ODI Scores Research Articles

Percutaneous lumbopelvic fixation is effective in the management of unstable transverse sacral fractures

ObjectivesHistorically, fractures causing lumbopelvic dissociation have been managed with open lumbosacral fusion and instrumentation. Our aim was to evaluate outcomes and complications following surgical management of unstable transverse sacral fractures with percutaneous lumbopelvic fixation. MethodsDesign: Retrospective case series. Setting: Academic Single Center, Level I Trauma Center. Patient Selection Criteria: Patients with lumbopelvic dissociation undergoing surgery. Outcome Measures and Comparisons: Patient demographics, mechanism of injury, ISS, associated injuries, radiographic classification (Roy-Camille), patient-reported outcomes (PROMIS PI, PF, D, and ODI), and complications were collected. Results27 patients were enrolled with an average follow-up of 18.7 ± 17.6 months and age of 54.4 ± 25.1 years. All patients underwent lumbar pedicle screw and iliac screw placement. Sacral laminectomy was performed if the patient had a preoperative neurological deficit. Patients were counseled on instrumentation removal at 6–12 months. 67 % of patients sustained a fall, and 33 % were involved in an MVA. 52 % were Roy-Camille Type 2, and 32 % and 20 % were Types 1 and 3, respectively. The mean EBL was 261 ± 400 ml. 37 % required concurrent sacral laminectomy. There were no intraoperative complications and four postoperative complications, including surgical site infection, rod dislodgment, and deep venous thrombosis. 63 % underwent removal of instrumentation after fracture healing. ODI scores significantly improved from 6 weeks post-op (35.5 ± 4.5) to one-year follow-up (18.3 ± 9.6, p = 0.005), two-year follow-up (20.3 ± 10.0, p = 0.03), and final follow-up (16.4 ± 8.8, p = 0.002). Statistically significant improvements were observed in the PROMIS PI, PF, and D domains (p < 0.05). ConclusionOur study demonstrates that lumbopelvic instrumentation leads to successful management of unstable transverse sacral fractures, with improvement in PRO. The combination of percutaneous instrumentation without arthrodesis did not result in any fracture non-union. Level of evidenceLevel IV

The Research on Spinopelvic Parameters and Clinical Outcomes of Oblique Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion in the Treatment of Complex Degenerative Lumbar Spondylolisthesis

PurposeTo investigate the improvement of spinopelvic parameters and therapeutic efficacy in the treatment of complex degenerative lumbar spondylolisthesis (CDLS) after OLIF and TLIF. MethodsFrom January 2018 to December 2020, 71 patients with CDLS underwent OLIF or TLIF at the same hospital: 31 in the OLIF group and 40 in the TLIF group. The spinopelvic parameters, perioperative data and clinical outcomes were elected and compared between the two groups. ResultsThere were no statistic differences in demographic, perioperative complication rates and preoperative spinopelvic parameters between the two groups. OLIF group showed lower serum C-reactive protein (CRP) in the early postoperative stage, shorter length of stay (LOS), less estimated blood loss (EBL) and larger slippage correction rate (SCR, 88.05 vs 62.37%) (all P＜0.05). There was no significant difference in the VAS and ODI scores before operation and three and six months after surgery, but OLIF group was better in the long-term with VAS and ODI (1.7/13.2vs 2.3/16.5). And it was significantly different in the lumbar lordosis angle (LLA), segmental lordosis angle (SLA), pelvic tilt (PT), sacral slope (SS)( 46.0°/9.3°/18.2°/35.9° vs 40.4°/7.2°/23.9°/31.1°) and sagittal vertical axis (SVA, 21.6 vs 31.7mm) after surgery between OLIF and TLIF groups (all P＜0.05). ConclusionIn the therapy of CDLS, OLIF can better reduce PT, LASD and SVA, and increase LLA and SS, showing advantages over TLIF in improving and maintaining spinopelvic parameters. Although there was no difference in complication rates between OLIF and TLIF, OLIF was more minimally invasive, had less tissue damage, had faster recovery, and had better long-term outcomes.

Preoperative Planning of Lumbar Lordosis for Adult Degenerative Scoliosis Surgery in the Chinese Population

Pelvic incidence minus lumbar lordosis mismatch (PI-LL) is directly related to poor quality of life in adult degenerative scoliosis (ADS) patients. The purpose of the study was to determine the most appropriate postoperative PI-LL value for patients with ADS. The medical records of patients with ADS in our department were retrospectively collected. The data included age, sex, body mass index, age-adjusted Charlson comorbidity index, osteopenia, length of hospital stay, operative duration, estimated blood loss, American Society of Anesthesiologists score, number of fusion levels, lumbar lordosis, sagittal vertical axis, pelvic incidence, PI-LL, Scoliosis Research Society-22 score, Oswestry Disability Index score, and mechanical complications. A total of 316 patients were enrolled. PI-LL, lumbar lordosis, sagittal vertical axis, Scoliosis Research Society-22 score, Oswestry Disability Index score at the time of last follow-up were 20.7 ± 8.5°, 23.4 ± 14.1°, 4.0 ± 2.1cm, 3.7 ± 0.9, and 18.1 ± 5.5, respectively. In terms of mechanical complications, 88 patients (27.8%), 34 patients (10.8%), and 19 patients (6.0%) had proximal junctional kyphosis, distal junctional kyphosis, and implant-related complications, respectively. In the fully adjusted model, compared with 0 grade PI-LL group and++ grade PI-LL group,+ grade PI-LL group had the best clinical outcomes and the fewest mechanical complications. The stability of these conclusions was verified in sensitivity analyses. Optimal PI-LL value should be 10°-20° after corrective surgery in patients with ADS, which is associated with excellent clinical outcomes and lower complication rates. Previous criteria may be at risk of overcorrection, which may lead to proximal junctional kyphosis.

Results of cement-augmented pedicle screw surgery in the treatment of thoracic and lumbar spine collapse in severe osteoporosis patients

Objective: This 2023 study aimed to assess pain relief, functional recovery, and kyphosis correction following pedicle screw surgery with cement augmentation in severe osteoporosis patients with vertebral collapse. Methods: Seventy-one patients underwent surgery and were evaluated for postoperative pain reduction (VAS score), functional improvement (ODI score), vertebral kyphosis angle, pre- and postoperative spinal curvature angles, and complications. Results: The study included 71 participants (13 males, 58 females; mean age 67.6±6.7 years). Trauma sources included falls (47.9%), heavy lifting (17%), and unclear mechanisms (35.2%). Mean hospital stay was 12±6.5 days. Preoperative, postoperative, and 1/6-month VAS scores were 8.7, 2.2, 1.5, 0.9 respectively (p&lt;0.001). ODI scores were 77.6, 52.8, 43.0, 37.9 respectively (p&lt;0.001). Kyphotic angle (vertebral body) decreased from preop 12.9° to postop 9.9°, 1/6 months 10.1° (p&lt;0.001); at surgical site, preop 15.4° to 1/6 months 11.9° (p&lt;0.001). Cement leakage occurred in 36.6% of cases, mostly asymptomatic, with distribution in the disc space (2.8%), blood vessels (8.5%), around vertebral body (12.7%), spinal canal (14.1%), and lungs (2.8%). Conclusion: Pedicle screw fixation with enhanced cement augmentation effectively manages severe osteoporotic vertebral compression fractures, providing significant pain relief, improved postoperative function, and spinal alignment. Symptomatic cement leakage is rare.

Outcome of Posterior Lumbar Interbody Fusion (PLIF) with Cage and Bone Graft in The Treatment of Degenerative Lumbar Spinal Canal Stenosis

Introduction: Posterior lumbar interbody fusion (PLIF) is a reliable treatment option for patients with Lumbar canal stenosis &amp; spondylolisthesis; providing spinal stabilization in a balanced alignment with the disc space height restored and with the neural elements being decompressed mechanically. The titanium cages provided immediate stability to spinal levels, restoration of the disc space and neuro-foraminal area, and an increased surface area leading to successful fusion. Materials and Methods: This prospective study was carried out at the Department of Orthopedic Surgery at DMCH, Dhaka within the defined period. All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using Statistical Package for Social Science. The results were expressed as percentage and mean ± SD and p&lt;0.05 was considered as the level of significant. Result: Mean age of the study population was 51.32±8.29 with a female: male ratio 1.6 :1 where maximum patient was housewife (57.14%). 60.72% patients had only single level involvement while 39.28% patients had multi-level involvement. Mean VAS score reduced significantly at final follow-up (6.55±0.66 to 2.29±0.46 for back pain and 6.59±0.65 to 1.21±0.42 for leg pain. Mean ODI score decreased significantly from 56.71±3.09 to 15.82±3.46 at final follow-up. Radiologically Grade-I fusion achieved in 89.28% cases. Overall functional outcome was excellent (89.29%) &amp; good (7.14%) according to Modified Macnab criteria. Conclusion: Posterior lumbar interbody fusion (PLIF) with cage and bone graft in the treatment of degenerative lumbar spinal canal stenosis provides excellent neurological and functional outcome and fusion rate at final follow-up. Medicine Today 2024, Vol.36 (2): 72-75

Clinical Analysis and Imaging Study of Lateral Lumbar Intervertebral Fusion in the Treatment of Degenerative Lumbar Scoliosis.

As the population ages and technology advances, lateral lumbar intervertebral fusion (LLIF) is gaining popularity for the treatment of degenerative lumbar scoliosis (DLS). This study investigated the feasibility, minimally invasive concept, and benefits of LLIF for the treatment of DLS by observing and assessing the clinical efficacy, imaging changes, and complications following the procedure. A retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36-Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line-C7 plumbline [CSVL-C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow-up were compared to their preoperative results. Compared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL-C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow-up (p < 0.001). There was no significant change in PI at either the postoperative or follow-up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF-36 scores improved considerably at postoperative and final follow-up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL-C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow-up (p < 0.001). PI showed no significant change at either the postoperative or follow-up timepoints. Lateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery.

Clinical effect and prognosis of transoral or endoscope-assisted transoral release for irreducible atlantoaxial dislocation: A retrospective cohort study

BackgroundThe clinical applications of endoscope-assisted transoral release for irreducible atlantoaxial dislocations are limited. This study aimed to investigate the clinical effect and prognostic factors of traditional and endoscope-assisted transoral release, as well as posterior reduction and fixation, in treating irreducible atlantoaxial dislocations. Materials and methodsWe conducted a retrospective study on 59 patients with irreducible atlantoaxial dislocation who underwent either traditional or endoscope-assisted transoral release, posterior fixation, and fusion between January 2018 and January 2023. Various data, including surgical time, blood loss, drainage volume, oral intake, hospital stay, complications, and neurological status (assessed by the Japanese Orthopedic Association [JOA] score and Oswestry Disability Index [ODI]), were recorded. Imaging parameters such as the atlantodontoid interval (ADI), space available for the cord (SAC), and cervicomedullary angle (CMA) were analyzed and compared. In addition, the correlation between ODI, JOA and patient age, course of disease, preoperative ADI, SAC and CMA were analyzed. ResultsNo significant differences were observed in age, sex, BMI, preoperative ADI, preoperative SAC, or preoperative CMA. All patients achieved excellent reduction with no significant differences between the two groups. Patients in the endoscopic group experienced significantly reduced blood loss, earlier oral intake, and shorter hospital stays compared to those in the open group (P < 0.05). The ODI and JOA scores improved significantly in both groups at 1, 6, 12, 18, and 24 months postoperatively (P < 0.05). Postoperative ADI, SAC, and CMA values in both groups were significantly better than preoperative values (P < 0.001). The patient age, course of disease and the preoperative ADI were negatively correlated with the postoperative ODI and the JOA improvement ratio (P < 0.01), and the preoperative SAC and preoperative CMA had positive correlations with the postoperative ODI and the JOA improvement ratio (P < 0.01) at 6, 12 and 24 months postoperatively. ConclusionPatient age, course of disease, preoperative ADI, SAC and CMA are correlated with the operative prognosis of irreducible atlantoaxial dislocation. The endoscope-assisted transoral approach, compared to the traditional transoral approach, is minimally invasive, resulting in less operative blood loss, earlier oral intake and a shorter length of hospital stay, which could be offered as an alternative for irreducible atlantoaxial dislocation.

Chiropractic rehabilitation in accelerated rehabilitation after total hip arthroplasty for Crowe type IV hip dysplasia.

To investigate the efficacy of chiropractic rehabilitation therapy in Crowe IV developmental dysplasia of the hip (DDH) patients after total hip arthroplasty. Seventy-two patients with Crowe IV type DDH hospitalized in the Department of Orthopedics I of Ya'an Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were selected for the study, and they were divided into 36 cases in the chiropractic rehabilitation therapy group (the treatment group) and 36 cases in the traditional rehabilitation therapy group (the control group) according to the method of randomized grouping. All patients were evaluated at preoperative, 1, 3, and 6 months postoperatively for follow-up, and the muscle strength of the affected limb, the patient's walking gait, the shortened length of the affected limb, the visual analog scale score (VAS score), the Oswestry Dysfunction Index Score (ODI score), the Harris Hip Score, and the degree of pelvic tilt were recorded to evaluate the results of the study. A total of 4 subjects withdrew from the study, 2 in the treatment group, and 2 in the control group. The muscle strength of the affected limb, walking gait, shortened length of the affected limb, VAS score, ODI score, Harris score, and pelvic tilt in the treatment and control groups improved significantly compared with the preoperative period. Comparisons between the 2 groups revealed that at the final follow-up visit, the limp gait of the patients in the treatment group was significantly reduced, the shortened length of the affected limb was significantly reduced, the VAS score was significantly reduced, and the ODI score was significantly reduced, in the treatment group relative to that of the control group, Harris Hip Score was significantly improved, and the degree of pelvic tilt was significantly reduced, but the improvement in muscle strength of the affected limb was not statistically significant. In future clinical practice, we recommend that chiropractic rehabilitation be used as a routine adjunctive treatment after TKA in patients with Crowe IV DDH to optimize outcomes and improve patients' quality of life.

Effects of a Mat Pilates Exercise Program Associated with Photobiomodulation Therapy in Patients with Chronic Nonspecific Low Back Pain: A Randomized, Double-Blind, Sham-Controlled Trial.

To investigate the effects of combining a Pilates program with photobiomodulation therapy (PBMT) in patients with chronic nonspecific low back pain (CNLBP). Thirty-eight adults with CNLBP were randomly assigned to two groups: Pilates exercise + active PBMT (PIL + PBMT) or Pilates exercise + sham PBMT (PIL + SHAM). Both groups performed an 8-week mat Pilates program and received PBMT on their lumbar muscles 10 min before and after each session. The following variables were assessed before and after intervention: peak pain intensity, postural balance (i.e., center of the pressure [A-COP], velocity anteroposterior [Vel AP], and velocity mediolateral [Vel ML]), perceived disability (i.e., Oswestry Disability Index [ODI] and Roland Morris Disability Questionnaire [RMDQ]), and pain-related fear of movement (i.e., Tampa Scale of Kinesiophobia [TSK], Fear Avoidance Beliefs Questionnaire [FABQ], and Pain Catastrophizing Scale [PCS]). Postural balance variables showed no statistically significant differences (p > 0.05) across time or between groups. The groups showed similar (p < 0.05) reductions in peak pain intensity, ODI, RMDQ, and PCS scores, but no statistically significant difference (p > 0.05) in TSK and FABQ scores. The mat Pilates program reduced peak pain intensity, perceived disability, and pain catastrophizing in adults with CNLBP, but PBMT had no additional effect on these variables. Mat Pilates alone or combined with PBMT was not able to improve postural balance.

Enhancing treatment of lumbar disc herniation with Erxian decoction and auricular acupoint pressure: A randomized controlled trial.

The incidence of lumbar disc herniation (LDH) is on the rise annually, with an emerging trend of affecting younger age groups. This study aims to investigate the clinical effectiveness of combining Erxian decoction with auricular acupoint pressure therapy in treating LDH. Our objective is to furnish evidence supporting the incorporation of traditional Chinese medicine (TCM) rehabilitation techniques in clinical settings. This randomized controlled trial enrolled 102 patients diagnosed with LDH and allocated them into Control and Intervention groups. The Control group underwent a 2-week rehabilitation regimen, whereas the Intervention group received an augmented treatment comprising Erxian decoction along with auricular acupoint pressure therapy based on the Control group. Main outcome measures included 3 scales - visual analog scale (VAS), Japanese Orthopedic Association (JOA), and Oswestry Disability Index - as well as 3 inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Additionally, pressure pain threshold and pain tolerance threshold values were evaluated. Participants were assessed at baseline, on 14-day, and on 28-day posttreatment. After 2 weeks of treatment, both the Control and Intervention groups exhibited significant improvements in the VAS, JOA, ODI, CRP, IL-6, TNF-α, pressure pain threshold, and pain tolerance threshold (P < .05). These improvements persisted at the 28-day in the VAS, JOA, and ODI scores (P < .05). On 14-day, the Intervention group showed significantly better outcomes compared to the Control group in terms of the VAS, JOA, ODI, CRP, TNF-α, and pressure pain threshold (P < .05). Compared to conventional rehabilitation therapy, the combination of Erxian decoction and auricular acupoint pressure therapy demonstrates clear benefits in alleviating symptoms in patients with LDH. This approach offers fresh perspectives and substantiates evidence for future treatment strategies in managing LDH.

Comparative analysis of different treatment strategies for septic spondylitis: a retrospective study of one hundred and twelve patients.

To compare the clinical efficacy and prognosis differences between conservative treatment and surgical treatment in patients with non-serious neurologically intact pyogenic spondylitis (Nsi-Nsni-PS), and to provide theoretical reference for the clinical treatment of Nsi-Nsni-PS patients. A retrospective analysis was conducted on 112 cases of Nsi-Nsni-PS patients treated in our hospital from June 2016 to June 2021. According to different treatment methods, they were divided into conservative treatment group (53 cases) and surgical treatment group (59 cases). The general data, laboratory tests, imaging examinations, length of hospital stay, duration of antibiotic use, VAS for pain before and after treatment, ODI, local kyphotic angle correction of diseased vertebrae, and recurrence rate were collected and analyzed in both groups. SPSS 26.0 statistical software was used for analysis. Measurement data were expressed as mean ± standard deviation, and independent sample t-test or rank sum test was used for comparison between groups, while variance analysis was used for intra-group comparison. Count data were expressed as number (%) and compared between groups using chi-square test or Fisher's exact test. Mann-Whitney U test was used to evaluate the changes in local kyphotic angle between the two groups. A p value < 0.05 was considered statistically significant. There were no significant differences in general data and imaging characteristics between the two groups (P > 0.05); there were no statistically significant differences in the positive culture rate of pathogens, length of hospital stay, duration of antibiotic use, treatment complications, WBC, CRP, ESR levels at admission and discharge, VAS and ODI at admission and last follow-up between the two groups (P > 0.05). The WBC and CRP levels of patients in the conservative group at discharge were lower than those in the surgical group (P < 0.05), and there was no significant difference in the decrease in inflammatory indicators (WBC, CRP, ESR) between the two groups (P > 0.05). By the last follow-up, the neurological function of patients in both groups had significantly improved compared to admission (P < 0.05), with 12 out of 15 ASIA grade D patients in the conservative group recovering to grade E, and 21 out of 25 grade D patients in the surgical group recovering to grade E, with no worsening of neurological function in either group. The differences in VAS and ODI scores at the last follow-up compared to before treatment were statistically significant in both groups (P < 0.05), and all patients regained normal activity. Compared with before treatment, the correction degree of local kyphotic angle in the surgical group at the last follow-up was 0.93 ± 4.94°, slightly higher than that in the conservative group (-0.83 ± 3.37°), and the difference was statistically significant(P < 0.05). During our follow-up, we found that both conservative and surgical treatments achieved satisfactory clinical outcomes in patients with Nsi-Nsni-PS. Compared to conservative treatment, surgical intervention did not demonstrate significant advantages in reducing hospitalization time and antibiotic usage duration, increasing pathogen culture positivity rate, lowering treatment complications, or controlling recurrence. However, surgical intervention showed superiority in correcting the local kyphotic angle of spinal lesions, albeit with relatively increased surgical trauma, risks, and treatment costs. At the last follow-up, the surgical group did not exhibit better long-term efficacy. Therefore, when formulating clinical treatment strategies for patients with Nsi-Nsni-PS, it may be preferable to prioritize conservative treatment, supplemented by the use of sensitive or empiric antibiotics for infection management, to improve patient prognosis.

Endoscopic Transforaminal versus Interlaminar Discectomy in Management of Lumbar Disc Herniation: A Systematic Review of Outcomes and Complications

Abstract Background Lumbar herniated discs are common manifestations of degenerative spine diseases, being the main cause of radiated lower back pain. Aim of the Work The aim of this study is to compare between the transforaminal approach and the interlaminar approach in the incidence of complications and clinical prognosis scores in patients with lumbar disc herniation. Patients and Methods Literature searches was conducted using the following databases:” PubMed, Web of Science, ScienceDirect, Scopus, Cochrane Library, Google Scholar, Medline” using the following key words: “percutaneous transforaminal endoscopic discectomy, percutaneous interlaminar endoscopic discectomy, operative complications, minimally invasive, discectomy, endoscopic” from studies published after 2010. Results Although there is no significant difference between the two groups of comparison regarding percentage of postoperative complications, VAS scores, or ODI scores, However, PEID was superior to PETD regarding fluoroscopy times and operative time. The increased radiation exposure might be caused by the higher iliac crest, narrower foramina, or larger facet joints, which increased the difficulty of percutaneous puncture. Repeated fluoroscopy must be used to guide the puncture. In addition, the hypertrophy of ligamenta flava might also contribute to the difficulty of puncture and further increase radiation exposure in the PETD group. Conclusion This review provides evidence that both PEID and PETD are safe, effective, and minimally invasive surgical methods for the treatment of lumbar disc herniation, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed.

Does Early Treatment With Teriparatide Prevent the Need for Surgical Intervention in Osteoporotic Vertebral Compression Fractures.

Retrospective Cohort Study. The primary objective of this study is to evaluate the efficacy of early administration of Teriparatide in preventing the necessity of surgical intervention in individuals with osteoporotic vertebral compression fractures. In a 24-month follow-up retrospective analysis, 191 OVCF patients from January 2016 to October 2020 were randomly assigned to Non teriparatide Group A (n = 104) or Group B teriparatide (n = 87). At baseline, 6months, 1year, and 2years following treatment, demographic data and need of surgical intervention, VAS, ODI, union rates, and kyphosis development, were examined. Our study found that non-teriparatide group individuals had an 11.53% higher risk of non-union formation that required surgery. Only 8.63% of teriparatide group patients needed surgery. Both groups had significant VAS score reductions. Non-teriparatide group scores declined from 8.38 ± 0.74 to 3.15 ± 1.40, while teriparatide group scores decreased from 8.49 ± 0.73 to 1.11 ± 0.31. The 2-year follow-up ODI scores significantly decreased, with values of 25.02 ± 13.94 for non-teriparatide patients and 15.11 ± 2.17 for teriparatide patients. The kyphosis progression angles in the teriparatide group were considerably lower (4.97 ± 0.78°) compared to the other group (8.09 ± 1.25°). With increasing elderly populations, it is necessary to take measures to prevent surgical intervention in osteoporotic spinal compression fractures. Teriparatide can be employed as an early medication in the management of these fractures to avert non-union and the minimise the progression of kyphosis.

Defining Age-Adjusted PI-LL Targets for Surgical Realignment in Adult Degenerative Scoliosis: A Retrospective Cohort Study.

Objectives: The purpose of this study was to investigate postoperative pelvic incidence minus lumbar lordosis mismatch (PI-LL) and health-related quality of life (HRQOL) outcomes to determine age-adjusted PI-LL targets. Method: The dataset encompassed a range of variables, including age, sex, body mass index, Charlson comorbidity index, presence of osteopenia, hospital stay, operative duration, blood loss, American Society of Anesthesiologists score, number of fusion levels, lumbar lordosis, sagittal vertical axis, pelvic incidence, and PI-LL. The non-linear relationship between PI-LL and clinical outcomes was examined using a curve analysis, with adjustments made for potential confounding variables. Upon identification of a non-linear relationship, a two-piecewise regression model was employed to determine the threshold effect. Results: A total of 280 patients were enrolled. In the fully adjusted model, the optimal PI-LL target for patients aged 45-54 years old was PI-LL < 10°, the optimal target for patients aged 55-74 was 10-20°, and the optimal target for patients older than 75 years was more suitable for PI-LL > 20°. In the curve-fitting graph, it could be seen that the relationship between PI-LL and HRQOL outcomes was not linear in each age group. The peaks of the curves within each group occurred at different locations. Higher and lower thresholds for optimal surgical goals were determined using the two-piecewise regression model from the SRS-22 score and the ODI score. Conclusions: This study showed that the optimal PI-LL after corrective surgery in adult degenerative scoliosis patients should be adjusted according to age.

New Axially Expandable Oblique Cage Designed for Anterior to Psoas (ATP) Approach: Indications-Surgical Technique and Clinical-Radiological Outcomes in Patients with Symptomatic Degenerative Disc Disease.

Background: Standard oblique cages cannot cover endplates side-to-side, which is an important biomechanical factor for reducing the risk of cage subsidence and for restoring correct segmental lordosis. The aim of this study is to evaluate the radiological and clinical results of a new oblique lumbar interbody fusion (OLIF) axially expandable cage. Methods: This is a prospective observational case-control study. From March 2018 to June 2020, 28 consecutive patients with lumbar degenerative disease underwent an ATP approach, with the insertion of a new axially expandable cage, which was used as a stand-alone procedure or followed by posterior percutaneous pedicle fixation. Results: Twenty-eight patients in both groups met the inclusion criteria. The mean follow-up time was 31.2 months (range of 13-37). The clinical results were not significantly different, although in the control group, two major intraoperative complications were recorded, and slight improvements in ODI and SF-36 scores were observed in the study group. The radiological results showed a less frequent incidence of subsidence and a higher rate of fusion in the study group compared to controls. Conclusions: The axially expandable oblique cage for lumbar inter body fusion, specifically designed for the ATP approach, represents an innovation and a technical improvement. The insertion and the axial expansion technique are safe and easy. The large footprint could obtain solid and effective arthrodesis, potentially reducing the risk of subsidence.

The Impact of Outpatient Physical Therapy on Patient-Reported Outcomes After Lumbar Fusion: Perspective from A Bundled Care Dataset

As value-based care grows in popularity across the United States, more payers have turned toward bundled payment models for surgical procedures. Though episode costs in spine are highly variable, physical therapy (PT) has been identified as a driver of 90-day cost. The goal of this study is to assess the impact of postoperative PT on patient-reported outcomes and cost after lumbar fusion surgery using bundled insurance data. Bundled payment information of lumbar fusion episodes-of-care (EOC) from 2019 to 2021 was reviewed at a single, urban, tertiary care center. EOC comprised a 210-day period surrounding the date of the procedure, beginning 30 days preoperatively and ending 180 days postoperatively. Patients were grouped into physical therapy (PT) and no physical therapy (no PT) groups based on the presence of PT claims. Bivariate analysis of surgical outcomes revealed similar overall complication rates (P= 0.413), 30-day readmissions (P= 0.366), and 90-day readmissions (P= 0.774). Patients who did not participate in postoperative PT had significantly better preoperative physical component score (PCS) (P= 0.003), 6-month postoperative PCS (P= 0.001), and 6-month ΔPCS (P= 0.026) compared with patients who participated in postoperative PT. At 1-year follow-up, patients who did not participate in PT had less leg pain (P= 0.041) than those who did participate in PT. Our study finds that PT after lumbar fusion is not associated with significant improvement in Oswestry Disability Index, PCS, mental component score, or visual analog scale pain scores. Additionally, the number of PT sessions a patient attends has no correlation with improvement in these outcomes.

A new technique for low back pain in lumbar disc herniation: percutaneous endoscopic lumbar discectomy combined with sinuvertebral nerve ablation

BackgroundPercutaneous endoscopic lumbar discectomy (PELD) has demonstrated efficacy in alleviating leg pain among patients with lumbar disc herniation. Nonetheless, residual back pain persists as a troubling issue for surgeons following the procedure. In the treatment of discogenic back pain, sinuvertebral nerve radiofrequency ablation has shown promising results. Nevertheless, the potential benefit of simultaneously implementing sinuvertebral nerve radiofrequency ablation during PELD surgery to address residual back pain has not been thoroughly investigated in current literature.MethodsThis retrospective study reviewed Lumbar disc herniation (LDH) patients with low back pain who underwent combined PELD and sinuvertebral nerve ablation in our department between January 2021 and September 2023. Residual low back pain post-surgery was assessed and compared with existing literature.ResultsA total of 80 patients, including 53 males and 27 females, were included in the study. Following surgical intervention, patients demonstrated remarkable improvements in pain and functional parameters. One month post-operatively, the VAS score for low back pain exhibited a 75% reduction (6.45 ± 1.3 to 1.61 ± 1.67), while the VAS score for leg pain decreased by 85% (7.89 ± 1.15 to 1.18 ± 1.26). Notably, the JOA score increased from 12.89 ± 5.48 to 25.35 ± 4.96, and the ODI score decreased form 59.48 ± 9.58 to 20.3 ± 5.37. These improvements were sustained at three months post-operatively. According to the modified Mac Nab criteria, the excellent and good rate was 88.75%. Residual low back pain is observed to be comparatively reduced compared to the findings documented in earlier literature.ConclusionThe combination of percutaneous endoscopic lumbar discectomy and sinuvertebral nerve ablation demonstrates effective improvement in low back pain for LDH patients.

Does obesity and varying body mass index affect the clinical outcomes and safety of biportal endoscopic lumbar decompression? A comparative cohort study

BackgroundEndoscopic spine surgery has recently grown in popularity due to the potential benefits of reduced pain and faster recovery time as compared to open surgery. Biportal spinal endoscopy has been successfully applied to lumbar disc herniations and lumbar spinal stenosis. Obesity is associated with increased risk of complications in spine surgery. Few prior studies have investigated the impact of obesity and associated medical comorbidities with biportal spinal endoscopy.MethodsThis study was a prospectively collected, retrospectively analyzed comparative cohort design. Patients were divided into cohorts of normal body weight (Bone Mass Index (BMI)18.0–24.9), overweight (BMI 25.0–29.9) and obese (BMI > 30.0) as defined by the World Health Organization (WHO). Patients underwent biportal spinal endoscopy by a single surgeon at a single institution for treatment of lumbar disc herniations and lumbar spinal stenosis. Demographic data, surgical complications, and patient-reported outcomes were analyzed. Statistics were calculated amongst treatment groups using analysis of variance and chi square where appropriate. Statistical significance was determined as p < 0.05.ResultsEighty-four patients were followed. 26 (30.1%) were normal BMI, 35 (41.7%) were overweight and 23 (27.4%) were obese. Patients with increasing BMI had correspondingly greater American Society of Anesthesiologist (ASA) scores. There were no significant differences in VAS Back, VAS Leg, and ODI scores, or postoperative complications among the cohorts. There were no cases of surgical site infections in the cohort. All cohorts demonstrated significant improvement up to 1 year postoperatively.ConclusionsThis study demonstrates that obesity is not a risk factor for increased perioperative complications with biportal spinal endoscopy and has similar clinical outcomes and safety profile as compared to patients with normal BMI. Biportal spinal endoscopy is a promising alternative to traditional techniques to treat common lumbar pathology.

How much improvement in Oswestry Disability Index is Necessary to make your Patient Satisfied after Lumbar Surgery?

Retrospective review of cohort studies. To clarify the necessary ODI improvement for patient satisfaction two years after lumbar surgery. Evaluating elective lumbar surgery care often involves patient-reported outcomes (PRO). While postoperative functional improvement measured by ODI is theoretically linked to satisfaction, conflicting evidence exists regarding this association. Baseline ODI and 2-year postoperative ODI were assessed. Patient satisfaction, measured on a scale from 1 to 5, with scores ≥4 considered satisfactory, was evaluated. Patients with incomplete follow-up were excluded. Statistical analyses included Mann-Whitney-U and multivariable logistic regression adjusted for age, sex, and BMI. Receiver operating characteristic (ROC) analysis determined threshold values for ODI improvement and postoperative target ODI indicative of patient satisfaction. 383 patients were included (mean age 65±10y, 57% female). ODI improvement was observed in 91% of patients, with 77% reporting satisfaction scores ≥4. Baseline ODI (median 62, IQR 46-74) improved to a median of 10 (IQR 1-10) 2 years postoperatively. Baseline (OR 0.98, P=0.015) and postoperative ODI scores (OR 0.93, P<0.001), as well as the difference between them (OR 1.04, P< 0.001), were significantly associated with patient satisfaction. Improvement of ≥38 ODI points or a relative change of ≥66% was indicative for patient satisfaction, with higher sensitivity (80%) and specificity (82%) for the relative change versus the absolute change (69%, 68%). With a sensitivity of 85% and a specificity of 77%, a postoperative target ODI of ≤24 indicated patient satisfaction. Lower baseline ODI and greater improvements in postoperative ODI are associated with an increased likelihood of patient satisfaction. A relative improvement of ≥66% or achieving a postoperative ODI score of ≤24 were the most indicative thresholds for predicting patient satisfaction, proving more sensitivity and specificity than an absolute change of ≥38 points.

Expression of cytokines at baseline correlate/predict in the disc the outcome of surgery after disc degeneration: A 12-month follow-up study.

Low back pain (LBP) is a highly prevalent condition that comprise a large portion of outpatient practice, challenging the diagnosis and treatment. However, the diagnostic tools are limited to clinical history, physical examination and imaging. Degenerative disc disease (DDD) is a significant cause of LBP, and emerging literature confirms the elevated levels of biomarkers in the discs. These biomarkers may serve as a tool for diagnosis, but may also be useful in predicting the treatment outcome. Here, we examine the expression of various cytokines on 1-year recovery from patients with LBP. Patient-reported outcome (PRO) in terms of pain intensity (VAS), disability (ODI), and quality of life (Eq-5D) is collected from 44 patients at baseline and 12 months after surgery to study the influence of baseline TNF-α, IL-1β, and IL-6 mRNA expression in both annulus fibrosus (AF) and nucleus pulposus (NP). Between baseline and follow-up, our cohort showed improvement in VAS back pain (p < 0.001), VAS leg pain (p < 0.001), ODI (p = 0.02), and Eq-5D (p = 0.01). Baseline levels of IL-1 β was positively correlated with VAS back pain scores in AF (p = 0.05) and NP (p = 0.01) at 1-year follow-up. TNF-α expression at baseline was also positively correlated to ODI scores (p = 0.01) at follow-up and inversely correlated to improvements in ODI score between baseline and follow-up, suggesting that high TNF-α expression at baseline is associated with poor outcomes from surgery. The results from our study support that TNF-α expression at baseline can serve as a very important predictor of treatment response from lumbar fusion surgery.