Neurogenic Symptom Score Research Articles

Single-Level Endoscopic TLIF Has Decreased Surgery Duration, Blood Loss, and Length of Hospital Stay While Achieving Similar 1-Year Clinical and Radiological Outcomes Compared With Conventional Minimally Invasive TLIF.

This study presents a single surgeon's experience comparing 1-year outcomes of endoscopic transforaminal lumbar interbody fusion (E-TLIF) vs minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in an Asian population. Retrospective review of consecutive patients who underwent single-level E-TLIF or MIS-TLIF by a single surgeon in a tertiary spine institution from 2018 to 2021 with 1-year follow-up. Inclusion criteria for both procedures were degenerative disc disease with grade I or II spondylolisthesis and mild to moderate central canal stenosis. Clinical outcomes assessed included surgery duration, blood loss, and length of stay. Patient-reported outcomes assessed included the visual analog score for back pain and lower limb pain, Oswestry Disability Index, and North American Spine Society Neurogenic Symptom Score. Radiographic parameters assessed included segmental lordosis, posterior disc height, listhesis, and the presence of cage migration or subsidence. Twelve E-TLIF and 34 MIS-TLIF patients were identified. E-TLIF had shorter surgery duration (165 ± 15 vs 259 ± 43 min for E-TLIF and MIS-TLIF groups, respectively; P < 0.001), reduced blood loss (83 ± 75 vs 181 ± 225 mL; P = 0.033), and decreased length of stay (1.8 ± 0.9 vs 4.7 ± 2.9 days; P < 0.001) compared with MIS-TLIF. E-TLIF and MIS-TLIF patients had significant improvements (P < 0.05) at 1 year in all patient-reported outcomes scores and radiographic parameters assessed. Both E-TLIF and MIS-TLIF patient groups also had similar postoperative patient-reported outcomes scores and radiographic parameters. No complications were recorded for E-TLIF, while MIS-TLIF had a case of dura tear and another case of meralgia paresthetica. There were no instances of cage subsidence, cage migration, or implant loosening in either group at 1 year. Although the study size was limited because E-TLIF is a relatively new technique in our institution, 1-year results demonstrate that E-TLIF can be a safe and efficacious option that achieves clinical and radiological results similar to MIS-TLIF with the additional benefits of decreased surgical duration, blood loss, and length of hospital stay. The results of this study support the effectiveness and potential advantages of endoscopic TLIF compared with MIS-TLIF.

Biplanar Expandable Cages for Transforaminal Lumbar Interbody Fusion Are Safe and Achieve Good 1-Year Clinical and Radiological Outcomes in an Asian Population.

This study investigated 1-year clinical and radiological outcomes of biplanar expandable (BE) cages following transforaminal lumbar interbody fusion (TLIF) in an Asian population. A retrospective review was conducted of all consecutive patients who underwent TLIF with BE cages performed by 2 fellowship-trained spine surgeons from 2020 to 2021. Inclusion criteria included open or minimally invasive (MIS) TLIF, of up to 3 spinal segments, performed for treatment of degenerative disc disease, spondylolisthesis, or spinal stenosis. Patient-reported outcomes, including visual analog score (VAS) for back and lower limb pain, Oswestry Disability Index (ODI) and North American Spine Society neurogenic symptom score (NSS), and various radiographic parameters, were evaluated. A total of 23 patients underwent TLIF with BE cages with a follow-up duration of 1.25 years. Of those patients, 7 (30%) underwent 1-level TLIF, 12 (52%) underwent 2-level TLIF, and 4 (18%) underwent 3-level TLIF, with a total of 43 spinal segments fused. Four patients (17%) underwent MIS TLIF while 19 patients (83%) underwent open TLIF. VAS for back pain scores improved by 4.8 ± 3.4 (P < 0.001) from 6.5 ± 2.6 to 1.7 ± 2.2; VAS for lower limb pain scores improved by 5.2 ± 3.8 (P < 0.001) from 5.7 ± 3.4 to 0.5 ± 1.6; ODI scores improved by 29.0 ± 18.1 (P < 0.001) from 49.4 ± 15.1 to 20.4 ± 14.2; and NSS scores improved by 36.8 ± 22.1 (P < 0.001) from 53.3 ± 21.1 to 16.5 ± 19.8. Significant improvements in radiological parameters included increase in anterior disc height, posterior disc height, foraminal height, segmental lordosis, and lumbar lordosis. There were no implant-related complications, cage subsidence, cage migration, or revision surgery at 1 year. TLIF performed with BE cages led to significantly improved patient-reported outcomes and radiographic parameters at 1 year and is safe for use in Asians. The results of this study support the effectiveness and safety of TLIF with biplanar expandable cages.

Full Endoscopic Lumbar Transforaminal Interbody Fusion in DDD Lumbar Degenerative Disc Disease: A Latest Technique.

Lumbar interbody fusion has long been used in the treatment of degenerative disc disease. Lumbar spinal interbody fusion surgery traditionally is an open surgical technique. Although lumbar spinal interbody fusions using endoscopy have been reported, the endoscope was used partially for the interbody fusion. We are reporting a case where lumbar interbody fusion with discectomy was entirely done through direct visualization with the endoscope. We report a case of a 55-year-old woman who underwent the transforaminal percutaneous full-endoscopic lumbar interbody fusion technique (FELTIF) under continuous and direct visualization at the L5-S1 level. To facilitate the interbody fusion, a foraminoplasty with complete resection of the superior articular process (SAP) and a partial pediculectomy of the S1 pedicle was performed. End plate sparing decortication techniques were used under direct video endoscopic visualization. The cage and bone graft insertion occurred through the endoscopic working cannula, thereby protecting the retracted traversing and exiting nerve roots at the surgical level. Posterior supplemental fixation with percutaneous pedicle screws was performed to complete the circumferential fusion. The VAS leg score was reduced to 2 from preoperative score of 7 and the VAS back score reduced 3 from preoperative score of 9. Her neurogenic symptom score improved from 8 before surgery to 1 at the last follow-up. The fusion is assessed by plain radiographs in follow up. We concluded that the insertion of an interbody fusion cage device directly through an endoscopic working cannula was technically feasible. Future research should focus on examining the clinical outcomes of this technique. 4.

The Effect of Body Mass Index on Long-Term Patient-Reported Outcome Scores after Anterior Cervical Discectomy and Fusion in an Asian Population: A 2-Year Study

Study DesignRetrospective cohort study.PurposeThis study aims to analyze the relationship between body mass index (BMI) subjective patient-reported outcomes (PRO) after 1- and 2-level anterior cervical discectomy and fusion (ACDF).Overview of LiteratureThe prevalence of cervical spondylosis and ACDF in expected to continue rising among the aging population of Asia. Moreover, the prevalence of obesity is also increasing. However, limited information is available about the mechanism by which BMI affects PRO after ACDF.MethodsTotal 878 patients underwent ACDF between 2000 and 2015. After excluding patients with previous cervical instrumentation, >2 levels fused, missing BMI measurement, or neoplastic/trauma indication for surgery, 535 patients were included. The PRO measures of the Neck Disability Index, Numerical Pain Rating Scale (NPRS) for Neck Pain, NPRS for Limb Pain, American Academy of Orthopaedic Surgeons–Neurogenic Symptom Score, and Japanese Orthopaedic Association myelopathy score were used. Patients were grouped based on their preoperative BMI, as per the World Health Organization guidelines for Asian populations. PRO scores were collected preoperatively, at 6 months postoperatively, and 2 years postoperatively. A generalized linear model was used to analyze the relationship of BMI category with the individual score, accounting for several factors that are likely to affect the outcomes.ResultsTotal 19 (3.4%) were underweight, 155 (28.0%) were normal weight, 112 (20.3%) were overweight, and 267 (48.3%) were obese. Patients across all BMI categories experienced significant and similar improvements in their postoperative PRO scores. There were no significant differences in the preoperative, 6-month postoperative, and 2-year postoperative PRO scores of the groups. Rate of reoperation was highest in patients with grade II obesity at 8.07%; however, the difference was not statistically significant.Conclusions Irrespective of the BMI, all patients exhibited similar satisfactory outcomes following ACDF. The results support surgery in all subgroups of patients with symptomatic nerve compression in the cervical spine.

A comparison of contiguous two-level anterior cervical discectomy and fusion using a structural allograft versus a Polyetheretherketone (PEEK) cage: the results of a three-year follow-up

BackgroundAllografts and polyetheretherketone (PEEK) cages are the two most commonly used materials in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in two-level ACDF remains controversial. The primary aim of this retrospective study was to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage.MethodsFrom 2010 to 2015, 88 consecutive patients underwent two-level ACDF, of whom 53 received an allograft and 35 patients received a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected before and six months and two years after surgery. Clinical efficacy was evaluated using a visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, the Neck Disability Index, the Neurogenic Symptom Score, and the Japanese Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up.ResultsA preoperative comparison revealed no difference between the two patient groups in terms of age, sex, body mass index, smoking status, preoperative symptoms, operation level, or follow-up (mean = 42.8 months). No differences in the improvements in clinical outcomes were observed between the two groups. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rate for the PEEK cage was 100% at both levels, while the fusion rate for the allograft group was 98.1% at the cephalad level and 94.2% at the caudad level (p > 0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) of segments in the PEEK group and 7.7% (4/52) of segments in the allograft group (p = 0.057). At the caudal level, a higher incidence of cage subsidence was noted in the PEEK group than in the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p = 0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p < 0.05).ConclusionThe use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF than the use of allografts. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

Preoperative Leg Pain Score Predicts Patient Satisfaction After Transforaminal Lumbar Interbody Fusion Surgery.

Study Design:Retrospective cohort study.Objectives:This study aims to determine the preoperative predictors of postoperative satisfaction in transforaminal lumbar interbody fusion (TLIF) surgery in order to improve management of patient groups at high risk of dissatisfaction. We retrospectively reviewed prospectively collected data on patients who underwent open TLIF in a tertiary hospital between 2008 and 2012 with 2-year follow-up and performed multivariate analysis for their preoperative variables.Methods:A multivariate regression analysis was performed for the 217 patients to identify preoperative predictors of postoperative satisfaction. Clinical outcomes were evaluated using Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom Score (NSS), 36-item Short-Form Survey (SF-36; mean Physical and Mental Health scores), numerical pain rating scale (NPRS) for pain, and NASS Questionnaire.Results:Significant improvements were seen in the postoperative ODI, NSS, SF-36, and NPRS scores at 2 years (P < .05). Eighty-six percent of the patients had their expectations of surgery met, and 94.7% of the patients were satisfied with the results of treatment at 2 years. From the multivariate regression model, patients with higher preoperative NPRS pain score (odds ratio = 1.323; 95% confidence interval = 1.071-1.633; P = .009) was more likely to be satisfied at 2 years.Conclusions:TLIF surgery provided significant health-related quality-of-life scores and symptom improvement in terms of SF-36, ODI, NSS, and NPRS, with a high proportion of patients being satisfied with the results of surgery. Patients with higher preoperative NPRS leg pain were more likely to be satisfied at 2 years. Patient-reported satisfaction may be largely influenced by the improvement of radicular leg pain.

Elderly Patients Achieving Clinical and Radiological Outcomes Comparable with Those of Younger Patients Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Study DesignRetrospective analysis of prospective database.PurposeTo compare 2-year clinical and radiological outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) among “middle-age” (50–64.99 years), “young-old” (65–74.99 years), and “old-old” (>75 years) patients.Overview of LiteratureOwing to higher perioperative morbidity and mortality rates, elderly patients with degenerative lumbar conditions are occasionally denied surgical care, even after conservative treatment failure. MIS-TLIF advantages include reduced blood loss, reduced analgesia requirements, early mobilization, and shorter hospital stays.MethodsBetween 2007 and 2012, 22 patients (age >75 years) treated with 1-2 level MIS-TLIF were matched with “young-old” and “middle-age” patients (22 each) based on race, body mass index (BMI), diagnosis, spinal level, number of spinal levels operated upon, and bone graft type. Clinical outcomes included the Oswestry disability index (ODI), neurogenic symptom score (NSS), 36-item short form health survey (SF-36), and visual analogue scale (VAS) for back and leg pain. Radiological assessment included plain radiographs and preoperative magnetic resonance imaging (MRI) and plain radiographs at 1, 3, 6, and 24 months postoperatively. Fusion grade, loosening, cage migration, and adjacent segment degeneration were assessed.ResultsThe groups had similar fluoroscopy time, operation duration, and postoperative analgesia type used. “Old-old” patients took longer to ambulate (1.6 days) and had longer hospital stays (6 days). All patients showed significant improvement in clinical outcome scores at all time-points compared with the preoperative status. “Middle-age” patients showed better ODI and SF-36 physical function scores than “old-old” patients preoperatively and 2 years post surgery. NSS, VAS (back and leg), and SF-36 mental function scores were similar between groups preoperatively and at every time-point postoperatively. Minimal clinical important differences (63.6%–95.5% at 2 years) were achieved. Grade 1 fusion occurred in a minimum of 80% patients in each group 2 years post surgery. Complication rates were similar. Adjacent segment disease occurred in 2 patients from the “young-old” group, with no significant differences between groups.ConclusionsMIS-TLIF showed comparable results in selected “old-old” patients compared with “young-old” and “middle-age” patients without increased complication risks.

Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis.

Study DesignRetrospective review of prospective registry data.PurposeTo determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis.Overview of LiteratureMIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion.MethodsThe outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates.ResultsOur patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m2. The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (p<0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported.ConclusionsSingle-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.

Associated lumbar scoliosis does not affect outcomes in patients undergoing focal minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) for neurogenic symptoms—a minimum 2-year follow-up study

Background ContextThere is no current literature comparing outcomes of patients with and without lumbar scoliosis having neurologic symptoms undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) technique. PurposeThis study aimed to determine whether associated lumbar scoliosis will result in different clinical, radiological, and operative outcomes in patients undergoing focal MISTLIF for neurogenic symptoms, without specific correction of the scoliosis. Study DesignA retrospective case comparison study from prospectively collected hospital registry data was carried out. Patient SampleTwo hundred and thirty eligible patients were evaluated and divided into two groups: Scoliosis Group (SG; n=57) with Cobb angle >10 degrees on anterioposterior (AP) plain lumbar spine radiographs and Non-Scoliosis Group (NSG; n=173) consisting of the remaining patients. Outcome MeasuresClinical outcomes were assessed using the Oswestry Disability Index, the North American Spine Society (NASS) Neurogenic Symptom Score, the NASS Satisfaction with Surgery Rating, the 36-Item Short-Form Health Survey (SF-36), and the Numerical Pain Rating Scale for back and leg pain. Radiological findings included Cobb angle, fusion, implant failure or loosening, and adjacent segment degeneration (ASD). MethodsBoth groups were compared for demographics, perioperative parameters, complications, clinical, and radiological outcomes. Interobserver agreement (kappa statistics) for measurement of Cobb angle was calculated on all cases of both groups by two authors. Patients were evaluated preoperatively, at 6 months, and 2 years after surgery. ResultsThe average follow-up was 2.88±1.47 years in the SG and 2.71±1.34 years in the NSG (p=.444). Differences in mean age (SG: 62.9±10.9 years and NSG: 57.6±13.1 years), estimated related risk of death (SG: 3.05±2.13 and NSG: 2.41±1.74), and gender (female=SG: 87.7% and NSG: 64.2%) were statistically significant (p<.05), whereas race distribution, body mass index |(BMI), spinal levels operated, number of levels operated, bone morphogenetic protein (BMP)-2 use, and type of bone graft were not. Fluoroscopic time, operative time, blood loss, postoperative opioid usage, time to ambulation, and length of hospitalization were similar (p>.05). Preoperative and postoperative clinical outcomes were similar in both groups (p>.05) except SF-36 physical function score, which was found to be significantly higher in the NSG at final follow-up (p<.05). Clinical outcomes scores improved significantly postoperatively (p<.05), and grade 1 fusion (Bridwell classification) was achieved in 93% in the SG and in 93.6% in the NSG (p=.417). Total complications were 11 (19.29%) in the SG and 21 (12.13%) in the NSG (p=.097). De novo ASD was found in 1 case in the SG and in 14 cases in the NSG (p=.124), with 1 case in the NSG requiring further surgery. ConclusionAssociated mild lumbar scoliosis (Cobb angle <30°) does not result in significantly different perioperative, clinical, and radiological outcomes in patients undergoing focal decompression and MISTLIF for neurogenic symptoms.

Predicting Factors for Patient Reported Satisfaction after Transforaminal Lumbar Interbody Fusion: A Two-Year Follow-Up

Introduction Transforaminal lumbar interbody fusion (TLIF) is an effective treatment of degenerative lumbar spine conditions, to reduce pain and improve function. Understanding predictors of post-operative patient satisfaction is important for better management of patient groups at high risk of dissatisfaction. This study aims to determine the pre-operative predictors of post-operative satisfaction in TLIF surgery. Material and Methods We retrospectively reviewed prospectively collected data on patients who underwent open TLIF for degenerative scoliosis, spondylolisthesis and spinal stenosis from the database of a tertiary hospital between 2008 and 2012 with 2 years follow-up. Clinical outcome was evaluated using Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom Score (NSS), SF-36 (mean Physical and Mental Health scores), numerical pain rating scale (NPRS) for back and leg pain and two questions from NASS Questionnaire: ((1) Has the surgery met the patient's expectations? (2) How would the patient rate the overall results of treatment?). Paired t-test was used to compare the clinical scores pre-operation and post-operatively at 6 months and 2 years. Univariate and multivariate analyses were conducted to determine significant pre-operative predictors of patient satisfaction at 2 years. Results 217 patients underwent TLIF by a single surgeon during the 5-year period. Mean pre-operative age was 61 and BMI was 25.9. 182 and 35 patients underwent primary TLIF and revision TLIF respectively. 140, 68 and 9 patients underwent single-level, two-level and three-level TLIF respectively. Significant improvement was seen in the post-operative ODI ( p &lt; 0.001), NSS ( p &lt; 0.001), SF-36 (mean physical score; p &lt; 0.001 and mean mental health scores; p &lt; 0.001) and NPRS (back pain; p &lt; 0.001 and leg pain; p &lt; 0.001) scores at 2 years follow-up. 86.8% of patients had their expectations of surgery met and 94.7% of patients were satisfied with the results of treatment at 2 years. Possible indicators identified by univariate analysis for post-operative patient satisfaction ( p &lt; 0.2) were pre-operative scores (NPRS leg pain score, SF-36 Physical Function score, mean Physical Health score and ODI). From multivariate regression model, patients with higher pre-operative NPRS pain score (OR, 1.323; 95% CI, 1.071–1.633; p = 0.009) was more likely to be satisfied at 2 years. Conclusion TLIF surgery provided significant health-related quality of life scores and symptoms improvement in terms of SF-36, ODI, NSS and NPRS (both back pain and leg pain). However, patient reported satisfaction is multi-factorial and their post-operative satisfaction may be largely influenced by expectations of surgery being met and improvement of pain. This highlights the importance of managing patients' expectation pre-operatively as a means of improving post-operative patient satisfaction.

Intraoperative reduction does not result in better outcomes in low-grade lumbar spondylolisthesis with neurogenic symptoms after minimally invasive transforaminal lumbar interbody fusion—a 5-year follow-up study

Background ContextIntraoperative reduction of low-grade lumbar spondylolisthesis (LGLS) remains disputed. There is currently no published data comparing midterm outcomes of reduction versus in situ fusion. PurposeThis study aimed to compare mid-term clinical, radiological, and perioperative outcomes for reduction versus in situ fusion in LGLS with neurogenic symptoms. Study Design/SettingA retrospective review of prospectively collected spine registry data in a single institution was carried out. Patient SampleAll patients who underwent minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for LGLS with neurogenic symptoms with a minimum 5-year follow-up comprised the patient sample. Outcome MeasuresSelf-reported measures were Oswestry Disability Index, North American Spine Society Neurogenic Symptom Score, Health Outcomes Survey Short Form-36 score, and Numerical Pain Rating Scale (back and leg pain). Radiological outcomes were fusion grading, adjacent segment degeneration (ASD), and implant failure or loosening. Perioperative outcomes were fluoroscopic time, operative time, intraoperative blood loss, opioid analgesia usage, time to ambulation, duration of hospitalization, and complication rate. Functional outcomes were patient satisfaction rate and rate of return to full function. MethodsA retrospective review was performed on prospectively collected registry data of patients undergoing MIS TLIF for LGLS with neurogenic symptoms, from 2004 to 2009. The operative technique and postoperative protocol were standardized. Two groups were formed based on complete reduction of the spondylolisthesis (reduction group [RG]) or the lack thereof (non-reduction group [NRG]) in the immediate postoperative radiograph. Outcomes at baseline, 6 months, 2 years, and 5 years postsurgery were compared. ResultsThere were 56 patients included (RG=30, NRG=26). The two groups had comparable baseline characteristics: demographics, body mass index, spondylolisthesis etiology, spinal level involved, bone graft and bone morphogenetic protein used, and all self-reported outcome measures. Perioperative outcomes were not significantly different. The early complication rate (RG=3.3%, NRG=19.2%, p=.086) and late complication rate (RG=10%, NRG=23.1%, p=.184) were similar. All patients achieved Bridwell grade 1 fusion from 2 years onward. Adjacent segment degeneration rate at 5 years was similar (RG=10%, NRG=0%, p=NS). Both groups showed significant postoperative improvement in all self-reported measures with no significant differences between the two groups at all follow-up points. Functional outcomes were equivalent. ConclusionsIntraoperative reduction does not improve outcomes in LGLS with neurogenic symptoms after MIS TLIF. Adequate decompression and solid fusion are likely the keys to good mid-term outcomes.

Five-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

Retrospective analysis of prospectively collected data. To compare midterm clinical and radiological outcomes of minimally invasive surgery (MIS) versus open transforaminal lumbar interbody fusion (TLIF). Open TLIF is a proven technique to achieve fusion in symptomatic spinal deformities and instabilities. The possible advantages of MIS TLIF include reduced blood loss, less pain, and shorter hospitalization. To date, there is no published data comparing their midterm outcomes. From 2004-2007, 40 cases of open TLIF were matched paired with 40 cases of MIS TLIF for age, sex, body mass index, and the levels on which the spine was operated. Oswestry Disability Index, neurogenic symptom score, the 36-Item Short Form Health Survey, and visual analogue scale scores for back and leg pain were obtained before surgery, 6 months, 2 years, and 5 years after surgery. Fusion rates were assessed using Bridwell classification. Fluoroscopic time (MIS: 55.2 s, open: 16.4 s, P < 0.001) was longer in MIS cases. Operative time (MIS: 185 min, open: 166 min, P = 0.085) was not significantly longer in MIS cases. MIS had less blood loss (127 mL) versus open (405 mL, P < 0.001) procedures. Morphine use for MIS cases (8.5 mg) was less compared with open (24.2 mg, P = 0.006). Patients who underwent MIS (1.5 d) ambulated earlier than those who underwent open fusion (3 d, P < 0.001). Patients who underwent MIS (3.6 d) had shorter hospitalization than those who underwent open fusion (5.9 d, P < 0.001). Both groups showed significant improvement in Oswestry Disability Index, neurogenic symptom score, back and leg pain, SF-36 scores at 6 months until 5 years with no significant differences between them. Grade 1 fusion was achieved in 97.5% of both groups at 5 years. The overall complication rate was 20% for the open group and 15% for MIS group (P = 0.774), including 4 cases of adjacent segment disease for each group. MIS TLIF is comparable with open TLIF in terms of midterm clinical outcomes and fusion rates with the additional benefits of less initial postoperative pain, less blood loss, earlier rehabilitation, and shorter hospitalization.

The conceptualization and development of a patient-reported neurogenic bladder symptom score

BackgroundThere is no single patient-reported instrument that was developed specifically to assess symptoms and bladder-related consequences for neurogenic bladder dysfunction. The purpose of this study was to identify and consolidate items for a novel measurement tool for this population.MethodsItem generation was based on a literature review of existing instruments, open-ended semistructured interviews with patients, and expert opinion. Judgment-based item reduction was performed by a multidisciplinary expert group. The proposed questionnaire was sent to external experts for review.ResultsEight neurogenic quality of life measures and 29 urinary symptom-specific instruments were identified. From these, 266 relevant items were extracted and used in the creation of the new neurogenic symptom score. Qualitative interviews with 16 adult patients with neurogenic bladder dysfunction as a result of spinal cord injury, multiple sclerosis, or spina bifida were completed. Dominant themes included urinary incontinence, urinary tract infections, urgency, and bladder spasms. Using the literature review and interview data, 25 proposed items were reviewed by 12 external experts, and the questions evaluated based on importance on a scale of 1 (not important) to 5 (very important). Retained question domains had high mean importance ratings of 3.1 to 4.3 and good agreement with answer hierarchy.ConclusionThe proposed neurogenic bladder symptom score is a novel patient-reported outcome measure. Further work is underway to perform a data-based item reduction and to assess the validity and reliability of this instrument.

Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty

Background contextMultilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach. PurposeTo elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study. Study designA prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty. Patient sampleIn total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3–C6 and C3–C7). Outcome measuresSelf-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales. MethodsComparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables. ResultsPosterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group. ConclusionsOur study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.