Oswestry Disability Index Scale Research Articles

Efficacy and Safety of Platelet-rich Plasma in the Management of Lumbar Disc Herniation: A Systematic Review and Meta-analysis

Background Lumbar radicular discomfort is often induced by mechanical compression of the nerve root and inflammatory reactions. Platelet-rich plasma (PRP) is an efficacious therapy modality, albeit ongoing controversies regarding its effectiveness, and it possesses the advantage of minimal side effects. Therefore, we conducted the current systematic review and meta-analysis to investigate the efficacy and safety of PRP in the treatment of lumbar disc herniation (LDH). Methods We conducted our database searching on PubMed, Scopus, and Web of Science from inception till August 2024 to look for articles that fulfil our aim. The search strategy was based on three main keywords: “Platelet-rich plasma” AND “Lumbar” AND “Hernia*”. We conducted the pooled analysis of continuous variables using mean difference (MD) and we used pooled odds ratio (OR) for dichotomous variables with 95% confidence intervals (CI). Results The use of PRP was statistically significant associated with reduced visual analogue scale (VAS) compared with no PRP with MD of -0.44 (95%CI:-0.76, -0.11, p=0.008), and Oswestry Disability Index (ODI) with MD of -5.36 (95%CI: -8.25, -2.48, p=0.0003). However, no significant difference was observed regarding Japanese Orthopedic Association (JOA) with MD of 2.52 (95%CI:-0.8, 5.84, p=0.14) with non-significant heterogeneity. PRP was also associated with reduced risk of complications with OR of 0.22 (95%CI:0.07, 0.68, p=0.009) and non-significant heterogeneity. Conclusion PRP use in patients with LDH is associated with positive outcomes presented in reduction of pain, and disability (decrease in ODI scale) in addition to being safe with less incidence of complications compared with patients not receiving PRP.

Effects of platelet-rich plasma injection on electrical activity and biomechanics of the erector spinae muscles in lumbar myofascial pain syndrome

Low back pain (LBP) is a highly prevalent disease. Among the various causes of LBP, one of the most frequent is myofascial pain syndrome (MPS) which affects the spinal stabilizer muscles. The aims of this study were to compare the differences in muscular electrical activity and biomechanical properties between the painful and non-painful sides in patients with unilateral MPS and to verify the feasibility of surface electromyography (sEMG) and MyotonPRO for assisting in MPS assessment. Forty patients with unilateral lumbar MPS were recruited via the Department of Rehabilitation Medicine Center of West China Hospital Sichuan University from October 2022 to October 2023. The electrical properties of the bilateral erector spinae muscles were characterized by sEMG signals during a trunk extension task. The following four time-domain features of sEMG were extracted: root mean square (RMS), mean absolute value (MAV), integrated EMG (iEMG), and waveform length (WL). And two frequency domain features were extracted: the median frequency (MDF) and mean power frequency (MPF). The mechanical properties of the muscles were assessed by MyotonPRO at rest. The following biomechanical parameters were acquired: oscillation frequency [Hz], dynamic stiffness [N/m], logarithmic decrement, relaxation time [ms], and Creep. The visual analog scale (VAS) was used to evaluate the pain severity, and the Oswestry Disability Index (ODI) was used to evaluate the severity of disability and disruption to lifestyle activities caused by LBP pain. The outcome measures were obtained prior to the Platelet-rich plasma (PRP) treatment and repeated two weeks after treatment. (1) Prior to the PRP treatment, all sEMG time-domain features on the painful side were significantly higher than those on the non-painful side (RMS, p < 0.001; MAV, p < 0.001; iEMG, p < 0.001; WL, p = 0.001). However, there was no significant difference in the sEMG frequency-domain features (MPF, p = 0.478; MDF, p = 0.758). On the mechanical side, there were significant differences in oscillation frequency (p = 0.041) and logarithmic decrement (p = 0.022) between the painful side and non-painful side, but no significant differences in dynamic stiffness, relaxation time, and creep (both p > 0.05). (2) Two weeks after the PRP treatment, statistically significant decreases were observed in both post-treatment VAS (p < 0.001) and ODI scales (p < 0.001), indicating the PRP treatment clinically significantly reduced the level of. MPS. This change coincided with all sEMG time-domain features, in which the values at the painful side decreased significantly (RMS, p = 0.001; MAV, p = 0.001; iEMG, p = 0.001; WL, p = 0.001). However, no significant difference in the sEMG frequency-domain features (MPF, p = 0.620; MDF, p = 0.850) was found. On the mechanical side, only logarithmic decrement on the painful side increased significantly (p < 0.001). Our combined MyotonPRO and sEMG results indicated that MPS likely leads to increased muscle tone and decreased muscle elasticity, manifested by abnormal time-domain features of sEMG and biomechanical properties. The changes in these objective measurements were agreed with the changes in subjective outcome measures of pain and function currently assessed in the patients with MPS. A single PRP treatment may alleviate muscle dysfunction caused by MPS. These preliminary results demonstrated the potential feasibility of using sEMG and MyotonPRO as tools for assessing the neuromuscular function of MPS.

Attributes of Low Back pain among Physical Therapists and Nurses in Pakistan

Low back pain is localized between the region of the 12th rib and less to the gluteal folds either radiating or not radiating to the lower limb. The prevalence of low back pain in Pakistan is about 41.4 percent. But all over the world, the Physical therapist's rate of work-related musculoskeletal problems is about 57 percent. Objective: To determine the attributes of low back pain among physical therapists and nurses in Pakistan. Methods: A cross-sectional study was done from August 2023 to January 2024, throughout Pakistan. A sample size of 661 was divided into two groups. The sampling technique was non-probability purposive sampling. There were two measurement tools used Visual Analog Scale and the Oswestry Disability Index scale to rule out pain and the level of disability. The data were analyzed through SPSS version 23.0 software. Results: The total number of participants was 661, of which 247 were physical therapists and 414 were nurses recruited from all over Pakistan. The pain was measured through the VAS and disability was measured by ODI. The Physical therapists felt mild pain in about 123(49.79%), and they faced no disability in about 127(51.41%) and nurses felt moderate pain in about 212(51.20%) and they have not faced disability in about 306(73.91%). Conclusions: Our study concluded the prevalence of low back pain is found in both nurses and physical therapists but the level of pain is higher in nurses as compared to a physical therapist due to the lack of ergonomics knowledge among the nurse population.

A cross-sectional survey study on impact of sitting postures in Trikashoola w.s.r. to Low Back Pain among Information Technology Professionals

Occupational health aims at the promotion and maintenance of highest degree of physical, mental and social well being of workers in all occupations. Now, around world the occupational health personnel are witnessing the emergence of health related problems in computer users. Sadathura, the person who are continuously exposed to illness because of their professions. Panyajivi is one among them. 21st century integrates technology where computer’s plays an important role in people’s life, which makes them to sit for long hours. Trikashoola is one among the Vatavyadhi. Vata Dosha is considered to be main reason for pain. Low back pain is a disease of modernization due to desk jobs and the sitting position, poor work station design (desk), bad postures, type of chair and use of foot rest. Back pain is the second most frequent reason for visiting a physician and the common pain syndrome in developed and in developing countries. Ergonomics is concerned with human engineering. Bengaluru is the India’s largest I.T hub, also called as Silicon Valley of India and home for large number of Information Technology Professionals. 311 subjects were included in this survey study. The diagnosis was done through Oswestry disability index scale.

Spondilolysthesis L5-S1: An Original Article

Objectives: To assess the clinical, functional and radiological outcome of Posterior Lumbar Interbody Fusion (PLIF) by Banana cage with bone graft. Material and Methods: This retrospective analytical study was carried out in unit of Orthopaedic surgery department from January 2010 to December 2020. We did PLIF by Banana cage with bone graft for High-grade Lumbar Spondylolisthesis at L5-S1. The follow up period ranges from 1 year to 2 years (average 18 months). Within these follow up period we have assessed the patients clinically, functionally and radiologically. All patients were assessed by Visual Analogue Score (VAS), Oswestry Disability Index (ODI), Waddell Disability Index (WDI), Spino-pelvic parameters, Modified Macnab’s Criteria to find out overall outcome and Hackenberge ctriteria for radiological fusion. Results and Conclusions: Total 40 patients were included among them 16were male and 24 were female. The average age of the patients was 52.45±10.1 years. Maximum (60.0%) patients were housewife followed by 20.0%, 10.0%, 10% were day laborer, farmer and service holder respectively. Average pelvic tilt was 26.05±6.27° preoperatively and 24.10±6.26° at the final follow-up, average PI was 66.07±7.39° preoperatively and 61.19±7.08° at the final follow-up. Preoperative lumbar lordosis was 45.55±6.71° with postoperatively 37.29±6.19°at final follow-up. VAS score and ODI scales were improved significantly from preoperative 6.90±6.16 and 57.60±15.66, respectively, to postoperatively and final follow-up 2.0±0.8 and 7.60±2.40, respectively. Pre-operative Translation ratio, slip angle and disc height ratio were 21.96±10.25, -18.87±8.28, 11.03±4.36 respectively and postoperatively 13.17±6.57, -18.44±7.12, 19.60±3.36 respectively. Fusion was achieved in 36 cases (90%), 3 cases (7.5%) were fragmented and pseudoarthrosis showed only 1 case (2.5%). Most of the study population according to post operative clinical outcome showed excellent outcome (95%), 1 (2.5%) case had good and 1 (2.5%) case had fair outcome. Conclusion: It can be concluded that, Posterior Lumbar Interbody Fusion (PLIF) by Banana cage with bone graft can be a very good option for the treatment of High-grade Lumbar Spondylolisthesis at L5-S1 levels.

The Effect of Combined Treatment with Passive Therapy, Physical Exercises, Lumbar Traction, and Walking Program on Chronic Low Back Pain

Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders worldwide with far-reaching implications for social, economic, and public health. The study aimed to compare the effect of combined physiotherapy treatment in patients with CLBP. This observational retrospective randomized controlled study involved reviewing medical records of patients who were treated during a period of 6 weeks in the physiotherapy department of the Special Hospital for General Rehabilitation “Banja e Kllokotit,” Kllokot, Republic of Kosovo. The observational research was conducted for 60 patients, divided into two groups: Group 1: experimental group (n=30), with mean age of 41.7 years, average height of 1.68 cm, and average body mass index (BMI) of 71.7 for both sexes; Group 2: control group (n=30) with mean age of 43.1 years, average height of 1.66 cm, and average body mass index (BMI) of 71.5 for both sexes. In Group 1, combined treatment with passive therapy [thermotherapy and transcutaneous electrical nerve stimulation (TENS)], physical exercises, lumbar traction, and walking program was applied, while in Group 2, passive therapy like thermotherapy and TENS was applied. Outcome measurements included pain intensity, lumbar flexibility, revised Oswestry disability index (ODI), and self-confidence, which were assessed pre-treatment, at 3 weeks, and after 6 weeks of clinical treatment. The results showed significant improvement in both groups. However, the improvement was greater and with a significant difference only after 6 weeks in Group 1 compared to Group 2. The differences were observed in various outcome measures, including the visual analog scale for pain (VAS; p&lt;0.0001), fingertip-to-floor distance (FTF; p&lt;0.0001), ODI (p&lt;0.0001), and Rosenberg self-esteem scale (RSE; p=0.0002). According to our data, combined treatment with thermotherapy, therapeutic exercises, lumbar traction, TENS, and walking program was more effective and can be considered as a treatment protocol for patients with CLBP. However, further research is recommended on the efficacy of combined physiotherapy treatment, especially lumbar traction for longer periods.

Basivertebral Nerve Ablation for the Treatment of Chronic Low Back Pain In A Community Practice Setting: A Prospective Study (P9-6.003)

<h3>Objective:</h3> To demonstrate the feasibility of basivertebral nerve ablation (BVNA) in a community practice setting to alleviate pain in patients suffering from chronic low back pain (CLBP). <h3>Background:</h3> Strong innervation of the vertebral endplates by the basivertebral nerve makes it an ideal target for ablation in the treatment of vertebrogenic CLBP. This data represents the clinical outcomes for 19 consecutively treated patients in a community setting. To our knowledge, this is the first independent clinical study on this novel procedure. <h3>Design/Methods:</h3> Evaluations were performed at baseline, 1 month, 3 months and 6 months and data recorded in Medrio electronic data capture software. Clinical improvements were recorded using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Quebec Disability Scale and RAND-36 scale. Statistical analysis was performed using Graphpad Prism software. A non-parametric Friedman test followed by Dunn9s post-hoc analysis was used with a significance level set at p=0.05. All the patients (n=19) completed the baseline, 1 month and 3 months follow-up at the time this abstract was prepared, and 14 had completed the 6-months follow-up. <h3>Results:</h3> The ODI, VAS and Quebec Disability Scales showed significant improvement at 1 month (p=0.019, 0.015, 0.019), 3 months (p=0.012, 0.030, 0.000) and 6 months (p=0.030, 0.001, 0.000). The average ODI was reduced by 26 points in 6 months, VAS by 53.2 % and the Quebec Disability Scale by 34.9 points. The pain, physical functioning, energy/fatigue and social functioning outcomes of the RAND-36 testing also showed significant improvement over the 6 months follow-up. <h3>Conclusions:</h3> Basivertebral nerve ablation appears to be a durable, minimally invasive treatment for the relief of CLBP which can be successfully implemented in a community practice setting. <b>Disclosure:</b> Dr. Schnapp has received intellectual property interests from a discovery or technology relating to health care. Mr. Martiatu has nothing to disclose. Dr. Delcroix has nothing to disclose.

12-Month clinical and radiographic outcomes of ViBone viable bone matrix in patients undergoing cervical and lumbar spinal fusion surgery

BackgroundTo investigate the clinical safety and efficacy of ViBone® Viable Bone Matrix (VBM), a next generation cellular bone matrix allograft that comprises all three essential bone-forming components: osteogenic, osteoinductive, and osteoconductive factors, and is optimized to enhance cell viability and bone formation.MethodsThis was a multi-center, prospective, post-market study evaluating the safety and efficacy of ViBone VBM in patients undergoing 1–3 level anterior cervical discectomy and fusion or lumbar interbody fusion surgery. Patients were evaluated at baseline, 6-month, and 12-month follow-up clinically and radiographically. Clinical assessment included Visual Analog Scale for pain (VAS-pain), the Neck Disability Index (NDI) for patients with cervical pathologies, and the Oswestry Disability Index (ODI) for patients with lumbar pathologies. Fusion success defined by an independent radiologist was determined radiographically by plain films.ResultsClinical outcomes evaluated with VAS-pain, NDI, and ODI scales were improved significantly at 6 and 12 months compared to baseline. All patients reached clinically significant improvements at 12 months. There were no adverse events or infections attributed to ViBone VBM. At 12 months, the fusion rate per patient was 88.1% in cervical and 97.6% in lumbar patients, while per-level fusion was 98.5% for cervical and 100% for lumbar segments.ConclusionsPatients undergoing cervical and lumbar spinal fusion implanted with ViBone VBM demonstrated favorable outcomes at 6 months and 12 months as measured by subjective clinical measures and radiographic fusion rates.Trial registration This study was registered as NCT03425682 on 1/29/2018.

Does Laminectomy Affect Spino-Pelvic Balance in Lumbar Spinal Stenosis? A Study Based on the EOS X-Ray Imaging System.

Lumbar spinal stenosis (LSS) is a degenerative disorder causing the forward bending of the trunk and pelvic retroversion with the consequent loss of lumbar lordosis; surgical treatment is intended to enlarge the canal and foramina and decompress the nerve roots. The purpose of our study is to determine whether and to what extent facet-sparing laminectomy affects the spino-pelvic balance. The spino-pelvic balance of 26 patients was analysed before and after surgery through the EOS X-ray Imaging System. The following parameters were considered: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Clinical data were expressed in numeric values according to the Oswestry Disability Index (ODI), the visual analogue scale (VAS) and the modified Japanese Orthopaedic Association (mJOA) scoring system. Significant SS decreases and PT increases were noticed after surgery, without modification in LL, axial vertebral rotation (AVR) and the general alignment. Pain and disability had a significant improvement, as represented by a decrease in scores on the VAS and ODI scales and an increase in scores on the mJOA functional scale. The most important parameter seems to be a congruence between pelvic and spinal parameters, which achieves an economic posture with the physiologic position of the axis of gravity. According to the literature, a standard sagittal balance (SB) has not been defined.

Impact of previous lumbar spine surgery on the outcome of lumbar total disc replacement: analysis of prospective 5-year follow-up study data.

It is sometimes anticipated that patients with prior spine surgery will have a compromised outcome from future procedures. The purpose of this study was to compare TDR outcomes in patients with prior lumbar spine surgery to those with no previous surgery. Post hoc analysis was performed on 5-year follow-up data collected prospectively in the multi-centre FDA-regulated trial for the activL® Artificial Disc which involved 376 patients treated for single-level symptomatic disc degeneration. Clinical outcome measures included the Oswestry Disability Index (ODI), visual analog scales (VAS) assessing back and leg pain, SF-36, adverse events, and re-operations. Radiographic outcomes included flexion/extension range of motion (ROM) and translation of the operated segment. Patients were divided into two groups: Prior Lumbar Surgery (PLS, n = 92) and No Prior Lumbar Surgery (NPLS, n = 284). Baseline demographics were similar in the two groups. ODI, VAS, and SF-36 Physical Component Scale scores improved significantly (p < 0.05) from baseline in both groups with improvements maintained through 5-year post-TDR with no significant differences between groups. There were no statistically significant differences in rates of serious device-related events, procedure-related events, or re-operations. While ROM was significantly less prior to TDR surgery in the PLS group, there was no significant difference in ROM at post-operative points. Prior lumbar spine surgery was not associated with compromised outcomes following TDR. These results are in line with reports from earlier studies with shorter follow-up, finding that non-destabilizing prior surgery is not a contra-indication for TDR provided that selection criteria are met. Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Influence of microsurgical decompression on segmental stability of the lumbar spine – One-year results in a prospective, consecutive case series using upright, kinetic-positional MRI

BackgroundStandard procedure in patients with lumbar spinal canal stenosis is decompression to relieve the neural structures. Clinical results generally show superiority compared to nonoperative therapy after an observation period of several years. However, there is still a question of postsurgical segmental stability and correlation to clinical findings. Therefore, the aim of this prospective study was to evaluate the clinical outcome in patients who underwent microsurgical decompression in lumbar spine and particularly to analyze intervertebral movement by use of upright, kinetic-positional magnetic resonance imaging (MRI) over a period of 12 months and then to correlate the clinical and imaging data with each other.MethodsComplete clinical data of 24 consecutive participants with microsurgical decompression of the lumbar spine were obtained by questionnaires including visual analogue scale (VAS) for back and leg, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Short-Form-36 (SF-36), walking distance and use of analgesics with assessment preoperatively and after 6 weeks and 12 months. At the same points of time all patients underwent upright, kinetic-positional MRI to measure intersegmental motion of the operated levels with determination of intervertebral angles and translation and to correlate the clinical and imaging data with each other.ResultsVAS for leg, ODI, RMDQ and physical component scale of SF-36 improved statistically significantly without statistically significant differences regarding intersegmental motion and horizontal displacement 6 weeks and 12 months after operation. Regression analysis did not find any linear dependencies between the clinical scores and imaging parameters.ConclusionsIn awareness of some limitations of the study, our results demonstrate no increase of intersegmental movement or even instability after microsurgical decompression of the lumbar spine over a follow-up period of 12 months, which is equivalent to preservation of intervertebral stability. Furthermore, the magnitude of intervertebral range of motion showed no correlation to the clinical score parameters at all three examination points of time.

A comparison between effectiveness of gluteal trigger point and epidural steroid injection in lumbosacral canal stenosis patients: a randomized clinical trial

Background Lumbosacral Spinal Stenosis (LSS) is a degenerative spine disease and a major cause of pain and disability, especially in geriatrics. Primary symptom control in patients with LSS includes conservative treatment and non-surgical methods. In this study, we aimed to compare the effect of steroid injection via epidural and gluteal trigger point techniques. Methods Patients aged 40–75 years old who had pain and other clinical signs of spinal stenosis in the last 6 months were included in our study and divided into two groups of gluteal trigger point (TP) or epidural steroid injection (ESI). The patients were evaluated based on the visual analog scale (VAS), Roland-Morris Disability Questionnaire (RDQ), Oswestry Disability Index (ODI), and the Quebec back pain disability scales during their pre-injection period and 2 weeks after follow-ups till 8 weeks. A P value of less than 0.05 was considered significant. Results A total of 44 patients were included in our study. The TP group had a significant decrease in comparison with their follow-ups; however, in the epidural group, the significant decrease was only observed compared to the pre-injection period and the scores did not have any significant decreases after the second week regarding the ODI, RQM, and VAS scales. The TP group demonstrated significantly higher scores of decreases of ODI and Quebec score compared to the epidural group at weeks 4 and 8. Regarding RQM, the TP groups demonstrated significantly higher scores of decreases compared to the epidural group at weeks 2, 4 and 8. (p < 0.001 p = 0.008, and p < 0.001, respectively). Conclusion Both epidural and TP steroid injection significantly reduced the patients’ pain and improved their QoL and function; however, more satisfactory results were observed in the TP group during the patients’ follow-ups, while the epidural group demonstrated only statistically significant improvement during the short-term follow-up.

Comparison of efficacy of particulate and non-particulate steroids in patients with lumbosacral pain, non-operated patients with chronic radicular symptoms.

In our study, we aimed to retrospectively evaluate patients who were given particulate and non-particulate steroids for transforaminal epidural steroid injection due to non-operated chronic low back pain with radicular symptoms in terms of the change in pain and the change in functional capacity before the procedure. This study was carried out by examining the files of 130 patients, underwent an interventional procedure. Records of patients pertaining to age, gender, location of pain, Visual Analog Scale, Patient Global Impression of Change, and Oswestry Disability Index Scale (ODI) before the interventional procedure and at the 1st and 3rd months after the procedure were recorded using the hospital automation system and patient follow-up forms. The functional capacity of the patients was evaluated, and in the comparison of the ODI score before the procedure, at the 1st month, and at the 3rd month, a statistically significant difference was found in the particulate steroid group compared to the non-particulate group at the 1st and 3rd months. When evaluated using the Generalized Linear Models, a statistically significant difference was found in both groups (p=0.039), and the ODI score was approximately 2,951 units lower in patients who were treated with particulate steroids than those who were treated with non-particulate steroids at each measurement time. In our study, it has been demonstrated that particulate steroids are superior to non-particulate steroids in improving functional capacity in the early period, and non-particulate steroids are advantageous in the long term.

Эндоскопическое лечение дегенеративного стеноза позвоночного канала

Microsurgical decompression technique has been regarded as the standard surgical method in degenerative spinal diseases to date. The conventional method may lead to instability and lead to chronic lower back pain due to injury of facet joints, posterior ligamentous complex, as well as paraspinal muscles. To avoid these complications, the new biportal endoscopic technique has been introduced in our clinical practice. Since 2019, we have been widely using this technique and for the first time in Russia we have accumulated unique experience that allowed us to complete this article. The aim of this study is to demonstrate a new biportal endoscopic spinal surgical technique’s possibility in treatment of degenerative lumbar spine diseases and to report the results of using this technique in our clinic. Study design: retrospective study. One hundred two patients who were suffering from neurologic symptoms by degenerative lumbar spine diseases were included in study. All patients were divided into 3 groups according to the clinical condition: 1st group — patients with degenerative central spinal stenosis who underwent biportal endoscopic bilateral decompression using a unilateral approach, 2nd group — patients with foraminal spinal stenosis who underwent biportal endoscopic foraminotomy using a extraforaminal approach, 3rd group — patients with degenerative monosegmental instability, degenerative or isthmic spondylolisthesis who underwent biportal endoscopic lumbar interbody fusion. Clinical outcomes were analyzed in accordance with modified-Macnab criteria, Oswestry Disability Index (ODI), Numeral rating scale (NRS), also postoperative complications were analyzed. There was a significant improvement in the dynamics of pain syndrome, ODI scale in all 3 groups. According to the McNab scale, no unsatisfactory results were observed in any group. There were 4 cases of durotomy. In all cases, the durotomy did not exceed 3 mm and did not require further treatment. No cases of infectious complications were identified. Biportal endoscopic surgery can be considered an alternative to the traditional microsurgical technique of spinal decompression and spinal fusion in the lumbar spine. The use of this technique can significantly reduce muscle trauma, achieve sufficient decompression, and reduce the frequency of infectious complications.

Comparison between single anterior and single posterior approaches of debridement interbody fusion and fixation for the treatment of mono-segment lumbar spine tuberculosis

PurposeTo compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients.MethodsEighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups.ResultsThe average period of follow-up was 34.3 ± 9.5 months (24–56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up.ConclusionBoth single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.

Effects of McKenzie Approach and Kinesio Taping Technique in Individuals with Mechanical Low Back Pain: A Comparative Study

Objective of this study is to compare the effects of McKenzie approach and kinesio taping technique in individuals with mechanical low back pain. Materials and Methods used are, Quasi experimental study design in the study setting of Department of Physiotherapy, Kovai Medical Centre and Hospital, Coimbatore with the sample of the 20 Patients with Mechanical low back pain who met the inclusion criteria were selected for the study. They were Grouped in A and B with each of 10 Patients. Among the patients, Group A received McKenzie approach and Group B received Kinesio taping. Patients were measured for Pain status by Visual Analogue Scale, Functional ability by Modified Oswestry Disability Index Scale. Results of the data were analyzed using paired, and independent “t‟ tests at 5% level of significance. Even though, there was a significant improvement in both the groups, the McKenzie approach group showed a greater improvement when compared to Kinesio taping technique group. We conclude that McKenzie approach is more effective therapy for mechanical low back pain patients. KEY WORDS: Mechanical low back pain, McKenzie approach, Kinesio taping technique.

Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease.

There is a growing number of publications highlighting sarcopenia and myosteatosis as poor prognosic factors for treatment results in oncological patients. The decrease in the cross-sectional area (CSA) of the multifidus muscle and muscle steatosis is associated with lumbar disc herniation and low back/limb pain. Nevertheless, no studies have analyzed the influence of the above parameters on patient satisfaction, pain decrease and return to daily activities. The aim of the study was to verify whether decreased preoperative CSA of the paraspinal and psoas major muscles and their fatty degeneration (myosteatosis) may influence the outcome of surgical treatment of lumbar disc disease (LDD). One hundred and one patients with LDD undergoing open microdiscectomy were enrolled in the analysis. Relative cross-sectional areas (rCSA) of the paraspinal and psoas major muscles as well as their fatty degeneration were measured. Patients were assessed according to the validated Polish versions of the EURO EQ-5D, Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) 1 and 6months postoperatively. The association between the variables was calculated using Pearson r and Spearman rank correlation. The Kruskal-Wallis test was used to compare the results between the groups with different rCSA of paraspinal and psoas major muscles and a different degree of paraspinal muscle myosteatosis. Fatty degeneration of the paraspinal muscles correlated with better outcomes 1 and 6months postoperatively according to ODI (P = 0.003 and P = 0.027, respectively). Patients with higher rCSA of the paraspinal and psoas major muscles achieved better results on the EURO EQ-5D scale (P = 0.0289 and P = 0.0089, respectively). Higher rCSA of the paraspinal and psoas major muscles did not correlate with better outcomes measured using ODI, COMI and VAS scales (P ≥ 0.072). The degree of fatty degeneration of the paraspinal muscles correlates with better outcomes 1 and 6months after microdiscectomy.

Clinical and Radiological Outcome of Minimally Invasive- Transforaminal Lumbar Interbody Fusion in Patients with Single or Double-Level Involvement with Minimum 2-Year Follow-up

Purpose: The objective of this study is to analyze the clinical and radiological outcome of Minimally Invasive-Transforaminal Lumbar Interbody Fusion (MIS-TLIF) in terms of estimated blood loss (EBL), operative time, length of stay (LOS) in the hospital, complication, Oswestry disability index (ODI) score, visual analog scale (VAS) score, and parameters of sagittal spinal balance before and after surgery. The parameters of sagittal spinal balance included in this study were pelvic Incidence (PI), lumbar lordosis, focal lordosis at the index level. Materials and Methods: All cases were retrospectively followed up. Single-level and double-level MIS-TLIF procedures for back pain and leg pain operated between 2015 and 2018 were included in the study. PI, Lumbar lordosis, Focal lordosis at index level was measured on preoperative, post-operative, and final follow-up lateral lumbosacral X-ray in the supine position. Demographic data, intraoperative blood loss, operative time, LOS, ODI score, and VAS score at different times were reviewed and analyzed. Results: Fifty-four patients were included among them 24 were male and 30 were female. The average age of the patients was 51.6 ± 12.1 years. Sixteen double-level surgery and 38 single-level surgeries. The average value of follow-up was found to be 39.6 ± 12.4 months. The average value of operative time, the EBL and the LOS were 170.8 ± 19.8 min, 132.1 ± 34.8 mL, and 4.8 ± 0.8 days, respectively. The average PI was 54.9 ± 11.2° preoperatively, 55.0 ± 10.7° postoperatively and 54.8 ± 10.9° at the final follow-up. Pre-operative lumbar lordosis and focal lordosis were 44.55 ± 12.9° and 7.76 ± 5.2°, respectively with postoperatively and final follow-up to 48.88 ± 13.1° and 10.62 ± 5.1°, respectively. VAS score and ODI scales were improved significantly from preoperative 8.4 ± 0.9 and 56.3 ± 4.9, respectively, to postoperatively and final follow-up 2.0 ± 0.8 and 21.6 ± 5.4, respectively. The postoperative complications and revision occurred in 8 (14.8%) and 4 (7.4%) patients, respectively. Conclusion: MIS-TLIF is a novel technique with the good radiological and clinical outcome with decreased perioperative morbidity. It is also superior to open TLIF in terms of EBL, hospital LOS, operative time, perioperative morbidity, and surgical complications. Keywords: Minimally invasive-transforaminal lumbar interbody fusion, Clinical improvement, Pelvic incidence, Lumbar lordosis, Focal lordosis

Surgical Outcomes of Extraforaminal Microdiskectomy by Midline Incision for Far-Lateral Lumbar Disk Herniation.

Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy-partial facetectomy, and to evaluate mid-term surgical outcomes. 107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests. 58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant, p = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant, p = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes. The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability.

Minimally invasive spinal fusion technique in patients with lumbar segmental instability.

Background: Lumbar fusion is a common surgical procedure for treatment of back pain caused by degeneration of lumbar disc. The aim of fusion is to prevent motion in the destabilized segments to decrease the back pain . All types of interbody fusion approaches work with posterior pedicle screw fixation to increase stabilization and fusion rates. It has some disadvantages including paraspinal muscle dissection, screw malposition, neurologic risk , increased the time of operation with blood loss and risk of infection. A modified interspinous device can provide stabilization similar to pedicular screw fixation avoiding its complication when used for interbody fusion as a minimally invasive procedur. Patient and Methods: The study involved 20 patients with moderate segmental instability in lumbar spine . Transforaminal interbody fusion using the polyethere- therketone( PEEK )cage and rigid interspinous device fixation was performed. Patients were followed up and treatment outcomes were assessed within approximately 24 months after surgery. Results: according to pain intensity level on the visual analogue scale, the need for painkillers and the quality of life according to the Oswestry Disability Index scale during the early postoperative period demonstrated significantly better outcomes due to a less severe operative trauma to the paravertebral soft tissues. The formation of interbody bone formation was observed after 20—36 months in 94% of patients . Postoperative complications occurred in 2.2% of patient. Conclusion: The use of transforaminal interbody fusion and rigid interspinous stabilization provides better clinical outcomes and fewer postoperative complications in patients with moderate lumbar segmental instability.