Oswestry Low Back Disability Questionnaire Research Articles

A degeneratív spondylolisthesis instrumentált fúziós sebészi kezelésének hatása az életminőségre

[Objective - There is no internationally accepted guideline for treatment of spondylolisthesis in the literature, otherwise this degenerative disease has great social and economical impact. There is no hungarian study examining the efficacy of instrumented fusion procedure in surgical treatment of spondylolisthesis. In current study we examined the effectiveness of fusion technique focusing on the impact of quality of life. Methods - Between 1st January, 2011 and 30th June, 2012 we examined a group of patients - who were operated on by instrumented fusion technique because of spondylolisthesis -, in the National Institute of Clinical Neurosciences, using the Oswestry Low Back Disability Questionnaire. All patients were treated after ineffective conservative treatment. The question was wheather how has changed the patients’ quality of life after the operation. Paired-sample t-test was used in this study. Results - Eighty-eight of the 97 examined patients reported different levels of impovement in the postoperative period, two patient’s condition has not changed in spite of the surgery, seven patient’s condition showed progression in average one year after the surgery. The pain improved most significantly (55.5%) (p<0.0001). Using the 16 point borderline according to the Questionnaire (over moderate disability), significant improvement was detected in 50 patients (51.5%). Succesful surgical result - according to the quality of life - was seen in 77.41% of male and in 50.98% of female patients. According to the different age groups, 72.72% of the younger (before retirement), and 53.06% of the retired patients belonged to this group. At least 15 point improvement was detected 35.05% of the patients, the overall improvement was 10.5 point. Discussion - Our results proved effectiveness of instrumented surgical fusion procedure in the treatment of degenerative spondylolisthesis. According to our results the younger male population with significant symptoms is the group, where improvement in quality of life is more pronaunced after the surgical procedure. Conclusion - The instrumented fusion surgical technique provides successful clinical and surgical outcome in patients with degenerative spondylolisthesis. It could improve the quality of life. Althought multicentre follow-up studies are needed to determine the exact indication and optimal therapy.]

Obesity has an impact on outcome in lumbar disc surgery

PurposeTo investigate the effect of obesity on outcome in lumbar discectomy. MethodsA cross-sectional postal survey; a self-made questionnaire, Beck depression inventory IA (BDI IA) and the Oswestry low back disability questionnaire (ODI) were sent to the patients, who had undergone lumbar disc surgery in the Oulu University Hospital between June 2005 and May 2008. Patients were divided into three groups according to BMI: normal, pre-obese and obese. The ODI was also examined in the framework of the international classification of functioning, disability and health (ICF) to investigate its ability to describe various dimensions of functioning (body structure and functions, activities and participation). ResultsThe postal survey was sent to 642 patients, of whom 355 (55%) replied. Males dominated in the pre-obese (66%) and obese (62%) groups (p=0.01). Normal-weighted and pre-obese patients had lower BDI scores compared to obese patients (mean BDI: 8.0, 7.6, 11.2, respectively, p=0.035). Total ODI score was highest in the obese group compared to normal-weighted or pre-obese (20.3, 18.6, 26.4, respectively, p=0.011). When ODI was linked to the ICF there were significant differences in all activity domains (mobility, self-care and interpersonal interactions and relationships) and the mobility component of the participation domain between the weight groups. Conclusions and implicationsObesity has an impact on outcome in lumbar discectomy. Obese patients had higher scores in BDI and ODI indicating mild mood disturbances and moderate functional disability. According to ICF, functional disability of obese patients was observed to some extent in all activity domains. Obese patients will be more frequently present for disc surgery and increased morbidity risk must be recognized. We need a strategy to rehabilitate and activate obese patients pre- and postoperatively.

Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain

Motor control approach towards chronic non-specific low back pain (CNLBP) has gained increasing attention. CNLBP patients have shown to be more visually dependent for the postural control process than control subjects but no study has yet investigated the treatment programs effect on this disorder. Forty CNLBP patients volunteered to participate in this experimental study. The subjects were randomly assigned into either stabilization exercise (SE) or control group both receiving 12 sessions of routine physiotherapy for four weeks. The SE group also received intensive stabilization exercise. Balance (in terms of overall (OSI), anteroposterior (APSI) and mediolateral stability indices (MLSI)) and functional disability were assessed by Biodex Balance System(®) (BBS) and Oswestry Low Back Disability Questionnaire, respectively prior and after the interventions. The balance tests were performed with open and closed eyes. Both interventions significantly decreased all stability indices but the SE group showed a more pronounced improvement in OSI and APSI. In the SE group, vision deprivation had smaller destabilizing effects on OSI and APSI as compared with the control group. The groups were not statistically different prior and after the interventions on all dependent variables. Oswestry index reduction in the SE group was more pronounced but the interaction of time and group variables were not significant on pain intensity. Both interventions effectively enhanced stability indices and functional capabilities and reduced pain intensity in CNLBP patients. The SE protocol made the patients less visual dependent perhaps via better stability. Since pain reduction was not different between the groups, more functional improvement in SE group cannot simply be interpreted via the pain interference and might be related to postural control capabilities of the patients.

Interspinous Device Implant and Sopraspinous Ligament Removal: An Alternative Approach for Low Back Pain Syndrome Persistence: Our Experience after 2 Years

Introduction Low-back pain syndrome is, up to date, one of the most common cause of inability, especially for young-adult people. In 20% of cases, patients have a degenerative disc disease associated with radiculopathy due to neuroforamen diameter reduction and lumbar soft-stenosis. Interspinous devices were extensively used in the treatment of this pathology, with different outcomes. Material and Methods An observational study was conducted comparing the interspinous device implant only, according to the standard technique, versus the devices implant together with a supraspinous ligament removal. Since April 2012, 81 patients with low-back pain and foraminal “soft” stenosis were enrolled and divided into two groups, homogeneous for age, sex, and disease severity (clinically and instrumentally assessed). Before surgery, all patients were subjected to medical therapy for at least 6 months without any clinical benefit. A total of 39 patients (group A, control) underwent interspinous devices implant only, according to the standard technique and 42 patients (group B) underwent device implant and supraspinous ligament removal. A clinical follow-up was performed at month 1, 3, 6, 12, and 24 by mean of visual analog scale (VAS), neurogenic claudication outcome score (NCOS), and Oswestry low back pain disability questionnaire (OLBPDQ). A radiographic control was obtained at month 1 and 6 (dynamic radiographic studies included). A MRI was done at month 6. The data were analyzed by mean of the Kaplan–Meier curve (results yielding a p value &lt; 0.05 were considered statistically significant). Results Until month 12, slight differences in VAS, NCOS, and OLBPDQ values were noticed between the two groups, but these scores was significantly higher in group B at month 24. Furthermore, radiographic evaluation showed a more significant neural foramina height recovery (mean value: 23 ± 3% vs. 41 ± 3%, respectively, in groups A and B). Although the supraspinous ligament is removed, there is not iatrogenic instability risk, because the device produces an immediate mechanical stability and a consequent intervertebral fusion. At follow-up there were no “fixation failure” and none patient underwent revision surgery. The standard technique provides the intraspinous ligament incision only and the devices positioning in the space between the spinous processes. In our opinion, this approach represents only a partial approach. Although the device implant is useful for radiculopathy resolution, usually low back could decrease, but in many cases only at the beginning. In fact the device may produce a supraspinous ligament extreme elongation, through to the intervertebral distraction. The nociceptors are abnormally stimulated and the back pain can reappear or in some cases persist. Conclusion This approach is able to definitively resolve both radiculopathy and low-back pain. This is an effective technique in terms of safety and efficacy, capable to provide a structural and functional correction, without back pain persistence risk, due to supraspinous ligament extreme elongation.

Helikopter Pilotlarında Bel Agrisinin Belirleyicileri

Objective: Helicopter pilots frequently complain about low back pain (LBP). The aim of this study is to investigate the effect of age, body mass index, total flying hours, smoking habit, regular sports participation and core endurance on LBP, and to determine the predictors of LBP in helicopter pilots. Methods: Twenty-one military helicopter pilots (29.09±6.52 years) were assessed. Demographic information and total flying hours were recorded. Low back disability was evaluated with the Oswestry low back disability questionnaire. The prone bridge test, side bridge test, supine isometric chest raise test and Sorenson test were conducted to assess the core endurance. The parameters affecting the Oswestry disability score were analyzed with the Spearman’s correlation coefficient. A multiple linear regression model was used to identify the independent predictors of the Oswestry score. Dependent variable was the Oswestry score, and the independent variable were age, body mass index, total flying hours, smoking habit, regular sports participation, the prone-bridge, side-bridge, Sorenson and supine isometric chest raise test scores. Results: The low back disability was correlated with age and total flying hours (r=0.55, p=0.015; r=0.53, p=0.01). Results of the linear regression showed that age, total flying hours, smoking status, regular sports participation, the side bridge test score, the prone bridge test score were all the predictors of low back disability (R 2 =0.54, p<0.05). Conclusion: Increased t otal flying hours, smoking habit, sedentary lifestyle, the impaired back muscle endurance and age negatively affected the low back disability status. Modification of the lifestyle and improving the endurance of the back muscles might positively affect the disability level due to the LBP in helicopter pilots. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Normal Tablo; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Times New Roman; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi;}

CSM 2015 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL63)

CSM 2015 Orthopaedic Section Platform Presentations (Abstracts OPL1–OPL63)

Results of lumbar spine surgery: A postal survey

Background and aimsNo studies have been published regarding the results of lumbar spine surgery in a population-based setting in Finland. Our objective was to investigate functional capacity and quality of life after lumbar spine surgery in a population-based cohort in Northern Finland, focusing on working-age patients. MethodsThis was a cross-sectional postal survey. Three questionnaires (a self-made questionnaire, the Oswestry Low Back Disability Questionnaire and the SF-36) were sent the patients aged 18–65 years, who had undergone lumbar spine surgery due to disc herniation, instability or spinal stenosis in the Oulu University Hospital between June 2005 and May 2008. ResultsThe postal survey was sent to 814 patients, of whom 537 patients (66%) replied. Of these, 361 (67%) underwent disc surgery, 85 (16%) stabilizing surgery and 91 (17%) decompression. Pain was absent or present only occasional in 51% in the disc surgery group, whereas it was present daily in 59% in the stabilizing surgery group and in 58% in the decompression group (P<0.001). Axial pain was slightly more intense than radicular pain. Pain was milder in the disc surgery group compared with the stabilizing surgery and decompression groups: mean (SD) axial pain with 0–10 NRS was 4.0 (2.3), 4.7 (2.4) and 4.8 (2.3) respectively (P=0.002) and radicular pain 3.5 (2.6), 4.2 (2.8), 4.5 (2.6) respectively (P<0.001). The total ODI score (mean, SD) was 20 (17) in the disc surgery group, 35 (17) in the stabilizing surgery group and 32 (17) in the decompression group (P<0.001). The physical dimension sum score from the SF-36 was 42 (11) in the disc surgery group and 34 (10) in the stabilizing surgery and decompression groups (P<0.001). Mental sum scores did not vary significantly between the groups. Conclusions and ImplicationsOutcome was good after lumbar disc operations but less favourable after stabilizing surgery and decompression regarding pain, functional capacity and quality of life. Implications. This study offers important information about outcome after lumbar spine surgery in Oulu University Hospital. It also brings out that in Finland we need systematic national spine register, with accurate pre- and postoperative data.

Prevalence of low back pain in working nurses in Zagazig University Hospitals: an epidemiological study

Nursing is one of the occupations with a high risk for back injuries. The etiology of low back pain (LBP) among nurses is usually multifactorial, probably because job demands in nursing is a mixture of physically demanding and mentally demanding tasks. The aim of this study was to identify the prevalence of and risk factors for chronic LBP in nursing personnel working in Zagazig University Hospitals. This study is a quantitative, retrospective, analytical, cross-sectional one. It included 150 female nurses who are currently working in Zagazig University Hospitals. All participants completed a self-administered Oswestry Low Back Disability Questionnaire. Data for risk factors of LBP (age, height, weight, BMI, marital state, parity) and working conditions (duration of employment in the current work, average working hours per week, work demands, duration of absence from work in the last year) were collected. LBP prevailed in 79.3% of the studied group of working nurses. The highest percentage was found among nurses working in the ICU (95.0%) and the least among those working in the outpatient clinics (64.0%). There was a highly significant association between LBP and body mass index (BMI) (P < 0.001). A higher incidence of LBP was associated with lifting heavy loads, followed by twisting, prolonged standing, prolonged sitting, walking for long distances, and bending forward. Prevalence of LBP is high among nurses, resulting in significant medical and socioprofessional consequences. Risk factors necessitate multidisciplinary involvement to reduce the incidence of LBP and related costs.

Microdiscectomy and Micro-Interlaminotomy Approach versus Standard Open Discectomy and Laminectomy: Comparison of Two Techniques

Introduction Life expectancy increased, in the last years, have led to a larger proportion of elderly population and consequently to a greater incidence of degenerative arthritic disease. Lumbar spine is one of the most common localization. Therefore, low-back pain syndrome-increased prevalence was noted. In 20% of cases, patients have a degenerative disc disease associated with disc-root conflict and lumbar stenosis. Materials and Methods An observational study was conducted, comparing microdiscectomy and micro-interlaminotomy approaches versus standard open discectomy and laminectomy. Since February 2010, 60 patients with lumbar disc herniation and unilateral root involvement with spinal canal stenosis were enrolled and divided into the two groups, homogeneous for age, sex, and disease severity (clinically and instrumentally assessed). Before surgical operation, all patients had been under medical therapy for at least 6 months without any clinical benefit. Of the 60 patients, 30 patients (group A) underwent microdiscectomy and micro-interlaminotomy and 30 patients (group B, control) underwent standard open approach. A clinical follow-up was performed at 1, 3, 6, and 12 months by mean of visual analog scale, neurogenic claudication outcome score, and oswestry low back pain disability questionnaire. A radiographic control was obtained at 1 and 12 months. Results As time goes by, disc degeneration is associated with intervertebral space reduction, yellow ligament hypertrophy, and calcification. Intervertebral articulations overload and subsequent hypertrophy can lead to arthritis, epidural osteophytes, and spinal stenosis over time; then, disc-root conflict and lumbar stenosis may occur. Open discectomy and laminectomy has been the standard treatment over the last years. This approach allows a wide decompression, leading to good short-term results. This approach is invasive and not anatomic, as it is associated with a significant posterior elements demolition (both bony and ligamentous); then, instability may occur. This surgical technique is also associated with an increased intraoperative bleeding, leading to a dural adhesions great risk, fibrous scar, and recurrences. Conclusion Microdiscectomy and micro-interlaminotomy approaches allow obtaining disc-roots conflict resolution and an effective medullary “recalibrage” in a noninvasive fashion. The minimal and controlled laminae demolition and the paraspinal muscles respect, result in a postoperative pain reduction, in a faster recovery time, in reduction of recurrence's risk, and in best long-term results. Disclosure of Interest None declared References Tharin S, Mayer E, Krishnaney A. Lumbar microdiscectomy and lumbar decompression improve functional outcomes and depression scores. Evid Based Spine Care J 2012;3(4):65–66 Schroeder JE, Dettori JR, Brodt ED, Kaplan L. Disc degeneration after disc herniation: are we accelerating the process? Evid Based Spine Care J 2012;3(4):33–40 Banczerowski P, Bognár L, Rappaport ZH, Veres R, Vajda J. Novel surgical approach in the management of longitudinal pathologies within the spinal canal: the split laminotomy and “archbone” technique: alternative to multilevel laminectomy or laminotomy. Adv Tech Stand Neurosurg 2014;41:47–70 Choi WS, Oh CH, Ji GY, et al. Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis. Eur Spine J 2013

No Difference in Lumbar Disk Height between Operated and Nonoperated Patients at 9-Year Follow-Up

Introduction Degeneration of the lumbar spine is a common and age-related finding in the normal population (1;2). Several factors may contribute to lumbar disk degeneration, such as ageing, genetic, and fusion (3). Patients treated for disk degeneration and CLBP may be more prone to further degeneration than the rest of the population. We hypothesized that degeneration of the disks will proceed independent of fusion, also within the fused segments. Materials and Methods A total of 124 patients were included in the original two studies (4–6). At 9-year follow-up, baseline and long-term radiographs were available in 48 patients, 23 had lumbar fusion, and 25 had no lumbar fusion. Measurements of disk height were performed with Distortion Compensated Roentgen Analysis (DCRA) (7). Three levels were examined; one operated level (L4/L5), and two nonoperated levels (L2/L3 and L3/L4). The Norwegian version (1.0) of the Oswestry disability index (ODI) (8;9) was used to evaluate condition-specific disability and pain. Back pain was measured on a vertical visual analogue scale from 0 to 100 wherein 100 reflected the worst pain imaginable. Maximum pain, minimum pain, and current pain were scored on three different scales. The mean of the three scores provided the pain index for back pain (10) Results Disk height was reduced in both groups at levels L3/L4, and L4/L5, but not formally significant ( p = 0.06) at L2/L3 with no disk height differences between the operated and nonoperated group at any level at 9-year follow-up. ODI and back pain were improved in both groups from baseline to 9-year follow-up, but ODI and back pain correlated poorly with disk degeneration at 9-year follow-up. Conclusion Disk height was decreased from baseline to 9-year follow-up with no differences between groups and no association between pain and back disability and disk height. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Carragee EJ, Paragioudakis SJ, Khurana S. 2000 Volvo Award winner in clinical studies: Lumbar high-intensity zone and discography in subjects without low back problems. Spine (Phila Pa 1976 ) 2000;25(23):2987–2992 Kanayama M, Togawa D, Takahashi C, Terai T, Hashimoto T. Cross-sectional magnetic resonance imaging study of lumbar disk degeneration in 200 healthy individuals. Journal of Neurosurgery Spine 2009;11(4):501–507 Battie MC, Videman T, Parent E. Lumbar disk degeneration: epidemiology and genetic influences. Spine (Phila Pa 1976 ) 2004;29(23):2679–2690 Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disk degeneration. Spine (Phila Pa 1976 ) 2003;28(17):1913–1921 Brox JI, Reikeras O, Nygaard O, Sorensen R, Indahl A, Holm I, et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disk herniation: a prospective randomized controlled study. Pain 2006;122(1–2):145–55 Brox JI, Nygaard OP, Holm I, Keller A, Ingebrigtsen T, Reikeras O. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis 2010;69(9):1643–1648 Frobin W, Brinckmann P, Biggemann M, Tillotson M, Burton K. Precision measurement of disk height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech (Bristol, Avon ) 1997;12(1):S1-S63 Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66(8):271–273 Holm I, Friis A, Storheim K, Brox JI. Measuring self-reported functional status and pain in patients with chronic low back pain by postal questionnaires: a reliability study. Spine 2003;28(8):828–833 Fritzell P, Hagg O, Wessberg P, Nordwall A. 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976 ) 2001;26(23):2521–2532

Combined open decompressive laminectomy and vertebroplasty for treatment of thoracolumbar fractures retrospective review of 41 cases

BackgroundVertebral compression fractures are common, and can occur concomitantly in patients with symptomatic degenerative stenosis. Less commonly, complicated vertebral body fractures may involve retropulsion of bone into the spinal canal, resulting in stenosis with myelopathy and/or radiculopathy. Decompression of the neural elements can lead to destabilization and progressive kyphotic deformity. Laminectomy combined with open vertebroplasty provides a way to decompress the neural elements and stabilize the anterior columns in patients who cannot tolerate extended surgical time or complications associated with instrumentation and fusion. The authors describe the combination of decompressive laminectomy and open transpedicular vertebroplasty as a means to decompress neural elements and simultaneously stabilize the anterior vertebral column. MethodsForty-one patients with a total of 51 thoracolumbar fractures were included in this retrospective case review. A decompressive laminectomy was performed first, followed by vertebroplasty using an open transpedicular approach. For subjective assessment of outcome, the patients were assessed using the Oswestry Low Back Disability Questionnaire and additional questions pertaining to the patient's condition. ResultsOut of 51 fractures, there were 15 burst fractures and 36 compression fractures. Fracture levels ranged from T12 to S1. The average follow-up period was 27 months (range, 0.5–60 months). The mean post-operative Oswestry score was 16 (range, 0–39), and all patients except for one were subjectively pleased with the results of the procedure and said they would recommend it to others. All patients were able to return to all routine activities of daily living. ConclusionsThe authors’ cases indicate combining open decompressive laminectomies with vertebroplasty can be an effective treatment for patients with complicated thoracic and lumbar fractures without involving bone fusion or spinal instrumentation and with good long-term outcomes.

Skipping Posterior Dynamic Transpedicular Stabilization for Distant Segment Degenerative Disease

Objective. To date, there is still no consensus on the treatment of spinal degenerative disease. Current surgical techniques to manage painful spinal disorders are imperfect. In this paper, we aimed to evaluate the prospective results of posterior transpedicular dynamic stabilization, a novel surgical approach that skips the segments that do not produce pain. This technique has been proven biomechanically and radiologically in spinal degenerative diseases. Methods. A prospective study of 18 patients averaging 54.94 years of age with distant spinal segment degenerative disease. Indications consisted of degenerative disc disease (57%), herniated nucleus pulposus (50%), spinal stenosis (14.28%), degenerative spondylolisthesis (14.28%), and foraminal stenosis (7.1%). The Oswestry Low-Back Pain Disability Questionnaire and visual analog scale (VAS) for pain were recorded preoperatively and at the third and twelfth postoperative months. Results. Both the Oswestry and VAS scores showed significant improvement postoperatively (P < 0.05). We observed complications in one patient who had spinal epidural hematoma. Conclusion. We recommend skipping posterior transpedicular dynamic stabilization for surgical treatment of distant segment spinal degenerative disease.

Surgical options and result analyses in adult degenerative lumbar scoliosis

To investigate the clinical and radiographic outcomes for varying degrees of degenerative lumbar scoliosis using different surgical options with a minimal 5-year follow-up. From May 1998 to November 2002, 31 patients with degenerative lumbar scoliosis underwent operations at our hospital. The mean age of 19 females and 12 males was 55.8 years old (range: 45 to 71). All patients were divided into 4 groups: Group A, mild coronal deformity with obvious sagittal deformity, 13 cases; Group B, obvious coronal deformity with mild sagittal deformity; Group C, both significant coronal and sagittal deformities; Group D, both mild coronal and sagittal deformities. Posterior decompression, internal fixation and bone graft fusion were performed in Groups A, B and C. And posterior decompression was performed in Group D. All patients were followed up for at least 5 years. Patients answered the Oswestry low back pain disability questionnaire at pre-operation, and 1 year, 5 year post-operation. Thirty patients were followed up for the whole process. According to Cobb's angle methods, there was great post-operative improvement for patients with internal fixation (Groups A, B, C) while there was no significant difference for patients with posterior decompression at pre-and post-operation. After surgery, the average Oswestry Disability Index score in the patients with internal fixation (Groups A, B, C) was significantly lower than the preoperative score (25.8 vs 58.0; P < 0.001). However there was statistical difference for patients with internal fixation between 1 year and 5 year postoperatively. No perioperative death or major medical complications occurred. Ten patients had adjacent segment degeneration. The surgical aim for adults with a spinal deformity is to achieve a stable, balanced and pain-free spine. Surgical treatments should consist of decompression and fusion with segmental instrumentation to avoid instability and curb progression. Despite the complexity of adult lumbar degenerative scoliosis, it might improve the quality of life for patients by choosing an appropriate operation option on the basis of varying degrees of lumbar deformity.

Comparison of isokinetic exercise versus standard exercise training in patients with chronic low back pain: a randomized controlled study

Objective: To compare the effectiveness of an isokinetic exercise programme and a standard exercise programme in patients with chronic low back pain in terms of pain, mobility, disability, psychological status and muscle strength. Design: A randomized controlled trial. Setting: An outpatient rehabilitation clinic. Subjects: A total of 40 patients with low back pain were included in the study. Interventions: Patients with low back pain were randomly allocated into group 1 (n=20, isokinetic exercises) and group 2 (n=20, standard exercise). Main measures: Outcome measures included a visual analogue scale (VAS) for pain, fingertip-to-floor test for spinal mobility, Modified Oswestry Low Back Disability Questionnaire (MOLBDQ), Beck Depression Inventory and isokinetic muscle testing. Results: The isokinetic and standard exercise groups demonstrated significant improvement in the VAS, fingertip-to-floor test, MOLBDQ, Beck Depression Inventory scores, and muscle strength compared with the baseline that persisted until the end of the first month (P<0.05). Comparison of both exercise groups in terms of these parameters obtained at the end of the treatment and at the first month after treatment showed no significant difference (P>0.05). Conclusion: Isokinetic and standard exercise programmes have an equal effect in the treatment of low back pain, with no statistically significant difference found between the two programmes. The standard exercise programme was easily performed and had a low cost, making it the preferred option for exercise.

Content Comparison of Low Back Pain-Specific Measures Based on the International Classification of Functioning, Disability and Health (ICF)

The objective of this study was to compare the content covered by the North American Spine Society Lumbar Spine Outcome Assessment Instrument, the Oswestry Low Back Disability Questionnaire, and the Roland-Morris Disability Questionnaire based on the International Classification of Functioning, Disability and Health (ICF). The linkage of items of the three measures to the ICF involved three steps, which were performed by two different health professionals and in which 10 different linking rules were applied. In the 48 items of the three instruments, a total of 123 concepts were identified and linked to the ICF. The concepts contained in the items were linked to 10 ICF categories of the component "body functions," 27 of the component "activities and participation," and 4 of the component "environmental factors." The estimated kappa coefficients ranged from 0.67 to 1.00. Comparison based on the ICF provides insight into both the breadth of health dimensions measured as well as the thoroughness and depth of measurement. Therefore, it can be a useful tool when selecting specific measures for a study. Compared with other types of qualitative review, the most important advantage of the content comparison of measures based on the ICF is the use of an external and independent reference to which all the instruments can be linked and by which all the instruments can be compared. The three back-specific measures are comparable, with their common focus on physical aspects of body functions and activities and participation.

Two different back pain scales and their relation to pain intensity in women

People suffering from low back pain (LBP) fail in performing many daily living activities. The aim of this study was to compare two different back pain scales and to determine the relation between pain intensity and these scales on women with low back pain. Fifty-five women with chronic LBP (X ± SD: 37.76 ± 5.12 years) participated in this study. Their disabilities were determined by Quebec Back Pain Disability Scale (QBPDS) and Oswestry Low Back Disability Questionnaire Scale (OLBDQS). Pain intensity was measured by a visual analogue scale (VAS). Outcome of this study showed that the QBPDS and OLBDQS were highly correlated. Also, VAS scores were correlated with both scale scores but this correlation was less strong. These two disability measuring methods are comparable, but OLBDQS has the advantage of requiring shorter time. summary

The effect of physical impairment on low back pain and disability on mothers of children with and without neuromuscular disorders

Abstract Introduction : Physical impairments such as inadequacy of muscle strength, endurance and flexibility may be lead to low back pain. The aim of this study was to compare of the effect of physical impairment on low back pain and disability on mothers of children with and without neuromuscular disorders. Methods : Mothers of children with muscular dystrophies (Group I, n = 30) and mothers of healthy children (Group II, n = 30) participated to the study. The mother muscle strength of trunk flexion and extension, flexibility of trunk extension and lateral flexion, and endurance of abdominal muscles were assessed. Body mass index of the mothers and children were recorded. Low back pain was assessed by Oswestry low back pain disability questionnaire (OLBQDS) and visual analogue scale (VAS). Results : There were positive correlations between children's body mass index, OLBQDS scores and VAS of mothers in both groups. A negative correlation was found between muscle strengths, flexibility and VAS in Group I...

Comparison of the quality of life of patients with lumbar and cervical disc herniation

AbstractLumbar and cervical disc herniations are medical problems that affect the quality of life. The purpose of this study was to compare the quality of life in patients with lumbar and cervical disc herniations. The degree of pain in all patients was assessed by the Million visual analogue scale, disability in patients with lumbar disc herniation by the Oswestry low back pain disability questionnaire, disability in patients with cervical disc herniation by the neck disability index, quality of life by functional limitation profile, occupational handicap in all patients by the occupational handicap scales of the World Health Organization and status of depression in all patients by the Zung depression scale. Quality of life was lower and occupational handicap was greater in the patients with lumbar disc herniation than in those with cervical disc herniation. Intensity of pain and depression and disability were not significantly different in the two groups.

Functional changes in back muscle activity correlate with pain intensity and prediction of low back pain during pregnancy

Objective: To assess low back pain (LBP) intensity and subjective disability during pregnancy and compare the pain scores with lumbar motion patterns. Design: A prospective study of pregnant back pain sufferers and healthy controls. Setting: Kuopio University Hospital, Kuopio, Finland. Participants: Study group consisted of 32 pregnant women with LBP; control group consisted of 21 healthy pregnant women. Main Outcome Measures: Back pain intensity was assessed by visual analog scale (VAS), and subjective disability index was measured by Oswestry Low Back Disability Questionnaire, at 20 and 36 weeks of pregnancy. Back muscle activities were recorded by surface electromyography, and movement sensors were used to detect lumbar motion. Results: In the study group current pain scores (VAS) at first and last trimester correlated strongly ( r = .82, p < .00). Pain scores correlated with body weight at the first trimester ( r = .54, p = .003) and at the last trimester ( r = .67, p < .00). Significant correlation was noted between current pain intensity and back muscle activity level during forward body flexion at first trimester ( r = .704, p < .00). Back muscle activity during bending measured at first trimester significantly correlated with pain intensity at last trimester ( r = .703, p < .00). Back muscle activity during the first trimester of pregnancy had a negative correlation with current ( r = −.57, p = .002) and later subjective disability index ( r = −.42, p = .02). It correlated inversely ( r = −.54, p = .003) with pain score at last trimester of pregnancy, ie, the lower the back muscle activity at the beginning of pregnancy, the more pain and disability throughout pregnancy. In the control group, three women developed LBP and disability feelings during pregnancy. They had increased muscle activity during flexion at delivery, ie, disturbed flexion relaxation. Conclusions: Prepregnancy LBP predicts renewed pain during pregnancy, and dysfunction of back muscles has been established in LBP. In this study, disturbance in the relaxation of the back muscles was linearly related to current, and also to later, pain scores. In addition, back muscle activity level was inversely related to the disability index. For the first time, it has been shown prospectively that the function pattern of back extensors seems to predict, and is related to, future back pain. Simple function testing is promising and might be valuable in identifying mothers with a high risk of pregnancy-related back pain and in directing preventive intervention to high risk women by making them aware of self-treatment methods.

Effect of an early intervention program on the relationship between subjective pain and disability measures in nurses with low back injury.

The effect of a workplace-based early intervention program on perceptions of pain and disability in nurses with low back injury was studied using a preintervention versus postintervention design with concurrent control group. To examine the relationship and changes over time between pain and disability measures in two groups of back-injured nurses--those who received the early intervention program (study) and those who were not offered the program (control). The relationship between back pain and disability is not straightforward. The effects of an intervention program on changes in perceptions of pain and disability over time have not been widely reported. The Oswestry Low Back Disability Questionnaire and a visual analog pain scale were administered to 46 study nurses and 137 control nurses at time of injury and at 6 months after injury. Correlation and regression analyses were used to explore the relationships between the two measures. Changes over time were compared with analyses of variance. Pain and disability were positively correlated in both groups at time of injury and at follow-up evaluation. Mean scores for pain and disability were lower at follow-up evaluation than at initial injury in both groups; study nurses had significantly (P < 0.01) lower scores at 6 months than nurses in the control group. Disability at time of injury predicted disability at 6 months only for nurses in the control group. This workplace-based early intervention program decreased levels of pain and disability in back-injured nurses and altered the relationship between these two variables over a 6-month time interval.