Mean Oswestry Disability Index Scores Research Articles

Comparison of Clinical Outcomes Following Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis With Degenerative Spondylolisthesis.

Introduction: Both lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have been used to treat one-level lumbar spinal stenosis (LSS) with degenerative spondylolisthesis, while the differences of the clinical outcomes are still uncertain.Methods: Among 60 consecutive patients included, 24 surgeries were performed by LE-ULBD and 36 surgeries were performed by MI-TLIF. Patient demographics, operation characteristics and complications were recorded. Sagittal parameters, including slip percentage (SP) and slip angle (SA) were compared. The visual analog scale (VAS) score, the Oswestry Disability Index (ODI) score, and Macnab criteria were used to evaluate the clinical outcomes. Follow-up examinations were conducted at 3, 6, 12, and 24 months postoperatively.Results: The estimated blood loss, time to ambulation and length of hospitalization of the LE-ULBD group were shorter than the MI-TLIF group. Preoperative and final follow-up SP of the LE-ULBD group was of no significant difference, while final follow-up SP of the MI-TLIF group was significantly improved compared with preoperative SP. The postoperative mean VAS and ODI scores decreased significantly in both LE-ULBD group and MI-TLIF group. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 95.8 and 97.2%, respectively, in both LE-ULBD group and MI-TLIF group. Intraoperative complication rate of the LE-ULBD and the MI-TLIF group were 4.2 and 0%, respectively. One case of intraoperative epineurium injury was observed in the LE-ULBD group. Postoperative complication rate of the LE-ULBD and the MI-TLIF group were 0 and 5.6%, respectively. One case with transient urinary retention and one case with pleural effusion were observed in the MI-TLIF group.Conclusion: Both LE-ULBD and MI-TLIF are safe and effective to treat one-level LSS with degenerative spondylolisthesis.

A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain

BackgroundWalking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice.MethodsRandomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate.ResultsN = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks.ConclusionsOverall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP.Trial registrationUnited States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).

Does Patient Body Mass Index Affect the Outcome of Multimodal Rehabilitation in Chronic Mechanical Low Back Pain?

Retrospective. The aim of this study was to investigate the effect of body mass index (BMI) on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation. Despite being a well-known risk factor for developing LBP, there is minimal data on the effect of BMI on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation. Data from patients with chronic mechanical LBP who underwent multimodal rehabilitation treatment at a chain of spine rehabilitation outpatient clinics in one of the three BMI groups-1564 patients in normal body weight (BMI ≥18.5-24.9), 1990 patients in overweight (BMI ≥25-29.9), and 891 patients in obese (BMI ≥ 30) groups-were retrospectively analyzed. Pre- and post-treatment Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores, and final treatment outcomes were compared between the three groups. Multivariate analysis was used to determine the association between pre-treatment covariates and post-treatment clinical outcomes. Post-treatment, the mean NPRS (P = 0.005) and mean ODI (P < 0.001) scores were significantly higher with a significantly lower percentage of full success outcome (P = 0.009) in the obese group when compared to normal and overweight groups. However, multivariate analysis showed a significant correlation between age, the number of treatment sessions, pre-treatment NPRS and ODI scores, and post-treatment NPRS and ODI scores and treatment failure, and no correlation with patient BMI. Patient BMI may not affect pain and disability outcomes in patients undergoing a multimodal rehabilitation treatment for chronic LBP. In contrast to BMI, other covariates such as age, treatment sessions, and pre-treatment NPRS and ODI scores may be associated with increased risk for poor treatment outcome. Obese individuals can expect clinical outcomes similar to normal or overweight individuals with multimodal physical rehabilitation for chronic LBP.Level of Evidence: 3.

Partial Resection of Spinous Process for the Elderly Patients with Thoraco-Lumbar Kyphosis: Technical Report.

Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis.

Extracorporeal Shock Wave Therapy Combined With Oral Medication and Exercise for Chronic Low Back Pain: A Randomized Controlled Trial

ObjectiveTo compare extracorporeal shock wave therapy combined with oral medication and an exercise program vs sham treatment with medication and exercise for the treatment of chronic low back pain (CLBP). DesignRandomized controlled trial. SettingOutpatient clinic at a university hospital. ParticipantsEligibility criteria were age older than 18 years and duration of CLBP exceeding 3 months. Exclusion criteria were concurrent treatment or history of surgery for CLBP, cancer, fractures, infections, and disk degeneration. InterventionThe intervention group received extracorporeal shock wave therapy once a week for 4 weeks along with oral medications and an exercise program. The control group received sham extracorporeal shock wave therapy along with oral medications and an exercise program. Main Outcome MeasuresVisual analog scale and Oswestry Disability Index (ODI) were used to assess pain and disability at baseline and after 3 months. ResultsThe pain score in the intervention group (N=16) was 6.6 at baseline and 3.0 after 1 month (P<.0001) and 1.8 after 3 months (P<.0001). In the control group (N=16), the pain score was 6.8 at baseline, 4.6 after 1 month (P<.0001), and 1.1 after 3 months (P<.0001). ODI scores decreased significantly in both groups compared with baseline values (first month: P<.001, third month: P<.05). The mean ODI score did not differ significantly between the groups (P=.942). ConclusionExtracorporeal shock wave therapy combined with oral medication and exercise was safe and effective in the short-term treatment of chronic low back pain.

The Synergistic Effect of Combined Transforaminal and Caudal Epidural Steroid Injection in Recurrent Lumbar Disc Herniations.

BackgroundRecurrent lumbar disc herniation (RLDH) is one of the most common causes of chronic low back and leg pain. Although surgical treatment has high success rates in primary lumbar disc herniations, recurrence is not an uncommon clinic condition after the surgery. Considering the recurrent surgeries have lower success rates and higher risks, such as dural tear and nerve injury, alternative treatment modalities are needed for RLDH patients. Epidural steroid injections (ESI), particularly transforaminal steroid injection (TFESI) and caudal steroid injection (CESI), which are the alternative treatments to surgery, have not shown reasonable results in RLDH separately. In this study, we aimed to investigate the effects of combined TFESI and CESI (TFESI + CESI) treatment, which has been found successful in primary lumbar disc herniation (PLDH) and on pain control and quality of life in RLDH patients for the first time.Materials and methodsA total of 71 patients, who had ESI treatment as only TFESI or TFESI + CESI because of RLDH in our clinic between March 2017 and February 2020, were investigated retrospectively. The visual analog scale (VAS) leg, VAS back, and Oswestry disability index (ODI) were used to assess leg pain, low back pain, and limitation of daily routine activities. Each assessment was done before the intervention and repeated at the third week, the third month, and the sixth month of injection, and the results were noted.ResultsOut of 71 patients, 38 were female and 33 male. Patients were divided into two subgroups according to the applied ESI methods as only TFESI (n = 32) and TFESI + CESI (n = 39). In the only TFESI group, the mean VAS leg score was 7.84, 4.63, 5.40, and 6.19 before, at the third week, the third month, and the sixth month of the injection, respectively. Also, in this group, the mean VAS back score was 8.06, 4.16, 4.88, and 5.97; the mean ODI score was 55.81, 34.31, 37.5, and 49.04 in the same respect. In the TFESI + CESI group, the mean VAS leg score was 8.20, 2.87, 3.64, 4.23; mean VAS back score 8.03, 3.05, 3.90, 4.08; mean ODI score 56.56, 28.05, 30.21, 33.64 before, at the third week, third month, and sixth month of the injection, respectively. The mean of the initial VAS leg, VAS back, and ODI scores was not found to be statistically significantly different between the two groups. The mean of all VAS leg, VAS back, and ODI scores was found to be lower in the TFESI + CESI group than the only TFESI group at each third-week, third-month, and sixth-month controls, and these differences were statistically significant. (p<0.0001 at each controls for VAS leg; p = 0.001 at third week, p = 0.002 at third month and p <0.0001 at sixth month for VAS back; p= 0.0003 at third week, p<0.0001 at third month, p<0.0001 at sixth month for ODI)ConclusionOur study demonstrates that TFESI + CESI treatment is an effective non-surgical treatment for RLDH. Considering the higher risks and lower success rates of recurrent surgeries, TFESI + CESI can be a potential treatment option for RLDH patients.

Facet Arthrodesis with the FFX Device: One-Year Results from a Prospective Multicenter Study.

Facet osteosynthesis can be performed to treat facet syndrome (FS) and reduce spinal instability following laminectomy in patients with lumbar spinal stenosis (LSS). The present study evaluated clinical and radiological outcomes following facet osteosynthesis with the FFX device. Patients with FS or LSS were prospectively enrolled in a single-arm, multicenter study. The device was placed at affected levels with or without concomitant posterior lumbar interbody fusion (PLIF) procedures. The visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Computed tomography scans to assess fusion and migration were performed 1 year following surgery. Fifty-three patients (26 men/27 women) with a mean age of 65.0 ± 9.6 years (range: 37-83 years) were enrolled. A total of 205 FFX devices were implanted with 15 patients undergoing concurrent PLIF procedures. There were no intraoperative or postoperative surgical complication reported, and no patient required revision surgery. Mean VAS leg and back pain scores significantly improved from 5.57 to 2.09 (P < .001) and 5.74 to 3.13 (P < .001), respectively, between the preoperative and 1 year follow-up assessments. Mean ODI scores also significantly improved from 44.7% to 24.0% (P < .001) during the same time period. Facet fusion occurred with 86.3% of device placements after 12 months. There was 1 (0.5%) asymptomatic device migration. Eight devices (3.9%) were considered misplaced. The use of the FFX device is associated with a significant reduction in both pain and disability following surgery with a high facet joint fusion rate. 4. This is the first study reporting clinical experience using the FFX device to facilitate facet osteosynthesis. The ability of the device to relieve pain, reduce disability, and enhance lumbar facet fusion with a low rate of device misplacement and migration was demonstrated.

The Success Rate of Ultrasound-Guided Sacroiliac Joint Steroid Injections in Sacroiliitis: Are We Getting Better?

The sacroiliac joint is one of the most common sources of low back pain; however, it is difficult to place the needle accurately inside the joint space without image guidance. Improvement of ultrasound technology may lead to a high success rate for intra-articular drug deposition. Assessment of the success rate of ultrasound-guided intra-articular sacroiliac joint injection. Prospective observational study. Ultrasound-guided injections were performed on 34 patients suffering from sacroiliitis. After injection of the drug solution and withdrawal of the needle, an anteroposterior fluoroscopy image was obtained and recorded for the injected joint to detect whether it was predominantly intra-articular or peri-articular. Clinical outcome using a numeric pain rating scale as well as limitation of physical functioning measured by the Oswestry Disability Index (ODI) were determined. Thirty-three injections (84.6%) were intra-articular, while 6 injections (15.4%) were peri-articular, as confirmed by fluoroscopy, with no statistical difference regarding clinical outcome between them. The baseline mean pain score decreased from 7.21 to 1.92 1month after injection, and the mean ODI scores improved from 61.41% to 17.13%. Intervention was well tolerated, and 91.2% of patients were satisfied or mostly satisfied. Ultrasonography provides a high success rate of intra-articular sacroiliac joint injection as confirmed by fluoroscopy. No significant difference in clinical outcome between intra-articular and peri-articular injection was found.

Comparison of lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive surgery transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis

BackgroundThe aim of the present study is to compare the clinical outcomes and postoperative complications of lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) to treat one-level lumbar spinal stenosis (LSS) without degenerative spondylolisthesis or deformity.MethodsA retrospective analysis of 112 consecutive patients of one-level LSS undergoing either LE-ULBD or MIS-TLIF was performed. Patient demographics, operation time, estimated blood loss, time to ambulation, length of hospitalization, intraoperative and postoperative complications were recorded. The visual analog scale (VAS) score for leg and back pain, the Oswestry Disability Index (ODI) score, and the Macnab criteria were used to evaluate the clinical outcomes. The healthcare cost was also recorded.ResultsThe operation time, estimated blood loss, time to ambulation and length of hospitalization of LE-ULBD group were shorter than MIS-TLIF group. The postoperative mean VAS and ODI scores decreased significantly in both groups. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 90.6 and 93.8% in the two groups. The mean VAS scores, ODI scores and outcomes of the modified Macnab criteria of both groups were of no significant difference. The healthcare cost of LE-ULBD group was lower than MIS-TLIF group. Two cases of intraoperative epineurium injury were observed in the LE-ULBD group. One case of cauda equina injury was observed in the LE-ULBD group. No nerve injury, dural injury or cauda equina syndrome was observed in MIS-TLIF group. However, one case with transient urinary retention, one case with pleural effusion, one case with incision infection and one case with implant dislodgement were observed in MIS-TLIF group.ConclusionsBoth LE-ULBD and MIS-TLIF are safe and effective to treat one-level LSS without degenerative spondylolisthesis or deformity. LE-ULBD is a more minimally invasive option and of less economic burden compared with MIS-TLIF. Decompression plus instrumented fusion may be not necessary for one-level LSS without degenerative spondylolisthesis or deformity.

Efficacy of a Novel Vertebral Body Augmentation System in the Treatment of Patients with Symptomatic Vertebral Body Fractures

PurposeTo evaluate the safety and efficacy of a novel augmentation implant in the treatment of patients with symptomatic vertebral body fractures.Materials and MethodsThirty consecutive patients (seven males and 23 females), mean age of 70 years (range 56 to 89) with osteoporotic fractures and/or low-energy trauma fractures (osteoporosis confirmed by CT), were enrolled in an IRB-approved prospective study. The type of fracture was classified according to the Magerl classification. The patients were treated with the Tektona® dedicated vertebral body augmentation system. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were obtained after 1, 6 and 12 months. Quality of life was assessed with the SF36 score.ResultsA total of 37 vertebral bodies, mostly from T6 to L5, were treated in the 30 enrolled patients. In 67.6% of the cases (n = 25), lumbar fractures were treated. Most of the fractures (43%; n = 16) were A1.1 according to the Magerl classification. A significant pain reduction evaluated by VAS scores (p < 0.0001) was observed on average 7.6 (before the procedure) to 2.8 (immediately post-treatment), 2.1 and 2.7 (after 6 and 12 months later, respectively). The mean ODI score was 55.5% before treatment, and this was statistically significant reduced to 22.3% and 26.9%, respectively, at 6 and 12 months after treatment (p < 0.0001). The SF36 scores, both physical and mental components, showed statistically significant variations (p < 0.0001) whose direction was subpopulation dependent.ConclusionPatients with confirmed osteoporosis, suffering from symptomatic vertebral body fractures (osteoporotic and/or low-energy traumatic), were treated safely and effectively using this novel implant.

The effect of an integrated multidisciplinary rehabilitation programme for patients with chronic low back pain: Long-term follow up of a randomised controlled trial

Objective: To compare the long-term effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme, in terms of back-specific disability, in patients with chronic low back pain. Design: A single-centre, pragmatic, two-arm parallel, randomised controlled trial. Setting: A rheumatology rehabilitation centre in Denmark. Subjects: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. Interventions: An integrated programme (a pre-admission day, two weeks at home, two weeks inpatient followed by home-based activities, plus two 2-day inpatient booster sessions, and six-month follow-up visit) was compared with an existing programme (four-week inpatient, and six-month follow-up visit). Main measure: The primary outcome was disability measured using the Oswestry Disability Index after one year. Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). Analysis was by intention-to-treat, using linear mixed models. Results: 303 patients were assessed for eligibility of whom 165 patients (mean age 50 years (SD 13) with a mean Oswestry Disability Index score of 42 (SD 11)) were randomly allocated (1:1 ratio) to the integrated programme (n = 82) or the existing programme (n = 83). The mean difference (integrated programme minus existing programme) in disability was –0.53 (95% CI –4.08 to 3.02); p = 0.770). No statistically significant differences were found in the secondary outcomes. Conclusion: The integrated programme was not more effective in reducing long-term disability in patients with chronic low back pain than the existing programme.

Impact of Spinal Correction Surgeries with Osteotomy and Pelvic Fixation in Patients with Kyphosis Due to Osteoporotic Vertebral Fractures.

Study DesignCombination of retrospective and prospective study.PurposeWe aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment.Overview of LiteratureThe clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved.MethodsWe analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period.ResultsIn the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value <0.05). There was no significant difference in the incidence of PJK in the local and pelvic groups, but there was a higher rate of DJK (41.7%) in the local group. In contrast, rod fractures were more common in the pelvic group (45.5%). Patients with DJK had higher ODI scores 2 years after surgery (52.0 in DJK patients vs. 34.8 in non-DJK patients; p-value <0.05).ConclusionsFor patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.

11. Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: five-year treatment results from a prospective randomized double-blind sham-controlled multicenter study

BACKGROUND CONTEXT Current literature suggests that degenerated or damaged vertebral endplates are a significant cause of vertebrogenic chronic low back pain (CLBP). Modic changes are one objective MRI biomarker for this specific subset of patients. Intraosseous basivertebral nerve (BVN) ablation, using radiofrequency energy under image guidance, was compared to a sham control in a randomized controlled trial (RCT) and demonstrated superiority at 12 months. Two-year data from the treatment arm of this RCT showed maintenance of clinical improvements at 2 years following ablation of the BVN. PURPOSE This study reports the 5-year clinical outcomes in this cohort of patients. STUDY DESIGN/SETTING Prospective, open label, single arm five-year follow-up of the SMART RCT. The primary requirements for inclusion in the original RCT were CLBP with a duration greater than 6 months; CLBP nonresponsive to at least 6 months of nonsurgical management; and Modic Type 1 or 2 changes at the vertebral endplates of the levels targeted for treatment. BVN ablation was performed under image guidance in an outpatient setting for those patients randomized to the treatment arm. PATIENT SAMPLE This five-year follow-up study was conducted in the U.S. at the 13 study sites that treated patients in the original RCT. In the US BVN ablation arm, 117 patients were successfully treated and targeted, and comprise the per protocol (PP) population for this study. OUTCOME MEASURES Patient-reported outcomes of Oswestry Disability Index (ODI), visual analog score (VAS), responder rates, postablation treatments, and patient satisfaction were collected. The primary outcome was mean change in ODI from baseline. Comparisons between the postablation and baseline values were performed using a paired t-test at the 0.05 level of significance. METHODS A single telephonic study visit was conducted by an independent research nurse between June 2019 to November 2019 (a minimum of 5 years post-BVN ablation). Self-reported patient outcomes were collected via interview using validated questionnaires that were sent in advance of the visit. No additional interventions were required in the 5-year+ follow-up study. RESULTS One hundred of the 117 US treated patients (retention rate 85%) were available for review with a mean follow-up of 6.4 years (range 5.4 to 7.8 years). Mean ODI score significantly improved from 42.81 to 16.86 at 5 years of follow-up, a reduction of 25.95 points (p 50% reduction in pain, 47% reported a >75% reduction in pain, and 34% reported complete pain resolution. Responder rates were maintained at five years with 75% of patients exceeding a combined threshold of ≥15-point ODI and ≥2-point VAS for function and pain improvement, and 65% reporting they had returned to their pre– low back pain activity level. CONCLUSIONS CLBP patients treated with BVN ablation exhibit sustained clinical improvements in function and pain with high responder rates at a mean of 6.4 years following treatment. BVN ablation appears to be a durable, minimally invasive treatment for the relief of vertebrogenic CLBP. FDA DEVICE/DRUG STATUS Intracept procedure (Approved for this indication).

Percutaneous Vertebroplasty and Facet Blocking for Treating Back Pain Caused by Osteoporotic Vertebral Compression Fracture.

Methods Clinical and radiological data of 204 patients were reviewed. The patients were divided into Group A (PVP alone) and Group B (PVP and FB combined therapy) according to treatments. Back pain was evaluated with Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The operation, fluoroscopic exposure time, and bone cement leakage were recorded. The χ2 test, Student's t-test, and repeated measures analysis of variance were used to compare the differences between the two groups. Results There were 125 patients in Group A and 79 patients in Group B. Their baseline characteristics were similar (P > 0.05). The mean VAS scores of Group A and Group B were 7.03 and 7.21 at admission, 4.7 and 3.2 at 1 day after operation, 4.0 and 3.0 at 3 months, and 2.2 and 2.2 at 12 months after operation, respectively. The mean ODI scores of Group A and Group B were 30.9 and 29.8 at admission, 17.6 and 17.7 at 3 months, and 10.5 and 10.9 at 12 months after operation, respectively. The mean operation time and fluoroscopic exposure time of Group A (35.6 minutes and 7.2 seconds, respectively) was significantly shorter than that of Group B (45.7 minutes and 11.7 seconds, respectively, P < 0.01). The incidence of bone cement leakage and new fractures after operation did not have statistically significant difference between groups. Conclusion PVP and FB combined therapy could provide better pain relief than PVP alone in short term after operation in patients with OVCFs associated back pains.

Low Back Pain Induced by Posterior Longitudinal Ligament Incision in Percutaneous Transforaminal Endoscopic Lumbar Discectomy.

ObjectiveTo illustrate the posterior longitudinal ligament is one of the tissue candidates who can contribute to low back pain (LBP).MethodsThis is a retrospective study. A series of 72 patients who underwent single‐level percutaneous endoscopic lumbar discectomy performed for lumbar disc herniation with LBP from June 2014 to June 2016 were examined. There are 42 males and 30 females. The ages of patients were 40 to 57 years, and the mean age was 49.8 years. The symptomatic disc level was at L4‐5 in 43 patients and L5S1 in 29 patients. Thirty‐two patients (19 patients in L4‐5 disc level, 13 patients in L5S1 disc level) had LBP (which was limited to the lower back and buttock area) before the operation. All of the operative approaches were performed under local anesthesia. A posterior body diagram (15 cm × 10 cm) was made for this study to record the pain distribution. The centered foci of low back pain were subjectively recorded before, during, and after the operation. The transforaminal endoscopic spine system technology was used in this study. Radiological examinations (X‐ray, computed tomography, and magnetic resonance imaging) were performed prior to and after surgery. The Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) scores were taken before and after the surgery to observe the degree of pain. The VSA and ODI score before and after operation were expressed as mean ± SD, and compared by t‐test for statistical analysis.ResultsWhen inciting the posterior longitudinal ligament during the operation, all 72 patients had provoked low back pain. Forty‐three patients with symptomatic discs at L4‐5 had pain foci in the lower back and upper gluteal region under the L4 spinous process. Twenty‐nine patients with symptomatic discs at L5S1 had pain foci in the gluteal region under the S1 spinous process. The pain localizations of L4‐5 and L5S1 were different. After the surgery, the provoked low back pain disappeared, and had not returned in any of the patients at the 6‐month follow‐up. After the operation, one patient suffered from lower limb pain that he did not have before the operation, and the lower limb pain abated a few days later. Three patients had cerebrospinal fluid leakage and were treated with higher pressure applied on the incision and bed rest for 10 days. During the 6‐months follow‐up period, the mean VAS decreased from 5.97 ± 1.10 to 2.13 ± 0.78. The mean ODI score decreased from 23.14 ± 3.28 to 7.92 ± 1.85.ConclusionsThe intervertebral posterior longitudinal ligament may be one of the tissues from which low back pain originates.

Minimally invasive sacroiliac joint fusion using a novel hydroxyapatite-coated screw system improves functional outcomes in patients with sacroiliitis at two year follow-up

PurposeThe aim of the present study is to understand the clinical outcomes of a novel hydroxyapatite-coated (HA-coated) titanium screw for surgical treatment of SI joint dysfunction. BackgroundThe mainstay of therapy for disorders of the sacroiliac (SI) joint has been non-operative treatment including activity modification, non-steroidal anti-inflammatory drugs, and physical therapy. SI joint injections provide diagnostic information and occasional durable therapeutic benefit. When these modalities fail, sacroiliac joint fusion may be recommended. ObjectiveThe objective of this study is to describe the clinical outcomes of a novel HA-coated titanium screw for surgical treatment of SI joint dysfunction. MethodsThis study is a retrospective Institutional Review Board-exempt chart review of 45 consecutive patients who underwent minimally invasive SI joint fusion with a novel HA-coated screw system. Patients were diagnosed based on North American Spine Society guidelines and evidence-based criteria. Clinical assessments were collected, evaluated, and compared preoperatively and at 3, 6, 12, and 24 months postoperatively. ResultsMean patient age was 68.8 ± 9.4 years, and 61.7% of patients were female. Of the 44 patients, nine underwent bilateral SI joint fusion, while the remaining were unilateral. Screw size ranged from 10 × 35 mm to 10 × 50 mm. Mean preoperative visual analog scale (VAS) SI pain scores decreased significantly by a mean of 6.1 points at 12 months postoperatively (P < 0.001). Mean Oswestry Disability Index (ODI) scores significantly improved from 52.3% at baseline to 11.3% at 3-month follow-up, 11.5% at 6 months, 10.9% at 12 months, and 9.5% at 24 months, leading to improvements of 41.0, 40.8, 41.4, and 42.8 points, respectively. ConclusionThe clinical outcomes of SI joint fusion using an HA-coated screw system to treat sacroiliitis demonstrated significant decreases in VAS SI and ODI scores at 3, 6, 12, and 24 months.

Recurrence of backache following discectomy: An analysis of management.

Abstract Background Data: Intervertebral disc prolapse, being one of the most common spine problems in the industrialized world, has a lot of medical, social, legal, and economic implications following the recurrence of pain following surgery. Due to variability in the causes of the pain generators, it is hard to devise a definitive treatment plan. However, the threshold for conservative and surgical management needs to be understood. Purpose: The study was conducted to find out the causes for recurrence of backache following lumbar discectomy and to evaluate the effect of conservative management. The number of patients requiring a second surgery, the causes, and the effects of the second surgery on the patients were analyzed. Study Design: Observational analytic prospective study Patients and Methods: Thirty-one consecutive patients who presented with recurrence or persistence of backache between September 2016 and September 2017 following lumbar discectomy at our centre were evaluated. These patients were examined clinically and underwent evaluation in the form of blood investigations, plain radiographs, and MRI (Magnetic Resonance Imaging) as per protocol and further management was decided accordingly. Patients who underwent surgical and conservative management were followed up separately at of 1, 6, and 12 months and evaluated using SLR (Straight Leg Raising), ODI (Oswestry Disability Index), and VAS (Visual Analogue score). Results: Patients were in the age range of 28–66 years and the male/female ratio was 1.8:1. The operated level that presented most with recurrence was L4-L5. Repeat prolapse was the most common cause of recurrence. Twenty-three out of 31 patients responded to conservative management and 8 patients required surgery. The mean SLR, VAS, and ODI scores improved significantly by conservative methods. Furthermore, these scores improved significantly by surgery, but the rate and the sustenance of improvement varied in the two groups. Conclusion: Most of the patients responded well to conservative management following recurrence except for cases who had absolute indications for surgery such as infection, pseudomeningocele, or re-herniation with severe compression. The common causes ofrecurrence of symptoms varied according to the primary surgery done (laminectomy/fenestration). Outcomes of both conservative and surgical management were good at the end of 1 year. (2020ESJ206) Background: Intervertebral disc prolapse, being one of the most common problems in the industrialized world, has a lot of medical, social, legal and economic implications following recurrence of pain following surgery. Due to variability in the causes of the pain generators, a definitive treatment plan is hard to devise. However the threshold for conservative and surgical management needs to be understood. Purpose: The study was done to find out the causes for recurrence of backache following discectomy in our centre along with patient demographics and evaluate the effect of conservative management on them. The number of patients requiring a second surgery, the causes for them and the effect of second surgery on the patient also needed to be analyzed. Study Design: Observational analytic prospective study Methodology: Thirty one consecutive patients who presented between September 2016 and September 2017 with recurrence or persistence of backache following discectomy at our centre were evaluated. These patients were examined clinically and underwent evaluation in the form of blood investigations, radiographs and MRI (Magnetic Resonance Imaging) as per protocol and further management was decided accordingly. Patients who underwent surgical and conservative management were followed up seperately at intervals of 1, 6 and 12 months and evaluated using SLR (Straight Leg Raising), ODI( Oswestry Disability Index) and VAS (Visual Analogue score). Results: Patients were in the age range of 28-66 years and the male:female ratio was 1.8:1. Operated L4-L5 level presented most commonly with recurrence. Repeat prolapse was the most common cause for recurrence. 23 out of 31 patients responded to conservative management and 8 patients required surgery. The mean SLR, VAS scores and ODI scores were noted to have improved significantly by conservative methods. These scores improved significantly by surgery too but the rate and sustainance of improvement varied in the two methods. Conclusion: Most of the patients responded well to conservative management post recurrence except for cases which had absolute indications for surgery such as infection, pseudomeningocele or reherniation with severe compression. The common causes of recurrence of symptoms varied according to the surgery done (laminectomy / fenestration). Outcome of both conservative and surgical management were good at the end of 1 year.

Relationship of the character of rod fractures on outcomes following long thoracolumbar fusion to the sacrum for adult spinal deformity

BACKGROUND CONTEXTRod fractures (RF) and pseudarthrosis are a frequent occurrence after adult spinal deformity (ASD) surgery and may be problematic. However, not all RF signal nonunion and cause clinical concern. An improved understanding of the sequelae after RF occurrence is valuable for further management. PURPOSETo characterize the radiographic findings, clinical outcomes, and revision rates between patients who developed unilateral RF (URF) and bilateral RF (BRF) following thoracolumbar posterior spinal fusions to the sacrum for ASD and identify patient characteristics associated with clinically significant RF that lead to subsequent revision surgeries and detection of nonunion. STUDY DESIGN/SETTINGA retrospective single-center cohort study was performed. PATIENT SAMPLEPatients undergoing long-construct posterior spinal fusions to the sacrum performed at a single institution from 2004 to 2014 and developed a RF postoperatively were included. OUTCOME MEASURESPatient demographics, radiographic parameters, surgical data, Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22), and revision rates. METHODSInclusion criteria were ASD patients age >18 who had ≥5 vertebrae instrumented and fused posteriorly to the sacrum and development of RF. Data were compared among patients: who developed unilateral-nondisplaced RF (UNRF), unilateral-displaced RF (UDRF), bilateral-nondisplaced RF and bilateral-displaced RF (BDRF) at baseline and follow-up. ODI and SRS-22 scores were assessed at baseline, 1 year postoperatively, the time of RF occurrence, and latest follow-up. RESULTSOf 526 patients who met inclusion criteria, 96 (18.3%) developed RF (URF n=70 [73%]; BRF n=26 [27%]). Preoperative demographics and surgical parameters were similar between the groups. BRF patients had substantial loss of sagittal correction from 1-year postoperatively to the time of RF, including loss of sagittal vertical axis (4.8 cm vs. 2.2 cm; p<.001), loss of lumbar lordosis (14.8° vs. 4.9°; p=.010) and loss of pelvic incidence minus lumbar lordosis mismatch (PI-LL) mismatch (5.0° vs. 14.6°; p=.020) compared with those of URF patients. The BDRF group had more loss of ODI scores (13.4 vs. 4.2; p=.013), SRS pain score (0.8 vs. 0.2; p=.024), SRS function score (0.3 vs. 0; p=.020) and SRS subscore (0.4 vs. 0.1; p=.148) from 1-year postoperatively to the time of RF and underwent revision surgery more often than the UNRF group (87.5% vs. 4.8%; p<.0001). At final follow-up (median 2.8 years, range 1–10.3 years after RF detection), URF patients who did not undergo revision surgeries still maintained equivalent sagittal alignment correction (sagittal vertical axis, LL and PI-LL; all p>.05) and had similar, not worse, mean ODI scores, SRS Subscore and SRS pain compared with the time at RF and 1-year follow-up. CONCLUSIONSRF are not uncommon after ASD operations. Asymptomatic, UNRF in our study did not jeopardize clinical outcomes or radiographic alignment parameters and, in most cases, did not represent a nonunion, as opposed to BRF. BRF patients exhibited loss of sagittal correction, loss of clinical outcome improvements, as measured by ODI, SRS pain and SRS Subscore at the time of RF, and were revised more often than URF patients.

Modified Full-Endoscopic Interlaminar Discectomy via an Inferior Endplate Approach for Lumbar Disc Herniation: Retrospective 3-Year Results from 321 Patients

Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure that shows satisfying outcomes for the treatment of L5-S1 and even L4-5 disc herniation. PEID can be divided into direct and indirect approaches according to the established method of the working channel. The direct approach mainly uses the puncture needle directly through the intervertebral space into the intervertebral disc under indirect vision and insertion of the guidewire into the puncture needle to guide the dilator and into the working channel to retract the ligamentum flavum, dural sac, and nerve roots. This approach requires a skilled puncture technique, given the high risk of damage to the nerve roots and dural sac. Therefore, we improved this interlaminar access procedure, placing the puncture target at the inferior endplate and performing preoperative epidurography to expose the spinal nerve roots and dural sac after the puncture needle was passed through the ligamentum flavum. We then positioned the puncture needle at the posterior edge of the superior centrum. Finally, we inserted the working sleeve for the operation. This approach is convenient and effectively reduces the learning curve andintraoperative complications. Here we introduce theprocedure and report the safety and efficacy of full-endoscopic interlaminar discectomy via an inferior endplate approach for the treatment of lumbar disc herniation. We performed full-endoscopic interlaminar discectomy via the inferior endplate approach in 321 patients who met our inclusion criteria between May 2014 and May 2017. All operations were completed under local anesthesia. Under fluoroscopic guidance, we performed epidurography to expose the spinal nerve roots and dural sac. The working sleeve and endoscope were then introduced into the inferior endplate of the superior centrum. Herniated disc material was removed using forceps and a laser under clear endoscopic visualization. We retrospectively evaluated the 321 patients with more than 30 months (range, 12-48 months) of follow-up. The therapeutic effects were assessed using scores of the visual analog scale (VAS), Oswestry disability index (ODI), Macnab standard, and infrared thermal imaging. The mean VAS score for radicular pain improved from 6.3 ± 1.01 preoperatively to 1.01 ± 0.35 at the final follow-up (P < 0.01). The mean ODI score improved from 85.5 ± 12 preoperatively to 12.4 ± 3.7 at the final follow-up (P < 0.01). According to the MacNab standard, the excellent and good outcome scores were 96.5%. The infrared thermal imaging scores indicated significantly improved skin temperature of both lower extremities at 1 week after surgery compared with the preoperation temperature (P < 0.01). The inferior endplate approach for percutaneous endoscopic interlaminar discectomy provides a safe and effective alternative for the treatment of lumbar disc herniation.

Modified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Compression Fractures.

ObjectiveTo evaluate the cases of osteoporotic compression fracture with kyphotic deformity treated with modified pedicle subtraction osteotomy and analyze the usefulness of this osteotomy.MethodsTwenty patients (nine men, 11 women; mean age, 66.4 years; mean follow‐up duration, 39.6 months) who underwent modified pedicle subtraction osteotomy at our hospital between November 2003 and July 2012 with a minimum follow‐up period of 2 years were included. All cases were injuries induced by a fall incurred while standing or lifting heavy objects without high‐energy trauma. The mean bone mineral density‐dual energy x‐ray absorptiometry (BMD‐DEXA) was 0.673 g/cm2 (0.571–0.740 g/cm2), which was ‐2SD below normal, indicating severe osteoporosis. The indications for surgery included gait disturbance due to severe pain with pseudarthrosis, increased kyphotic angle, and progressive neurological symptoms. We evaluated Japanese Orthopaedic Association scores, Oswestry Disability Index scores, bone union, change in kyphotic angle, estimated blood loss, complications, and the patient's overall clinical satisfaction.ResultsThe collapsed vertebrae were thoracic (T9, 11, 12) in 13 cases and lumbar (L1) in seven cases. The mean pre‐ and post‐operative kyphotic angles were 26.2 ± 9.9 degrees and 8.3 ± 8.1 degrees, showing an 18.3‐degree correction. Plain radiography at the last follow‐up showed a mean angle of 17.9 ± 12.6 degrees, indicating a 9.5‐degree correction loss. The overall correction was 8.2 degrees. Bony union was achieved at the last follow‐up in all cases. Clinical outcomes showed improvement in mean Japanese Orthopaedic Association score from 13.2 to 21.7 and mean Oswestry Disability Index score from 40.3 to 13.6. Overall clinical patient satisfaction showed 12 excellent results, five moderate results, and three poor results. Mean operation time was 4.2 h (range, 4–6 h). The overall mean estimated blood loss (EBL) was 1098 mL (range, 750–1370 mL). The mean hospital stay was 3.6 weeks (range, 2–6 weeks). There was one case of cauda equina syndrome at 2 days postoperatively, and two cases of screw loosening. There were no cases of distal junctional kyphosis, but there were two cases of proximal junctional kyphosis.ConclusionsDespite limited correction of kyphotic angle, our modified pedicle subtraction osteotomy technique resulted in satisfactory outcomes in our patients, who had persistent severe back pain, increased kyphotic angle with pseudarthrosis, and progressive neurologic deficits. Nevertheless, this procedure requires careful follow‐up and strict surgical indications because of the risk of neurological damage and technical problems.