Oswestry Score Research Articles

Minimally invasive sacroiliac joint fusion secondary to lumbosacral fusion: Clinical and functional results at 2 years of follow-up

IntroductionDegenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion. Materials and methodsWe carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years’ follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27–88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1–7) before the SI fusion. ResultsThe lumbar and radicular NRS were 8.4 (7–10) and 5.1 (2–10) preoperatively and 5.2 (0–8) and 3.0 (0–8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52–86) preoperatively to 45.6 (29–70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery. DiscussionAfter minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included. ConclusionMinimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally. Level of evidenceIV, retrospective study.

Anxiety and depression among patients with chronic sciatica

IntroductionSpinal radicular syndromes are currently a significant healthcare concern in society. A common manifestation of these syndromes is sciatic pain, characterized by severe pain radiating along the course of the sciatic nerve. In many patients, chronic pain can lead to psychological problems.ObjectivesThe aim of this study was to assess the frequency of anxiety and depression disorders in patients with sciatica and their impact on functional capacity.MethodsWe conducted a cross-sectional study, including patients suffering from documented common sciatic pain evolving for more than 3 months. The study was conducted in a rheumatology department over a period of 3 years. We used the Hospital Anxiety and Depression Scale (HADS) questionnaire, supplemented with information about the study group, pain location, and patients’ occupations. Additionally, the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) were applied.Results The study included 104 patients (71 women and 33 men, with a male-to-female sex ratio of 0.46). The mean age of our patients ranged from 23 to 74 years. The most frequent etiology of sciatic pain was a herniated disc, followed by lumbar spinal stenosis and spondylolisthesis. The root path was L5 in 74 cases and S1 in 30 cases. The average duration of sciatic pain was 6.4 months. The mean Oswestry score was 25 (ranging from 15 to 38). The mean VAS score was 7.4 (ranging from 4 to 9). The mean Work Ability Index (WAI) was 25.2 (ranging from 15 to 38). Depression was noted in 53 patients (50.9%) with a mean HADS depression score of 10.8 (ranging from 4 to 16). Anxiety was noted in 8 patients (7.6%) with a mean HADS anxiety score of 6.40 (ranging from 3 to 16). In univariate analysis, anxiety was associated with the low educational level of patients and with the duration of sciatic pain (p &lt; 0.05). There was a significant association between depression and anxiety (p = 0.000). However, there was no relationship between these psychiatric disorders and functional status (p &gt; 0.05).Conclusions Among patients with sciatic pain, there is a high prevalence of psychiatric disorders, including anxiety and depression. Regular screening for these disorders should be conducted by healthcare providers.Disclosure of InterestNone Declared

Cognitive behavioral therapy (CBT) and meditation in the treatment of persistent low back pain: Interventional Study

Objective: To compare the effect of both CBT and Meditation in chronic lower back pain patients.&#x0D; Method: Participants fulfilling the exclusion and inclusion criteria and who are between the age group of 35-50 years with CLBP were included. Numerical pain rating scale and Montreal Cognitive Assessment (MOCA) was used for the participant selection. The participants were further divided into three groups and 4-week intervention of conventional physiotherapeutic exercise, meditation and CBT, was given to the participants. Numerical Pain Rating Scale and Oswestry Low Back Pain Disability Questionnaire were used as outcome measures.&#x0D; Results: 40 chronic back pain patients were enrolled and randomized. All enrolled participants completed baseline tests, providing cross-sectional data for this study. Simple randomization allocated 14 patients to the control group and 13 patients each to Experimental Group 1 and Experimental Group 2. Significant within-group improvements occurred on the Numerical Rating Scale and Oswestry scores between baseline and final visits for all groups. However, the experimental groups showed significantly greater decreases in pain intensity versus controls, evidenced by reduced mean Numerical Rating Scale and Oswestry scores at follow-up. One-way ANOVA and Welch tests revealed significantly reduced Numerical Rating Scale and Oswestry scores after treatment across groups. Both tests yielded statistically significant p-values &lt;0.01.&#x0D; Conclusion: The findings show that meditation and cognitive behavioural therapy (CBT) are beneficial in reducing pain. As a result, for patients with persistent low back pain, taking into consideration these two treatment techniques is critical.&#x0D; Keywords: Cognitive Behavioural Therapy, Chronic Pain, Oswestry Questionnaire

Evaluation of the Cartinorm Use in the Therapy of Patients with Knee Osteoarthritis.

Knee osteoarthritis is the most common rheumatic disease characterized by pain, structural changes and impairment of quality of life. This disease has a multifactorial etiopathogenesis, and the main role is attributed to mechanical factors. There is a primary and secondary form of osteoarthritis. Osteoarthritis diagnosis is carried out on the basis of history, clinical picture and radiological examinations. Osteoarthritis is a major cause of absenteeism for middle-aged people. In the treatment of osteoarthritis, the triad is important: education, rehabilitation and supportive therapy with chondroprotective drugs. As part of the study, 60 patients with clinical and radiographic signs of knee osteoarthritis were given Cartinorm (1500mg glucosamine sulfate, 800mg chondroitin sulfate, 5000mg forti gel, 250mg vitamin C). After 3 months of treatment, there was an improvement in movement, a reduction in pain and an improvement in activities of daily living as measured by the Oswestry score. Objective: The aim of this study was to evaluate the reduction of pain, improvement of the clinical picture and improvement of the quality of life, after three months of supportive therapy with chondroprotective drugs (Cartinorm -1500mg glucosamine sulfate, 800mg chondroitin sulfate, 5000mg forti gel, 250 mg vitamin C). In a study that is prospective, analytical and descriptive, 60 subjects of both sexes with clinical and radiological signs of knee osteoarthritis were included. The study was conducted in six cities (Sarajevo, Tuzla, Banja Luka, Mostar, Zenica and Bijeljina) and lasted three months. During the study for pain relief, patients could only use Paracetamol and all patients took Cartinorm 1x a day. Pain Scale and Ostwestry index tests were performed for each patient to assess the quality of life at the beginning of the study, at the end of the first, second and third month. Results and. Total number of 60 subjects with clinical and radiological signs of knee osteoarthritis were included in the study. The analysis of the gender structure showed the dominance of the female gender (43 respondents), compared to the male population (17 respondents). The largest number of respondents had bilateral knee osteoarthritis. Assessment of pain through the VAS pain scale on the first day and at the end of the 3-month study showed a statistically significant reduction in pain. Analysis of the quality of life at the beginning of the study showed that 22 subjects performed activities with many difficulties, and at the end of the study only 5 subjects performed activities with many difficulties, which shows an improvement in the quality of life after 3 months of taking Cartinorm. Conclusion: Proper education of subjects with knee osteoarthritis and application of chondroprotective drugs (Cartinorm) for a period of 3 months showed an improvement in terms of pain reduction measured through the VAS scale, improvement of knee mobility and improvement of quality of life measured through Oswestry Scor.

Moderate scoliosis continues to progress at 30-year follow-up: a call for concern?

This natural history study reports long-term radiographic and clinical outcomes of patients with diagnosis of AIS with curves between 30° and 50°. Our purpose was to determine if any intervention in the natural history is warranted. This was a longitudinal descriptive study at a single institution. We reviewed patient factors, radiographic parameters, and patient-reported outcomes at 20- and 30-year follow-up. A total of 31 patients were included. At skeletal maturity (which was the initial point of measurement), the median age was 17years (range 12-21), the thoracic Cobb angle was 35° ± 5° (maximum-minimum 27°-47°), and the lumbar Cobb angle was 33° ± 7° (maximum-minimum 18°-45°). The median final follow-up was 35years (median age 52, range 32-61) when the thoracic Cobb angle was 47° ± 12° (maximum-minimum 31°-74°) and the lumbar Cobb angle was 40° ± 17° (maximum-minimum 19°-69°). At final follow-up, 9 (29%) patients had a structural curve > 50°. Ten (32%) patients had a curve from 40° to 49° and 11 (35%) patients had a curve < 40°. The thoracic Cobb angle had progressed from < 40° to > 50° in 5 patients. Thoracolumbar and lumbar Cobb angles progressed from < 40° to greater than > 50° in 1 and 3 patients, respectively. Few patients had functional limitations according to Roland-Morris, Oswestry, and SF36 scores. Pain scores were minimal at final follow-up. All AIS curves between 30° and 50° at skeletal maturity tend to progress. Thoracic curves progress more than lumbar curves during the first 20years and then progression slows down. The opposite happens with lumbar curves. Therefore, the rate of progression decreases with thoracic curves and increases with lumbar curves. Nevertheless, few patients have functional limitations. Further follow-up is necessary to define the true long-term outcome of moderate curves at maturity.

EFFECTIVENESS OF DIFFERENT PHYSICAL THERAPY EXERCISE TECHNIQUES IN CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROLLED STUDY

Purpose: Exercise therapy is the most common conservative treatment for low back pain. Exercise has generally been associated pain and kinesiophobia. In this context, especially paraspinal muscles need to be focused on. For this reason, the aim of our study is to evaluate different types of exercises that will help increase neuromuscular facilitation and core stability in paraspinal muscles by considering patient satisfaction.&#x0D; Methods: A total of thirty-seven female patients with chronic low back pain were included in the study. The Oswestry Low Back Pain Questionnaire was used to assess functionality. Core stability was evaluated with a stabilizer. Pain intensity and satisfaction were measured with Visual Analog Scale. Patients' kinesiophobia levels were assessed by using Tampa Kinesiophobia Scale. Patients were randomized into three groups according to the interventions as: Proprioceptive Neuromuscular Facilitation exercise group (n = 9), core stability exercise group (n = 14) and control (n = 14) group. The duration of applications was 3 days per week with a total of 6 weeks.&#x0D; Results: There were group differences for core muscle strength (p = .045), Oswestry scores (p = .001), pain intensity score (p = .003) and Tampa score (p = .001). There were significant gains for Core muscle strength and Oswestry scores for Proprioceptive Neuromuscular Facilitation and Core stability groups (p &lt; .05).&#x0D; Conclusion. Core stabilization exercises have additional effects to improve rehabilitation outcomes for patients. Besides that, the level of patient satisfaction was importantly different between all groups in favor to Core stability in chronic low back pain.

A Comparative Study of McKenzie Back Program and Conventional Physiotherapy in Relieving Backache due to Lumbar Disc Prolapse

Introduction: Low Back Pain (LBP) is considered as one of the commonest problems, in which pain felt in the lumbosacral spinal and paraspinal regions which encompass the buttocks and upper thigh. Objectives: The main objective of the study is to find the comparison between McKenzie back program and conventional physiotherapy in relieving backache due to lumbar disc prolapse. Material and methods: This cross sectional study was conducted in Rashid Latif Medical College Lahore during January 2022 to June 2022. Persons having MRI and previously diagnosed as Disc herniation or Lumbar disc herniation LDH or Prolapsed Lumbar intervertebral disc (PLID) were also enrolled and screened for the second time, the persons who had no MRI were advised to perform with proper justification. Results: Data was collected from 40 patients. There were 22 females and 18 males. Both groups were matched as regards age, gender, weight, height, and BMI. ODI scores showed a significant decrease in both groups post-treatment (p = 0.001) indicating a decrease of functional disability. The percentage of decrease in Oswestry scores was higher in group B than group A (6.87% versus 4.82%). Practical Implication: This study will be helpful in reducing pain, increasing lumbar spine mobility and decreasing disability. Conclusion: It is concluded that McKenzie back program is more effective in reducing pain, increasing lumbar spine mobility and decreasing disability than conventional physiotherapy and stretching exercises in patients with backache due to lumbar disc prolapse. Keywords: Effective, Backache, Pain, Disability

Can lumbar paraspinal muscle/fat ratio and spinopelvic parameters predict short-term outcomes after decompressive surgeries in lumbar disc herniation and lumbar spinal stenosis?

We aimed to investigate whether the lumbar paraspinal muscle/fat ratio influences the outcomes of patients who had simple decompressive surgeries for lumbar disc herniation (LDH) or lumbar spinal stenosis. We also wanted to see if the spinopelvic parameters change with surgery and whether this change influences the outcomes. This was a prospective study on patients with lumbar spinal stenosis (20 patients) and LDH (20 patients) who underwent simple discectomy or decompressive surgery between November 2021 and May 2022. Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index, and Japanese Orthopedic Association (JOA) score were performed before and 3 months after surgery. Spinopelvic parameters were measured on whole spine radiographs before and 3 months after surgery. On axial magnetic resonance images, paraspinal muscle volume and muscle/fat ratios were calculated. All data were statistically analyzed with SPSS program. There was a significant improvement in VAS, Oswestry, and JOA scores after surgery. We observed that more preoperative paraspinal muscle mass was positively correlated with lumbar lordosis (LL) and negatively correlated with sagittal vertical axis (SVA), VAS leg scores, and Oswestry scores. Furthermore, we observed a positive correlation between preoperative SVA and VAS leg scores. Despite limited number of patients, and shorter follow-ups, this prospective study demonstrates a correlation among the lumbar paraspinal muscle/fat ratio, preoperative/postoperative spinopelvic parameters, and surgical outcomes. Increased paraspinal muscle ratio was correlated with lower SVA values and increased LL; lower VAS leg scores; higher Oswestry scores which reflects better surgical outcomes.

Conservative Management of Cauda Equina Syndrome: A Case Report

BACKGROUND: Cauda equina syndrome (CES) treatment usually involves immediate consultation for surgical management. CASE PRESENTATION: We report the case of a 64-year-old woman exhibiting a 6-monthold progressive low back pain associated with motor weakness (right psoas and quadriceps), hyporeflexia (right patellar, left hamstring, and bilateral Achilles tendons) hypoesthesia on the L2-3 dermatome, and sexual and bowel dysfunction. The patient was referred for a neurosurgical consultation. Surgery was not considered at this time, and the patient was referred to the universitybased chiropractic clinic. OUTCOME AND FOLLOW-UP: After 22 treatments, the patient reported a self-perceived percentage of improvement of 80%, a verbal numeric pain-rating scale at 2/10 and a 22% Oswestry score. Her bowel dysfunction, sexual dysfunction, and perineal numbness were resolved. DISCUSSION: We aim to work in collaboration with surgical teams to conduct shared decisionmaking with patients and offer conservative care for CES if deemed safe and appropriate. Future research should contribute to the identification of CES cases that might benefit from conservative care when surgery is not considered an immediate option. JOSPT Cases 2022;2(4):189–195. Epub: 12 October 2022. doi:10.2519/josptcases.2022.10946

Impaction Bone Grafting with Low Dose Irradiated Freeze-Dried Allograft Bone for Acetabular Reconstruction.

ObjectiveReconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium‐term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population.MethodsThis was a single‐center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze‐dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior–posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry's criteria, and complication was documented at the last follow‐up. Independent sample ANOVA test and Pearson chi‐square tests are used for statistical analysis.ResultsThere were 61 hips in 57 patients. The average follow‐up time was 35.59 months (5–77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32–58) preoperatively to 86.98 (range: 78–93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during follow‐up. Although one cup migrated, no revision, re‐revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow‐up.ConclusionsIBG with low‐dose irradiated freeze‐dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA.

Postoperative recovery patterns following discectomy surgery in patients with lumbar radiculopathy

This retrospective study of prospectively collected data aimed to identify unique pain and disability trajectories in patients following lumbar discectomy surgery. Patients of this study population presented chiefly with lumbar radiculopathy and underwent discectomy surgery from thirteen sites enrolled in the CSORN registry. Outcome variables of interest included numeric rating scales for leg/back pain and modified Oswestry disability index scores at baseline, 3, 12, and 24 months post-operatively. Latent class growth analysis was used to identify distinct courses in each outcome. Data from 524 patients revealed three unique trajectories for leg pain (excellent = 18.4%, good = 55.4%, poor = 26.3%), disability (excellent = 59.7%, fair = 35.6%, poor = 4.7%) and back pain (excellent = 13.0%, good = 56.4%, poor = 30.6%). Construct validity was supported by statistically significant differences in the proportions of patients attaining the criteria for minimal important change (MIC; 30%) or clinical success in disability (50% or Oswestry score ≤ 22) (p < 0.001). The variable proportions of patients belonging to poor outcome trajectories shows a disconnect between improved disability and persistence of pain. It will be beneficial to incorporate this information into the realm of patient expectation setting in concert with future findings of potential factors predictive of subgroup membership.

Meta-Analysis of the Clinical Effect of MIS-TLF Surgery in the Treatment of Minimally Invasive Surgery of the Orthopaedic Spine.

Minimally invasive surgery (MIS) has already had a significant impact on surgical treatment (spine). Because they are less invasive, minimally invasive treatments are often preferred over open spine surgery. MIS and open spine surgery in terms of posterior lumbar fusion (PLF), lumbar disc herniation (LDH), and cervical disc herniation (CDH) were all observational studies based on randomized controlled trials. Seventeen RCTs and six observational studies were conducted. Chemotherapy had no effect on the long-term alleviation of the neck or arm pain in patients with CDH. In LDH, MIS was superior in terms of pain relief, rehospitalization rates, and improvement in quality of life. At the expense of increased perioperative endoscopic, readmission, and revision rates, MIS achieved a significant reduction in 2-year expenditures, fewer medical problems, and improved Oswestry score ratings. There is no evidence to support the use of MIS over open surgery for lumbar or cervical process disc herniation. In comparison, MIS-TLIF has several advantages, in addition to lower revision/readmission rates. However, MIS significantly increases the surgeon's radiation exposure, regardless of the patient's sign. However, the effect on patients is unknown. These findings could help patients make better decisions when comparing open spine surgery to minimally invasive spine surgery, especially given how much advertising is out there for MIS.

Effect of Artificial Tiger Bone Powder (Jintiange Capsule®) on Vertebral Height Ratio, Cobb's Angle, Bone Mineral Density, and Visual Analog Score.

ObjectivesTo investigate the effect of Jintiange capsule on acute bone atrophy (vertebral height, Cobb's angle, bone mineral density, and visual analog score (VAS) in patients with osteoporotic vertebral compression fracture.MethodsA total of 106 patients with osteoporotic vertebral compression fractures were selected and randomly divided into study and control group. Vertebral height ratio (VHR), Cobb's angle, bone mineral density (BMD), and VAS analyses were performed as study indexes. The study was performed from January 2019 to December 2019 as a double‐blind, randomized, controlled trial and all the participants were blinded throughout the study. There were 24 males and 29 females in the study group, with 14 cases of thoracic fractures and 39 cases of lumbar fractures. The age was 61–75 years, with an average of 67.5 ± 2.7 years, and the course of disease was 1–9 days, with an average of 2.7 ± 0.5 days. There were 22 males and 31 females in the control group, with 17 cases of thoracic fractures and 36 cases of lumbar fractures. Patients in the control group received conventional postoperative treatment, while patients in the study group were treated with Jintiange capsule. The treatment continued for 3 months. The ages of the participants were from 60 to 70 years, while the average ages of both groups were 67 ± 2.8 years and the study recruited participants of both sexes.ResultsThe clinical efficacy, vertebral imaging indexes before and after treatment, as well as pain and daily activity dysfunction scores were compared. The effect of the Jintiange capsule was followed for 3 months and both the groups were compared. The total effective score of the study group was significantly increased (90.6%) in contrast to the control group (67.9) and the P value was less than the 0.5. The vertebral height and bone mineral density of the study group was significantly improved compared to the control group (P < 0.034) using t‐test. However, the Cobb's angle of the study group was significantly (P < 0.047) lower than the control group using t‐test after the treatment. On the other hand, the VAS score and Oswestry score of the study group were significantly lower than control group at 1 month and 3 months after treatment (P < 0.05). There was no significance difference (all P > 0.05) in term of gender and ages in both the recruited groups.ConclusionIt can be concluded that Jintiange capsule can significantly improve the clinical efficacy rate, vertebral height, Cobb's angle, and bone mineral density, pain relief, and daily activity function.

The Effectiveness of Core Stability Exercise to Improve Functional Ability in A Lumbar Herniated Nucleus Pulposus Patient: A Case Study

Background: Hernia Nucleus Pulposus (HNP) is a condition in which the nucleus pulposus has bulged from the intervertebral disc, consequently damages the walls of the annulus fibrosus and compresses the nerves. Clinical problems such as radiating pain, sensory disturbances according to dermatomes, muscle weakness, restricted range of motion, especially during flexion, and decreased functional ability. Core stability exercise is one of the physiotherapy treatments to reduce pain and improve the patient's functional ability with lumbar HNP. The purpose of this study is to determine the effectiveness of core stability exercise on increasing functional ability in cases of lumbar HNP with Modified Oswestry Low Back Pain Disability Questionnaire as a parameter. Methods: A single case study provided a physiotherapy intervention to a 56-year-old female patient for four weeks with four evaluations. The dose of exercise given was three times a week, three sets, five repetitions, 6-9 minutes of each type of exercise, and hold time 5-10 seconds. The improvement of functional ability is measured by using the Modified Oswestry Low Back Pain Disability Questionnaire. &#x0D; Results: There was an improvement in functional ability as measured by Modified Oswestry Low Back Pain Disability Questionnaire. At pre-intervention, the Modified Oswestry score was 52% meaning the patient had severe disability. On the 4th week evaluation, the patient's Modified Oswestry score decreased to 26%, indicating moderate disability. &#x0D; Conclusion: This study showed that core stability exercise effectively improved functional ability in a patient with lumbar HNP.

Mismatch Between Pelvic Incidence and Lumbar Lordosis is the Key Sagittal Plane Determinant of Patient Outcome at Minimum 40 Years After Instrumented Fusion for Adolescent Idiopathic Scoliosis.

Retrospective review. Assess measures of spinal-pelvic balance in predicting functional outcome in patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis (AIS) at minimum 40-year follow-up. Back pain and long-term function are considered when choosing levels for surgery in AIS patients. Three hundred and fourteen patients underwent fusion for AIS between 1961 and 1977. One hundred and thirty-four patients were located for potential long-term follow-up. With Institutional Review Board approval, medical records and public resources were used to locate patients. Patients completed health-related quality of life (HRQoL) instruments, and returned for assessment including full radiographs. Radiographs were analyzed for scoliosis measures, and recognized spinal-pelvic measures including the lumbar lordosis, sagittal vertical axis (SVA), pelvic incidence, and pelvic tilt (PT). Bivariate and multivariable analyses were performed to assess the association between spinal-pelvic measures and patient-reported outcomes. Thirty-five of 134 patients agreed to return for complete HRQoL and radiographic follow-up. There were no differences at baseline between those agreeing and declining participation. The cohort was 94% female, had an average age of 60.5 years, and average follow-up of 46 years. In bivariate analysis, pelvic incidence and lumbar lordosis difference (PI-LL) was the only spinal-pelvic parameter which statistically discriminated between patients doing well and not, as assessed by the Oswestry Disability Index and the Patient-reported Outcomes Measurement Information System (PROMIS) Pain Interference and Fatigue instruments. In multivariable analysis, (PI-LL > 9°) was associated with worse scores in PROMIS-Pain Interference, Physical Function, Depression, Fatigue, Social Function and the total Oswestry score. An SVA > 50 mm was associated with worse scores in the Scoliosis Research Society-7. In a cohort of 35 patients with average follow-up of 46 years after posterior spinal instrumentation with Harrington rods (PSIF) for AIS, spinal-pelvic mismatch as identified by (PI-LL > 9°) was associated with inferior HRQoL outcomes. Other spinal-pelvic measures (SVA and PT) were not reliably associated with inferior HRQoL.Level of Evidence: 4.

Surgical treatment for lumbar spinal stenosis: a single-blinded randomized controlled trial

ObjectiveTo evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis.MethodsSixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale).ResultsNo significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group.ConclusionsLumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment.Trial registrationClinicaltrials.gov (NCT02879461).

Linking Oswestry Disability Index to the PROMIS pain interference CAT with equipercentile methods

When different health care providers use different patient-reported outcome (PRO) instruments, it is challenging to integrate findings that describe particular patient groups or to establish treatment effectiveness across studies. It is therefore critical to develop accurate ways to convert scores between various instruments for clinicians and researchers to make comparisons across health outcomes. To develop a common metric so that scores on the Oswestry Disability Index (ODI) and scores on the PROMIS Physical Function can be converted interchangeably. Data were collected from a prospective study. A single-group linking design was used. The study population included 9020 patients presented to an orthopedic spine clinic from November 2013 to March 2019. Patients completed the ODI and the PROMIS Pain Interference scale delivered by Computerized Adaptive Testing (CAT) at the same time prior to their visit with a spine clinician. Equipercentile linking methods based on log-linear smoothing approach and non-smoothing approach were used to establish a common metric across the two measures. The two measures assess the similar contruct of pain. The correlation between the scores of the ODI and the PROMIS PI was 0.81. The standardized Root Expected Mean Square Difference (REMSD) values for gender, ethnic, and racial groups ranged from 3.55% to 4.81%. Hence, the assumptions for the equipercentile linking method were met. The crosswalk derived linked scores based on the log-linear smoothing method yielded small deviations (Δ=0.09) from the observed scores. We then identified linked PROMIS-PI scores corresponding to the benchmark ODI scores for the five disability levels and for various categories of patients. This study is the first to create crosswalks to interchangeably convert scores between the ODI to the PROMIS-PI in a large population of spine patients using the equipercentile linking method. The results of this study provide confidence in the validity and usefulness of the derived crosswalks based on the equipercentile linking approach. The crosswalks are helpful for comparing new and old studies on the two measures and identifying benchmark scores for various diseases and disability levels.

Распространенность депрессивных симптомов у пациентов с хронической пояснично-крестцовой радикулопатией

Study Objective: To study the prevalence of depressive syndromes in patients with chronic lumbosacral radiculopathy and pain syndrome, and to identify correlations between neuropathic pain and psychoemotional disturbances. Study Design: open perspective study. Materials and Methods. The study included 126 patients (45 (35.7%) males and 81 (64.3%) females) of 19 to 78 years old with verified unilateral lumbosacral radiculopathy of L4, L5, S1 radicules resulting from degenerative damage of the spine lasting for more than 12 weeks. For assessment, we used the Pain Detect Questionnaire, visual analogue scale for pain syndrome, Oswestry Disability Index, and Beck Depression Inventory. Study Results. Among patients with chronic lumbosacral radiculopathy, depressive syndromes were diagnosed in 74 (587%) cases as follows: 26 (20.6%) patients had mild (subclinical) depression, 33 (26.2%) cases were of moderate intensity, 12 (9.5%) patients had marked, and 3 (2.4%) had severe depression. We used Spearmen’s rank-order correlation to identify statistically significant correlations between Beck Depression Inventory score and neuropathic pain syndrome intensity (Pain Detect Questionnaire) (r = 0.861; p = 0.006). Pain Detect Questionnaire and Oswestry score correlated as well (r = 0.745; p = 0.001). Conclusion. Chronic pain syndrome in patients with lumbosacral radiculopathy resulting from degenerative damage of the spine is characterised by high comorbidity with depression. The results justify inclusion of psychoemotional assessment into a routine screening program for patients with lumbosacral radiculopathy. Keywords: depression, chronic back pain, lumbosacral radiculopathy, neuropathic pain syndrome.

Association of Foot Posture with Lumbar Lordosis Angle in Teachers

Context: Anatomical alteration in the alignment of the foot leads to changes in proximal joints that in turn cause mechanical variations in the spine. Changes in the lower kinematic chain can have functional consequences in the form of low back pain and may be seen in professions requiring long-standing. This is often an unexplored, under-evaluated component of low back pain and hence proves its need. Aim: To study the relationship between ankle-foot complex and lumbar spine, and also to determine the association between Foot Posture and Lumbar Lordosis angle in teachers. Settings and Design: Data for the observational study were collected from school and college teachers of Belagavi city. Materials and Methods: Foot posture of 200 teachers in the age group of 20–50 years was assessed using Chippaux Index and Foot Posture Index-6 (FPI-6). Lumbar curvature was measured using Flexi curve ruler and angle was calculated. Functional limitation was assessed using Low Back Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire. Statistical Analysis Used: Spearman's rank correlation and t-test were used for analysis. Results: Statistically significant association was noted between FPI-6, lumbar angle, Low back pain scores, and Modified Oswestry score with P = 0.0001. Gender comparison of the outcome measures did not reveal any significant relationship. Conclusion: Alteration in foot posture leads to changes in lumbar lordosis angle, which in turn may cause low back pain.

Investigation of The Pain and Disability Situation of The Individuals Working "Home-Office" At Home At The Covid-19 Isolation Process

The aim of our study is to examine pain and disability in low back, knee and shoulder regions of individuals working at home during COVID-19 isolation process. In our study, 87 volunteers were included in digital media by questionnaire with data collection method. Individuals who worked in the office before COVID-19 isolation but started working from home during the isolation were included in our study. In addition to the socio-demographic characteristics of the individuals, their situation about the working environment at home was questioned. In addition, pain in the low back, knee and shoulder regions was evaluated with an 11-point pain scale (EPPS). In order to determine the level of disability, individuals were asked to fill in the Oswestry Disability Index (for the lumbar region), Lysholm Knee Score (for the knee region) and the Disability of Arm, Shoulder and Hand Questionnaire (DASH) (for the shoulder region). It was seen that 86.2% preferred desk environment more frequently as home working environment and 65.5% spent 3 to 8 hours in this environment. During the home isolation process, the highest pain was observed for low back pain (50.6%) in individuals (EPPS:4-5), then shoulder pain (44.8%) (EPPS:5) and knee pain (35.6%) (EPPS:4-5). When the levels of disability were evaluated, the Oswestry score was found 13.08±11.98, the Lysholm score was found 91.20±12.23 and the DASH score was found 9.61±16.78. It has been observed that individuals working at home during COVID-19 isolation process may develop shoulder and knee pain, and mostly in the low back region, and all these pain are defined as moderate severity pain. However, when we look at the levels of disability, it was seen that low back pain, knee pain or shoulder pain did not pose a significant problem in the life of the patient and the level of disability was low.