able to avoid surgery with short term improvement in their symptoms, but the study also revealed that patients who experienced greater than 50% pain relief within the first 6 weeks after PRP injection, also showed continued improvement in their symptoms long term.

Ultrasound-guided dry needling versus traditional dry needling for patients with knee osteoarthritis: A double-blind randomized controlled trial.

ObjectiveTo compare the effect of ultrasound (US)-guided dry needling (DN) with traditional DN in the treatment of pain and dysfunction for patients with knee osteoarthritis (KOA).DesignA double-blind, randomized controlled trial.MethodsPatients (25 male and 65 female), age 50–80 years diagnosed with KOA were recruited and randomly assigned to one of three groups in a 1:1:1 ratio for intervention: real US-guided DN with exercise therapy (G1), placebo US-guided DN with exercise therapy (G2), and exercise therapy solely (G3). G1 and G2 were blinded to the application of real or placebo US guidance by turning the monitor of US imaging out-of-view from participants’ vantage points. The effectiveness of blinding was evaluated by asking the participants whether they had received real-US guided DN. The responses were assessed by Chi-square test. Visual Analogue Scale (VAS), Knee injury, and Osteoarthritis Outcome Score (KOOS) subscales (KOOS-pain, KOOS-symptoms, KOOS-quality-of-life (QoL)) were collected at baseline, 4 weeks, and 8 weeks by a blinded assessor. Data were analyzed by mixed model analysis of variance (ANOVA) with Bonferroni correction.ResultsEighty-four participants (61.26±5.57 years) completed the study. G1 achieved significant improvement in VAS at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = -15.61, 95% CI [-25.49, -5.51], p = 0.001; G1 vs. G3: MD = -19.90, 95% CI [-29.71, -10.08], p< 0.001). G1 achieved significant improvement in KOOS-pain at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = 9.76, 95% CI [2.38, 17.14], p = 0.006; G1 vs. G3: MD = 9.48, 95% CI [2.31, 16.66], p = 0.010). KOOS-symptoms and KOOS-QoL were not statistically significant between groups. G2 had no significant difference of the perceptions as G1 with p = 0.128. G2 were successfully blinded to placebo US-guided DN.ConclusionUS-guided DN with exercise therapy may be more effective than traditional DN with exercise therapy or exercise therapy alone in reduce pain of KOA.

Comparative Study of Endoscopic and Conventional Septoturbinoplasty in Patients with Nasal Airway Obstruction

Objectives: The goal of our study was to perform endoscopic septoplasty with or without turbinate reduction and also to determine its postoperative subjective and objective improvements. Methods: This was a hospital-based pre and post clinical trial study of 63 patients with nasal septal deviation treated with endoscopic and conventional septoplasty with or without turbinoplasty from 2013 to 2016. Nasal airway patency was recorded before and 2.7 months after surgical treatment using a visual analogue scale (VAS), Glatzel mirror test and bilateral peak nasal inspiratory flow (PNIF) measure. Results: Endoscopic (27 patients) and conventional septoturbinoplasty (36 patients) was performed on 63 patients (40 males; 23 females) with a mean age of 35 years. The results showed a significant improvement of nasal passage condition in scales of VAS, Glatzel mirror test, and bilateral PNIF values after surgery in both groups. In both surgical techniques septoplasty with turbinate reduction showed better improvement in VAS and bilateral PNIF scores than septoplasty alone. Conclusion: The application of endoscopic technology has an advantage of precise visualization and is a valuable tool especially when it is used for educational reasons. Subjective and objective improvements were confirmed equally in both endoscopic and conventional groups.

Indirect Decompression Using Oblique Lumbar Interbody Fusion Revision Surgery Following Previous Posterior Decompression: Comparison of Clinical and Radiologic Outcomes Between Direct and Indirect Decompression Revision Surgery.

ObjectiveThis study compared the radiological and clinical outcomes with transforaminal lumbar interbody fusion (TLIF) to evaluate the effect of indirect decompression through oblique lumbar interbody fusion (OLIF) as revision surgery. MethodsWe enrolled patients who underwent single-level fusion with revision surgery at the same level as the previous decompression level. We retrospectively reviewed 25 patients who underwent OLIF from 2017 to 2018 and 25 who received TLIF from 2014 to 2018. Radiologic and clinical outcomes were evaluated by cross-sectional area (CSA) of the spinal canal, thickness and area of ligamentum flavum (LF), subsidence, disc height, fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). ResultsCompared with OLIF, the thickness and area of the LF after surgery were significantly less in TLIF, and the resulting CSA extension was also significantly higher. However, both groups showed improvement in ODI and VAS after surgery, and there was no difference between the groups. Complications related to the posterior approach in TLIF were 4 cases, and in OLIF, there were 2 cases that underwent additional posterior decompression surgery and 6 cases of transient paresthesia. ConclusionSince complications associated with the posterior approach can be avoided, OLIF is a safer and useful minimally invasive surgery. Therefore, appropriate indications are applied, OLIF is a good alternative to TLIF when revision surgery is considered.

Three-Year Durability of Restorative Neurostimulation Effectiveness in Patients With Chronic Low Back Pain and Multifidus Muscle Dysfunction

BackgroundRestorative neurostimulation is a rehabilitative treatment for patients with refractory chronic low back pain (CLBP) associated with dysfunction of the lumbar multifidus muscle resulting in impaired neuromuscular control. The ReActiv8-B randomized, sham-controlled trial provided evidence of the effectiveness and safety of an implanted, restorative neurostimulator. The two-year analysis previously published in this journal demonstrated accrual of clinical benefits and long-term durability. ObjectiveEvaluation of three-year effectiveness and safety in patients with refractory, disabling CLBP secondary to multifidus muscle dysfunction and no indications for spine surgery. Materials and MethodsProspective, observational follow-up of the 204 implanted trial participants. Low back pain visual analog scale (VAS), Oswestry Disability Index (ODI), EuroQol quality of life survey, and opioid intake were assessed at baseline, six months, and one, two, and three years after activation. The mixed-effects model repeated measures approach was used to provide implicit imputations of missing data for continuous outcomes and multiple imputation for proportion estimates. ResultsData were collected from 133 participants, and 16 patients missed their three-year follow-up because of coronavirus disease restrictions but remain available for future follow-up. A total of 62% of participants had a ≥ 70% VAS reduction, and 67% reported CLBP resolution (VAS ≤ 2.5cm); 63% had a reduction in ODI of ≥ 20 points; 83% had improvements of ≥ 50% in VAS and/or ≥ 20 points in ODI, and 56% had these substantial improvements in both VAS and ODI. A total of 71% (36/51) participants on opioids at baseline had voluntarily discontinued (49%) or reduced (22%) opioid intake. The attenuation of effectiveness in the imputed (N = 204) analyses was relatively small and did not affect the statistical significance and clinical relevance of these results. The safety profile remains favorable, and no lead migrations have been observed to date. ConclusionAt three years, 83% of participants experienced clinically substantial improvements in pain, disability, or both. The results confirm the long-term effectiveness, durability, and safety of restorative neurostimulation in patients with disabling CLBP associated with multifidus muscle dysfunction. Clinical Trial RegistrationThe Clinicaltrials.gov registration number for the study is NCT02577354.

Epidural Steroid Injection Versus Conservative Measures in Treatment of Chronic Axial Low Back Pain, A Prospective Randomized Controlled Study

Chronic low back pain (CLBP) is a very common disorder with various management strategies. There is still debate regarding treatment alternatives for axial CLBP. This study aimed to compare the effect of epidural steroid injection (ESI), interferential current (IFC) therapy and core strengthening exercises in a prospective randomized controlled manner. Hence, sixty patients complaining of axial CLBP were included and randomly assigned into either a group of ESI and exercises (group A) or IFC and exercises (group B) or exercises only (group C); each group was of 20 patients. Outcomes were visual analogue scale (VAS) for pain, Oswestry disability index (ODI) for function and Beck's depression inventory (BDI) for depression, assessed at baseline and 3-, 6- and 12-week follow-ups. At the start of the study, there were no significant differences between the three groups in age, gender, cause and duration of CLBP, body mass index, abdominal muscle power, muscle spasm or tenderness (p &gt; 0.05). Significant improvement in VAS and ODI at 3-, 6- and 12-weeks was observed compared to baseline assessment in the three studied groups. The improvement was higher for group A compared to B and C. BDI was significantly improved in group A and C at 3 weeks, and in all groups at 6- and 12-weeks compared to baseline. However, at the end of the study, there was no significant difference in the BDI between the three groups. From this study and over a period of 3 months, all studied groups showed improvement in pain, function, and depression but the group who received epidural steroid injection with core strengthening exercises was statistically better than the other two groups, with significant improvement in pain and function, but not in depression. Early effective assessment and dealing with depression, even prophylactic treatment and cognitive behavioral therapy should be addressed. Trial registration: The Pan African Clinical Trial Registry (www.pactr.org) identification number is PACTR201901523042787 on 16 January 2019.

Multicenter Retrospective Analysis of Intradiscal Condoliase Injection Therapy for Lumbar Disc Herniation.

Background and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in Japan, multiple single-site trails have highlighted its effectiveness, however, the effect of LDH types, and influences of patient age, sex, etc., on treatment success remains unclear. Moreover, data on teenagers and elderly patients has not been reported. In this retrospective multi-center study, we sought to classify prognostic factors for successful condoliase treatment for LDH and assess its effect on patients < 20 and ≥70 years old. Materials and Methods: We reviewed the records of 137 LDH patients treated through condoliase at four Japanese institutions and assessed its effectiveness among different age categories on alleviation of visual analog scale (VAS) of leg pain, low back pain and numbness, as well as ODI and JOA scores. Moreover, we divided them into either a “group-A” category if a ≥50% improvement in baseline leg pain VAS was observed or “group-N” if VAS leg pain improved <50%. Next, we assessed the differences in clinical and demographic distribution between group-A and group-N. Results: Fifty-five patients were classified as group-A (77.5%) and 16 patients were allocated to group-N (22.5%). A significant difference in Pfirrmann classification was found between both cohorts, with grade IV suggested to be most receptive. A posterior disc angle > 5° was also found to approach statical significance. In all age groups, average VAS scores showed improvement. However, 75% of adolescent patients showed deterioration in Pfirrmann classification following treatment. Conclusions: Intradiscal condoliase injection is an effective treatment for LDH, even in patients with large vertebral translation and posterior disc angles, regardless of age. However, since condoliase imposes a risk of progressing disc degeneration, its indication for younger patients remains controversial.