Oswestry Disability Index Pain Scores Research Articles

Outcomes of percutaneous vertebroplasty in multiple myeloma: a tertiary neurosciences experience with long-term follow-up.

Multiple myeloma is diagnosed in 5,800 people in the United Kingdom (UK) each year with up to 64% having vertebral compression fractures at the time of diagnosis. Painful vertebral compression fractures can be of significant detriment to patients' quality of life. Percutaneous vertebroplasty aims to provide long-term pain relief and stabilize fractured vertebrae. Data was collected from all cases of percutaneous vertebroplasty performed on patients with multiple myeloma from November 2017 to January 2019. Pain scores were measured using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) pre-procedure, 2 months post procedure and 4 years post-procedure. Procedure related complications and analgesia use were also documented. 22 patients were included with a total of 119 vertebrae treated. Patients reported a significant improvement in overall pain score with a median pre-procedure VAS of 8 and a median post-procedure VAS of 3.5 (p<0.0001). There was a median pre-procedure ODI score of 60% and a median post-procedure ODI score of 36% (p<0000.1). There was improvement across all ODI domains and a 77% reduction in analgesic requirement. There were small cement leaks into paravertebral veins or endplates at 15 levels (12%) which were asymptomatic. There were 8 responders to the long-term follow-up questionnaire at 4 years. This demonstrated an overall stable degree of pain relief in responders with a median VAS of 3.5 and median ODI of 30%. At this center, vertebroplasty has been shown to reduce both VAS and ODI pain scores and reduce analgesia requirements in patients with VCFs secondary to multiple myeloma with long lasting relief at 4 years post-procedure.

The Safety and Efficacy of Posterior Lumbar Interbody Fusions in the Outpatient Setting.

Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed. Results The current study included 36 outpatient PLIF cases with 94.4% of the study cohort undergoing a single-level PLIF. The average Oswestry Disability Index (ODI) score improved by 20.4 points from preoperative measurements (p = 0.0002), and the visual analog scale (VAS) score improved by 27.2 points (p = 0.0001). The postoperative fusion rate was 94.4%. One intraoperative complication occurred (2.78%), and four postoperative complications occurred (11.11%). There were no subsequent admissions throughout the postoperative follow-up period; however, two of the 36 patients (5.56%) did require reoperation, both in an outpatient setting. Conclusions This study demonstrates that open posterior lumbar interbody fusions performed in an outpatient setting can be performed safely and effectively, with a significant reduction in VAS and ODI pain scores.

Effect Of Bracing For Scoliosis In Improving Gait Mechanics

Patients with scoliosis demonstrate altered gait due to changes in global postural control strategies caused by pain and the spinal deformity. Bracing has been found to reduce pain and increase trunk support in adult degenerative scoliosis (ADS) patients.However, only anecdotal evidence of their efficacy is available in improving gait and posture control mechanics. PURPOSE: Investigate the impact of scoliosis bracing on lower extremity kinematics and effectiveness in gait rehabilitation. METHODS: 15 patients with ADS (cobb angle >25°; age:73.9±2.9yr; weight:66.6±16.2kg) were recruited using the adult deformity SRS-Schwab system. Oswestry Disability Index (ODI) scores were recorded and patients performed 3m timed up & go, 6 minute walk tests and over-ground 10m walk trials at a self-selected speed at initial evaluation (pre), 45min post fitting (post45) with Peak™ scoliosis brace and after 8 weeks of bracing (post8w). Gait variables were calculated for 5 walking trials and compared between the 3 time points (pre, post45 and post8w) using RM-MANOVA (p< .05). RESULTS: Patients walked faster on 3m timed test (pre: 12.5s; post8w: 10.0s) and covered greater distances in the 6 min walk test (p= .01; 61.2m). For kinematic variables, significant differences were observed for swing time of left leg (p =.013; pre:0.40s; post45:0.42s; post8w:0.39s), step length on right (p=.019; pre:0.52m; post45:0.57m; post8w:0.56m), right ankle peak dorsiflexion (p =.049; pre:8.7°; post45:7.9°; post8w:11.7°), both knee peak flexion and extension angles (p <.001- .048), and right hip (p =.002; pre:37.2°; post45:39.2°; post8w:31.6°) and knee ROM (p =.018; pre:29.8° ; post45:31.6°; post8w:37.7°). ODI pain scores (p=.06) showed tendency for statistical significance. CONCLUSIONS: Patients with scoliosis demonstrated few immediate and long-term benefits for improving pain and altered gait mechanics. Faster walking speeds, greater walking distances, longer step lengths and greater ROM as observed are indicators of improved gait and dynamic balance. Bracing has immediate effects on improving ambulation and for any neuromuscular adaptation, brace might need to be worn for at least 8 weeks.

Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: a meta-analysis of prospective comparative studies.

The goal of this article is to evaluate the efficacy and the safety of the percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in dealing with the osteoporotic vertebral compression fracture (OVCF). In July 2014, a comprehensive systematic computer-based online search was performed by using the databases of PubMed, EMBASE, Cochrane Library, Web of Science, Wan Fang, and the China Biological Medicine. Only prospective comparative trials (PCT) and randomized controlled trials (RCT) that compared PVP with PKP were included. Trials were screened based on the inclusion and exclusion criteria previously formed. The Cochrane collaboration guidelines were also used to assess the quality of these included studies. The primary data of these studies [volume of the cement, postoperative vertebral height, visual analog scale (VAS) score and Oswestry Disability Index (ODI) score after the surgery, and so on] were carefully abstracted and processed by Revman 5.2.0 software The publication bias of the main results (cement leakage and adjacent-level fracture) were examined by Stata 12.0 (Begg and Egger test). Furthermore, the stability of the main results were also detected by sensitivity and cumulative analyses. Six RCT and 14 PCT studies involving 1,429 patients met our criteria and were included finally. Comparing these two methods, the PKP group took more operation time [SMD = 0.66, 95 % CI (0.28, 1.03), p = 0.0006] with higher anterior vertebral body height [SMD = 1.40, 95 % CI (0.49, 2.32), p = 0.003], greatly reduced Cobb angle in the long run [SMD = -0.61, 95 % CI (-1.04, -0.19), p = 0.005] and had lower risk of cement leakage. However, in VAS scores and ODI scores after the surgery whether for the short-term efficacy (no more than 1 week after the surgery) or long-term efficacy (more than six months), Cobb angle in the short run and new fracture in the adjacent level, no statistically differences were found between the two groups. Based on current evidence, PVP takes less time in the operation, while it has greater risk of cement leakage, was inferior in reducing Cobb angle in the long term and results in lower anterior vertebral body height after the surgery. For pain relief, which is the main desire of the patients, both procedures provide significant improvement in VAS and ODI pain scores. PVP is still an effective procedure.