Orthopaedic Association Back Pain Evaluation Research Articles

Assessing the Impact of Preoperative MRI-Based Vertebral Bone Quality Scores on 5-Year Prognosis in Lumbar Spine Surgery.

Retrospective cohort study. To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the 5-year clinical outcomes following lumbar spine surgery. Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking. A total of 189 patients who underwent lumbar surgery (≤3-disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75 to 3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and 1, 2, and 5 years postoperatively. Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain (P=0.013), walking ability (P=0.005), social life function (P=0.010) of JOABPEQ, and physical component summary of the SF-36 (P=0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse 5-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score. A high preoperative VBQ score is a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and healthcare costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes. 3.

Impact of Osteoporosis on Short-Term Surgical Outcomes in Lumbar Degenerative Disease Patients Undergoing Lateral Lumbar Interbody Fusion: A Retrospective Analysis

This retrospective study assesses the influence of osteoporosis on the short-term clinical outcomes of lateral lumbar interbody fusion (LLIF) surgery in patients with lumbar degenerative diseases (LDD), focusing on complications, pain intensity, and quality of life improvements. The primary aim of this study is to investigate the impact of osteoporosis on the short-term clinical outcomes following LLIF surgery in LDD patients, with a particular focus on the incidence of cage subsidence (CS) and overall patient well-being postoperatively. A retrospective review was conducted on 73 patients who underwent LLIF for LDD. Patients were categorized into two groups based on osteoporosis status determined by dual-energy X-ray absorptiometry (DXA) scans: those with osteoporosis (n=20) and those without osteoporosis (n=53). Data collection included demographics, surgical details, complications, magnetic resonance imaging (MRI) analysis, pain intensity, and quality of life (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: JOABPEQ). The groups had no significant differences regarding operative time, estimated blood loss, and hospital stay duration. However, the incidence of CS was 40% in patients with osteoporosis, compared to 17% in non-osteoporotic patients. Despite this, significant improvements in spinal canal dimensions were observed in both groups. Both groups experienced significant reductions in pain intensity, with notable improvements in functional outcomes assessed by JOABPEQ, indicating the overall effectiveness of LLIF in enhancing patient well-being and functionality, irrespective of osteoporosis status. Osteoporosis increases the risk of CS in LLIF surgery for LDD patients but does not affect short-term pain relief and quality of life improvements.

Value of Spinal Infection Treatment Evaluation Score, Pola Classification, and Brighton Spondylodiscitis Score from Decision to Surgery in Patients with Spondylodiscitis: A Receiver-Operating Characteristic Curve Analysis.

This was a retrospective study. This study aimed to assess the value of the Spinal Infection Treatment Evaluation (SITE) score, Brighton Spondylodiscitis Score (BSDS), and Pola classification to predict the need for surgical intervention in patients with spondylodiscitis. Spondylodiscitis is a rare disease, and the prediction of its outcome is crucial in the decision-making process. All case records were assessed to extract information on the American Spinal Injury Association (ASIA), Visual Analog Scale (VAS), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores before and after surgery. The SITE score, Pola classification, and BSDS were recorded. The receiver-operating characteristic (ROC) curve analysis and the area under the curve (AUC) were applied to estimate the predictive ability of the scoring systems. Patients' satisfaction with surgery outcomes was evaluated using the VAS, ASIA, JOABPEQ, and Likert scale for quality-of-life evaluation. In all 148 patients, case records were reviewed. The mean±standard deviation age of the patients was 54.6±14.7 years. Of these, 112 patients underwent surgery. The AUC scores were 0.86, 0.81, and 0.73 for the SITE score, BSDS, and Pola classification, respectively. In the comparison of the AUC of ROC curves, SITE score vs. BSDS showed a significantly greater AUC, 0.13 (Z =2.1, p =0.037); SITE score vs. Pola classification, 0.05 (Z =0.82, p =0.412); and Pola classification vs. BSDS, 0.08 (Z =1.22, p =0.219). The optimal cutoff score was 8.5 (sensitivity, 80.6%; specificity, 81.2%) for the SITE score and 9.5 (sensitivity, 52.8%; specificity, 83.0%) for the BSDS in the decision to surgery. VAS back pain and JOABPEQ subscales showed a significant difference when compared with preoperative scores. According to ASIA grading, none of the patients experienced neurological deterioration. Overall, patients' satisfaction was observed. The findings suggest that the SITE score is a useful measure and helps clinicians make clinically sound decisions in patients with spondylodiscitis.

Recovery of the Japanese orthopedic association back pain evaluation questionnaire score and walking ability following lumbar spinal stenosis surgery.

We investigated the recovery of the Japanese orthopedic association back pain evaluation questionnaire (JOABPEQ) scores and 6min walk distance (6MWD) in patients after surgery for lumbar spinal stenosis and identified the items among 25 questions of JOABPEQ that showed recovery. A total of 227 patients (average age 71.5years; SD: 7.5; 121 men) were included from a single center. The outcome measures were JOABPEQ, visual analog scale (VAS), and 6MWD and obtained preoperatively and at 1, 3, 6, and 12months postoperatively. Mixed-model repeated measures were used to compare the variables at each time point between the surgery groups. The JOABPEQ, VAS, and 6MWD scores generally improved at 1month postoperatively compared with those obtained preoperatively, and some parameters further improved at 3months. However, improvement in the lumbar spine dysfunction item of JOABPEQ was delayed, showing improvement at 3months postoperatively for decompression surgery (average score: pre, 64.6; 3months, 78.5) and 6months postoperatively for fusion surgery (average score: Pre, 64.3; 6months, 77.1). Responses to the individual JOABPEQ questions generally improved after surgery. No significant changes in lumbar spine dysfunction occurred in the fusion group. Our results demonstrated the early postoperative recovery course of JOABPEQ and 6MWD. In the fusion group, significant changes in lumbar spine dysfunction started at 6months postoperatively. These findings could help medical staff explain postoperative recovery to patients after lumbar spinal stenosis surgery and in their decision making regarding surgery.

The efficacy of silver needle therapy for treating low back pain: a protocol for meta-analysis of randomized controlled trials.

As population aging and unhealthy living habits may exacerbate the prevalence and burden of low back pain (LBP), effective treatment and improvement of patient quality of life are particularly critical. Silver needle therapy (SNT), having evolved from traditional acupuncture, involves placing silver needles into muscles, tendons, and fascia for treatment. However, it still lacks robust clinical evidence to substantiate its effectiveness. Therefore, it is necessary to conduct more emphasis on meta-analysis to evaluate the clinical efficacy of SNT for treating LBP. We will search PubMed, Medline, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Databases up until December 2023 to identify randomized controlled trials of SNT treatment in adult patients with LBP. The primary outcome will be the intensity of pain after pain management. Secondary outcomes will include the Oswestry Disability Index, Japanese Orthopedic Association Back Pain Evaluation Questionnaire, requirement for analgesic drugs, and treatment-related adverse reactions. Two investigators conducted the literature search, selected studies that might meet the inclusion criteria based on the title and abstract, and extracted data from the eligible literature independently and will independently assess the risk of bias using the Revised Cochrane Risk-of-Bias (RoB2) tool. Multivariate analyses (including subgroup analysis, trial sequential analysis (TSA), sensitivity analysis, etc.) will be conducted to improve the quality of evidence. Registration: PROSPERO Registration Number: CRD42023466207, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023466207.

Quantifying Satisfaction of Degenerative Lumbar Spinal Stenosis Patients in Post-Lateral Lumbar Interbody Fusion Surgery: Establishing Critical JOABPEQ Cutoff Scores.

This retrospective study aimed to determine the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) cutoff scores for assessing patient satisfaction post-lateral lumbar interbody fusion (LLIF) in degenerative lumbar spinal stenosis (DLSS) patients. Analyzing 136 DLSS patients (83 males, 53 females), the study evaluated demographics, pain (Numeric Rating Scale), and JOABPEQ outcomes (low back pain, lumbar function, walking ability, social life, mental health). Patient satisfaction was surveyed, and based on their responses, patients were categorized into "Beneficial" and "Non-Beneficial" groups. Statistical analysis encompassed the Kolmogorov-Smirnov test, t-tests, Mann-Whitney U test, and Receiver Operating Characteristic (ROC) curve analysis for JOABPEQ cutoff determination. Postoperative improvements in JOABPEQ scores, especially in walking ability, social life function, and mental health, were significant. Pain intensity, assessed using the Numeric Rating Scale, also showed notable reductions. The Δwalking ability cutoff was set at 25.00, indicating substantial mobility improvement. This domain's area under the curve (AUC) was 0.815 (95% CI: 0.726-0.903), demonstrating high effectiveness in assessing patient satisfaction post-surgery. The study also found no significant differences in complication rates between groups for conditions like transient motor weakness, thigh pain/numbness, and revision surgery. This study underscores the value of patient-centered outcomes in evaluating LLIF surgery success for DLSS. The identified JOABPEQ cutoff values provide a quantitative tool for assessing patient satisfaction, emphasizing the necessity of comprehensive postoperative evaluations beyond traditional clinical metrics for improved patient care and life quality.

The Impact of Frailty on Surgical Outcome of Patients with Lumbar Spinal Canal Stenosis.

Frailty is an important factor in surgical outcomes. The current study aimed to evaluate the effect of preoperative frailty on postoperative outcomes in older patients with lumbar spinal canal stenosis (LSCS). We retrospectively examined 209 patients aged ≥65 years who underwent surgery for LSCS. Health-related quality-of-life (HRQOL) tools, including the Roland-Morris Disability Questionnaire (RDQ), Zurich Claudication Questionnaire (ZCQ), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), were used in the assessment conducted before surgery and at 6 months and 1 year after surgery. Frailty was categorized based on the 11-item modified frailty index (mFI-11). Patients with mFI-11 of 0, <0.21, and >0.21 were classified under the robust (R), pre-frailty (P), and frailty (F) groups, respectively. According to the mFI-11, 24, 138, and 47 patients were included in the R, P, and F groups, respectively. Regarding preoperative radiographic parameters, there was a remarkable increase in the sagittal vertical axis and a significant decrease in the development of lumbar lordosis with frailty progression. The preoperative scores of RDQ and ZCQ, and lumbar function, walking ability, social life, and psychological disorder domain scores of JOABPEQ differed significantly among these groups. The frequency of revision surgery was not higher in the F group than in the other groups. After adjustment for factors have shown different distributions among the three groups, the frequency of effective surgical cases did not show a clear trend among the three groups in all domains of the JOABPEQ. The preoperative HRQOL scores and the radiographic parameters of patients with LSCS worsened with frailty severity. However, frailty did not affect the rate of revision surgery and surgical efficacy in patients with LSCS. Although this study has limitations, our findings indicated that even LSCS patients with frailty can be considered for surgery if they have an indication for LSCS surgery.

Evaluating the Efficacy of IL-6 as Predictors of Lateral Lumbar Interbody Fusion Success: Insights From Pain Scores and JOABPEQ Assessments.

A prospective study. This study aims to explore the correlation between interleukin (IL)- 6 levels in intervertebral disc (IVD) tissue and clinical outcomes in patients undergoing lumbar surgery for lumbar degenerative disease (LDD). This prospective study analyzed 32 patients (22 men and 10 women, average age 69.6 years) who underwent lateral lumbar interbody fusion (LLIF). IL-6 gene expression in IVD tissues collected during surgery was measured and correlated with pre- and postoperative clinical outcomes, including pain intensity assessed via Numeric Rating Scales (NRS) and quality of life (QOL) evaluated through the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). IL-6 levels showed statistical correlations with postoperative intensity of low back pain (LBP) and several JOABPEQ domains. Patients with higher expression of IL-6 levels experienced more severe postoperative LBP and lower scores in lumbar function, walking ability, social life function, and mental health. The effectiveness rate of JOABPEQ scores was exceptionally high for low back pain (.548), walking ability (.677), and social functioning (.563), demonstrating the effectiveness of LLIF. The average operation time was 105.6 minutes, and the estimated blood loss was 85.6mL. The study underscores IL-6 as a potential biomarker for predicting surgical outcomes in LDD. High IL-6 levels correlate with worse postoperative LBP and lower QOL scores. Integrating molecular markers like IL-6 with patient-reported outcomes could provide a more comprehensive approach to postoperative care in spinal disorders, aiming to improve the overall QOL for LDD patients undergoing LLIF surgery.

Comparison of facet fusion rates and clinical outcomes between cortical bone trajectory screw and percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis

BACKGROUND CONTEXTCortical bone trajectory (CBT) screws have been introduced as an alternative technique for pedicle screw (PS) insertion because they have greater contact with the cortex and a greater uniaxial pullout load than traditional PS. CBT screwing can also minimize muscle dissection. However, CBT screws and traditional PSs have not yet been compared in terms of fusion rates and clinical outcomes for particular operative procedures. PURPOSEThis study aimed to assess the fusion rate and clinical outcomes of facet fusion (FF) fixed with CBT screws (CBT-FF) and to compare them with those of FF fixed with percutaneous PS (PPS-FF). STUDY DESIGNRetrospective study. PATIENT SAMPLERecords of 68 patients who underwent CBT-FF for single-level degenerative lumbar spondylolisthesis (DLS) with at least 1 year of follow-up were retrospectively reviewed. The control group comprised 143 patients who underwent PPS-FF under the same conditions. OUTCOME MEASURESComputed tomography was performed to confirm fusion. Therapeutic effectiveness was assessed as a clinical outcome using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Roland-Morris Disability Questionnaire (RMDQ), and visual analog scale (VAS) preoperatively and 1 year postoperatively. The rate of revision surgery was also calculated. Intraoperative blood loss was measured. METHODSFusion rate, clinical outcomes, revision surgery rate, and intraoperative blood loss of CBT-FF and PPS-FF were compared. RESULTSThe CBT-FF and PPS-FF fusion rates were 91.2% and 90.1%, respectively. The JOABPEQ category scores demonstrated therapeutic effectiveness in 74.5% and 77.1% of the patients for low back pain; the corresponding proportions for walking ability were 84.7% and 89.3%, respectively. No significant differences in therapeutic effectiveness were observed for any category, including the RMDQ and VAS scores for buttock and lower limb pain. Three patients required revision surgery for adjacent segment disease between 6 months and 3.5 years after CBT-FF (revision surgery rate, 4.4%), whereas the revision surgery rate for PPS-FF was 6.3% (9/143 cases). Average intraoperative blood loss was significantly less in the CBT-FF group than in the PPS-FF group. CONCLUSIONSBoth procedures were equally useful in terms of fusion rate and clinical outcomes for DLS management.

Automated entry of paper-based patient-reported outcomes: Applying deep learning to the Japanese orthopaedic association back pain evaluation questionnaire

BackgroundHealth-related patient-reported outcomes (HR-PROs) are crucial for assessing the quality of life among individuals experiencing low back pain. However, manual data entry from paper forms, while convenient for patients, imposes a considerable tallying burden on collectors. In this study, we developed a deep learning (DL) model capable of automatically reading these paper forms. MethodsWe employed the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, a globally recognized assessment tool for low back pain. The questionnaire comprised 25 low back pain-related multiple-choice questions and three pain-related visual analog scales (VASs). We collected 1305 forms from an academic medical center as the training set, and 483 forms from a community medical center as the test set. The performance of our DL model for multiple-choice questions was evaluated using accuracy as a categorical classification task. The performance for VASs was evaluated using the correlation coefficient and absolute error as regression tasks. ResultIn external validation, the mean accuracy of the categorical questions was 0.997. When outputs for categorical questions with low probability (threshold: 0.9996) were excluded, the accuracy reached 1.000 for the remaining 65 % of questions. Regarding the VASs, the average of the correlation coefficients was 0.989, with the mean absolute error being 0.25. ConclusionOur DL model demonstrated remarkable accuracy and correlation coefficients when automatic reading paper-based HR-PROs during external validation.

Baduanjin exercise for chronic non-specific low back pain: protocol for a series of N-of-1 trials

IntroductionChronic non-specific low back pain (CNLBP) is one of the most common health problems worldwide. According to the clinical guideline released by the American College of Physicians, exercise has been...

Lower preoperative Hounsfield unit values as a risk factor for poor 5-year clinical outcomes after lumbar spine surgery.

Hounsfield Unit (HU) value has been associated with future osteoporotic fractures and postoperative complications. However, no studies on the impact of low HU values on mid-term clinical outcomes following lumbar spine surgery have been reported. We aimed to evaluate the usefulness of preoperative HU values for 5-year clinical outcomes following lumbar spine surgery. We enrolled 200 patients who underwent lumbar surgery (≤ 3-disc levels) for lumbar spinal stenosis. HU values were assessed using preoperative lumbar computed tomography as part of routine preoperative planning for lumbar surgery. Patients were divided into two groups based on the cutoff value of the HU values obtained from the receiver operating characteristic curve for the incidence of vertebral fractures within five years postoperatively. Clinical scores preoperatively and 1, 2, and 5years postoperatively, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were compared using a mixed-effects model. Comparative analysis indicated that all domains of JOABPEQ, except for lumbar function, and the physical component summary of the SF-36 were significantly worse in the low HU group than in the high HU group. Using multiple regression analysis, low HU values were significantly correlated with worse 5-year postoperative scores in all domains of JOABPEQ and SF-36. Low preoperative HU values are a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. HU values are not only a valuable tool for analyzing bone mineral density but also may be a valuable poor prognostic factor of postoperative clinical outcomes.

Impact of surgical treatment on lipid metabolism in patients with lumbar spinal disorders: Prospective observational study

PurposeIt is still unclear how lumbar spinal surgery affects the lipid metabolism of patients with lumbar spinal disorders (LSDs) such as lumbar spinal canal stenosis and lumbar disk herniation. The present study aimed to assess the impact of lumbar spinal surgery on lipid metabolism in patients with LSDs and clarify the factors associated with changes in visceral fat (VF) accumulation before and after lumbar spinal surgery.MethodsConsecutive patients with lumbar spinal surgery for LSDs were prospectively included. Abdominal computed tomography images and blood examination of the participants were evaluated before surgery and at 6 months and 1 year after surgery. The cross-sectional VF area (VFA) was measured at the level of the navel using computed tomography images. Blood examination items included triglycerides and high-density lipoprotein (HDL).ResultsThe study enrolled a total of 138 patients. Female patients with LSDs had significantly increased VFA and serum triglyceride levels after lumbar spinal surgery. On multivariable analysis, the group with > 100 cm2 of preoperative VFA and a postoperative decrease in VFA had a significantly worse preoperative walking ability based on the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (relative risk 2.1; 95% confidence intervals 1.1–4.1).ConclusionsThe present study demonstrated that patients with LSDs did not necessarily improve their lipid metabolism after lumbar spinal surgery. Instead, female patients with LSDs had significantly deteriorated lipid metabolism after lumbar spinal surgery. Finally, a worse preoperative walking ability was associated with the improvement in excess VF accumulation after lumbar spinal surgery.

The Effect of Age-adjusted Sagittal Alignment on the Result of Posterior Decompression Surgery for Lumbar Spinal Canal Stenosis.

Retrospective case series. The aim of this study was to compare the outcomes of posterior decompression surgery for lumbar spinal canal stenosis (LSS) in patients with preoperative sagittal malalignment to those without, after adjusting for age and sex. Sagittal balance is an important factor in spine surgery and is thought to affect postoperative outcomes following LSS. However, the relationship between sagittal malalignment and postoperative outcomes has not been thoroughly examined. We included 533 patients who underwent surgical treatment for LSS and also achieved two-year follow-up. Patients were categorized into either a malalignment (MA+) group (69 patients) or a matched-alignment (MA-) group (348 patients) based on age-adjusted preoperative sagittal alignment. We compared the baseline and two-year postoperative health-related quality of life (HRQOL) using the Visual Analog Scale and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores. We also calculated clinical efficacy using the minimal clinically important difference (MCID) based on JOABPEQ scores, and age- and sex-adjusted JOABPEQ scores two years after surgery. Differences between groups were examined using the Mann‒Whitney U test and χ 2 analysis, where applicable. Both groups showed an improved HRQOL after decompression surgery. Similar proportions of patients showed substantial improvement, as estimated by the MCID, in four out of five subdomains of the JOABPEQ. A significantly smaller proportion of patients in the MA+ group showed substantial improvement in lumbar function. The age- and sex-adjusted HRQOL scores two years after surgery were lower in the MA+ group, particularly in the lumbar function and social life function subdomains of the JOABPEQ. The effects of posterior decompression surgery alone can still be observed at least two years postoperatively for patients with LSS and concomitant sagittal malalignment. Patients with sagittal malalignment may experience lower HRQOL than those without this type of malalignment.

Comprehensive Assessment of Indirect Decompression Through Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Japanese Orthopedic Association Back Pain Evaluation Questionnaire-Based Analysis.

A retrospective study. This study aimed to comprehensively evaluate the clinical outcomes of lateral lumbar interbody fusion (LLIF) as an indirect decompression technique for degenerative spondylolisthesis (DS) and concomitant degenerative lumbar spinal stenosis (DLSS) patients. We utilized the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to assess treatment success and its impact on patient's quality of life (QOL). We included 124 patients who underwent LLIF. Pre- and postoperative JOABPEQ evaluations indicated treatment success. Subgroup analysis categorized patients' perceptions of surgery as beneficial or non-beneficial. 89% of patients (110/124) reported satisfaction with LLIF. Lateral lumbar interbody fusion achieved successful indirect decompression, increasing canal diameter and central canal area. Significant improvements occurred across all JOABPEQ domains, notably for low back pain, lumbar function, walking ability, social life function, and mental health. Patients who perceived the surgery as beneficial experienced fewer postoperative complications, lower numeric rating scale scores for pain relief, and greater functional outcome improvements compared to non-beneficial patients. Our findings highlight the utility of JOABPEQ as a valuable and sensitive tool for assessing treatment effectiveness and patient-reported outcomes in DS and concomitant DLSS patients. Patients undergoing LLIF. The results affirm the favorable outcomes of LLIF as a surgical option for DLSS patients and emphasize the importance of considering patient perspectives when evaluating overall treatment success. The study provides valuable insights into the impact of indirect decompression on patients' QOL, supporting the effectiveness of LLIF as a minimally invasive technique for DLSS and DS management.

Phase angle is related to physical function and quality of life in preoperative patients with lumbar spinal stenosis

Lumbar spinal stenosis (LSS) can interfere with daily life and quality of life (QOL). Evaluating physical function and QOL and helping patients to improve is the focus of rehabilitation. Phase angle (PhA) assessment is widely used to measure body composition and is considered an indicator of physical function and QOL. This study investigated the relationship between PhA and physical function, physical activity, and QOL in patients with LSS. PhA, handgrip strength, walking speed, Timed Up and Go test (TUG), Life Space Assessment (LSA), Prognostic Nutritional Index (PNI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and EQ-5D were assessed and statistically analyzed. The study included 133 patients with LSS. Multiple regression analysis of PhA adjusted for age, sex, and body mass index (Model 1) and for Model 1 + PNI (Model 2) showed significant correlations (P < 0.05) with handgrip strength, walking speed, TUG, and LSA. Regarding QOL, PhA was significantly correlated (P < 0.05) with lumbar function in JOABPEQ. PhA was associated with physical function and QOL in patients with LSS and might be a new clinical indicator in this population.

Preoperative factors affecting the two-year postoperative patient-reported outcome in single-level lumbar grade I degenerative spondylolisthesis

BackgroundThe choice of operative method for lumbar spinal stenosis with Meyerding grade I degenerative spondylolisthesis remains controversial. The purpose of this study was to identify the preoperative factors affecting the 2-year postoperative patient-reported outcome in Meyerding grade I degenerative spondylolisthesis. MethodsSeventy-two consecutive patients who had minimally invasive decompression alone (D group; 28) or with fusion (DF group; 44) were enrolled. The parameters investigated were the Japanese Orthopaedic Association back pain evaluation questionnaire as patient-reported assessment, and L4 slippage (L4S), lumbar lordosis (LL), and lumbar axis sacral distance (LASD) as an index of sagittal alignment for radiological evaluation. Data collected prospectively at 2 years postoperatively were examined by statistical analysis. ResultsSixty-two cases (D group; 25, DF group; 37) were finally evaluated. In multiple logistic regression analysis, preoperative L4S and LASD were extracted as significant preoperative factors affecting the 2-year postoperative outcome. Patients with preoperative L4S of 6 mm or more have a lower rate of improvement in lumbar spine dysfunction due to low back pain (risk ratio=0.188, p=.043). Patients with a preoperative LASD of 30 mm or more have a higher rate of improvement in lumbar dysfunction due to low back pain (risk ratio=11.48, p=.021). The results of multiple logistic analysis by operative method showed that there was a higher rate of improvement in lumbar spine dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more in DF group (risk ratio=172.028, p=.01). ConclusionsPreoperative L4S and LASD were extracted as significant preoperative factors affecting patient-reported outcomes at 2 years postoperatively. Multiple logistic analyses by the operative method suggested that DF may be advantageous in improving lumbar dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more.

Outcomes of Microscopic-Assisted Decompression Surgery Without Instrumented Fixation in Patients With Spinal Canal Stenosis and First-Degree Degenerative Spondylolisthesis: A Prospective Case Series

Objective: To describe the minimally invasive, microscopic-assisted over-the-top technique and report its clinical and radiological outcomes in cases of spinal canal stenosis and first-degree degenerative lumbar spondylolisthesis.Methods: Twenty-two patients with grade I degenerative spondylolisthesis and spinal canal stenosis who underwent microscopic decompression without fusion between April 2017 and December 2020 were included in the study. Results: The study population included 13 men and 9 women, with an average age of 66.7 years (range, 55–79 years) and a mean duration of symptoms of 14.8 ± 11.6 months. The mean follow-up was 49.3 months (range, 24–67 months). At the last follow-up, 13 patients were fully satisfied, 7 patients were partially satisfied, and 2 patients (9%) were not satisfied and required revision surgery with fusion. At the final follow-up, the mean leg pain numerical pain rating scale (NPRS), back pain NPRS, Oswestry Disability Index score, and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire showed significant improvements in all patients, and no patients showed progression of the degree of spondylolisthesis.Conclusion: The minimally invasive, over-the-top technique using surgical microscopy is a viable option in cases with first-degree degenerative spondylolisthesis and predominantly stenosis symptoms.

Safety and Clinical Results of Continuous Low-Dose Aspirin in Microendoscopic Laminectomy.

It remains controversial whether it is better to continue oral low-dose aspirin (LDA) during the perioperative period in spinal surgery. This study aims to evaluate the safety of continued LDA administration in the perioperative periods of microendoscopic laminectomy (MEL) by assessing perioperative complications and clinical outcomes. We ultimately included 88 patients (35 males, 53 females) who underwent one level of MEL for lumbar spinal canal stenosis from April 2016 to March 2022. Patients who did not undergo anticoagulation therapy were classified into Group A (65 patients), those who stopped anticoagulation therapy at the perioperative periods were classified into Group B (9 patients), and those who continued oral administration of LDA throughout the perioperative periods were classified into Group C (14 patients). Surgery time, intraoperative estimate blood loss (EBL), differences between hemoglobin (Hb) and platelet (Plt) before and after surgery, perioperative complications, and cross-sectional area of hematoma and dural sac on MRI taken within 1 week and at 6 months or more after surgery were assessed between three groups. The EuroQol-5 dimensions (EQ-5D), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were also evaluated as the clinical outcomes. There was no statistically significant difference between the three groups in operation time, intraoperative EBL, differences between Hb and Plt before and after surgery, and cross-sectional area of hematoma and dural sac on MRI. A case of hematoma removal was confirmed in Group A. There was also no statistically significant difference between the three groups in EQ-5D, ODI, and each domain of JOABPEQ. The continuation of LDA throughout the perioperative periods did not affect perioperative complications and clinical outcomes of one-level MEL. In MEL, it might be possible to continue oral administration of LDA throughout the perioperative periods.

Occurrence of Postural Low Back Pain in Association with Physical Inactivity among Bank Officers of Faisalabad

The quality of life for several bank officials around the world is impacted by postural low back discomfort. Prescription drugs and over-the-counter analgesics are the two main forms of treatment. Objectives: To assess the prevalence of postural low back pain and its association with inactivity among Faisalabad bank employees. Methods: A purposive sample was drawn from the community of bankers for this cross-sectional survey, which also included a consent form. The data were gathered using the JOABPEQ, or Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. We computed the sample size for our study and employed a purposive sampling technique. The study had 164 participants in total (Faisalabad bank officers). For analysis, chi-square was used. The coded data were entered using the statistical package for service solution (SPSS V-16). Results: The findings revealed that there was a 75% incidence of postural low back pain and frequency was 74.5 among Faisalabad bank personnel. Findings showed that p &lt; 0.05 for postural low back pain and physical inactivity which means there is an association exists between variables. Conclusions: The majority of bank officers do not adjust their posture, and there is no substantial relationship between gender and posture change. The majority of bank officers experience low lumber pain, although there is no discernible link between gender and low lumber pain, as it affects both men and women equally. Majority of the bank officers do not leave their chair and walk during their working hours so, there is significant association between the lower lumber pain and inactivity.