Low Back Pain Score Research Articles

Effect of Core Stability Exercises on Low Back Pain and Disability in Mother’s of Cerebral Palsy

Background: In mothers with Cerebral Palsy children,higher prevalence of musculoskeletal disorders areseen due torepetitive bending, lifting, and twisting activity while taking care of the child.Reduced coremuscle strength especiallyof Transverse Abdominis&Multifidusmuscle will lead to increase in low backpain and disability in this population. Hence, the purpose of this study was to find out the effect of CoreStability exercises on low Back pain and disability in mothers of Cerebral Palsy Children.Method: Thirty mothers with chronic low back pain who fulfilled the inclusion criteria were included inthe study. Core muscle strength was assessed using pressure Bio-Feedback, pain was measured using VisualAnalogue Scale and Disability was measured using Owestry Disability Index. Core stability exercises weregiven for 3 times a week for 6 weeks.Result: The result showedthat there was significant improvement in Core muscle strength, and reduction inpain and disability in patients with Chronic Low Back pain.Conclusion: The study concluded that there was significant improvement in the abdominal muscle strength,low back pain score and disability score post core stability exercises in mothers of cerebral palsy childrenhaving low back pain.

Clinical Application of High Frequency Ultrasound in Diagnosis and Treatment of Lumbar Muscle Injury After Strenuous Exercise

The purpose of this study was to analyze the clinical application of high-frequency ultrasound in the diagnosis and treatment of lumbar muscle injury after strenuous exercise. In this study, high-frequency ultrasound imaging technology was used to examine the patients' lumbar and dorsal position, and ultrasound examination was performed on the affected side and the healthy side of lumbar dorsal muscle before and after treatment. According to the thickness of abdomen transverse muscle, psoas muscle, lumbar muscle, gluteus medius revealed by ultrasound, as well as the visual analogue scale (VAS) pain score and J0A low back pain score, the rehabilitation of patients was analyzed. Through the observation of ultrasound images, it was found that the thickness of the transverse abdominis, lumbar maximus, quadratus lumborum muscle and gluteus medius on the affected side was significantly improved after treatment, the average VAS pain score was significantly decreased, and the average JOA lower back pain score was significantly increased, indicating that the patient's condition was significantly improved after treatment. The use of high-frequency ultrasound to detect the disease status before and after treatment can accurately understand the course of the disease and the curative effect after treatment. In a word, high-frequency ultrasound has a great clinical effect on patients with lumbar dorsal muscle injury.

Real-time ultrasonography-magnetic resonance image fusion navigation for percutaneous transforaminal endoscopic discectomy.

Percutaneous transforaminal endoscopic discectomy (PTED) is usually performed under fluoroscopic guidance and is associated with a large radiation dose. Ultrasonography (US)-MR image fusion navigation combines the advantages of US and MRI and requires significantly less radiation than fluoroscopy. The purpose of this study was to evaluate the safety and effectiveness of US-MR image fusion navigation for PTED. From January to September 2018, patients with L4-5 lumbar disc herniation requiring PTED were randomized to have the procedure conducted with US-MR image fusion navigation or fluoroscopy. The number of fluoroscopies, radiation dose, duration of imaging guidance, intraoperative visual analog scale (VAS) pain score, intraoperative complications, and clinical outcomes were compared between the groups. There were 10 patients in the US-MR navigation group and 10 in the fluoroscopy group, and there were no significant differences in age, sex ratio, or BMI between the 2 groups (all p > 0.05). Intraoperatively, the total radiation dose, number of fluoroscopies performed, duration of image guidance, and VAS low-back and leg pain scores were all significantly lower in the US-MRI navigation group than in the fluoroscopy group (all p < 0.05). There were no intraoperative complications in either group. Postoperative improvements in Japanese Orthopaedic Association, Oswestry Disability Index, and VAS pain scale scores were similar between the 2 groups. US-MR image fusion navigation is a promising technology for performing PTED and requires significantly less radiation than fluoroscopy.Clinical trial registration no.: NCT03403244 (ClinicalTrials.gov).

Comparison of Preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study.

Percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) has been used in the treatment of lumbar degenerative diseases, as a novel minimally invasive technique. To compare the surgical trauma and the medium-short term postoperative outcomes of PETLIF and traditional minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). From April to August of 2018, 75 patients with lumbar degenerative diseases received PETLIF (Group PE, 35 cases) or MIS-TLIF (Group MIS, 40 cases) were enrolled in the prospective cohort study. We recorded the serum creatine kinase (CK) and C-reactive protein (CRP), blood loss, visual analog scale (VAS), Oswestry Disability Index (ODI), modified Macnab criteria score, complications, and fusion rates of the 2 groups. There were significant reductions in CRP (P=0.002) on postoperative day (POD) 3, and CK (P=0.011) on POD 1 for Group PE than Group MIS. The mean true total blood loss (P<0.001), intraoperative blood loss (P<0.001), postoperative drains (P<0.001), and hidden blood (P=0.020) in the Group PE were significantly less compared with Group MIS. The VAS score for low-back pain, leg pain and ODI score improved significantly in both groups after surgery (P<0.05). The VAS of low-back pain on POD 1 was significant less (P<0.001) for Group PE. There was no statistical difference (P=0.561) in CT fusion rates between Group PE (85%) and Group MIS (92%). No serious complication was observed in any patients. The study indicated that PETLIF had advantages of less surgical trauma, less postoperative low-back pain, less hidden blood loss, and faster recovery, compared with MIS-TLIF. There was no significant difference in medium-short term surgical outcomes between the 2 techniques. However, the indications of PETLIF is relatively limited, and the learning curve of PETLIF is deep, surgeons need to select indications strictly. Further study with big sample size and long-term follow-up is needed.

Improvement of Lower Back Pain in Lumbar Spinal Stenosis After Decompression Surgery and Factors That Predict Residual Lower Back Pain.

Study Design:Retrospective observational study.Objectives:There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP.Methods:We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R.Results:LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P < .001; JOABPEQ LBP score, 41.3 vs 79.6, P < .001; RMDQ, 10.3 vs 3.6, P < .001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R.Conclusions:Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.

Minimally invasive lateral lumbar interbody fusion significantly improves the sagittal balance for adult degenerative scoliosis

Objectives: To evaluate the effect of minimally invasive lateral lumbar interbody fusion (LLIF/OLIF) on the sagittal balance of adult degenerative scoliosis. Methods: From January 2014 to June 2017, a total of 23 patients with degenerative scoliosis underwent staged minimally invasive surgery in Shanghai Ruijin Hospital. All patients were implanted with LLIF or OLIF cage from the lateral approach first, and was followed by the posterior percutaneous pedicle screw fixation or pedicle screw fixation via Wiltse approach. If the sagittal deformity correction was not satisfactory after the first surgery, a posterior osteotomy can be performed during the second stage operation. A biplanar X-ray of the whole spine was taken with the EOS imaging system before and after surgery. The EOS software was used to measure and evaluate the patient's sagittal balance parameters including pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), the sagittal vertical axis (SVA) and the coronal Cobb angle. The visual analogue scale (VAS) score for low back pain, the Oswestry Disability Index (ODI) score were evaluated before and after surgery. Paired t test or repeated measures ANOVA was used to compare the data before and after surgery. Results: There were 6 males and 17 females with a mean age of (72±4) years (62-79 years). Nine patients were treated with LLIF and 14 patients with OLIF. Sixteen cases were implanted with three cages, five with two cages and two with four cages. The mean follow-up period was 24.2 months (15-42 months). After the first operation, the Cobb angle of the patient was significantly improved (18°±7° vs 33°±8°, t=13.2, P<0.01). All the parameters for sagittal balance, including PI-LL (20°±8° vs 31°±8(o)), SVA ((5.3±2.0) cm vs (8.2±3.5) cm), PT (16°±6° vs 23°±4°) were all significantly improved as well (t=6.8, 4.5, 9.0, ALL P<0.01). At the last follow-up, the VAS score of low back pain (3.4±1.1 vs 6.3±1.0) and ODI scores (27.3%±3.0% vs 47.1%±5.9%) were also significantly improved (t=11.3, 17.8, both P<0.01). No major complications occurred in this group. Conclusions: Minimally invasive LLIF/OLIF can significantly improve the coronal and sagittal balance of adult degenerative scoliosis. Staged minimally invasive surgery can significantly alleviate pain and improve function in these patients.

Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road.

Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting. One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique. Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4-L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02). The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

Stem Cell Therapies for Treatment of Discogenic Low Back Pain: a Comprehensive Review.

Discogenic low back pain (DLBP) stems from pathology in one or more intervertebral discs identified as the root cause of the pain. It is the most common type of chronic low back pain (LBP), representing 26-42% of attributable cases. The clinical presentation of DLBP includes increased pain when sitting, coughing, or sneezing, and experiencing relief when standing or ambulating. Dermatomal radiation of pain to the lower extremity and neurological symptoms including numbness, motor weakness, and urinary or fecal incontinence are signs of advanced disease with disc prolapse, nerve root compression, or spinal stenosis. Degenerative disc disease is caused by both a decrease in disc nutrient supply causing decreased oxygen, lowered pH, and lessened ability of the intervertebral disc (IVD) to respond to increased load or injury; moreover, changes in the extracellular matrix composition cause weakening of the tissue and skewing the extracellular matrix's (ECM) harmonious balance between catabolic and anabolic factors for cell turnover in favor of catabolism. Thus, the degeneration of the disc causes a shift from type II to type I collagen expression by NP cells and a decrease in aggrecan synthesis leads to dehydrated matrix cells ultimately with loss of swelling pressure needed for mechanical support. Cell-based therapies such as autologous nucleus pulposus cell re-implantation have in animal models and human trials shown improvements in LBP score, retention of hydration in IVD, and increased disc height. Percutaneously delivered multipotent mesenchymal stem cell (MSC) therapy has been proposed as a potential means to uniquely ameliorate discogenic LBP holistically through three mechanisms: mitigation of primary nociceptive disc pain, slow or reversal of the catabolic metabolism, and restoration of disc tissue. Embryonic stem cells (ESCs) can differentiate into cells of all three germ layers in vitro, but their use is hindered related to ethical concerns, potential for immune rejection after transplantation, disease, and teratoma formation. Another similar approach to treating back pain is transplantation of the nucleus pulposus, which, like stem cell therapy, seeks to address the underlying cause of intervertebral disc degeneration by aiming to reverse the destructive inflammatory process and regenerate the proteoglycans and collagen found in healthy disc tissue. Preliminary animal models and clinical studies have shown mesenchymal stem cell implantation as a potential therapy for IVD regeneration and ECM restoration via a shift towards favorable anabolic balance and reduction of pain.

Effect of pre-existing adjacent segment degeneration on short-term effectiveness after lumbar fusion surgery

To analyze the prospective effect of pre-existing spinal stenosis of adjacent segment on the short-term effectiveness after lumbar fusion surgery. A prospective comparative study was conducted to divide 183 patients with L 4-S 1 lumbar spinal stenosis who met the selection criteria between July 2015 and December 2017 into two groups according to the status of adjacent segment degeneration (ASD) judged by preoperative disc degeneration and spinal stenosis. There were 98 patients in group A (no degeneration of adjacent segments before operation) and 85 patients in group B (adjacent segments degenerated before operation). There was no significant difference in gender, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), combined spondylolisthesis, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05); the age of group A was significantly younger than that of group B ( t=-3.560, P=0.000). The operation time, intraoperative blood loss, hospitalization stay, and perioperative complications were recorded and compared. The VAS score of low back pain and leg pain, JOA score, and ODI score at last follow-up were used to evaluate the effectiveness. The incidence of ASD after operation was compared between the two groups, and logistic regression was used to analyze the independent risk factors affecting the occurrence of ASD after operation. There was no significant difference in operation time, intraoperative blood loss, and hospitalization stay between the two groups ( P>0.05). The incidence of perioperative complications in groups A and B was 13.3% and 20.0%, respectively, with no significant difference ( χ 2=1.506, P=0.220). Two groups of patients were followed up, the follow-up time of groups A and B was (24.9±8.8) months and (24.8±7.8) months, respectively, there was no significant difference ( t=0.050, P=0.960). At last follow-up, no adjacent segment disease was found in either group. There was no significant difference in Pfirrmann grade between the two groups at last follow-up ( P>0.05), and there was significant difference in Pfirrmann grade between the two groups before operation and at last follow-up ( P<0.001). At last follow-up, 21 cases (21.4%) in group A and 53 cases (62.4%) in group B had ASD, with significant difference ( χ 2=31.652, P=0.000). The main cause of ASD was the severity of adjacent spinal canal stenosis. The clinical scores of the two groups at last follow-up were significantly improved when compared with those before operation ( P<0.05). The JOA score of group A was significantly higher than that of group B at last follow-up ( P<0.05). In group B, the VAS score of low back pain and ODI score in patients with ASD after operation at last follow-up were significantly higher than those in patients without ASD ( P<0.05). logistic regression analysis showed that preoperative pre-existing degeneration and BMI were independent risk factors for ASD after operation ( P<0.05). Pre-existing mild spinal stenosis in adjacent segment can significantly affect the effectiveness, and can significantly increase the risk of ASD early after operation. The main pathological type of ASD was the severity of adjacent segment spinal stenosis. For preoperative assessment of pre-existing degeneration, we should evaluate the overall degeneration of the adjacent segment of the spinal canal, rather than simply evaluating the degeneration of the adjacent disc and facet joints.

O-arm Navigation Combined With Microscope-assisted MIS-TLIF in the Treatment of Lumbar Degenerative Disease.

This is a retrospective study. The purpose of this study is to compare the clinical outcomes between O-arm navigation combined with microscope-assisted minimally invasive transforaminal lumbar interbody fusion (novel MIS-TLIF) and open-TLIF for the treatment of 1-level lumbar degenerative disease. MIS-TLIF is becoming increasingly popular; however, the limited visualization may increase various surgical complications. O-arm navigation and microscope have the potential to display the specific anatomic structures and better magnification. This study involved 45 patients with 1-level lumbar degenerative disease who underwent novel MIS-TLIF or open-TLIF. Operating time, intraoperative blood loss, and hospitalization stay were analyzed. The accuracy of pedicle screw placement was assessed by computed tomography. Visual analog scale (VAS) scoring and Oswestry disability index (ODI) were assessed preoperatively and postoperatively. Intraoperative blood loss was significantly less in the novel MIS-TLIF group compared with the open-TLIF group (P<0.05). The average time for hospitalization stay in the novel MIS-TLIF group was significantly shorter than open-TLIF group (P<0.05). However, the operative time of novel MIS-TLIF group was longer than open-TLIF group (P<0.05). The accuracy rate of pedicle screw position in the novel MIS-TLIF group which guided by O-arm navigation was higher than conventional open-TLIF group (96.4% vs. 86.5%; P<0.05). Meanwhile, the VAS score for the low back pain and ODI score in the novel MIS-TLIF group were lower than that in the open-TLIF group 1 month after surgery (P<0.05). No difference of the VAS score for leg pain was found between these 2 groups (P>0.05), neither as the fusion rate in between the 2 groups (P>0.05). O-arm navigation combined with microscope-assisted MIS-TLIF may has several advantages including less blood loss, shorter hospitalization stay, higher accuracy of pedicle screw placement, and faster recovery period in treating 1-level lumbar degenerative disease.

EFFECT OF JAW RELAXATION TECHNIQUE ON LOW BACK PAIN AND SELECTED VITAL SIGNS AMONG NURSING STAFF: A RANDOMIZED CONTROLLED TRIAL

Background: Nurses are repeatedly exposed to many forms of occupational hazards such as low back pain while doing their jobs. Aim: The aim of this study was to examine the effect of jaw relaxation technique on low back pain and selected vital signs among nursing staff. Methodology: A randomized control clinical trial study design was utilized. A randomized sample composed of 60 adult male and female nurses working in both medical and surgical specialty departments in a governmental hospital in Egypt were recruited. Three tools were utilized for data collection: I. Demographic- and Work-Related Data, II. Numeric Pain rating scale (NPRS) and III. Medical related data. Results: There was a statistically significant difference in mean systolic and diastolic blood pressure, heart and respiratory rates, as well as low back pain score among nurses before and after practicing Jaw relaxation technique. While, no statistically significant difference was found in low back pain mean score and selected vital signs between post intervention 1& 2. Conclusion: Low back pain mean score improved among nurses after implementation of the jaw relaxation technique. Recommendation: Jaw relaxation technique is recommended to be endorsed as an adjuvant non-pharmacological pain management and coping strategy.

Volumetric evaluation of lumbar epidural fat distribution in epidural lipomatosis and back pain in patients who are obese: introducing a novel technique (Fat Finder algorithm)

ObjectiveSpinal epidural lipomatosis (EL) represents an excessive deposition of unencapsulated adipose tissue in the spinal canal that can result in chronic back pain in patients who are obese with and...

Effectiveness of the back school program on the low back pain and functional disability of Iranian nurse.

Low back pain (LBP) as a recurrent and costly health problem and one of the leading causes of disability, is common in nurses. It can have adverse effects on the quality of life of nurses and quality of care of patients. The aim of the study was to evaluate the effectiveness of Back School program on the LBP and functional disability of Iranian nurses. A quasi-experimental methodological design was utilized for this study. Participants were nurses with back pain who participated in the Back School program workshop and completed a self-report visual analogue scales and Roland–Morris Disability questionnaire that measuring LBP and functional disability. Data were analyzed descriptively and comparisons in LBP and functional disability made between groups with t-test for pre-intervention and analysis of covariance for after intervention. Sixty-four participants (16 males, 48 females) completed this survey. The study participants’ mean age was 38.9 ± 8.1 years in intervention group and 38.1 ± 8.2 in control group. There were no significant differences in terms of pain (P = 0.575) and disability scores (P = 0.844) before intervention. Although, the intervention led to a decrease in the functional ability and LBP scores of the nurses (P<0.001) in the intervention group compared with that in the control group. Overall, Back School program as an educational strategy can reduce the LBP and functional disability in nurses. This program can be suitable for preventing of pain and functional disability among nurses working in hospital settings.

Minimally Invasive Sacroiliac Joint Fusion with Cylindrical Threaded Implants Using Intraoperative Stereotactic Navigation

Significant progress in hardware and surgical techniques for sacroiliac joint (SIJ) fusion surgeries has facilitated safer and more efficacious procedures for patients. Triangular-shaped implants for SIJ fusions are the most-studied devices and have demonstrated good short-term and long-term clinical outcomes. Reports on cylindrical threaded implants are very limited. Owing to biomechanical differences in the implants and the surgical techniques required for their placement, previously reported results may not be applicable to cylindrical threaded implants. The aim of this study was to report preliminary clinical experience with minimally invasive SIJ fusion using intraoperative stereotactic navigation and the Rialto SI Fusion System. We retrospectively reviewed 24 patients who underwent SIJ fusions between May 2015 and October 2017 performed by a single surgeon. Mean total satisfaction score was 89.0% ± 27.6%. A statistically significant reduction (P= 0.0028) in low back pain scores was noted from an average baseline score of 6.6 ± 2.4 to 3.7 ± 3.3 postoperatively. Leg pain scores decreased from 4.8 ± 3.8 to 1.5 ± 2.9 (P= 0.0034). Mean surgical time was 53.0 ± 13.9 minutes. It took significantly longer (P= 0.0089) to perform the initial 13 cases (59.9 ± 15.2 minutes) compared with subsequent cases (45.4 ± 7.3 minutes). Estimated blood loss was minimal (10.4 ± 5.2 mL). Minimally invasive SI joint fusion using cylindrical threaded implants can be safely performed with minimal morbidity and good clinical outcomes.

The Effectiveness of Leech Therapy in Chronic Low Back Pain.

Leech therapy has been found to be effective in the treatment of a number of chronic musculoskeletal pain syndromes. Leeches are also often used empirically to treat chronic low back pain, but data from clinical trials have been lacking to date. We therefore conducted the first randomized trial of leech therapy for chronic low back pain. Patients with chronic low back pain were randomized to receive either a single session of local treatment with 4-7 leeches or four weekly sessions of exercise therapy (1 hour each) led by a physical therapist. The primary endpoint was a change in average back pain intensity, as measured using a 100-mm visual analog scale (VAS), after 28 days. Secondary end- points included functional impairment (Roland-Morris Disability Questionnaire, Hannover Functional Ability Questionnaire), quality of life (Short-Form Health Questionnaire [SF 36]), pain perception (pain perception scale = Schmerzempfindungsskala [SES]), depressivity (Center for Epidemiological Studies Depression Scale [CES-D]), and analgesic consumption (questionnaire/ diary). Trial visits took place before treatment and on days 28 ± 3 and 56 ± 5 after the start of treatment; the overall duration of the trial was 56 ± 5 days. The mean low back pain score improved from 61.2 ± 15.6 before treatment to 33.1 ± 22.4 on day 28 in the leech ther- apy group (n = 25) and from 61.6 ± 14.8 to 59.8 ± 16.7 in the exercise therapy group (n = 19) (group difference -25.2; 95% con- fidence interval [-41.0; -9.45]; p = 0.0018). Significant benefits of leech therapy were also found at both time points with respect to physical impairment and function as well as physical quality of life. The patients' expectations from treatment were higher in the leech therapy group but did not significantly affect the findings. A single session of leech therapy is more effective over the short term in lowering the intensity of pain over the short term and in improving physical function and quality of life over the intermediate term (4 weeks and 8 weeks, respectively). The limitations of this trial are the lack of blinding and the small number of patients. Leech therapy appears to be an effective treat- ment for chronic low back pain.

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)

Low back pain intensity among childbearing women and associated predictors. A cohort study

BackgroundLow back pain is a common condition among childbearing women, causing physical disability and an increased risk of sick leave and obstetric complications. AimsTo assess the prevalence and intensity of low back pain during pregnancy, to describe the physical disability and sick leave in relation to the severity of low back pain and to identify predictors of moderate to severe low back pain in socio-demographic, health and obstetric characteristics among childbearing women. MethodsA cohort study was undertaken (n=566) during August 2015 to March 2016. Questionnaires were used to obtain information about low back pain intensity, physical disability due to low back pain and sick leave at 20 and 32weeks of gestation. Of the 654 eligible women, 87% completed the first questionnaire. FindingsThree out of four reported any low back pain at 20weeks of gestation, and nine out of ten women at 32weeks. Of these women, one in three reported moderate to severe pain at 20weeks, increasing to half of the women at 32weeks. Both sick leave and physical disability increased with increasing low back pain scores. Pre-pregnancy low back pain, multiparity and lower level of education were all identified as predictors of moderate to severe low back pain. ConclusionsWomen with pre-pregnancy low back pain, multiparity and lower level of education, represent the group of women with the highest risk of moderate to severe low back pain during pregnancy and should be payed special attention.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P61. Clinical outcomes of microendoscopic decompression for lumbar canal stenosis: a comparison between patients with and without degenerative lumbar scoliosis

BACKGROUND CONTEXT The operative management of degenerative lumbar scoliosis includes decompression or decompression with fusion. However, there is currently no consensus on the criteria for the role of adjunctive fusion. We have performed microendoscopic decompression in patients with the chief complaint of radicular and/or cauda equina symptoms due to degenerative lumbar scoliosis. Although the surgical procedure almost improved leg symptoms, it seemed that the patients had severe low back pain postoperatively as compared with patients without degenerative lumbar scoliosis. PURPOSE To compare the clinical outcomes of microendoscopic decompression for lumbar canal stenosis between patients with and without degenerative lumbar scoliosis. METHODS A total of 75 patients with lumbar canal stenosis between March 2006 and December 2014 were included in this study. The patients who had disc herniation and foraminal stenosis were excluded. The patients were treated with microendoscopic decompression and followed more than two years after the surgery. Of those, 34 were males and 41 were females. The mean age at the time of the surgery was 73.1years (range, 61–86 year). The mean follow-up period was 48.1 months (range, 24–102 months). Twenty-seven patients had degenerative lumbar scoliosis with coronal curvature of more than 10° measured by Cobb's method (DLS group). The other 48 patients had neither degenerative lumbar scoliosis nor degenerative lumbar spondylolisthesis (nonDLS group). Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score and Short-Form 36 (SF-36) preoperatively and at the final follow-up. Recovery rate of the JOA score was calculated as (postoperative score − preoperative score)/(29 − preoperative score)×100%. The visual analogue scale (VAS) for low back pain was also measured at the final follow-up. RESULTS In the DLS group, the JOA score significantly improved from 13.7 preoperatively to 23.4 postoperatively. Also in the nonDLS group, the preoperative JOA score of 15.7 significantly improved to 25.0 postoperatively. Recovery rate in the DLS and nonDLS group were 62.5% and 69.0%, respectively. There were no significant differences in preoperative and postoperative JOA scores between the two groups. At the final follow-up, VAS for low back pain in the DLS group (45.4 mm) was significantly higher than that in the nonDLS group (25.4 mm). As for the preoperative SF-36 score, there were no significant differences in all 8 subscales between the two groups. In the DLS group, a significant improvement was observed only in bodily pain scores after surgery. In the nonDLS group, all subscales except general health perception significantly improved after surgery. All postoperative subscales except social role function and mental health in the DLS group were significantly lower than in the nonDLS group. CONCLUSIONS This study showed that the patients with lumbar degenerative scoliosis had higher VAS for low back pain and lower QOL scores after microendoscopic decompression as compared with the patients without lumbar degenerative scoliosis. We might consider other surgical options in patients with lumbar canal stenosis due to degenerative lumbar scoliosis.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: achieving lumbar interbody fusion: 197. Expandable graft-containing fabric mesh system for single-level lumbar interbody stabilization: 1-year clinical and radiographic results from a prospective clinical IDE trial

BACKGROUND CONTEXT Interbody fusion with rigid cages are commonly employed in the surgical treatment of medically-refractory degenerative disc disease and spondylolisthesis. However, they require a certain degree of soft-tissue dissection and bone removal to accommodate placement of the cage. The SCOUT study is an on-going FDA IDE trial (clinicaltrials.gov NCT #: NCT02347410, IDE: G140140) investigating the safety and efficacy of a novel device for lumbar interbody fusion. It is exploring the use of an expandable bone graft-containing fabric mesh for use as the interbody spacer, a device that can be deployed through a delivery portal only 8mm in diameter. PURPOSE To report on 12-month follow-up data on patients participating in the SCOUT trial. STUDY DESIGN/SETTING Multiinstitutional prospective single-arm trial. PATIENT SAMPLE Skeletally mature adults, aged 21 to 80, with single-level symptomatic lumbar degenerative disc disease (levels L2–S1) requiring interbody fusion surgery. OUTCOME MEASURES Patient-reported satisfaction, VAS low back pain scores, ODI, and radiographic fusion rates at 12-month follow-up. METHODS All patients underwent either a MIS-TLIF or an open PLIF approach (determined by surgeon preference), and all received supplemental pedicle screw fixation. All patients had a minimum Visual Analogue Score (VAS) of 40mm (0-100 mm scale) and a minimum Oswestry Disability Index (ODI) of 40. All patients had a BMI RESULTS At most recent follow-up, 84 patients had undergone surgery, with 60 completing 6-month follow-up and 29 completing 12-month follow-up. Intraoperative and perioperative characteristics remained favorable in terms of estimated blood loss (mean: 129±150 cc), operative time (mean: 161±53 minutes), and length of stay (2.3±1.1 days). At twelve-month follow-up, all 29 patients (100%) demonstrated radiographic fusion, as defined by evidence of bridging bone on CT scan by two independent radiologists. Twenty of 29 patients (69%) reported “Excellent” satisfaction with their surgery and seven (24%) reported “Good” satisfaction. Compared to a baseline VAS low back pain score of 73.0±16.6 (Mean±SD) and baseline ODI of 54.0±12.1, there were significant improvements at both 6-months (VAS: 24.1±25.7, ODI: 25.3±20.4, p CONCLUSIONS At twelve-month follow-up, there are encouraging clinical and radiographic results for the use of an expandable fabric mesh device for lumbar interbody fusion. There is potential for such a system to provide good fusion and pain relief while minimizing tissue disruption.

Minimally invasive surgery for the severe degenerative lumbar scoliosis: two stage protocol

Objective: To investigate the surgical outcome of minimally invasive surgery(MIS) for severe degenerative lumbar scoliosis(DLS) and put forward a two-stage MIS surgical strategy. Methods: Prospective study of MISDEF Ⅲ DLS patients from June 2016 to August 2017 in the Second Affiliated Hospital of Zhejiang University was carried out, excluding the patients whose apex vertebrae of scoliosis was above L(1/2) level or whose facet joint got spontaneous fusion. Fifty-three patients were included in this study for staging evaluation and MIS surgical treatment. Information was recorded, including gender, age, body mass index, follow-up period, pelvic incidence (PI), blood loss, operation time, visual analogue pain score (VAS), Oswestry disability index (ODI), complications in the perioperative period and follow-up period, and also the radiographic parameters such as scoliosis Cobb angle, the mismatch between pelvic incidence and lumbar lordosis (PI-LL), sagittalvertical axis (SVA), coronal balance (CB) before and after each stage of surgery or latest follow-up. The paired-samples t test was used to analyze the effectiveness of staging surgery. Results: Fifty-three patients (18 males and 35 females) were included in this study. All patients had completed clinical and the follow-up records, with an average follow-up period of 11.52 months (6-20 months). A total of 168 segments fusions were performed with CLIF, 113 segments were performed with anterior column realignment (ACR), the average correct angle was 15.6°±6.3°(7°-28°) in sagittal plane each level. After the stage Ⅰ surgery, lumbar scoliosis cobb had been corrected for 55.35%, after the stage Ⅱ surgery, rate of correction was 75.6%. PI-LL had been matched (-32.8°±14.9° to -2.5°±9.4°), SVA was changed from 5.7 cm to 0.6 cm, the stage Ⅰ rate of correction was 80.3 and stage Ⅱ was 88.8%, pelvic tilt (PT), lumbar lordosis (LL) and CB had been restored; 13 (24.5%) patients were performed paraspinal approach transforaminal decompression. The posterior minimally invasive fixation indexes: 11(20.8%) patients were performed paraspinal approach transforaminal multi-segment transforaminal osteotomy (TFO) and internal fixation; 36(67.92%) cases were performed paraspinal approach transforaminal multi-segment fixation; 6(11.33%) patients were treated with percutaneous pedicle screw fixation. The average fixed segments was 7.4±1.4 in each patient. The blood loss of stage Ⅰ and stage Ⅱ operation was (157±71) ml, (343±224)ml, respectively. The operation time was (214±60) min, (190±54)min respectively in the two stage operations. The low back pain and leg pain VAS score and ODI improved after the stage Ⅰ and Ⅱ surgery (t=17.948, 10.099, 14.619, all P<0.001). Conclusions: MIS for the severe degenerative lumbar scoliosis can achieve good clinical outcome and deformity correction. The two-stage protocol has the advantages of less complications and is well-tolerated.