Mean Oswestry Disability Index Scores Research Articles

Comparison of Oswestry Disability Index Scores Between Surgical Candidates and General Population: Insights into Evaluation Criteria for Spine Surgery.

A mixed-methods investigation with both retrospective and prospective components. Determine the mean Oswestry Disability Index (ODI) scores for individuals who underwent surgical intervention compared to a non-surgical population and identify threshold values that distinguish between these groups. The Oswestry Disability Index (ODI) quantifies disability in patients with low back pain and commonly serves as a significant determinant in lumbar spine pathology and surgical outcomes. An empirically established ODI threshold can aid in optimizing surgical decision-making processes. This study retrospectively analyzed 557 patients who consulted with a spine surgeon and subsequently underwent lumbar spine surgery from 2019 to 2023. Additionally, ODI scores were surveyed from 797 individuals in the general American population using the CloudResearch Connect platform, with participants matched for age and sex according to US census data. Mean ODI scores stratified by age group and sex were calculated for each cohort. Receiver Operating Characteristic (ROC) analysis was utilized to ascertain ODI cutoff values for different demographics. The retrospective cohort demonstrated a higher disability level with an overall mean ODI of 34.7 (95% CI [33.1, 36.2]) for ages 18-89. In contrast, the general population surveyed had a mean ODI of 14.4 (95% CI [13.3, 15.4]). An ROC-derived ODI threshold of 16.5 within the comprehensive age group of 18-89 exhibited a sensitivity of 0.84 and a specificity of 0.68. The ODI values identified in this study offer benchmarks that can assist in the evaluation process for spine surgery. These findings highlight the importance of considering ODI scores as part of a comprehensive clinical evaluation, rather than as standalone indicators for surgical intervention. Further prospective validation of these findings and their integration into clinical practice is recommended for future research.

Perioperative Complications of Oblique Lumbar Interbody Fusion (OLIF): 5 Years of Experience with OLIF

Abstract Objective The objective of this study was to share our early experience with oblique lumbar interbody fusion (OLIF), with emphasis on the perioperative complications and determine clinical outcomes following OLIF. Materials and Methods It was a retrospective prospective study performed at a single institute from March 2019 to August 2023. A total of 56 consecutive patients who had undergone OLIF for degenerative spine disorders were enrolled in the study. Pre-, intra-, and postoperative data on these patients were collected. All the patients were followed up at regular intervals with an evaluation of Visual Analog Scale (VAS), Oswestry Disability Index (ODI), neurological parameters, and X-rays to look for fusion, screw loosening, pseudoarthrosis, and cage slippage. Statistical analysis was done with the odds ratio, chi-square test, and Student's t-test. A p-value of < 0.05 was considered significant. Results The overall incidence of complications was 25%, with no mortality. Intraoperative complications were noted in 10.7% of cases. This included endplate fractures (n = 3), peritoneal lacerations (n = 2), and ureteric injury (n = 1). The most common early postoperative complications were postoperative ileus (n = 6), followed by anterior thigh or groin numbness (n = 3), ipsilateral psoas weakness (n = 2), and superficial surgical site infection (n = 2). Of the late postoperative complications, cage subsidence was the most common, which occurred in 4 patients, followed by adjacent segment degeneration (n = 2) and loss of indirect decompression (n = 1). The mean ODI and VAS scores showed significant improvement (p < 0.05) at the final follow-up. Conclusion OLIF is a promising surgical technique with the potential to treat a variety of degenerative conditions of the lumbar spine with a good clinical outcome. Despite its various benefits, OLIF can lead to complications in rare instances, which every spine surgeon should be aware of.

Catamaran SI Joint Fusion System(R) MAINSAILTM Study: a prospective, single-arm, multi-center, post-market study of six-month clinical outcomes and twelve-month radiographic findings

ABSTRACT Background Minimally invasive surgical techniques for sacroiliac joint (SIJ) fixation have the potential to reduce risk and improve patient outcomes, but evidence remains limited. This interim analysis presents initial findings from an ongoing prospective study evaluating the safety and efficacy of the Catamaran System. Methods The primary endpoint of success at 6 months was defined as a ≥20 mm improvement in SIJ pain (Visual Analog Scale, VAS), no neurologic worsening, absence of device-related serious adverse events (SAEs), and no surgical reintervention. Secondary endpoints included 6 month evaluation of the Oswestry Disability Index (ODI), patient satisfaction, and 12 month radiographic CT fusion, performed by an indpendent radiologist. Results Thirty-three consecutive patients (mean age: 58.9 years; %-females: 76%; Body Mass Index: 30.5) were treated across six U.S. clinical sites. At the primary endpoint of 6 months, 80% of patients met the criteria for success, with no device-related SAEs and no surgical reintervention reported. VASSIJ-Pain significantly decreased from preoperative levels (mean: 80.9 mm) to 6 months postoperatively (31.1 mm; p < 0.001). Mean ODI scores also showed a significant improvement from preoperative values (51.9%) to 6 months postoperatively (29.6%, p < 0.01). Patients reported high satisfaction rates throughout all follow-ups, with 93.3% of patients being satisfied at 6 months. Conclusion In patients diagnosed with chronic SIJ pain, minimally invasive inferior-posterior delivery of the Catamaran implant was safe and effective in relieving pain and reducing disability.

Describing functional low back pain disability in the American population: a crowd-sourced evaluation of the Oswestry disability index

BACKGROUND CONTEXTThe Oswestry disability index (ODI) is widely utilized as a patient reported outcome (PRO) tool to assess patients presenting with low back pain (LBP) and following thoracolumbar spine surgery. No primary study has calculated the baseline range of ODI values in the diverse American population. Establishing age-adjusted normative values for ODI in the American population is crucial for assessing the utility of treatment strategies. PURPOSEThe purpose of this study is to describe the baseline range of functional low back disability as measured by the ODI in an American population. STUDY DESIGN/SETTINGCross-Sectional Observational Study. PATIENT SAMPLEA total of 1214 participants were recruited from the United States in January 2024 using a combination of the Connect and PrimePanel platforms by CloudResearch to complete a survey administered on a RedCap online database. The survey consisted of 10 demographic questions and the 10 ODI survey questions. The distribution of the survey was designed to obtain approximately 100 respondents in each of the following age groups: 18–29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and 80 to 89. The distribution of the sample was similarly designed to match the United States Census racial data with 78.1% White, 13.9% Black, and 7.9% other. OUTCOME MEASURESOswestry disability index (ODI). METHODSA crowd-sourcing platform called Cloudresearch was used to collect a representative sample of the US population by answering questions of the Oswestry disability questionnaire (ODQ), a 10-question survey. RESULTSThe final sample size was 797 participants including 386 (48.4%) males and 411 (51.6%) females; 169 participants were excluded that did not complete the survey and an additional 248 were excluded for failing attention check questions. The overall mean ODI score for the combined age groups was 14.35 (95% CI [13.33, 15.37]). The mean ODI scores increased with age, with the highest mean ODI in ages 70 to 79 at 18.0 (95% CI [14.76, 21.24]). Female participants reported higher mean ODI scores than their male counterparts in the 18 to 29 age group (p=.01), 50 to 59 age group (p=.01), and 60 to 69 age group (p=.02). Additionally, a weak positive correlation was found between Body Mass Index (BMI) and ODI scores (r = 0.22, p<.001). CONCLUSIONOur findings demonstrate a clear trend of increased disability with age. This study describes the baseline range of functional low back pain disability in the United States population. By defining these parameters, healthcare professionals can better tailor age and sex-specific interventions to manage disability in the aging US population, ultimately improving patient care and both operative and nonoperative treatment plans for LBP-related thoracolumbar pathology.

Nurse-led web-based self-management program to improve patient activation and health outcomes in patients with chronic low back pain: an acceptability and feasibility pilot study

BackgroundPatients with chronic low back (cLBP) pain report reduced physical function and ability to participate in social roles and are more likely to use opioid pain medications. While self-management interventions have been shown to support these patients, their effectiveness has been limited due to poor patient engagement. “Patient activation” encompasses the skills, knowledge, and motivation that a person has to manage their health. Supporting patient activation may improve the effectiveness of self-management for cLBP.MethodsIn this single-masked pilot study of adults with cLBP, patients were randomized to receive either no intervention (control) or 6 weekly sessions of an evidence-based web-based self-management program (SMP) with or without health behavior change counseling (HBCC) using motivational interviewing. Participants were assessed at baseline and at 12 and 26 weeks using the Patient Activation Measure, Oswestry Disability Index and PROMIS physical function, social role participation, and pain interference. We assessed acceptability and feasibility based on recruitment, session attendance, and follow-up.ResultsOf 187 individuals screened, 105 were eligible and 34 were randomized to control (n = 12), SMP (n = 4), or SMP + HBCC (n = 18). The population had 19 women, 22 patients married or living with significant other, 13 Black or African American patients, and 4 Hispanic or Latino patients. Participants had a mean (SD) Oswestry Disability Index score of 42 (12), moderate impairments in physical function (40 (6.6)) and social roles (45 (10)), and moderately severe pain interference (61 (6.7)). Of 22 participants receiving SMP sessions, 20 participated in at least 1, 15 participated in at least 3, and 7 participated in all 6 sessions. Loss to follow-up was 6 over the 26-week study. Participants in the SMP and SMP + HBCC groups had at least medium effect size improvements in Patient Activation Measures and small-to-medium effect size improvements in Oswestry Disability Index scores and physical function and large effect size improvement in social roles at 12 weeks. Improvements persisted in the SMP + HBCC group at 26 weeks.ConclusionsA web-based SMP is acceptable and feasible in this population. Participants who received augmentation with HBCC had persistent improvements in health outcomes at 26 weeks.Trial RegistrationClinicalTrials.gov Identifier NCT06236529 (2/1/2024 – retrospectively registered).Level of Evidence3.

Effectiveness of Ultrasonography- and Fluoroscopy-Guided Caudal Epidural Injections in the Management of Chronic Lumbar Disc Disease: A Retrospective Comparative Study.

Lumbar disc disease is one of the common causes of lower back pain caused by a change in the structure of the normal disc. Most of the time, disc disease happens as a result of aging and the normal breakdown that occurs within the disc.Caudal epidural steroid injections are the popular treatment for patients with chronic low back pain that does not respond to conservative management. A retrospective survey was administered to 160 patients whohad received caudal epidural injections forchronic low back pain in the past, but only 74 patients who completed the scheduled follow-ups were included in the study. They were divided into two groups based on the imaging modality used for guiding the caudal epiduralsteroid injections, either ultrasonography or fluoroscopy, and thenassessed for improvement in pain on the Numeric Rating Scale (NRS), forfunctional improvement on theOswestry Disability Index (ODI), and for satisfaction on the North American Spine Society Patient Satisfaction Scale (SSPSS). Mean NRS pain scores improved significantly from baseline at 6.78 and 7.00 in the fluoroscopy and ultrasound groups, respectively, to 2.03 and 2.16 at 12 weeks post-procedure. The difference between the groups was not statistically significant (p > 0.05). The Oswestry Disability Index was completed at baseline and after 12 weeks of follow-up for both groups, and there was no significant difference between the two groups; the fluoroscopy group's mean Oswestry Disability Index scores were 52.4 at baseline and 35.6 at 12 weeks, whereas the scores for the ultrasound group were 50.3 at baseline and 37.9 at 12 weeks. Conversely, patient satisfaction as assessed using the SSPSS rose in both groups up to 12 weeks (p > 0.05). The ultrasound- and fluoroscopy-guided caudal epidural steroid injections proved equally effective in easing the pain, disability, and satisfaction levels of patients with chronic lower back pain.

Comparison of the Clinical Outcomes of Percutaneous Vertebroplasty Using Different Surgical Approaches and Bone Cement Distribution

Objective: To compare clinical outcomes of percutaneous vertebroplasty (PVP) through different surgical approaches and bone cement distribution in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: The clinical data of 231 patients with OVCF who underwent PVP from June 2020 to June 2022 were retrospectively analyzed. Clinical characteristics and surgical data were collected for statistical analysis. The total patients were divided into a unilateral approach group (Group UA) and a bilateral approach group (Group BA) according to different surgical approaches. Then, patients in Group BA were divided into a continuous bone cement group (Group CBC) and a discontinuous bone cement group (Group DBC) according to the distribution of bone cement. Results: In each group, the postoperative visual analog scale (VAS) score and Oswestry disability index (ODI) score were significantly decreased (P &lt; 0.001). The operation time and fluoroscopy times of Group UA were less than those of Group BA (P &lt; 0.001). However, compared with Group BA, Group UA had a lower mean VAS score (P = 0.013) and ODI score (P = 0.004) at the last follow-up. The VAS (P = 0.032) and ODI (P = 0.024) scores in the CBC group were significantly lower than those in the DBC group at the last follow-up. Conclusions: Unilateral PVP presented several advantages over bilateral PVP, particularly in terms of shorter surgery time, less fluoroscopy frequency, and less trauma. Continuous bone cement was closely related to good clinical outcomes. In clinical practice, we suggest unilateral PVP is performed for patients and ensure the continuity of bone cement for better clinical outcomes.

Effectiveness of Dry Needling versus Cupping Therapy for Pain in Piriformis Syndrome

Background: Piriformis syndrome is characterized by discomfort in the buttocks and throughout the course of the sciatic nerve. Dry needling modulates pain perception, disrupts pain signaling pathways, and induces local tissue responses. Cupping therapy facilitates localized blood flow, lymphatic drainage, and tissue oxygenation to alleviate muscular tension and improve circulation. Both interventions have shown promise in improving symptoms of piriformis syndrome. Objective: The purpose of this study was to evaluate the efficacy of dry needling versus cupping therapy in managing piriformis pain syndrome. Methods: This experimental study was conducted at Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore, from October 2023 to May 2024. Eighty participants diagnosed with piriformis syndrome, aged between 18 and 65 years, were randomly assigned to one of two groups: Group A (dry needling) and Group B (cupping therapy). Exclusion criteria included pregnancy and previous surgical interventions for piriformis syndrome. Both groups received their respective treatments three times a week for six weeks. Pain intensity was measured using the Visual Analogue Scale (VAS), disability was assessed with the Oswestry Disability Index (ODI), and quality of life was evaluated using a standardized questionnaire. Data were analyzed using SPSS version 25, with paired sample t-tests used for within-group comparisons and independent sample t-tests for between-group comparisons. Statistical significance was set at p &lt; 0.05. Results: In the dry needling group, the mean VAS score decreased from 6.216 ± 1.931 to 3.432 ± 0.987 (p &lt; 0.001), while the cupping therapy group saw a reduction from 6.108 ± 2.195 to 4.189 ± 1.697 (p &lt; 0.001). The mean ODI score in the dry needling group decreased from 27.432 ± 7.617 to 10.054 ± 3.036 (p &lt; 0.001), and in the cupping therapy group from 26.270 ± 7.209 to 12.918 ± 7.495 (p &lt; 0.001). Quality of life scores improved significantly in both groups, with the dry needling group showing a mean reduction from 12.702 ± 3.673 to 7.270 ± 1.627 (p &lt; 0.001), and the cupping therapy group from 13.027 ± 3.523 to 8.270 ± 1.609 (p &lt; 0.001). Conclusion: Both dry needling and cupping therapy are effective interventions for managing piriformis pain syndrome, with dry needling showing greater improvements in pain reduction, disability reduction, and quality of life. These findings support the use of dry needling as a preferred therapeutic option for piriformis syndrome.

Effect of Quadratus Lumborum Block in Patients With Acute-Subacute Unilateral Lumbar Strain.

Lumbar strain originating from the quadratus lumborum (QL) is an important cause of low back pain; however, its diagnosis is often missed, and treatment is often inadequate. This leads to unnecessary diagnostic investigations and chronicization of pain. Therefore, it is important to treat it effectively and safely. In this study, we aimed to find out the effect of ultrasound (US)-guided QL block in acute-subacute low back pain caused by a strain of QL. Our study was retrospective, and the changes in the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores within one week in 50 patients with acute-subacute localized low back pain, unilateral lumbar strain, palpation tenderness, paravertebral spasm, and decreased lumbar range of motion in the QL muscle, in whom we applied US-guided block to the QL muscle, were analyzed. There was a significant decrease in the mean VAS and ODI scores of the patients after the procedure. There was a negative correlation between improvement rates in VAS and ODI scores and age and body mass index (BMI). Recovery rates were higher in female patients than in male patients. It can be said that US-guided QL block is an effective treatment method for QL-induced lumbar strains, and younger age, female gender, and lower BMI are associated with better responses after injection.

Safety and efficacy of Yaobitong capsules for lumbar disc herniation: A multicenter, randomized, double-blinded, parallel, positive-controlled clinical trial.

Lumbar disc herniation (LDH) is one of the most common diseases and is a global medical and socioeconomic problem characterized by leg or back pain, weakness in the lower extremities and paresthesia. A multicenter, randomized, double-blinded, parallel, positive-controlled clinical trial was conducted to evaluate the efficacy and safety of Yaobitong capsules (YBT) for LDH. Patients (n = 479) were recruited and randomized into YBT and Jingyaokang capsule (JYK) groups (the positive control), and received YBT or JYK at a dose of 3 capsules 3 times per day after a meal for 30 days. The primary efficacy outcome was the Oswestry Disability Index (ODI), with the visual analogue scale (VAS) used as the secondary efficacy outcome. The adverse events and adverse reactions were also evaluated. There was no significant difference in baseline characteristics between YBT (n = 358) and JYK groups (n = 120), and no difference was observed between groups for mean ODI score at day 0 (p = 0.064) or day 7 (p = 0.196), but there were differences at days 14, 21 and 30 (p < 0.001). The YBT showed more decline from baseline, and the decreased ODI score was substantially different from JYK (p < 0.001). The differences in decreased VAS scores between YBT and JYK were also significant at each time point (days 7, 14, 21, and 30), with better scores in the YBT group than in the JYK group (p < 0.001). In terms of safety, there was no obvious disparity in adverse events or adverse reactions between the 2 groups (p > 0.05). Yaobitong was better than JYK for LDH treatment, with no significant difference in safety. The study suggests that YBT is a promising and effective treatment for LDH.

The effects of psychological distress after surgery in patients undergoing lumbar spinal fusion

BackgroundThe aim of this study was to evaluate the psychological distress pre-operatively, at 3, 6, and 12 months in patients who underwent lumbar spine fusion surgery.MethodsA total of 440 patients received instrumented lumbar spine fusion were enrolled. Psychological distress was evaluated using the Modified Somatic Perception Questionnaire (MSPQ) and the Modified Zung Depressive Index (ZDI). The results of lumbar fusion surgery were evaluated using the Oswestry Disability Index (ODI), the Japanese Orthopedic Association (JOA-29), and the visual analog scale (VAS).ResultsPsychological distress was reported among 23% of patients and 7, 5.5, and 4.0% of the patients preoperatively, at 3, 6, and 12 months after lumbar surgery, respectively. The mean MSPQ score decreased from 8.78 (before surgery) to 4.30, 3.52, and 3.43 at 3, 6 and 12 months in after surgery, respectively, in patients with psychological distress patients (p < 0.001). The mean ZDI score decreased from 17.78 to 12.48, 10.35, and 9.61 (p < 0.001). The mean ODI score decreased from 22.91 to 11.78, 10.13, and 9.96 (P < 0.001). The mean JOA score increased from 13.65 to 22.30, 23.43, and 23.61 (P < 0.001). The mean low back pain (LBP) VAS score decreased from 4.48 to 1.96, 1.52, and 1.51 (P < 0.001); moreover, the mean leg pain (LP) VAS score decreased from 5.30 to 1.30, 1.04, and 1.03 (P < 0.001).ConclusionsPatients with psychological distress may experience surgical intervention benefits equal to those of ordinary patients. Moreover, reduced pain and disability after surgical intervention may also alleviate psychological distress. Hence, we highly recommend that patients with psychological distress undergo surgical intervention as normal patients do, but appropriate screening measures and interventions are necessary.

A Retrospective Study of 91 Patients Treated with Percutaneous Kyphoplasty for Mild Osteoporotic Vertebral Compression Fractures and a New Evaluation Scale of Shape and Filling Effect of Cement

BackgroundPercutaneous kyphoplasty (PKP) is commonly used to treat severe osteoporotic vertebral compression fractures (OVCFs) by restoring vertebral height. However, its application in mild cases is not frequently discussed. MethodsThe study retrospectively included 100 treated vertebral bodies of the 91 patients mentioned before, and efficacy was evaluated using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores preoperatively, 2 days postoperatively, and at 1 and 6 months after treatment, as well as mean variation in vertebral body height. The study also examined complications such as pain recurrence, delayed vertebral fracture, and loss of vertebral height, and developed a scale to assess the shape and filling effect of cement (SFEC) and its impact on complications. ResultsThe results showed significant reductions in mean VAS and ODI scores from pre- to post-surgery and an increase in vertebral body height. However, complications occurred in 10 patients who received treatment for 11 vertebral bodies, including pain recurrence, fractures, and loss of vertebral height. Among the 10 patients with complications, 7(63.6%) vertebral bodies had dissatisfied SFEC scores, compared to 22(24.7%) vertebral bodies with dissatisfied SFEC scores in 81 patients without complications (89 vertebral bodies). ConclusionsPKP is a safe and effective method for treating mild OVCFs, but attention should be paid to the shape and filling effects of cement during surgery to prevent later complications. The developed SFEC scale provides a specific and quantitative standards for evaluating the recovery status after PKP, which need further validations.

Biportal Endoscopic Trans-Kambin Lumbar Interbody Fusion: Surgical Techniques and Treatment Outcomes

Objective: Lumbar interbody fusion with cages is a commonly used surgical solution for spinal conditions that do not respond to conservative management. Biportal endoscopic trans-Kambin lumbar interbody fusion (BE-KLIF) is a modern technique that offers several benefits over prior techniques, including early ambulation, reduced postoperative pain, and shorter hospital stays.Methods: This retrospective study enrolled 128 patients who underwent BE-KLIF between March 2018 and August 2022. The primary indications for surgery were segmental lumbar listhetic instability, failed decompression with neuroforamen stenosis, adjacent segment disease, and burst fracture of the lumbar vertebrae. The outcome measures included Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores, and postoperative fusion status at 1 year after the procedure was graded using the Bridwell fusion grading scale.Results: BE-KLIF yielded significant improvements in patient outcomes. Successful fusion was achieved in 91.8% of segments. The mean ODI score was significantly lower at the 1-year follow-up than before the procedure. Similarly, VAS scores for leg and back pain significantly improved after the procedure. Seven early and 3 late postoperative complications were observed. The mean length of hospital stay was shorter for BE-KLIF than for the older transforaminal lumbar interbody fusion technique.Conclusion: BE-KLIF resulted in less bone removal, preservation of the facet joint, facilitation of a more oblique trajectory, and potential for larger cages with wider effacements compared with prior techniques. However, the technique lacks central and contralateral decompression. We recommend performing same-side unilateral laminotomy with bilateral decompression to provide central and contralateral decompression.

Effectiveness of Acupotomy Combined with Epidural Steroid Injection for Lumbosacral Radiculopathy: A Randomized Controlled Pragmatic Pilot Study.

Background and Objectives: This pilot study aimed to evaluate the clinical effectiveness, cost-effectiveness, and safety of acupotomy combined with epidural steroid injection (ESI) in lumbosacral radiculopathy and examine its feasibility for the main study. Materials and Methods: This randomized, controlled, two-arm, parallel, assessor-blinded, pragmatic study included 50 patients with severe lumbosacral radiculopathy who had insufficient improvement after an ESI. Patients were randomized (1:1 ratio) into a combined treatment (acupotomy + ESI, experimental) and an ESI single treatment (control) group. Both groups underwent a total of two ESIs once every 2 weeks; the experimental group received eight additional acupotomy treatments twice a week for 4 weeks. Types of ESI included interlaminar, transforaminal, and caudal approaches. Drugs used in ESI comprised a 5-10 mL mixture of dexamethasone sodium phosphate (2.5 mg), mepivacaine (0.3%), and hyaluronidase (1500 IU). The primary outcome was the difference in changes from baseline in the Oswestry Disability Index (ODI) scores between the groups at weeks 4 and 8. The incremental cost-utility ratio (ICUR) was calculated to evaluate the cost-effectiveness between the groups. Adverse events (AEs) were assessed at all visits. Results: Mean ODI scores for the experimental and control groups were -9.44 (95% confidence interval [CI]: -12.71, -6.17) and -2.16 (95% CI: -5.01, 0.69) at week 4, and -9.04 (95% CI: -12.09, -5.99) and -4.76 (95% CI: -7.68, -1.84) at week 8, respectively. The difference in ODI score changes was significant between the groups at week 4 (p = 0.0021). The ICUR of the experimental group versus the control group was as economical as 18,267,754 won/quality-adjusted life years. No serious AEs were observed. Conclusions: These results demonstrate the potential clinical effectiveness and cost-effectiveness of acupotomy combined with ESI for lumbosacral radiculopathy and its feasibility for a full-scale study. Larger, long-term follow-up clinical trials are needed to confirm these findings.

CT-Guided Microwave Ablation with Vertebral Augmentation for Spinal Metastases with Posterior Wall Defects.

To evaluate the efficacy and safety of combined microwave ablation (MWA) and vertebral augmentation (VA) in the treatment of spinal metastases with posterior wall defects. A retrospective review was conducted for 67 patients (42 men, 25 women) with painful spine metastases and posterior wall defects who underwent MWA combined with VA. Among these patients, 52 vertebrae had no epidural invasion and 33 had mild invasion but did not compress the spinal cord. Procedural effectiveness was determined by comparing visual analog scale (VAS) scores and Oswestry disability index (ODI) scores before the procedure and during the follow-up period. The procedure was technically successful in all patients. The mean VAS score declined significantly from 6.85 ± 1.81 before the procedure to 3.27 ± 1.97 at 24 h, 1.96 ± 1.56 at 1 week, 1.84 ± 1.50 at 4 weeks, 1.73 ± 1.45 at 12 weeks, and 1.71 ± 1.52 at 24 weeks post-procedure (p < 0.01). The mean ODI score was lower post-procedure than before the procedure (p < 0.001). Transient nerve injury occurred in two patients (SIR classification D), and the incidence of asymptomatic bone cement (SIR classification A) was 43.5% (37/85). MWA combined with VA is an effective and safe treatment for painful spine metastases with posterior wall defects.

Work-Related Ergonomıc Rısks and Musculoskeletal Problems in Operating Room Nurses

Purpose: The purpose of this study was to investigate on the work-related ergonomic risks and musculoskeletal problems operating room nurses. &#x0D; Methods: This study was a descriptive study.The study was conducted on operating room nurses from 3 state, 1 pivate and 1 university hospital in Turkey (N= 92). Data were collected to Descriptive form , The Oswestry Disability Index (ODI), Neck Disability Indeks (NDI) and Rapid Entire Body Assesment (REBA). The study conducted from March to October 2019.&#x0D; Results: The mean age of nurses was 34.99±8.31 years and it was found that nurses had lumbar (76.1%), back (64.1%) and neck (59.8%) pain. It was determined that 75.2% of the nurses have a very high risk in terms of ergonomics. It was found that there is a statistically significant negative relationship between age and work posture of nurses. It was determined that there was a statistically significant difference between disability caused by low back and neck pain and exercise statu. There was a statistically significant difference between weekly and daily standing hours and disability due to neck pain . A strong positive correlation was found between the mean ODI scores and NDI scores. A weak negative correlation was found between the mean NDI scores and REBA scores.&#x0D; Conclusion: It was determined that the majority of operating room nurses experience musculoskeletal disorders. It was found that the work-related ergonomic risks of the operating room nurses and the issue requires urgent measures.

Short-segment spinal fusion for chronic low back pain with bone marrow edema adjacent to the vertebral endplate in adult spinal deformity.

Corrective long spinal fusion is a widely accepted surgical method for patients with adult spinal deformities. However, instrumented long fusion is associated with a significant risk of complications. Therefore, we aimed to assess the success of short-segment spinal fusion, particularly for bone marrow edema (BME) adjacent to the vertebral endplate, in patients with low back pain (LBP) and spinal deformity. A prospective study was performed at multiple hospitals wherein we monitored patients with spinal deformities and accompanying LBP. Patients aged ≥ 50years with a minimum LBP severity score of 40mm on the visual analog scale (VAS) were included in the study. We also included patients with lumbar BME on magnetic resonance imaging. Short spinal fusion was performed on segments with BME. Clinical evaluations of LBP on VAS and Oswestry Disability Index (ODI), and radiological parameters for sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL) and pelvic tilt (PT) were carried out. Overall, 35 patients (22 men and 13 women), with a mean age of 66.7years and a mean follow-up period of 32months, were included in the study. The mean VAS and ODI scores were 72.4mm and 49.0% before surgery and 25.5mm and 29.9% at the final follow-up, respectively; these parameters significantly improved after surgery. The SVA, PI-LL, and PT scores were 70.1mm, 20.9°, and 22.8° before surgery and 85.4mm, 13.8°, and 22.7° at the final follow-up, respectively. The spinal alignment parameters did not change significantly after surgery. Short-segment spinal fusion is effective for treating LBP and spinal deformity with BME adjacent to the vertebral endplate without spinal correction.

Functional Outcomes and Successful Predictors of Lumbar Transforaminal Epidural Steroid Injections (LTFESIs) for Lumbar Radiculopathy Under Fluoroscopic Guidance: A Prospective Study.

Lumbar radiculopathy, a common and debilitating condition, often necessitates a multimodal approach for effective management. Lumbar transforaminal epidural steroid injection (LTFESI) has emerged as a valuable therapeutic option when conservative measures fall short. Recent interest in long-acting and non-particulate steroids prompts a critical examination of their impact on LTFESI outcomes. This prospective study aims to evaluate the efficacy of LTFESI in improving pain and functional outcomes in patients with lumbar radiculopathy, focusing on long-acting and non-particulate steroids, and analyse the associated economic burden. The study, conducted from October 2017 to April 2019, involved 52 patients with lumbar radiculopathy meeting specific criteria. LTFESI was administered using a hospital-based prospective design. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) scores at various intervals. Statistical analyses were performed to identify predictors of successful outcomes. Participants (average age 43.22 years, 27 (51.92%) male) exhibited diverse Michigan State University (MSU) grade profiles and predominantly had pathology at the L4-5 level. The study demonstrated a significant and lasting functional improvement in 43 (82.69%) of patients after LTFESI. Patients with 2AB-type intervertebral disc prolapse (IVDP) showed lower response rates, emphasizing subtype influence. The efficacy of LTFESI was sustained for up to six months in almost 82.69% of patients, highlighting its potential for long-lasting benefits. The difference in the mean ODI score pre-injection and six months post-injection is statistically significant (p<0.0001). A total of four patients (7.69%) underwent surgical treatment for lumbar radiculopathy as their symptoms did not improve after injection. For all four patients (7.69%), surgery was done one month after injection. Five patients (9.61%) had ODI scores of more than 40, indicating severe disability at the end of six months. So, in nine patients (17.3%), the injection given was not effective at the end of six months, four (7.69%) of whom were operated on and five (9.61%) patients received conservative treatment. Thus, 43 (82.69%) of patients had a good outcome. The study reinforces LTFESI as an effective and safe intervention, providing substantial and lasting benefits for lumbar radiculopathy. The majority experienced immediate relief, supporting its role as an intermediate option between conservative management and surgery. Identified predictors of decreased success underscore the importance of early intervention and tailored treatment plans. The study emphasizes LTFESI's diagnostic and therapeutic potential, with economic benefits and safety highlighted. LTFESI emerges as a safe and effective intervention for lumbar radiculopathy, offering substantial and enduring pain relief. The study contributes valuable insights into the nuanced outcomes of LTFESI, including the impact of IVDP subtypes, factors influencing success, and the procedure's cost-effectiveness. While acknowledging limitations, this work adds to the growing evidence supporting LTFESI as a crucial component in the management of lumbar radiculopathy.

Prospective 5-year follow-up of L5-S1 versus L4-5 midline decompression and interspinous-interlaminar fixation as a stand-alone treatment for spinal stenosis compared with laminectomies.

Spinal stenosis treatment includes laminectomies with or without fusion or with interspinous distraction with or without fixation. Lack of published data on interspinous fixation devices (IFD) at L5-S1 is less considered as an option due to the smaller anatomical S1 spinous process and the higher stresses from the immobile sacrum. Our objective was to evaluate the outcomes of an IFD used as a stand-alone treatment for spinal stenosis at L5-S1 and L4-5 compared to historical data on open laminectomies. Prospective comparative cohort study (Level 2) looking at collected preoperatively and postoperatively Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) data, complications, and revision rates on 100 consecutive patients with spinal stenosis treated with midline decompression and InSpan (InSpan LLC, Malden, MA, USA) IFD, at L5-S1 and L4-5, up to five-year follow-up. All patients were treated by a single surgeon in an academic private practice. Historical published outcome data for open laminectomies were compared. Among the 100 patients, 45 underwent surgery at L5-S1 with a mean VAS pain score that decreased by 75% and ODI improved by 63% (P<0.001). Fifty-five patients had surgery at L4-5 with mean VAS and ODI scores improved by 80% and 66% (P<0.001) respectively. Preoperative and postoperative ODI and preoperative VAS scores were similar at L5-S1 and L4-5, however, postoperative VAS scores were significantly less for L4-5 versus L5-S1 (P<0.01). All surgeries were completed in less than one hour. There was a total of one L4-5 revision (1.8%) and two L5-S1 revisions (4.4%). Comparable laminectomy data showed decrease in VAS and ODI scores by 51% and 62% (P<0.05). The reoperation rate for laminectomies at five to ten years varied up to 24%. Spinal stenosis patients treated with midline decompression and InSpan IFD, used as a stand-alone treatment for interspinous-interlaminar fixation, at L4-5 and L5-S1, showed improved outcome scores and low complication and revision rates at five years and were comparable to historical open laminectomy data. InSpan is a successful substitute for laminectomies in selected patients and was performed in less than 60 minutes. We recommend choosing the appropriately sized implant to achieve adequate distraction decompression to avoid recurrent symptoms.

Unilateral Percutaneous Kyphoplasty In Patients With Painful Osteoporotic Vertebral Compression Fractures; Single Center Experience

ABSTRACT&#x0D; &#x0D; Aim&#x0D; The objective of this study is to evaluate the outcomes of unilateral percutaneous kyphoplasty (PKP) performed in treatment-resistant patients with osteoporotic vertebral fractures.&#x0D; &#x0D; Material and Methods&#x0D; The study sample consisted of eight patients with painful osteoporotic compression fractures who did not respond to conservative treatment methods. However, the respective clinical results were evaluated based on radiological findings pertaining to 18 operated vertebrae of the said eight patients. The Oswestry Disability Index (ODI) scores and Visual Analogue Scale (VAS) scores were recorded before the procedure and at the 1st-month and 6th-month follow-up visits. Vertebral angle (VA), and anterior height (AH), central height (CH) and posterior height (PH) of the superior and inferior endplates of the vertebrae were measured before the procedure and at the 6th-month follow-up using direct radiography.&#x0D; &#x0D; Results&#x0D; Mean VAS and ODI scores decreased 66.87% and 65.13%, respectively, over a 6-month period. The mean vertebral height increased after kyphoplasty, as reflected by a 4.70% increase in AH, 26.84% increase in CH and 1.63% increase in PH. Additionally, VA was found to have increased by 14.1%.&#x0D; &#x0D; Conclusion &#x0D; The results of this study featuring a small patient population indicated that unilateral balloon PKP can be used safely and effectively to achieve earlier mobilization with faster pain relief and fewer complications.