Low Back Pain Disability Index Research Articles

The effects of rice grain and Thai herbal hot pack on pain and back extensibility in persons with low back pain

Objectives Low back pain (LBP) is the most prevalent musculoskeletal condition. Superficial heat has been utilized for decades to alleviate the symptoms; however, there has been no study of the effect of rice grain and Thai herbal hot packs using a microwave method in persons with low back pain. The purpose of this study was to compare pain scale scores and back extensibility with rice grain and Thai herbal hot packs with standard hot packs in individuals with LBP. Methods Forty participants with LBP were stratified using a random sampling method into two groups: a rice grain and Thai herbal hot pack group (n=20) and a standard hot pack group (n=20). Twenty-minute duration treatments were given. Each patient was followed-up 6 times (3 times per week for 2 weeks). Pressure pain threshold (PPT) and back extensibility were measured using a visual analogue scale (VAS) and the Thai Oswestry low back pain disability index. Results VAS scores and the Thai Oswestry low back pain disability index in both groups were reduced significantly (p < 0.05). PPT and back extensibility were significantly increased after rice grain and Thai herbal hot pack and hot pack treatment (p < 0.05). After treatments, PPT with rice grain and Thai herbal hot pack was significantly higher than the standard hot pack group. (p < 0.05). Conclusions Rice grain and Thai herbal hot pack may be considered as an alternative method for relieving pain and improving pressure pain threshold and back extensibility in persons with LBP. Chiang Mai Medical Journal 2021;60(1):75-86. doi 10.12982/CMUMEDJ.2021.07

Reliability and validity of the Istanbul Low Back Pain Disability Index in lumbosacral radiculopathy

Lumbosacral radiculopathy is associated with a broad range of complaints; therefore, specific disability measurements should be validated for this condition. The aim of this study was to investigate the validity and reliability of the Istanbul Low Back Pain Disability Index (ILBPDI) in lumbosacral radiculopathy. Patients diagnosed with radiculopathy caused by a disc herniation were included. Disability and quality of life were evaluated with the Oswestry Disability Index (ODI) and Short Form-36 (SF-36), respectively. The severity of low back pain and leg pain were evaluated using a Numeric Rating Scale (NRS). The reliability of the ILBPDI was assessed using the Cronbach's alpha coefficient. The relation of ILBPDI with SF-36, ODI, NRS-back and NRS-leg scores were analyzed for convergent validity. The relation of the ILBPDI with age, body mass index (BMI), and disease duration was analyzed for divergent validity. Factor analysis was used to establish the internal construct validity. One hundred patients (55% female) were included in this study. The Cronbach's alpha coefficient was 0.92. The ILBPDI was found to be correlated with the ODI (rho: 0.619, p< 0.005) and NRS-leg score (rho: 0.597, p< 0.005), but not with NRS-back score (rho: 0.164, p> 0.05). The ILBPDI was significantly correlated with physical functioning (rho: -0.638, p< 0.005), bodily pain (rho: -0.488, p< 0.005), general health (rho: -0.264, p= 0.008) and social function (rho: -0.372, p< 0.005) subscales of SF-36 (convergent validity). The ILBPDI was not correlated with age, BMI, or disease duration (divergent validity). Factor analysis showed that the scale had three-factors which were correlated to bending forward, standing, and sitting activities. The ILBPDI is a valid and reliable instrument in patients with lumbosacral radiculopathy.

Characterization of biopsychosocial factors of patients with chronic nonspecific low back pain

ABSTRACT BACKGROUND AND OBJECTIVES: Low back pain is considered a public health problem worldwide and has a personal, social, occupational and economic impact. Psychosocial signs such as inappropriate beliefs about pain, fear of movement, anxiety, stress, depression and low job satisfaction are characteristics of individuals with low back pain. These clinical signs are mediators of chronic pain and disability. The present study aimed to assess psychological comorbidities in patients with chronic non-specific low back pain who are undergoing physical therapy and patients awaiting physical therapy; in addition to characterizing the psychosocial profile of these individuals. METHODS: This research was carried out with 31 individuals recruited from physical therapy clinics in the region of greater Florianopolis. They were divided into two groups: Treatment (TG) and non-treatment (CG). The following self-report instruments were applied: Hospital Anxiety and Depression Scale (HADS), Health Status Questionnaire (SF-36V2), Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Index (OLBPDI), Fear-Avoidance Belief Questionnaire (FABQ) and Pain Castatrophizing Scale (PCS). RESULTS: Significant differences (p<0.05) were observed in the scores of the instruments applied between the groups. The CG had higher averages than the GT. CONCLUSION: The results obtained in this study support previous findings about the benefits of physical therapy for individuals with chronic nonspecific low back pain, suggesting that, in addition to reducing pain and disability, there are benefits related to psychosocial factors.

Repair of spondylolysis using a pedicle screw U-shaped rod construct: A preliminary study of 25 young patients with a mean follow-up of 24 months.

Study Design:Prospective case series, therapeutic Level IV.Objectives:Functional and radiographic outcome evaluation of patients with spondylolysis treated with pars interarticularis defect repair with iliac bone grafting and application of a construct consisting of a pair of polyaxial pedicle screws connected by a U-shaped rod passing beneath the spinous process.Methods:Twenty-five patients (27 operated lumbar levels) with an average of 20 months of follow-up (range 12–24 m) with spondylolysis who met our inclusion criteria were treated with the above-mentioned technique. Functional assessment was by the Visual Analog Score (VAS) for low back pain (LBP) and Oswestry Disability Index (ODI). Fusion was confirmed with plain x-rays and when indicated with computed tomography scan. Return to activities of daily living (ADL) was also assessed.Results:There were 16 males (64%) and 9 females (36%), with a mean age of 18 ± 3 years at surgery, with a mean operating time of 79 ± 13 min and a mean blood loss of 186 ± 57 ml. ODI significantly improved from a mean of 63 ± 7 preoperatively to 10 ± 4 at 12 months postoperatively (P < 0.001). The mean preoperative LBP VAS score 8 ± 1 showed also a statistically significant decrease of values to 1 ± 1 at 12 months, (P < 0.001). At 12 m, all patients returned to unrestricted ADL. Pars healing was present in 19 patients (76%) at 6 months and in all patients at 12 months.Conclusions:Polyaxial pedicular screws with a U-shaped rod offer an effective and reproducible treatment for spondylolysis with an appropriate fusion rate, predictable return to daily activities, and good pain relief in young adults.

Outcome of Tantalum Cage in Posterior Lumbar Interbody Fusion in Lumbar Degenerative Disc Disease and Low-grade Spondylolisthesis

Background Data: Posterior lumbar interbody fusion (PLIF) provides better stability and fusion as a surgical treatment for degenerative disc disease (DDD) and spondylolisthesis. Different cage designs are available for interbody fusion. Tantalum cages are recent and appealing options in these techniques. Purpose: To assess the clinical and radiological outcome of tantalum interbody cage in PLIF without autologous bone graft inside the cage. Study Design: A retrospective case series study. Patients and Methods: A total of 25 patients with single-level DDD (n = 16) or spondylolisthesis (n = 9) who underwent single-level PLIF surgeries with 1-year follow-up were recruited for this study. Clinical and functional assessment was done using the visual analogue scale (VAS) for low back pain and Oswestry Disability Index (ODI). Tantalum cage stability and fusion were assessed radiologically on static and dynamic lateral X-ray. Results: VAS and ODI showed significant postoperative improvement at 6-week and 3-, 6-, and 12-month follow-up intervals. No significant migration or subsidence of tantalum cage was reported on static X-ray, no significant mobility was reported on dynamic X-ray, and the total sound bone fusion rate was 96% at 1-year follow-up. Conclusion: Our data suggest that PLIF with tantalum interbody cage in lumbar DDD and low-grade spondylolisthesis showed good clinical and functional results in 1-year follow-up with high spinal stability and bone fusion rate (2020ESJ225).

Visit Frequency and Outcomes for Patients Using Ongoing Chiropractic Care for Chronic Low-Back and Neck Pain: An Observational Longitudinal Study

BACKGROUND: Chronic spinal pain is prevalent and long-lasting. Although provider-based nonpharmacologic therapies, such as chiropractic care, have been recommended, healthcare and coverage policies provide little guidance or evidence regarding long-term use of this care. OBJECTIVE: To determine the relationships between visit frequency and outcomes for patients using ongoing chiropractic care for chronic spinal pain. STUDY DESIGN: Observational 3-month longitudinal study. SETTING: Data collected from patients of 124 chiropractic clinics in 6 United States regions. METHODS: We examined the impact of visit frequency and patient characteristics on pain (pain 0-10 numeric rating scale) and functional outcomes (Oswestry Disability Index [ODI] for low-back pain and Neck Disability Index [NDI] for neck pain, both 0-100 scale) using hierarchical linear modeling (HLM) in a large national sample of chiropractic patients with chronic low back pain (CLBP) and/or chronic neck pain (CNP). This study was approved by the RAND Human Subjects Protection Committee and registered under ClinicalTrials.gov Identifier: NCT03162952. RESULTS: One thousand, three hundred, sixty-two patients with CLBP and 1,214 with CNP were included in a series of HLM models. Unconditional (time-only) models showed patients on average had mild pain and function, and significant, but slight improvements in these over the 3-month observation period: back and neck pain decreased by 0.40 and 0.44 points, respectively; function improved by 2.7 (ODI) and 3.0 points (NDI) (all P &lt; 0.001). Adding chiropractic visit frequency to the models revealed that those with worse baseline pain and function used more visits, but only visits more than once per week for those with CLBP were associated with significantly better improvement. These relationships remained when other types of visits and baseline patient characteristics were included. LIMITATIONS: This is an observational study based on self-reported data from a sample representative of chiropractic patients, but not all patients with CLBP or CNP. CONCLUSIONS: This 3-month window on chiropractic patients with CLBP and/or CNP revealed that they were improving, although slowly; may have reached maximum therapeutic improvement; and are possibly successfully managing their chronic pain using a variety of chiropractic visit frequencies. These results may inform payers when building coverage policies for ongoing chiropractic care for patients with chronic pain. KEY WORDS: Chronic low back pain, chronic neck pain, spinal pain, physical function, hierarchical linear modeling, healthcare utilization, chiropractic visits, insurance coverage

Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device-Part II: Consecutive Case Series.

Advances in operative techniques and instrumentation technology have evolved to maximize patient outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). The transfacet MIS-TLIF is a modified approach to the standard MIS-TLIF that leverages a bony working corridor to access the disc space for discectomy and interbody device placement. To evaluate clinical and radiographic results following transfacet MIS-TLIF using an expandable interbody device. We performed a retrospective review of consecutive patients who underwent transfacet MIS-TLIF for degenerative lumbar spondylolisthesis. Patient-reported outcome measures for pain and disability were assessed. Sagittal lumbar segmental parameters and regional lumbopelvic parameters were assessed on upright lateral radiographs obtained preoperatively and during follow-up. A total of 68 patients (61.8% male) underwent transfacet MIS-TLIF at 74 levels. The mean age was 63.4 yr and the mean follow-up 15.2 mo. Patients experienced significant short- and long-term postoperative improvements on the numeric rating scale for low back pain (-2.3/10) and Oswestry Disability Index (-12.0/50). Transfacet MIS-TLIF was associated with an immediate and sustained reduction of spondylolisthesis, and an increase in index-level disc height (+0.71 cm), foraminal height (+0.28 cm), and segmental lordosis (+6.83°). Patients with preoperative hypolordosis (<40°) experienced significant increases in segmental (+9.10°) and overall lumbar lordosis (+8.65°). Pelvic parameters were not significantly changed, regardless of preoperative alignment. Device subsidence was observed in 6/74 (8.1%) levels, and fusion in 50/53 (94.3%) levels after 12 mo. Transfacet MIS-TLIF was associated with clinical improvements and restoration of radiographic sagittal segmental parameters. Regional alignment correction was observed among patients with hypolordosis at baseline.

Is It Time to Replace the Oswestry Index With PROMIS Physical Function Computer Adaptive Test?

ObjectiveTo address the relative influence of psychological factors on variation in Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) Computer Adaptive Test (CAT) and Oswestry Low Back Pain Disability Index (ODI) scores. DesignCross-sectional. SettingWe enrolled patients with low back pain, presenting to clinicians specializing in the treatment of spine conditions in a large urban area. ParticipantsNew and return English-speaking patients (N=116). Main Outcome MeasuresThe PF CAT and ODI. MethodsPatients completed the Pain Catastrophizing Scale short form, Patient Health Questionnaire short form (PHQ-2), Pain Self-Efficacy Questionnaire short form (PSEQ-2), PROMIS PF CAT and ODI on a secure tablet. ResultsThe 95% CI for the amount of variation in PROMIS PF CAT scores (95% CI, 0.06-0.31) accounted for by psychological measures overlapped with the 95% CI for the amount of variation in ODI scores (CI, 0.26-0.53). PROMIS PF CAT had a strong correlation with ODI (r=−0.69; P<.001). Greater PROMIS PF CAT scores were independently associated with fewer symptoms of depression (β=−1.6; 95% CI, −2.7 to −0.58; P=.003). Higher ODI scores were independently associated with more catastrophic thinking (β=1.2; 95% CI, 0.60-1.88; P<.001) and less self-efficacy (β=−2.4; 95% CI, −3.2 to −1.5; P<.001). PSEQ-2 accounted for the largest proportion of variation in ODI. PHQ-2 accounted for the largest proportion of variation in PROMIS PF CAT. Psychological measures explained more variation in ODI (semipartial R2=0.48 for psychological measures; adjusted R2 full model=0.49) than in PROMIS PF CAT (semipartial R2=0.17 for psychological measures; adjusted R2 full model=0.31). ConclusionsThe ODI and PROMIS PF CAT are comparably sensitive to psychological factors in patients with persistent lower back pain. Given that the PROMIS PF CAT is more efficient to administer, clinicians might consider using PROMIS PF CAT when assessing physical limitations in patients with persistent lower back pain.

Validity, reliability, and factor structure of the Istanbul Low Back Pain Disability Index in axial spondyloarthritis

Objective To investigate the validation and reliability of Istanbul Low Back Pain Disability Index (ILBPDI) in axial spondyloarthritis (Ax-SpA). Methods Patients with Ax-SpA according to The Assessment of SpondyloArthritis International Society criteria were recruited. The validation was assessed by face, content, and construct (convergent and divergent) validities, whereas the reliability was assessed by internal consistency and test–retest reliability. Factor analysis was performed. Convergent validity was assessed by correlations of ILBPDI with functional parameters (The Bath Ankylosing Spondylitis Functional Index, The Dougados Functional Index, and The Health Assessment Questionnaire). Divergent validity was assessed by correlations of ILBPDI with non-functional parameters. Results Two hundred forty patients were recruited. Cognitive debriefing showed ILBPDI to be clear, relevant, and comprehensive. Cronbach’s alpha coefficient was 0.953. The test–retest reliability was good with the intraclass correlation coefficient of 0.870. ILBPDI was represented by three-factor groups of activity: axial bending, sitting/rest, and standing activities. ILBPDI had good correlations with the functional parameters (rho changes between 0.809 and 0.580), and it had poor or non-significant correlations with the non-functional parameters (absolute rho changes between 0.669 and 0.001). Conclusion ILBPDI is a practical, accurate, and non-time-consuming scale which is valid and reliable to evaluate the functional disability in patients with Ax-SpA.

Injections of concentrated bone marrow aspirate as treatment for Discogenic pain: a retrospective analysis

BackgroundThere are an overwhelming number of patients suffering from low back pain (LBP) resulting from disc pathology. Although several strategies are being developed pre-clinically, simple strategies to treat the large number of patients currently affected is still needed. One option is to use concentrated bone marrow aspirate (cBMA), which may be effective due to its intrinsic stem cells and growth factors.MethodsThirty-three patients who received intradiscal injections of cBMA to relieve LBP were followed up based on Numeric Rating Scale (NRS), Oswestry Low Back Pain Disability Index (ODI), and Short Form-36 Health Survey (SF-36) scores. Patients were also subdivided into those with a pre-injection NRS > 5 and pre-injection NRS ≤ 5. The proportion of patients demonstrating at least 50% improvement (and 95% confidence intervals) from baseline at five follow-up visits for each outcome was evaluated.ResultsAt least 50% improvement in NRS was observed for 13.8, 45.8, 41.1, 23.5, and 38.9% of patients across five follow-up visits, out to 1 year. When stratified by high (> 5) versus low (≤ 5) baseline NRS scores, the values were 14.3, 45.5, 71.4, 22.2, and 44.4% among those with high baseline pain, and 13.3, 46.2, 20.0, 25.0, and 33.3% among those with low baseline pain. The 50% improvement rates across visits were 4.3, 28.6, 30.0, 22.2, and 30.8% for SF-36, and 4.2, 26.7, 36.4, 55.6, and 30.8% for ODI.ConclusionsIntradiscal cBMA injections may be effective to reduce pain and improve function. Patients with relatively higher initial pain may have potential for greatest improvement.

Outcome Measurements for Pain Relief in Elderly Patients with Spinal Stenosis Undergoing Epidural Steroid Injection: Is Conservative Approach an Option?

To evaluate the short-term outcomes of epidural steroid injections (ESIs) among elderly patients with lumbar spinal stenosis. This was a retrospective study. The sample consisted of 44 patients aged 65 or older who underwent epidural steroid injections secondary to lumbar spinal stenosis between 2014 and 2016 at a single center. Data were collected using the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Istanbul Low Back Pain Disability Index (ILBPDI) before and at 3-month follow-up visit. Participants had lower mean scale scores at all times after ESI administration than before. Four patients (9.1%) needed additional injections while two (4.5%) needed operation. No minor or major ESI-related complications were observed. Epidural steroid injections are an effective nonsurgical option for pain relief and improvement of physical function in elderly patients. The NRS, ODI, and ILBPDI are reliable and valid scales that can be used to evaluate the outcomes of ESIs in a selected group of elderly patients.

The need for educating healthcare professionals regarding good musculoskeletal health practice

The objective of this study was to assess the level of knowledge and practice of body mechanics towards preserving musculoskeletal health in daily routine activities of HCPs (medical officers, staff nurses, community health nurses, assistant medical officers, physiotherapists, and assistant nurses) from Hospital Tengku Ampuan Afzan, Pahang. A cross-sectional study was conducted with convenience sampling employed across five different departments. The departments were a department of medical, surgical, orthopedics, emergency and rehabilitation. The samples were selected according to a minimum of two years of clinical experience without any history of low back surgery. An instrument consists of socio-demographic background, knowledge on body mechanics and Owestry Low Back Pain Disability Index Questionnaire was used in this study. A total of 139 HCPs were recruited including medical officers, staff nurses, community health nurses, assistant medical officers, physiotherapists, and assistant nurses. A self-administered questionnaire pertaining to knowledge revealed that 73.4% of HCPs had inadequate knowledge of musculoskeletal body mechanics. Among all, 90.6% (minimal: 9.4%, moderate: 43.2%, severe: 42.4%, crippled: 5.0%) of HCPs showed moderate to crippled disability using Oswestry Disability Index classifications indicating the poor practice of body mechanics while working. The findings of this study indicate that a lack of knowledge among healthcare professionals lead to the inadequate practice of preserving musculoskeletal health while carrying out duty in caring patients. It is suggested that enforcing and emphasizing health education for healthcare professionals is urgently needed towards reducing the risk of the musculoskeletal problem among healthcare professionals.

Outcome measurement in patients with low back pain undergoing epidural steroid injection.

This study aims to evaluate the outcomes of epidural steroid injection (ESI) in patients with low back pain. This prospective study included a total of 82 patients (51 females; 31 males; mean age 50.8±14.2 years; range, 17 to 86 years) who underwent ESI due to lumbar disc hernia-induced radiculopathy between September 2014 and May 2015. The Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Istanbul Low Back Pain Disability Index (ILBPDI), and the Short Form-36 (SF-36) were administered to all patients before and three weeks and three months after ESI. The mean scores of all scales were significantly lower at three weeks and three months following ESI compared to the baseline scores. There were no significant differences between the mean scores at three weeks and three months. The NRS yielded the highest post-ESI change from baseline. Our study results showed that all scales used in this study were effective tools for the evaluation of outcomes of EPI in patients with low back pain. Although the NRS yielded the highest sensitivity for detecting change, evaluating functional state and quality of life is essential for multivariate analyses.

Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome.

Objective:To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome.Methods:This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated.Results:Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016).Conclusion:The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care.

Comparison of Epidural Steroid Injection Efficiency with Two Different Doses in Radiculopathies Associated with Lumbar Disc Herniation

Transforaminal epidural steroid injections (TFESIs) have been increasingly used in the treatment of lumbar radicular pain resistant to conservative modalities. Although different steroids can be used at different doses, the minimally effective steroid dose should be used to reduce side effects. The present retrospective study examined and compared the efficacy of 40 mg and 80 mg of methylprednisolone in TFESIs. We included 67 patients who had undergone unilateral L5-S1 TFESIs under fluoroscopic guidance in the present study. Assessments were conducted at baseline and at 1 hour, 3 weeks, and 3 months after the TFESIs. The Short-Form 36-item Health Survey, Numeric Rating Scale, Oswestry Disability Index, and Istanbul Low Back Pain Disability Index were used as outcome measures. The present study evaluated 33 patients who had undergone TFESIs with 40 mg of methylprednisolone and 34 patients who had undergone TFESIs with 80 mg of methylprednisolone. Although no statistically significant differences were found between the 2 groups' outcome measures, both groups showed significant improvements in pain, disability, and quality of life at 3 weeks and 3 months after treatment. TFESIs with 40 mg and 80 mg are effective for the treatment of pain that results from lumbar disc herniation. They also positively affect patients' disability and quality of life. However, neither steroid dose was more efficient than the other dose. Therefore, we believe the smaller dose should be preferred to reduce the potential side effects of steroids.

The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control

Background Data: In 1988, Modic et al first described magnetic resonance (MR) degenerative changes in the lumbar vertebral bodies. changes in the intervertebral endplates, Modic Changes (MC) can also be incriminated in the production of such pain due to the mechanical failure and structural changes that can be detected the most in the region of the highly pain sensitive intervertebral endplates. There is still a controversy regarding the surgical treatment of the predominantly axial pain secondary to degenerative lumbar disc disease.Study Design: This is a retrospective cohort study.Purpose: To evaluate the effect of adding fusion to simple discectomy in treatment of patients of lumbar disc herniation that show evidence of MC on preoperative MR images regarding the control of postoperative back pain and functional outcome.Patients and Methods: This study included 44 patients who underwent surgical management of low back pain and/or sciatica due to lumbar intervertebral disc herniation with concomitant presence of Modic changes in the preoperative MR images. Patients were divided into two groups: Group A (Discectomy group), and Group B (Fusion group). Patients included had single level lumbar disc herniation with modic changes. Patients with radiographic evidence of instability and patients whose 1-year post-operative data were incomplete were excluded. Twenty five patients were males and 19 were females with a mean age of 43.48 years. Nineteen patients (43.2%) were allocated in Group A and 25 patients (56.8 %) in Group B. Clinical results and functional outcome were assessed based on changes in preoperative and postoperative Visual Analogue Scale (VAS) of low back pain and Oswestry Disability Index (ODI) scores of the functional disability.Results: Postoperative back pain improvement was statistically significant in both groups when comparing preoperative values of VAS using paired student-t test with P<0.001 for both groups. Comparison of post-operative back pain VAS for both groups using independent student-t test revealed a statistically non-significant difference with a P=0.239 (Mean VAS for group A=2.211 while mean VAS for Group B=1.48).Conclusion: Unless otherwise indicated, simple lumbar discectomy without fusion is a reasonable surgical option in treatment of patients with lumbar intervertebral disc herniation even in the presence of Modic changes in their pre-operative MRI. (2018ESJ167)

Gender Differences in the Self-assessment of Quality of Life and Disability After Spinal Fusion for Chronic Low Back Pain at a Neurosurgical Center in Eastern Europe.

Background/AimsMechanical alterations of the spine, which can cause chronic low back pain (LBP), are a frequent indication for spinal fusion. Studies have shown differences between genders in patients’ evaluations of health-related quality of life (HRQoL) after spinal procedures, but results have been conflicting, and some authors have suggested that cultural variation could explain these discrepancies. The objectives of this study were to determine the influence that gender plays on HRQoL, disability, and the correlation between the 2 in people undergoing spinal fusion for chronic LBP at a neurosurgical centre in Eastern Europe. MethodsPatients undergoing fusion surgery at a single centre for LBP with a duration of more than 3 months were included. They were evaluated using the Short Form Health Survey version-2.0 (SF-36v2) and Oswestry Low Back Pain Disability Index (ODI) questionnaire preoperatively and 1 year after the surgical procedure to identify differences between genders and to evaluate correlations between disability and quality of life. ResultsWe included 31 female and 30 male patients. The male patients had higher disability scores at the preoperative evaluation, but improved more than females in all domains of disability at the postoperative evaluation. HRQoL improved similarly in both genders. The ODI score showed a strong or moderate correlation with 6 of the domains of the SF-36 in males, but with only 3 domains in females. Surgery had a positive impact on the mental status of more men than women at risk of depression. ConclusionThe type of benefit that surgery offers seems to be influenced by gender. While HRQoL improved in both genders, disability decreased significantly more in male patients. Male patients also showed a closer correlation between HRQoL and disability. We conclude that men and women place different importance on specific aspects of their overall quality of life.

Study of low back pain intensity and disability index among manual material handling workers of a tile and ceramic industrial unit, Iran (2016)

Study of low back pain intensity and disability index among manual material handling workers of a tile and ceramic industrial unit, Iran (2016)

The compression of L5 nerve root, single or double sites?-radiographic graded signs, intra-operative detect technique and clinical outcomes.

The L5 nerve root could be compressed at both L4-5 and L5-S1 regions. If L5 nerve root has confirmed compression at L4-5 level and questionable compression at L5-S1 foramina, performing both surgeries at L4-5 and L5-S1 levels may induce unnecessary extra surgery on L5-S1; however, ignoring foraminal stenosis of L5/S1 may require re-exploration. Two hundred seventeen patients with L5 nerve root compressed at L4-5 lateral access were performed with L4-5 decompression and interbody fusion. Lee et al. grade classification was used to assess the foraminal stenosis of L5-S1 preoperatively. Nerve root probe was designed and used to detect if there were foraminal stenosis at L5-S1 level that compressing the exiting L5 nerve root. Visual analog scale (VAS) of low back pain, leg pain and Oswestry Disability Index (ODI) were used to assess clinical outcomes. For all of 217 patients who underwent L4-5 surgery, L5-S1 foramina were preoperatively assessed as: grade 0: 125 cases, grade 1: 58 cases, grade 2: 23 cases, and grade 3: 11 cases. After intra-operative L5 nerve root detection, 11/11 patients with grade 3 radiographic foraminal stenosis, 6/23 (26.1%) with grade 2 and 2/58 (3.4%) who had grade 1 underwent L4-5 and L5-S1 transforaminal lumbar interbody fusion (TLIF), the others received only L4-5 TLIF. Compared to pre-operative baseline data, both L4-5 TLIF and L4-5 and L5-S1 TLIF groups had significant decreased VAS of low back pain and leg pain, and ODI at 3 and 24 months after operation. We suggested that our novel nerve root probe combined with pre-operative radiographic grade may be helpful to surgeons to identify the single or double compression of L5 nerve root and make a more precise surgical strategy to improve surgical outcome than the method depended on pre-operative radiographic grade alone.

Percutaneous laser lumbar disc decompression

Acute or chronic back and neck pain is a major social, economic and healthcare issue in all communities. Nearly 80% of the population experiences backache during their lifetime. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive methods for treating low back pain. There have been numerous reports of its use since the first case in 1986, and the indications are expanding daily. We present a case of a 38-year-old banker with chronic prolapsed intervertebral disc who had 7-year history of recurrent low back pain from prolapsed L4–L5 intervertebral disc with radiculopathy. She had PLDD procedure in our clinic under local anaesthesia as day case. After the procedure, the patient was observed for 4 h and discharged home. She felt significant pain relief after the operation and was placed on a lumbar corset for a week. The pre-surgery assessment using Oswestry Low Back Pain Disability Index was 58% (severe disability) but was reduced to 26.7% (moderate disability) after 3-month post-surgery follow-up. At 12-month follow-up, the Oswestry score was 16% and the patient outcome was good according to MacNab's criteria. PLDD is safe and effective for the treatment of low back pain seen in the post-operative result of this presented case.