Oswestry Disability Index Values Research Articles

Clinical Observation of Posterior Approach for Surgical Treatment of Thoracolumbar Pseudarthrosis in Ankylosing Spinal Disorders

To evaluate the surgical effectiveness of posterior procedure with long segment stabilization for treating thoracolumbar pseudarthrosis associated with ankylosing spinal disorders (ASD) without anterior fusion or osteotomy. Twelve patients with thoracolumbar pseudarthrosis in ASD were enrolled. All patients underwent posterior long-segment stabilization procedures. In some patients, the percutaneous technique or the aid of a robot or O-arm navigation was utilized for pedicle screw implantation. The clinical results were evaluated by means of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes were evaluated for bone fusion, anterior column defect, local kyphotic correction (LK) and position of the pedicle screws. All patients experienced effective bone fusion at the sites of pseudarthrosis. The mean operative time was 161.7±57.1 min, and the average amount of blood loss was 305.8 ± 293.2 ml. For six patients who underwent surgery with the assistance of a robot or O-arm navigation, there was no statistically significant difference observed in terms of operative time and mean blood loss compared to those who used the freehand technique (P>0.05). The VAS score, ODI value, and mean LK angle showed significant improvements at the final follow-up (P<0.05). The accuracy of pedicle screw placement was 96%. Posterior surgery with long-segment fixation, without anterior fusion or osteotomy, can achieve satisfactory outcomes in ASD patients with thoracolumbar pseudarthrosis. The application of percutaneous techniques, as well as the assistance of robots or navigation technique may be a good choice for the treatment of pseudarthrosis in ASD patients.

Direct Repair of Symptomatic Lumbar Spondylolysis Using Rod-Screw-Cable System

To assess the efficacy of a new direct lysis repair technique using internal fixation with rod, screws, and Songer cable in symptomatic lumbar spondylolysis. Between December 2015 and January 2020, patients who were diagnosed with symptomatic lumbar spondylolysis and surgically treated with a rod-screw-cable system were recruited. Pedicle screwing by the Magerl technique was performed in all included patients, followed by direct lysis repair with bone allograft and demineralized bone matrix by stabilizing the posterior lamina and spinous process using a rod-screw-cable system. Clinical outcome was measured using the visual analog scale and Oswestry disability index preoperatively and 6weeks, 3months, 6months, 1year, and 2years postoperatively. Sixteen patients were included in this study-11 men and 5 women (mean age: 47years; range, 26-67years). The lytic defects were at L4 and L5 in 6 and 10 patients, respectively. The mean follow-up period was 41months (24-62months). The visual analog scale values were 7.3, 6.1, 4.3, 3.3, 2.1, and 1.9 preoperatively and 6weeks, 3months, 6months, 1year, and 2years postoperatively, respectively. The Oswestry disability index values were 59.8%, 55.4%, 41.7%, 32.4%, 21.1%, and 16.9% for the same periods, respectively. No patient had an increase in the slip after surgery. There were no significant complications such as implant failure. Our technique provides rigid intra-segmental repair of spondylolysis without intersegmental motion interference, even if the patient is older or has disc degeneration.

Destandau Tekni̇ğiyle Lomber Diskektomi̇ Kısa Vadede Daha İyi Sonuçlar Veri̇yor

Background: The long-term results of patients who underwent lumbar discectomy using the Desdandau technique (EDDT) and standard open technique (SOD) were compared. Materials and Methods: A retrospective screening was made of patients, aged 18-70 years, who underwent single-level lumbar discectomy between 2007 and 2011. A total of 52 patients met the study criteria and were separated into 2 groups according to the surgical technique used, the EDDT group (n: 27) and the SOD group (n:25). All patients were compared using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. Results. The mean follow-up period was calculated as 158.2±9.2 months in the EDDT group and 161.2±11.1 months in the SOD group. The preoperative VAS and ODI values were observed to be similar in both groups (p=0.829); p=0.120 respectively). At the early postoperative visit, VAS and ODI values were lower in the EDDT group (VAS: EDDT: 2.2±0.6; SOD: 4.1±0.8, p&amp;lt;0.001; ODI: EDDT: 15.4±1.6, SOD: 29.1±1.9, p&amp;lt;0.001, respectively), however, there was no significant difference in VAS and ODI scores between the two groups at the last control (VAS: EDDT: 2.1±0.4, SOD: 2.4±0.5, p=0.078; ODI: EDDT: 14.6±2.1, SOD: 15.1±1.2, p=0.033, respectively). According to the modified MacNab criteria, good and excellent results were obtained in 88% of the SOD group and 92% of the EDDT group. Conclusion: The study found that the long-term results of both techniques were similar. However, the Destandau technique had better early results. The endoscopic method seems to be better in terms of early return to daily activities.

Predicting major complications and discharge disposition after adult spinal deformity surgery

Background ContextSeveral spine-specific comorbidity indices are available to help risk-stratify patients before they undergo invasive spine procedures. Studies of patients with adult spinal deformity (ASD) typically use the Charlson Comorbidity Index (CCI), which is not specific to spine patients. PurposeTo compare the CCI with the Seattle Spine Score (SSS), the Adult Spinal Deformity-Comorbidity Score (ASD-CS), and the Modified 5-Item Frailty Index (mFI-5) and identify which tool more accurately predicted major perioperative complications and discharge disposition after ASD surgery. Study Design/SettingRetrospective review. Patient SamplePatients with ASD who underwent spinal arthrodesis of at least four levels at a single institution. Outcome MeasuresSelf-reported measures include SSS, ASD-CS, and mFI-5. Functional measures include the CCI. MethodsWe retrospectively reviewed records of 164 patients with ASD who underwent spinal arthrodesis of ≥ four levels from January 2008 to February 2018 at our U.S. academic tertiary care center and who had available Oswestry Disability Index values. To assess the predictive ability of the comorbidity indices, we created five multivariable logistic regression models, with the presence of major complications and discharge disposition (home or inpatient rehabilitation) as the primary outcome variables. The base model used validated demographic and surgical factors that were predictors of complications and outcomes in those with ASD and within the broader spinal literature. The other four models used the base model along with one of the four indices. The predictive ability of each model was compared using goodness-of-fit testing, with higher pseudo-R2 values and lower Akaike information criteria (AIC) values indicating better model fit. ResultsThirty-one patients (19%) experienced major perioperative complications, and 68 (42%) were discharged to inpatient rehabilitation facilities (vs home). The model using the SSS had the highest pseudo-R2 value and lowest AIC value for both major complications and discharge disposition. The mFI-5 had a similar predictive ability. The models using the CCI and ASD-CS were weaker predictors. ConclusionsCompared with the CCI and the ASD-CS, the SSS and the mFI-5 were strong predictors of major complications and discharge disposition after ASD surgery. These results suggest that the SSS and the mFI-5 are preferable to the CCI for clinical risk stratification and outcomes research in patients undergoing ASD surgery.

A Retrospective Study of Far Lateral Midline Microlumbar Discectomy in 20 Patients at a Single Center in Turkey.

BACKGROUND Microdiscectomy is a minimally-invasive surgical technique for treating far lateral lumbar disc herniation (FLLDH). This retrospective study from a single center in Turkey aimed to evaluate midlinelumbar discectomy in 20 patients with far lateral lumbar disc herniation. MATERIAL AND METHODS We collected clinical data of 20 patients (11 men, 9 women) operated for FLDDH between January 2006 and January 2022. Patients' age, sex, surgical level, examination findings, motor deficit, duration of operation, complications during the operation and preoperative/postoperative 6 month visual analogue Scala (VAS), preoperative/postoperative 6th month Oswestry Disability Index (ODI) scores were evaluated. RESULTS The patients were 11 men (55%) and 9 women (45%), with a mean age of 52.08±11.21 years. The mean duration of symptoms before the operation was 3.4 weeks. Laseque sign positivity was found in 86.4% of the patients. Motor deficit was present in 30% of the patients. After 6-month follow-up, preoperative VAS value decreased from 9.35±0.75 to 0.84±0.75. Preoperative and postoperative VAS score averages were significantly different (P=0.0001). Operation ODI values were 73.63±3.76 before and after surgery, and decreased to 14.81±3.63 at 6 months. CONCLUSIONS The term distal lateral disc herniation was first defined in the literature in 1974 when the disc was seen in a different location than the normal location compared to the facet. Far lateral disc herniation can be operated on successfully with midline skin incision.

Comparison of the Particulate Steroids, Betamethasone and Methylprednisolone, in Caudal Steroid Injection Under Ultrasound Guidance

Pain relief in lumbar disc hernias is a challenging condition. This study retrospectively compared particulate steroids, methylprednisolone acetate (mid-term effective), against betamethasone acetate (long-term effective) on ultrasound-guided caudal epidural injection for lumbar disc herniation. A total of 40 patients with L4-5 and/or L5-S1 disc herniation were treated with ultrasound-guided caudal epidural injection between September 2021 and June 2022. Nineteen patients who were given methylprednisolone acetate (group A) as a steroid and a total of 21 patients who were used betamethasone acetate (Group B) were retrospectively collected, and their pain levels and functional improvement were compared retrospectively before, immediately after, and 3weeks after the injection in terms of the visual analog scale (VAS) and Oswestry Disability Index (ODI) as the efficacy value. There was no statistically significant difference between the groups regarding age, gender, and body mass index (P>0.05). In group A, preop VAS was 8.84±0.76, immediate postop period 3.10±1.37, and postop third week was 4.73±2.32. In group B, the preop VAS was 8.76±0.76, the postop early period was 3.14±1.27, and the postop third week was 3.12±1.30. In group A preop ODI was 49.84±9.11 and postop third week was 22.84±6.44. In group B, the preop ODI was 46.71±16.15 and postop third week was 30.80±17.65. Significant changes were observed in the reduction of VAS values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, a significant difference was not found between the changes in VAS values between the groups (P value > 0.005). Similarly, significant changes were observed in the decrease of ODI values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, no significant difference was observed in the ODI scores between the two groups. No significant difference was observed between betamethasone and methylprednisolone. Both steroid groups showed a substantial improvement in the preoperative pain scores of the patients.

Different Pain Types at Coccygodynia and its Relation with Vitamin D Level

Background; Coccygodynia is a musculoskeletal disease that affects quality of life. The main complaint of coccygodynia is nociceptive and/or neuropathic pain. Vitamin D deficiency has been associated with the development of pain in various diseases. &#x0D; Aims; In this study we aimed investigate the pain types (nociceptive, neuropathic, mixed) and the relationship between pain types and Vitamin D level in patients with coccygodynia. &#x0D; Study design; Observational study&#x0D; Materials and Methods; A total of 54 patients diagnosed with coccygodynia were included. Pain intensity, disablity and pain type were evaluated by Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the PainDETECT questionnaire, respectively. All participants had their vitamin D levels measured. &#x0D; Results; Neuropathic pain was detected in 27.8% of the patients with coccygodynia. Vitamin D was determined to be insufficient or deficient in 81.5% of the patients. A statistical significant correlation was found between neuropathic pain and prolongation of coccygodynia and increased ODI values (p&lt;0.05). The Vitamin D values were determined to show statistically similar distribution in the nociceptive, mixed type, and neuropathic pain groups (p=0.532). &#x0D; Conclusion; The frequency of neuropathic pain in coccygodynia increases with increasing disability and disease duration. Although vitamin deficiency or insufficiency is common in coccygodynia, it is not associated with the type of pain.

The novel Kambin Torpedo full-endoscopic lumbar interbody fusion technique: a case series.

Full-endoscopic lumbar interbody fusion (FELIF) is a new-generation treatment for spondylolisthesis. However, owing to their unique characteristics, the two main endoscopic fusion trajectories, the trans-Kambin and posterolateral approaches, have important limitations. Herein, we aimed to introduce a new technique called Kambin Torpedo FELIF (KT-FELIF). The KT-FELIF technique is based on the trans-Kambin approach. It additionally completes ipsilateral total facetectomy and contralateral direct decompression. Thus, this novel technique combines the advantages of the trans-Kambin and posterolateral approaches. We reported on the indications and technical steps of KT-FELIF and provided intraoperative and animated videos to clarify the procedure. Short-term follow-up based on 3-month postoperative computed tomography and plain films images taken at least 3months after surgery showed adequate bony decompression, a large bone graft contact area, and good intervertebral trabecular bone growth without radiolucent lines between the graft, cage, and end plate. The clinical results, such as ipsilateral and contralateral visual analog scale and Oswestry disability index values, gradually improved at 1 and 3months postoperatively. No complications were observed. KT-FELIF is a promising FELIF technique for achieving bilateral direct decompression through a unilateral approach while accomplishing thorough discectomy and endplate preparation.

Effects of the obstruction of erector spinae plane in affected people undergoing percutaneous vertebroplasty

BackgroundWe aimed to compare the difference between the therapeutic effects of percutaneous vertebroplasty (PVP) as well as PVP combined with erector spinae plane blocked (ESPB) in osteoporotic vertebral compression fractures (OVCFs) therapy.MethodsAfter the reception, 100 affected people to OVCFs were randomly divided into the PVP group as a control as well as the PVP + ESPB group as the observation, which included fifty affected people per group. The visual analog scale (VAS) for pain as well as the Oswestry Disability Index (ODI) per group was assessed before the operation, two hours after the operation, and when patients were discharged from the hospital. Operating time was also evaluated on the charged bulk of bone cement during the surgery, blood loss during the surgery, as well as operating costs for each group. Additionally, to assess differences, comparisons have been done among available groups in terms of ambulation as well as defecation or stool after the operation at the earlier time.ResultsThe PVP + ESPB category acquired lower VAS and ODI scores when assessments were processed 2 h after the operation and when they were discharged from a hospital. They also had earlier postoperative ambulation and defecation time than the category of PVP (p < 0.05). Regarding the other indicators, there did not show significant differences. Besides, no complications occurred within both group, either after the operation or when they discharge from the hospital.ConclusionPVP + ESPB for OVCF is related to less VAS, further effective alleviation of pain, and fewer ODI values in affected people after the operation than only PVP. Besides, affected people can involve in ambulation more swiftly. The PVP + ESPB therapy improves the quicker recuperation of intestinal function as well as helps to improve the overall life quality of patients.

A design of a targeted puncture trajectory applied to unilateral extrapedicular percutaneous vertebroplasty

ObjectiveIn this study, we introduced a design of a targeted puncture trajectory applied to unilateral extrapedicular percutaneous vertebroplasty.Methods62 individuals with osteoporotic vertebral compression fractures (OVCF) were included in this research at the Tongling People’s Hospital, from January 2019 to December 2020. Percutaneous Vertebroplasty (PVP) was performed on all patients using a targeted unilateral extrapedicular puncture technique guided by G-arm fluoroscopy. The operating time, volume and dispersion of bone cement, and cement leak were all evaluated. The oswestry disability index(ODI) and the visual analog scale (VAS) were used to assess pain relief and quality of life (QOL).ResultsThe targeted puncture trajectory for unilateral extrapedicular PVP was used to successfully treat a total of 62 fractured vertebrae without any apparent clinical issues. In comparison to their equivalent preoperative values, the VAS and ODI values after surgery were considerably lower (P < 0.01). The bone cement not only could be across the midline of the targeted vertebrae but also appeared in both the bilateral pedicle and the center projection region on the anteroposterior X-ray film, according to radiologic results in all injured vertebrae. There were 3 cases of leakage at the anterior border of the vertebral body and 2 cases of leakage into the intervertebral region without significant clinical manifestations. Furthermore, no bone cement leaked into the vessels or spinal canal.ConclusionThe design of the targeted puncture trajectory used in unilateral extrapedicular PVP not only ensures that the bone cement injector transcends the midline of the vertebral body, but it also improves the accuracy of the injector arriving at the contralateral pedicle projection area. As a result, this approach can increase well-distributed bone cement diffusion while preventing cement leakage into the spinal canal.

The Impact of Vertebroplasty on Sagittal Parameters in Traumatic Thoracic Vertebral Fractures

Objective: It is well-established that vertebroplasty has effects on sagittal parameters due to various pathologies of the spine. Our objective in the study was to reveal the impact of vertebroplasty that was applied to compression fractures due to trauma on sagittal parameters. Material and Method: Twenty patients were included in the study. Scoliosis radiographs were shot preoperatively and at first month during the postoperative period. Spinopelvic parameters of each patient including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), cervical lordosis (CL), and sagittal vertical axis (SVA) were assessed. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) assessments of the patients were performed as well. Results: Spinopelvic parameter values of the patients were assessed statistically through the analysis of the Paired sample T test before surgery and in the first month during the postoperative period. It was determined that the changes in the PT, SS and LL values of the patients between preoperative and first month postoperative were at the level of p 0.659, p=0.716, p=0.012; and the changes were not significant. It was determined that the changes in the TL, TK, CL, SVA, VAS and ODI values of the patients between preoperative and first month postoperative were at the level of p &lt;0.001and the changes were significant. Conclusion: Vertebroplasty is an efficient technique for relieving pain in thoracic fractures that have a score of 4 and over, based on the thoracolumbar injury classification score and that are type A, based on the AO Spine thoracolumbar injury classification score. Elimination of pain in the acute period is effective in ameliorating the sagittal parameters of patients.

Effect of Fluoroscopic-Guided Corticosteroid Injection in Patients With Sacroiliac Joint Dysfunction.

Background Sacroiliac joint dysfunction is a major cause of axial low back pain which can masquerade as pain from lumbar disc diseases. Treatment of axial back pain arising due to sacroiliac joint dysfunction remains a challenge. This study was conducted to evaluate the long and short-term effects ofintra-articularcorticosteroid injection in the relief of pain and disability caused by sacroiliac joint dysfunction. Methodology A total of 83 patients with sacroiliac joint dysfunction were included in this prospective randomized control study. Patients were randomized into two groups by a computer-generated randomization table. These two groups were treated with fluoroscopy-guided corticosteroid and local anesthetic injection (group A) and distilled water and local anesthetic injection (group B). Pre and post-intervention assessment of all patients was done based on the Numeric Pain Rating Scale (NPRS) for pain and Oswestry Disability Index (ODI) for disability. The outcome measures of the study were the NPRS and ODI assessed at the initial visit one (pre-injection), two weeks post-injection (visit 2), and four weeks post-injection (visit 3). Results Demographic data were comparable in both groups. There was no significant difference in pre-injection NPRS and ODI values in both groups. The changes in NPRS and ODI values were significant from pre-injection to two weeks to four weeks. Group A patients performed better in terms of a decrease in the perception of pain and a decrease in the perception of disability compared to group B patients in the second and fourth weeks of follow-up. Conclusions Fluoroscopy-guided corticosteroid injection is an effective measure for reducing pain and disability in patients with sacroiliac joint dysfunction.

A new method for establishing operative channels in unilateral biportal endoscopic surgery: Technical notes and preliminary results.

The unilateral biportal endoscopic (UBE) technique has been widely used in spine surgery. At present, a traditional rigid working channel is available for the UBE system. A metal semicircular canal is located in the working channel. However, due to the metal material of the working channel, arthroscopy and instruments are constrained from moving in UBE surgery. Additionally, an assistant is needed during the procedure to hold the traditional working channel. For simplicity of operation and convenient movement of the arthroscopy and instrument, we describe a new method for establishing operative channels in UBE surgery. We retrospectively reviewed 50patients who underwent unilateral biportal endoscopic discectomy (UBED) from February 2020 to August 2020 via our new method. The Oswestry Disability Index (ODI) and visual analogue scale (VAS) score were measured preoperatively and 1month, 3months, 6months and 12months postoperatively. Statistical comparisons were made using analysis of covariance and paired t tests. The VAS scores for back pain at the five time points were 5.20 ± 2.57, 1.96 ± 0.95, 1.50 ± 0.84, 1.64 ± 1.08 and 1.18 ± 0.39. The leg pain VAS scores were 7.02 ± 2.25, 2.02 ± 1.27, 1.48 ± 0.89, 1.32 ± 0.79 and 0.88 ± 0.52. The ODI values were 51.08 ± 19.97, 19.62 ± 15.51, 8.26 ± 7.40, and 7.54 ± 6.42 to 3.24 ± 1.10. The postoperative ODIs and VAS scores of low back pain and leg pain were significantly lower than those before surgery, and differences were statistically significant (all p< 0.05). The pressure of the closed outflow was significantly higher than that of the open outflow (37.35 ± 13.11mm Hg vs. 24.55 ± 12.64mm Hg p= 0.003). After we tightened the infusion strap to open the outflow, the pressure decreased significantly (26.4 ± 14.08mm Hg vs. 37.35 ± 13.11mm Hg p= 0.015). There were 2cases of complications, including 1case of postoperative recurrence and 1case of dural tears. This study demonstrates the technical feasibility, safety, and efficacy of modified channel establishment in UBE surgery.

Does Percutaneous Endoscopic Lumbar Discectomy for Adolescent Posterior Ring Apophysis Fracture Accompanied with Lumbar Disc Herniation Have Better Outcome Than Lumbar Disc Herniation Alone?

This study aims to compare the efficacy of percutaneous endoscopic lumbar discectomy (PELD) in treating adolescent posterior ring apophysis fracture (APRAF) accompanied by lumbar disc herniation (LDH) and lumbar disc herniation alone. Herein we present a case series of adolescent patients who underwent PELD surgery from June 2017 to September 2021. All patients were divided into two distinct groups (ie Group A and B), based on their preoperative Computed tomography (CT) scans. Group A included patients with PRAF (type III) accompanied by LDH. Group B patients had LDH alone. The general clinical characteristics, clinical outcomes, and complications in patients from the two groups were assessed and compared. Compared to before surgery, the back and leg visual analog scores (VAS) and Oswestry Disability Index (ODI) were markedly improved in both groups' patients at all follow-ups. Notably, no significant differences were observed in the back and leg VAS scores, and ODI values between the two groups at different time points after surgery. The mean intraoperative blood loss was significantly lower in Group B, relative to Group A. The mean operation time was significantly shorter in Group B, compared to Group A. There was no statistically significant difference in complication and recurrence rates between the two groups. APRAF (type III) accompanied by LDH and LDH alone can obtain roughly equal surgical effects through PELD surgery and turns out to be a safe and effective surgical approach.

Application of Musculoskeletal Ultrasound Guidance in Lumbar Transforaminal Endoscopic Surgery for Puncture and Catheterization.

BACKGROUND Foraminal puncture is a key step in foraminal endoscopic surgery, but the radiation dosage poses a clinical risk to patients. To reduce the radiation dosage, we investigated the feasibility and clinical effect of endoscopic transforaminal puncture through the use of the musculoskeletal ultrasound-guided lumbar percutaneous posterolateral approach. MATERIAL AND METHODS Retrospective data of 80 lumbar percutaneous posterolateral approach endoscopic surgery patients from March 2018 to June 2021 were analyzed. The clinical efficacy was assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) during the follow-up. RESULTS Between the musculoskeletal ultrasound-guided group and the C-arm X-ray machine fluoroscopy group, the puncture time of the musculoskeletal ultrasound-guided group was significantly shorter than that of the C-arm X-ray machine fluoroscopy group (t=13.113, P=0.010). The radiation received in the ultrasound guidance group was significantly less than in the C-arm X-ray group. There was no difference in ODI values between the 2 groups before surgery (t=0.195, P=0.286), 3 months after surgery (t=0.235, P=0.092), and 1 year after surgery (t=0.168, P=0.173). There was no significant difference in VAS scores between the 2 groups before surgery (t=0.715, P=0.610), 3 months after surgery (t=0.367, P=0.192), and 1 year after surgery (t=0.496, P=0.390). CONCLUSIONS Our data demonstrate that musculoskeletal ultrasound can accurately guide the lumbar percutaneous posterolateral approach for endoscopic foraminal puncture, which can significantly reduce the puncture time and the amount of X-ray radiation.

Analgesic effect of epidural anesthesia via the intervertebral foramen approach in percutaneous transforaminal endoscopic discectomy: a retrospective study

BackgroundSatisfactory intraoperative analgesia is critical for percutaneous transforaminal endoscopic discectomy (PTED). Local anesthesia (LA) and epidural anesthesia (EA) are recommended for PTED. LA alone does not achieve satisfactory pain management during PTED and other analgesics or sedatives are usually needed. Traditional EA, which involves implanting an epidural catheter through the midline or paramedian, has disadvantages such as difficulty in catheterization and increased preoperative preparation time. Rather than performing conventional EA, we injected local anesthetics through the intervertebral foramen during the puncture process, which we termed lumbar transforaminal EA (LTEA), and observed its feasibility and safety. This study aimed to conduct a comprehensive comparison of differences in analgesia between LA and LTEA in patients with PTED.MethodsWe performed a retrospective analysis of patients who underwent PTED between January 2018 and January 2021. Patients were divided into LA and LTEA groups. Data obtained from the electronic medical records included primary outcomes (visual analog scale [VAS] scores and anesthesia satisfaction rate) and secondary outcomes, including vital signs such as heart rate (HR), mean arterial pressure (MAP), total dosage of fentanyl, operation time, X-ray exposure time, Oswestry Disability Index (ODI) scores, and complications.ResultsIn total, 160 patients (80 in each group) were analyzed in this study. The VAS scores for lumbar and leg pain were significantly lower in the LTEA group than in the LA group (P < 0.0001). The anesthesia satisfaction rate was 90.0% in the LTEA group and 72.5% in the LA group (P < 0.005). MAP and HR values in the LTEA group were significantly lower than those in the LA group (P < 0.05). The total dose of fentanyl in the LTEA group was significantly lower than that in the LA group (P < 0.05). As for ODI values, the average operation time, X-ray exposure time, and incidence of complications were not significantly different between the two groups (P > 0.05).ConclusionsLTEA simplifies the process of EA and can achieve a good analgesic effect intraoperatively without increasing the preoperative preparation time; thus, it may be adopted as an alternative mode of anesthesia during PTED surgery.

Preoperative duration of pain is associated with chronic opioid use after adult spinal deformity surgery.

Few studies have explored the association between preoperative patient-reported measures and chronic opioid use following adult spinal deformity (ASD) surgery. We sought to explore the association between preoperative duration of pain, as well as other patient-reported factors, and chronic opioid use after ASD surgery. We retrospectively reviewed our U.S. academic tertiary care hospital's database of ASD patients. We included patients 18years or older who underwent arthrodesis of four or more spinal levels from January 2008 to February 2018, with 2-year follow-up. The primary outcome variable was chronic opioid use, defined as opioid use at both 1 and 2years postoperatively. We analyzed patient characteristics; duration of preoperative pain (<4years or ≥4years); radiculopathy; preoperative Scoliosis Research Society-22r (SRS-22r) score; Oswestry Disability Index (ODI) value; and surgical characteristics. Of 119 patients who met the inclusion criteria, 93 (78%) were women, and mean ± standard deviation age was 59 ± 13. Sixty patients (50%) reported preoperative opioid use, and 35 (29%) reported chronic opioid use. Preoperative opioid use was associated with higher odds of chronic use (adjusted odds ratio, 5.9; 95% confidence interval 1.6-21), as was preoperative pain duration of ≥4years (adjusted odds ratio, 3.3; 95% confidence interval 1.1-9.8). Patient characteristics, surgical variables, ODI value, and SRS-22r score were not significantly associated with chronic postoperative opioid use. Preoperative opioid use and duration of pain of ≥4years were associated with higher odds of chronic opioid use after ASD surgery. III.

Efficacy of Single-Position Oblique Lateral Interbody Fusion Combined With Percutaneous Pedicle Screw Fixation in Treating Degenerative Lumbar Spondylolisthesis: A Cohort Study.

ObjectiveTo investigate the surgical outcomes of single-position oblique lateral interbody fusion (OLIF) combined with percutaneous pedicle screw fixation (PPSF) in treating degenerative lumbar spondylolisthesis (DLS).MethodsWe retrospectively analyzed 85 patients with DLS who met the inclusion criteria from April 2018 to December 2020. According to the need to change their position during the operation, the patients were divided into a single-position OLIF group (27 patients) and a conventional OLIF group (58 patients). The operation time, intraoperative blood loss, hospitalization days, instrumentation accuracy and complication rates were compared between the two groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. The surgical segment's intervertebral space height (IDH) and lumbar lordosis (LL) angle were used to evaluate the imaging effect.ResultsThe hospital stay, pedicle screws placement accuracy, and complication incidence were similar between the two groups (P > 0.05). The operation time and intraoperative blood loss in the single-position OLIF group were less than those in the conventional OLIF group (P < 0.05). The postoperative VAS, ODI, IDH and LL values were significantly improved (P < 0.05), but there was no significant difference between the two groups (P > 0.05).ConclusionsCompared with conventional OLIF, single-position OLIF combined with PPSF is also safe and effective, and it has the advantages of a shorter operation time and less intraoperative blood loss.

AI Prediction of Neuropathic Pain after Lumbar Disc Herniation-Machine Learning Reveals Influencing Factors.

The treatment options for neuropathic pain caused by lumbar disc herniation have been debated controversially in the literature. Whether surgical or conservative therapy makes more sense in individual cases can hardly be answered. We have investigated whether a machine learning-based prediction of outcome, regarding neuropathic pain development, after lumbar disc herniation treatment is possible. The extensive datasets of 123 consecutive patients were used to predict the development of neuropathic pain, measured by a visual analogue scale (VAS) for leg pain and the Oswestry Disability Index (ODI), at 6 weeks, 6 months and 1 year after treatment of lumbar disc herniation in a machine learning approach. Using a decision tree regressor algorithm, a prediction quality within the limits of the minimum clinically important difference for the VAS and ODI value could be achieved. An analysis of the influencing factors of the algorithm reveals the important role of psychological factors as well as body weight and age with pre-existing conditions for an accurate prediction of neuropathic pain. The machine learning algorithm developed here can enable an assessment of the course of treatment after lumbar disc herniation. The early, comparative individual prediction of a therapy outcome is important to avoid unnecessary surgical therapies as well as insufficient conservative therapies and prevent the chronification of neuropathic pain.

Clinical observation of vertebroplasty and kyphoplasty in the treatment of patients with vertebral compression fractures in Duc Giang Hospital from 2015 to 2018

Objectives: To investigate the clinical efficacy of cement augmentation procedures on patients diagnosed with vertebral compression fracture. Subjects and methods: A serial cross-sectional study on 66 patients (76 compressed vertebrae) who underwent vertebroplasty or kyphoplasty at Duc Giang Hospital from 2015 to 2018. The data on vertebral height and kyphosis angle was collected from patient records using a data collection checklist. We used the Oswestry Disability Index (ODI) for functional disability and the Visual Analog Scale (VAS) for pain severity. ODI and VAS were collected using face-to-face patient interviews. All data was recorded pre-operative, at the time of discharge from the hospital, one-month follow-up, three-month follow-up, six-month follow-up, 12-month follow-up, 18-month follow-up, and 24-month follow-up. Results and conclusion: The mean age of patients was 68.9 ± 10.3 (50 to 95 years old), and 14 (21.2%) were male. The most commonly affected vertebrae were L1 and T12. Thirty-one vertebrae (40.8%) were treated by kyphoplasty and 45 vertebrae (59.2%) were treated by vertebroplasty. The average vertebral height andCobb angle had significant recovery (p &lt; 0.001). Following cement augmentation procedures, VAS and ODI values decreased significantly in the 12-month follow-up compared to pre-operative levels (p &lt; 0.001). * Keywords: Vertebral compression fracture; Vertebroplasty; Kyphoplasty; Clinical efficacy.