Preoperative VAS Research Articles

Ability of Visual Analogue Scale to predict Oswestry Disability Index improvement and surgical treatment decision in patients with adult spinal deformity

IntroductionThe effect of pain on HRQoL scores in ASD patients is not well studied. Disability is a major factor on decision and outcomes. On the other hand, little is known about the effect of perceived and reported pain on these parameters, especially in the elderly population. We hypothesized that baseline back and leg pain would not affect the treatment decision whereas may have a negative effect on outcomes. Research questionTo determine the correlation between preoperative ODI and VAS scores; and to identify the effect of baseline VAS score on treatment decision and ODI improvement following treatment. Material and methodsIn this retrospective study, patients with a follow-up duration of minimum 2 years were enrolled from a prospective multicentric ASD database. Pearson and Spearman correlation tests were used to evaluate the correlation between ODI and VAS scores; univariate binary logistic regression method was used to analyze the effect of VAS on treatment decision as well as the outcomes. Results1050 patients (mean age 48.2) were analyzed. Baseline ODI and back, leg pain VAS scores were significantly correlated (P ​< ​0.001). One unit increase in baseline back and leg pain VAS scores, increased the probability of improvement in ODI by 1.219 (P ​= ​0.016) and 1.182 times (P ​= ​0.029), respectively in surgically treated patients; and reduced it by 0.894 times (P ​= ​0.012) for conservatively treated patients. For patients >70 years old, one-unit increase in baseline leg pain VAS score increased the probability of deciding on surgical treatment by 1.121 times (p ​= ​0.016). Discussion and conclusionsPreoperative back and leg pain VAS scores were found to be significantly correlated with the preoperative ODI scores. Additionally, preoperative baseline back and leg pain VAS scores were useful in predicting the improvement in disability as assessed by ODI. Another important finding was that, higher baseline leg pain (but not back pain) VAS scores increased the rate of elderly patients preferring surgical treatment.

VERTEBROPLASTIA EM FRATURAS POR FRAGILIDADE ÓSSEA E TUMORAIS: RISCOS E BENEFÍCIOS

ABSTRACT Objective: To evaluate the results of percutaneous vertebroplasty (PV) in spinal fragility fractures (osteoporosis/tumor), analyzing possible complications. Method: We evaluated 33 patients with spinal fractures (FXV) due to osteoporosis or tumor who underwent PV between January and November 2021. A physical examination was performed, obtaining the history and risk factors for bone fragility/tumor and a radiological evaluation of the spine to verify FXV. Genant’s semiquantitative method was used for postoperative classification, the VAS score, and a disability questionnaire (ODI). A radiologist evaluated tomographic control to quantify vertebral filling and extravasation, determining where they occurred. Results: 46 vertebrae of 33 patients were operated on, with a mean age of 71 years, and 11 patients with more than one level of surgery. Of the total, 13 patients had tumor fractures, and 20 had fractures due to insufficiency. PMMA extravasation was observed in 31 vertebrae, most frequently in the External Vertebral Venous Plexus (23), Discal Body (9), Anterior Epidural Recess (4), Pulmonary Vessels (4), Internal Vertebral Venous Plexus (3), Inferior Cava (2), Adipose Plane (2) and Azygos Vein (1). No patient had clinical complications. Furthermore, the mean preoperative VAS was eight, the postoperative one was 3, the mean preoperative ODI was 56, and the postoperative one was 30. Conclusion: PMMA extravasation was frequent in several locations and levels without any clinical complications. VP proved to be effective in improving pain and function. Level III; Longitudinal Retrospective Cohort Study.

Transpedicular Corpectomy and Anterior Column Reconstruction for the Treatment of Traumatic Thoracolumbar Fractures.

To retrospectively analyze the results obtained from the posterior-only approach in non-pathological traumatic thoracolumbar body fractures with spinal cord compression. A total of 17 patients with traumatic non-pathological thoracolumbar fractures were included in the study. Demographic details include preoperative data such as neurological status, deformity, pain scores, and radiology; intraoperative data such as blood loss, duration of surgery, and complications, and postoperative data including the neurologic status; the duration of hospital stay, pain scores, and deformity correction were analyzed. Among the 17 patients, 8 were in ASIA A, 9 had incomplete neurologic deficits (ASIA C - D), and none was neurologically intact (ASIA E) preoperatively. All patients had TLICS scores > 4 and were treated surgically. The mean TLICS score was 7.31. Although no worsening was detected in the neurological images of the patients during the postoperative period, neurological improvement of at least one ASIA grade was detected in 13 patients. However, it was found that the neurological functions remained the same in the 4 patients. With significant improvement, the mean preoperative VAS score was 8.2, while the mean postoperative VAS score was 3.3. In addition, satisfactory outcomes were obtained in radiological examinations, both in terms of kyphotic deformity and vertebral body collapse. Traumatic thoracolumbar fractures can be effectively fixed with the posterior-only approach and the transpedicular route. One of the most significant advantages of this procedure is that peripheral decompression, reduction, anterior column reconstruction, and instrumentation all can be performed simultaneously in the same session.

Functional Outcome of Proximal Fibular Osteotomy in Medial Compartment Osteoarthritis of The Knee Joint

Background: Proximal Fibular Osteotomy (PFO) has been proposed as a new surgical option for pain relief in patients with medial compartment knee osteoarthritis. It is simple, safe and affordable. To assess functional outcome of proximal fibular osteotomy in medial compartment osteoarthritis of knee joint.&#x0D; Materials and methods: This prospective hospital based clinical trial was carried out in the Department of Orthopedic Surgery Chittagong Medical College Hospital (CMCH) Chattogram from July 2019 to June 2020. A total of 30 patients with knee osteoarthritis were enrolled through inclusion and exclusion criteria by purposive sampling. Proximal fibular osteotomy was done after taking written informed consent. Data was recorded in a predesigned case record form. All the patients were followed up to 6 months when final outcome was assessed by Oxford Knee Score. All the data were analyzed statistically by using Statistical Package for Social Sciences (SPSS-25). The result was expressed as frequency, percentage and mean ± SD. Level of significance was calculated at p&lt;0.05.&#x0D; Results: In this study, out of 30 cases, majority of the cases (57.7%) was in 55-64 years of age group. Mean ± SD pre-operative and post-operative VAS score were 7.13 ± 1.408 and 2.10 ± 0.803 respectively. According to Oxford Knee Score (OKS) pre-operative and postoperative mean ± SD were, 18.00 ± 2.117 and 36.53 ± 2.403. Mean ± SD pre-operative and post-operative Tibio Femoral Angle were 182.97 ± 1.810 and 178.63 ± 1.377 respectively. Mean ± SD pre-operative and post-operative Medial Joint Space (mm) were 1.223 ± 0.378 and 3.816 ± 0.982 respectively. Mean ± SD pre-operative and postoperative Lateral Joint Space (mm) were 6.640 ± 1.209 and 5.050 ± 0.897 respectively.&#x0D; Conclusion: After analyzing the results of present study, it can be concluded that proximal fibular osteotomy is a new, simple procedure in the management of medial compartment osteoarthritis of the knee which may delay the need for definitive knee procedures like unicompartmental knee arthroplasty or total knee replacement.&#x0D; JCMCTA 2021 ; 32 (2) : 137-141

A Study on Short Segment Fixation for Thoracolumbar Fractures

Background: Spine injury is being one of the commonest injuries which pose challenges to the patients and treating clinicians as well. Despite so much research and recent advances, there has not been unanimous consensus regarding the management of spinal injuries. However, the treatment aim of every injury to the spine is to restore of max possible function in patients. This study was conducted to assess the outcome of short segment fixation in fractures of the thoracolumbar spine.&#x0D; Methods and Materials: This is a prospective cohort study done at our Tertiary Center during the period from April 2018 To September 2020. Patients with thoracolumbar spine injuries were, included in the study. Study on short-segment pedicle screw fixation and inter- transverse fusion for single-level acute thoracolumbar fracture.&#x0D; Results: Mean age of the sample size was 40.58 years with male preponderance. The FRANKEL SCALE was used to grade the pre-op neurology; 17.2% were graded as E, 24.1% as D, 31% as C, 13.8 % as B, and 13.8% A. ASIA motor and sensory score preoperative and postoperative at one year follow up was compared was found to be significant (p&lt;0.05). Preoperative VAS and Functional independent measures also showed significant improvement.&#x0D; Conclusion: Surgical stabilization and decompression are essential strategies for further neuroprotection and recovery after a spine injury. Short segment fixation can be an option for thoracolumbar fracture. However, an unstable fracture may require extended fixation.

The association between sleep quality, preoperative risk factors for chronic postoperative pain and postoperative pain intensity 12 months after knee and hip arthroplasty.

Chronic postoperative pain following total joint replacement (TJA) is a substantial clinical problem, and poor sleep may affect predictive factors for postoperative pain, such as pain catastrophizing. However, the magnitude of these associations is currently unknown. This exploratory study investigated (1) the relationship between preoperative sleep quality, clinical pain intensity, pain catastrophizing, anxiety, and depression and (2) their associations with chronic postoperative pain following TJA. This secondary analysis from a larger randomized controlled trial included rest pain intensity (preoperative and 12 months postoperative; visual analogue scale, VAS), preoperative Pittsburgh Sleep Quality Index (PSQI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS) data from 74 knee and 89 hip osteoarthritis (OA) patients scheduled for TJA. Poor sleepers were identified based on preoperative PSQI scores higher than 5. Poor sleepers demonstrated higher preoperative VAS, pain catastrophizing, anxiety, and depression compared with good sleepers (all p < 0.003). Preoperative PSQI (β = 0.23, p = 0.006), PCS (β = 0.44, p < 0.005), and anxiety (β = 0.18, p = 0.036) were independent factors for preoperative VAS. Preoperative VAS (β = 0.32, p < 0.005), but not preoperative sleep quality (β = -0.06, p = 0.5), was an independent factor for postoperative VAS. The OA patients reporting poor preoperative sleep quality show higher preoperative pain, pain catastrophizing, anxiety, and depression. High preoperative pain intensity, but not poor sleep quality, was associated with higher chronic postoperative pain intensity. Future studies are encouraged to explore associations between sleep and chronic postoperative pain.

The expression and significance of TRPM8 among chronic rhinosinusitis with nasal polyps

Objective: To compare the expression and difference of melastatin-related transient receptor potential 8(TRPM8) among chronic rhinosinusitis, nasal polyps and normal mucosa tissues. And to explore the significant expression of TRPM8 among CRSwNP. Methods: Fifty-one patients underwent endoscopic sinus surgery in the Department of Otorhinolaryngology Head and Neck Surgery of Renmin Hospital of Wuhan University from February 2019 to January 2020 were recruited, including 33 males and 18 females, aged from 14 to 65 years old (34.55±1.689).Immunohistochemistry was used to detected the expression of TRPM8 protein among CRSsNP(17),CRSwNP (17) and control tissuses(17). In addition, the correlation between the expression of TRPM8 protein in CRSwNP patients and preoperative CT Lund-Mackay scores and preoperative VAS scores and sinonasal outcome test-20 scores was analyzed, respectively. The primary human nasal epithelial cells were cultured in vitro and the expression of TRPM8 was detected by quantitative real-time PCR and western blotting. The tissue in control group, chronic rhinosinusitis without nasal polyps (CRSsNP) group and the CRSwNP group were collected and grinded into tissue homogenized. The expression of TRPM8 protein was detected by western blotting after 24 h stimulation after homogenate was added into the medium of RPMI 2650 and primary nasal epithelial cells. Results: Compared with the control, the expression of TRPM8 was significantly up-regulated in nasal polyps (t=6.852, P<0.05). TRPM8 was mainly expressed in epithelial cells. The expression of TRPM8 in the epithelial cells of CRSsNP had no difference with the control group (t=1.980, P>0.05). In addition, the expression of TRPM8 in CRSwNP patients was positively correlated with the preoperative CT Lund-Mackay scores and VAS scores and SNOT-20 scores (r=0.512, P<0.05;r=0.853, P<0.01;r=0.814, P<0.01). After cultured primary epithelial cells in vitro, the expression level of TRPM8 in epithelial cells derived from nasal polyp was significantly higher than that in control group (t=8.845, P<0.05). By adding the homogenization of control and CRSsNP and CRSwNP tissues, the expression of TRPM8 in RPMI 2650 cells and primary nasal epithelial cells was changed and that was significantly increased after adding the homogenization of the group of CRSwNP. Conclusion: TRPM8 is highly expressed in nasal polyps epithelial cells, suggesting that TRPM8 may be involved in the pathogenesis of nasal polyps regulated by nasal epithelial cells.

Outcomes of Minimally Invasive TMJ Procedures: A New Quantitative Assessment Applied to 9 Published Studies

In the last 4 decades, the effectiveness of minimally invasive TMJ surgery has been demonstrated in dozens of peer-reviewed articles, with typical success rates of 70-90%.1-4 However, a definition of “success” for TMJ surgery lacks standardization. Important parameters that are used to determine outcomes include changes in maximal incisal opening (MIO), an objective measure, and changes in pain (VAS), a subjective, patient-reported measure. Potential flaws in measuring surgical outcomes include the following: a) an increase in a patient's MIO may not occur with a decrease in pain, and conversely, reduction in pain may not be accompanied with an increase in MIO, b) the relative importance of each parameter is also dependent on the baseline value prior to surgery. The development of an outcome measurement that weighs both changes in MIO and pain in the assessment of success or failure has the potential to reflect the surgical outcome more accurately. The researchers developed an outcomes assessment system, the MIO-Pain Change Score (MIOPCS), combining objective and subjective parameters of success. The aim of this study is to determine if the MIOPCS applied to additional patient populations demonstrates a statistically significant positive correlation of success rates of minimally invasive TMJ arthroscopy utilizing methods described in previous published studies.The authors conducted a literature search for minimally invasive TMJ surgery (primarily arthroscopy) studies that included data on pre-operative and postoperative MIO and VAS scores as well as reported success rates. Nine papers and the data (a total of 10 populations) were identified, with populations between 17-344 patients (average of 123 patients per study, Table 1). The MIOPCS outcomes measurement is a numerical value that provides relatively equal weight to changes in MIO and VAS (MIOPCS = change in VAS + ½ change in MIO). Using this simple formula, the MIOPCS was calculated for the patient population in each study using the average changes in MIO and VAS reported. The MIOPCS and the reported success rates were graphed on a scatter plot, and a linear regression T-test was performed to determine the statistical significance (Figure 1).Based on the linear regression, there is a positive correlation between the MIOPCS and the reported TMJ surgery success rates. The linear regression demonstrated that for every point change in MIOPCS, there was a 2.9% change in success rate of the surgery (P = .0005) in these 10 study populations. The correlation coefficient was 0.89 with a coefficient of determination of 0.79.Applying the MIOPCS numerical measurement to data from 10 studies, there was a significant correlation between the MIOPCS and the authors’ reported success rates in the patient population. In the future, the MIOPCS outcomes assessment will be applied to additional populations to further determine the utility of the MIOPCS as simple, accurate, and valuable outcome assessment for TMJ surgery. The results of this early investigation are encouraging, providing evidence that the MIOPCS score has the potential for creating a more standard outcomes assessment for evaluating TMJ surgery.

Partial uncinatectomy combined with anterior cervical discectomy and fusion for the treatment of one-level cervical radiculopathy: analysis of clinical efficacy and sagittal alignment

BackgroundBiomechanical studies have demonstrated that uncovertebral joint contributes to segment mobility and stability to a certain extent. Simultaneously, osteophytes arising from the uncinate process are a common cause of cervical spondylotic radiculopathy (CSR). For such patients, partial uncinatectomy (UT) may be required. However, the clinical efficacy and sagittal alignment of partial UT during anterior cervical discectomy and fusion (ACDF) have not been fully elucidated.MethodsA total of 87 patients who had undergone single level ACDF using a zero-profile device from July 2014 to December 2018 were included. Based on whether the foraminal part of the uncovertebral joint was resected or preserved, the patients were divided into the ACDF with UT group (n = 37) and the ACDF without UT group (n = 50). Perioperative data, radiographic parameters, clinical outcomes, and complications were compared between the two groups.ResultsThe mean follow-up was 16.86 ± 5.63 and 18.36 ± 7.51 months in the ACDF with UT group and ACDF without UT group, respectively (p > 0.05). The average preoperative VAS arm score was 5.89 ± 1.00 in the ACDF with UT group and 5.18 ± 1.21 in the ACDF without UT group (p = 0.038). However, the average VAS arm score was 4.22 ± 0.64, 4.06 ± 1.13 and 1.68 ± 0.71, 1.60 ± 0.70 at 1 week post operation and at final follow up, respectively, (p > 0.05). We also found that the C2-7 SVA and St-SVA at the last follow-up and their change (last follow-up value − preoperative value) in the ACDF with UT group were significantly higher than ACDF without UT group (p < 0.05). No marked differences in the other cervical sagittal parameters, fusion rate or complications, including dysphagia, ASD, and subsidence, were observed.ConclusionsOur result indicates that ACDF using a zero-p implant with or without partial UT both provide satisfactory clinical efficacy and acceptable safety. However, additional partial UT may has a negative effect on cervical sagittal alignment.

Hemorrhoidal artery ligation without using a doppler guide: Is it a feasible and safe technique?

The objective of this work was to analyze the results of the hemorrhoidal artery ligation technique without using a doppler guide, in patients with grade 3 hemorrhoidal disease; by evaluating cost-effectiveness, operation time, recurrence rate, postoperative pain, and secondary outcomes. A hemorrhoidal artery ligation procedure, without using a doppler guide, was performed on 43 patients (15 females, 28 males) with grade 3 symptomatic hemorrhoidal disease, from June 2015 to June 2019, in the Haseki Training and Research Hospital, Istanbul, Turkey. Patients were followed up clinically for one month. They completed a questionnaire within one year after their procedure. The median age was 46 years (range: 24 to 82 years). The main complaints were bleeding in 27 patients, pain in 22 patients, and skin tag in 14 patients. The mean preoperative VAS score was 3.4. The mean operating time was 18 mins (range: 13 to 25 min). All patients remained hospitalized for 24 h. Reoperation was necessary for only one patient because of bleeding. One year after the surgery, the pain was resolved in 21 (95.4%) out of 22 patients with preoperative pain, and bleeding resolved in 25 (92.5%) out of 27 patients with preoperative bleeding. The hemorrhoidal artery ligation is a simple method with a shorter learning curve producing similar postoperative results to other surgical procedures. The surgical technique is cost-effective as it does not require any particular device (anoscope with Doppler ultrasound) to apply.

Less Invasive Decompressive Laminectomy and One-Level Lumbar Fusion in the Setting of Interspinous Fixation: A Retrospective Analysis of 15 Patients.

Lumbar decompressive laminectomy for spinal stenosis can be performed using a less-invasive, unilateral approach with subperiosteal dissection and decompression by undermining the lamina from the ipsilateral to the contralateral side. A unilateral approach to bilateral decompression can be supplemented with interspinous instrumentation and facet fusion, a combined procedure that has not been studied before. The less-invasive technique appears to be as effective for lumbar stenosis as the traditional lumbar laminectomy. It also causes less blood loss and reduced operating time, and so may benefit patients who are elderly, medically frail, or with multiple comorbidities. Fifteen patients (eight females, seven males) underwent outpatient surgery by the author (HA) using this technique. These patients complained of progressive lower back pain associated with radicular pain exacerbated by prolonged standing or walking with improvement in flexed position of the lumbar spine with decreased walking distance ability. A one-level less-invasive lumbar laminectomy and foraminotomy with facet fusion and interspinous fixation were performed for spinal stenosis in conjunction with a Grade I degenerative spondylolisthesis. These patients all had a single-level facet fusion with bone graft material and local autograft. The approximate surgical time for each patient was between 50 and 80 minutes. The visual analog scale for pain (VAS) score decreased significantly after surgery; patients presented with preoperative VAS scores of 5-10/10 (mean 8.33/10). Postoperative VAS scores were 0-6/10 (mean 2/10), yielding a mean VAS improvement of 76% following surgery. Future analysis should be performed for evaluation of sustained VAS score, Oswestry Disability Index (ODI), Form 36 Health Survey Questionnaire (SF 36), and the Zurich Claudication Questionnaire (ZCQ).

Functional outcome of surgical management of calcaneal spur by excision and autologous platelet-rich plasma injection

The calcaneal spur is also known as an enthesophyte which is a bony outgrowth from the calcaneum at the plantar fascia insertion. Treatment aspect ranges from initial conservative methods, invasive techniques to surgical excision of the spur in cases which are not responding to any other alternative methods. This article aims in evaluating the functional outcome of calcaneal spur excision coupled with a dose of autologous platelet-rich plasma injection in recalcitrant cases of the calcaneal spur. A total of 42 cases of confirmed calcaneal spur cases were recruited for the study. All participants were offered with calcaneal excision with a dose of autologous platelet-rich plasma injection. All patients were evaluated preoperatively and post-operatively with VAS and FFI scores at the end of the 1, 3 and 6 months. The patients who received calcaneal spur excision along with a single dose of autologous platelet-rich plasma injection reported statistically significant pain relief at the end of 6 months while comparing with the pre-operative VAS score (p = 0.003) and FFI score showed a statistically significant functional outcome between both groups at the end of 6 months (p &amp;#60;0.001). Surgical removal of calcaneal spur along with a dose of an autologous platelet-rich plasma injection serve the better management for calcaneal spur and improves the functional quality of life.

P33. Risk factors for allograft subsidence following ACDF

<h3>BACKGROUND CONTEXT</h3> Studies investigating the impact of interbody subsidence in ACDF suggest a correlation between subsidence and worse radiographic and patient-reported outcomes. Though some interbody subsidence is anticipated, a normal range of subsidence has yet to be defined. Furthermore, no study has investigated the variables influencing allograft subsidence in ACDF. <h3>PURPOSE</h3> The primary purpose of this study was to utilize computed tomography to characterize subsidence of allograft interbodies in ACDF. The secondary aim of this study was to determine the impact of patient- and graft-related variables on subsidence in ACDF. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective study conducted at a single academic medical center. <h3>PATIENT SAMPLE</h3> Adult patients who underwent a 1 to 3 level ACDF with an allograft interbody and anterior plating between 2011-2017 were included. A total of 98 patients were included in the study. <h3>OUTCOME MEASURES</h3> Outcome measurements included superior endplate subsidence, inferior endplate subsidence, VAS scores, pseudoarthrosis, and reoperation rates. <h3>METHODS</h3> We performed a retrospective review of a prospective cohort of patients undergoing 1 to 3 level ACDF with an allograft interbody and anterior plating at a single institution between the years of 2011-2017. We collected demographic information, radiographic variables, and graft-related parameters. Graft subsidence was assessed on CT scan performed at least 6 months postoperatively. We classified subsidence as none if <2mm, mild if 2-3mm, moderate if 3-4mm, and severe if >4mm. Student's t-test and ANOVA were used to compare all means between groups. <h3>RESULTS</h3> We identified 98 patients (152 levels) for inclusion. On sagittal CT for the entire cohort, the mean superior endplate subsidence was 1.62mm+/-0.90 and the mean inferior endplate subsidence was 1.62mm+/-0.91. The number of levels that underwent <2mm, >2mm, and >4mm of subsidence was 73 (48.0%), 79 (51.9%), and 18 (11.8%), respectively. Of the 18 levels with severe subsidence, 14 occurred in multi-level constructs, 2 of which occurred in both levels of a two-level ACDF in one patient. Of the remaining 12 levels of severe subsidence, 11 (92%) occurred at the caudal level and to a significantly higher degree at the inferior end plate (p<0.001). On univariate analysis of levels with severe subsidence, both a decrease in the distance from the screw tip to the inferior endplate and in the screw tip height to vertebral body height ratio were associated with an increase in subsidence (p<0.05). Additionally, both mild and severe subsidence were significantly influenced by loss of vertebral body height on immediate postoperative X-rays (p<0.005). There was no significant difference in preoperative or postoperative VAS between groups (p>0.05). 16 patients (94.1%) with severe subsidence experienced pseudarthrosis compared to only 11 patients (13.6%) with <4mm subsidence (p<0.001). However, reoperation rate was not significantly different between the severe subsidence and non-severe subsidence groups (11.8% vs 17.3%, p=0.44). <h3>CONCLUSIONS</h3> The present study is the first to utilize advanced imaging to quantify and characterize allograft subsidence in ACDF. Univariate analysis of patients with severe subsidence demonstrated that inferior screw placement in the caudal instrumented vertebra was associated with increased subsidence, likely due to decreased buttress support and an increased working length with an associated decrease in construct rigidity. Furthermore, excessive endplate resection was associated with an increase in both mild and severe subsidence. Based upon our study, some allograft subsidence in ACDF is expected, but too inferior screw placement at the caudal vertebral level and excessive endplate resection should be avoided to prevent severe subsidence. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

106. Seven- to 21-year clinical outcomes of 1,187 patients treated with one- and two-level lumbar total disc arthroplasty

<h3>BACKGROUND CONTEXT</h3> Multiple studies have shown that lumbar total disc arthroplasty (TDA) is not only safe and effective in treating chronic lumbar degenerative disc disease (DDD), but also provides a better surgical alternative to fusion with respect to patient-reported results, restoring motion, and reducing reoperation rates and severity of adjacent level degeneration. Published evidence is limited for follow-up past 5-7 years after TDA. In this study, we expand the evidence favoring TDA with results up to 21 years, of a large patient cohort treated with semi-constrained ball-and-socket lumbar TDA. <h3>PURPOSE</h3> To compare the results for one-level vs two-level patients, and evaluate whether prior surgery at these levels has an effect on clinical outcomes. <h3>STUDY DESIGN/SETTING</h3> Retrospective clinical study. <h3>PATIENT SAMPLE</h3> A total of 1,187 chronic lumbar DDD patients (622 male, 565 female, mean age 43±9.81years, range 17-86 years), underwent lumbar TDA from 1999 to 2013. Of the total, 772 patients had one-level and 415 patients had two-level procedures; 373 out of 1,187 patients (31.5%) had prior index-level surgery (recurrent disc herniation or postdiscectomy syndrome). <h3>OUTCOME MEASURES</h3> Data collected included radiographic, neurological/physical assessment, self-evaluation using the Oswestry Disability Index (ODI) and visual analog back and leg pain Scores (VAS). Complication, reoperation/revision rates, and perioperative data points were also assessed. <h3>Methods</h3> Patients were evaluated preoperatively, then followed postoperatively at 3, 6, 12, and 18 months, then yearly thereafter. Patient follow-up ranged between 7 and 21 years (mean 11 years, 8 months). Patients were stratified into one- (1L) and two-level (2L) procedure groups, then divided into prior (PS) or no-prior surgery (NPS) at the index level for data comparison. Patient demographics (age and gender) were comparable for all groups. <h3>Results</h3> All groups showed dramatic and statistically significant ODI reduction by 3 months postsurgery (p<0.001) and then maintained scores over time. ODI improvement was mean 26 points for groups 1, 2 and 3, while group 4 (2L/PS) had mean 24 points ODI improvement. Although patients with prior surgery took longer to reach final VAS pain levels (6 vs 3 months), there was no statistical difference between groups in pain reduction at 24 months. Although not statistically significant, the group with highest average preoperative VAS pain (group 2) had the greatest reduction in pain. Improvement of ODI and VAS pain is documented in all study groups. Of the 1,187 patients, 49 (4.12%) required new or revision surgery. Revisions were classified into four groups: posterior release/laminectomy at same level; TDA revision; scar/hematoma; and adjacent level surgery (ALS). Rates were too low in all groups to compare them statistically. Total TDA revision and ALS rates over 7-21 years were very low: 0.67% and 1.85%, respectively. <h3>Conclusions</h3> In one of the largest groups of TDA patients evaluated, this study demonstrates the robust long-term clinical success of one- and two-level lumbar TDA, as assessed at 7-21 years postoperatively. Patients had significant and maintained reduction in disability and pain scores over time, and low rates of index revision/reoperation or ALS, when compared to long-term published fusion data. Also, both 1- and 2-level lumbar TDA patients improved and patients with prior surgery at the index level had outcomes equivalent to patients with no prior surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Outcomes of lumbar spinal fusion in super-elderly patients aged 80 years and over: Comparison with patients aged 65 years and over, and under 80 years.

Despite the increasing prevalence of spinal surgery in super-elderly (SE) patients, the outcomes and complication rates have not been fully elucidated. The purpose of this study was to compare the outcomes and complications of lumbar spinal fusion for degenerative lumbar spinal stenosis (DLSS) in SE patients aged 80 years and over with those in patients aged 65 years and over, and under 80 years.This study analyzed 160 patients who underwent spinal fusion for DLSS between January 2011 and November 2019. Thirty patients in the SE group (group SE, ≥80 years) and 130 patients in the elderly group (group E, ≥65 years and <80 years) were enrolled. The performance status was evaluated by preoperative American society of anesthesiologists (ASA) score. Visual analog scales for back pain (VAS-BP) and leg pain (VAS-LP), and Korean Oswestry disability index (K-ODI) were used to assess clinical outcomes preoperatively and 1 year postoperatively. Percent changes of VAS-BP, VAS-LP and K-ODI were also analyzed. Fusion rates were evaluated by computed tomography 6 months and 1 year postoperatively. Furthermore, bone mineral density, operative time, estimated blood loss, blood transfusion, hospital days, hospitalization in intensive care unit and postoperative complications were compared.The average age of group SE was 82.0 years and that of group E was 71.6 years. There were no differences in preoperative ASA score, preoperative or postoperative VAS BP and VAS-LP, bone mineral density, operative time, estimated blood loss, blood transfusion, hospital days, hospitalization in intensive care unit and fusion rates between the groups. Preoperative and postoperative K-ODI were higher in group SE than group E (all P < .05). However, percent changes of VAS-BP, VAS-LP and K-ODI showed no significant differences. Overall early and late complications were not significantly different between the groups; however postoperative delirium was more common in group SE than group E (P = .027). SE status was the only risk factor for postoperative delirium with odds ratio of 3.4 (P = .018).Spinal fusion surgery is considerable treatment to improve the quality of life of SE patients with DLSS, however careful perioperative management is needed to prevent postoperative delirium.

Implementation of Enhanced Recovery After Surgery (ERAS) protocol for elderly patients receiving surgery for intertrochanteric fracture: a propensity score-matched analysis

PurposeEnhanced Recovery After Surgery (ERAS) is a multimodal approach to perioperative care that aims to reduce patient perioperative complications, accelerate patient recovery, and improve patient satisfaction by refining and optimizing all perioperative management processes. By comparing two groups of patients before and after the implementation of ERAS for intertrochanteric fracture (ITF) with a matching analysis of propensity score (PS), we aimed to demonstrate that the implementation of ERAS protocol shortens the length of hospital stay (LOS), reduces pain, decreases the incidence of postoperative complications, and promotes functional recovery of the joint.MethodsWe selected 2 periods of 1 year, before (n=98patients) and after ERAS implementation (n=92patients). Data were collected on patient demographics, operative and perioperative details, LOS, VAS score, Harris score, and 30-day complications. ERAS-trained nurses are engaged to support patients at each step of the pre/per/postoperative process, including completing a satisfaction survey, with the help of a mobile app. PS analyses were used for dealing with confounding bias in this retrospective observational study.ResultsAfter PS matching, the outcomes of 124 well-balanced pairs of patients were compared (conventional vs ERAS). LOS was significantly reduced from 24.3±3.9 to 15.2±2.9 days (P<0.001). With the same preoperative VAS scores, we found that patients in the ERAS group had significantly lower postoperative VAS scores than those in the conventional group at days 3 and 7 (P<0.001), but the difference was not statistically significant at day 14. patients in the ERAS group had higher Harris scores than those in the conventional group at 1 and 3 months, but the difference was not significant at 6 months. In addition, we found that only one patient in the ERAS group developed complications, while nine patients in the conventional group developed different complications. There was no significant difference concerning the satisfaction survey.ConclusionThe introduction of ERAS for ITF in our institution has resulted in a significant decrease in LOS, alleviated patient pain, promoted early recovery of patient’s hip function while effectively preventing complications, and obtained patient satisfaction.

Clinical application of Orthopedic Tianji Robot in surgical treatment of thoracolumbar fracture

To explore the clinical application of Orthopedic Tianji Robot in the treatment of thoracolumbar fractures with minimally invasive percutaneous pedicle screw internal fixation. The clinical data of 46 patients with thoracolumbar fractures treated by minimally invasive percutaneous pedicle screw internal fixation from June 2018 to January 2020 in Gansu Provincial People's Hospital was retrospectively analyzed. According to the different aided equipments, the patients were divided into a C-arm X-ray plus robot assisted nail placement group (observation group) and simple C-arm X-ray assisted nail placement group (control group). Twenty-two patients in observation group, including 12males and 10 females, aged from 24 to 61 years old, with a mean of(40.23±12.19) years, 3 cases were T11 vertebrae fracture, 8 cases were T12, 9 cases were L1, and 2 cases were L2. And there were 24 cases in control group, including 15 males and 9 females, aged from 26 to 58 years old, with a mean of (42.88±10.31) years, 3 cases were T11 vertebrae fracture, 10 cases were T12, 7 cases were L1, and 4 cases were L2. The operation time, the number of intraoperative fluoroscopy, intraoperative blood loss, the days of hospitalization, and postoperative complications were recorded. Preoperative and postoperative VAS at 3 days, 1 week and 3 months were compared between two groups. The sagittal Cobb angle of the injured vertebral body and the percentage of the anterior edge height of the vertebral body were observed before and after operation, and evaluate the accuracy of nail placement according to the Gertzbein-Robbins classification criteria with collected postoperative CT images. All patients were followed up for 5 to 12 months with an average of (7.07±0.83) months. There was no significant differences in intraoperative blood loss, operation time and hospitalization days between two groups (P>0.05). The number of intraoperative fluoroscopy was (5.62±0.51) times in observation group and (12.54±0.52) in control group, the difference between two groups was statistically significant (P<0.05). The VAS, the percentage of the height of the injured vertebra anterior edge and the Cobb angle of the injured vertebral plane at each time point after operation were improved(P<0.05), but the difference between two groups was not statistically significant (P>0.05). One case of postoperative incision infection occurred in the control group, which was cured after active dressing changes. There were no serious complications such as screw loosening and breakage in all patients, and there was no statistically significant difference in the incidence of complications between two groups(P>0.05). The postoperative nail placement accuracy ratesof the observation group and the control group were 98.4% (126/128) and 90.3% (121/134), respectively, and the difference was statistically significant (P<0.05). In the surgical treatment of thoracolumbar fractures, compared with simple C-arm fluoroscopy, the pedicle screw placement assisted by Orthopedic Tianji Robot overcomes the shortcomings of surgeon's physiological tremor, fatigue and multiple intraoperative fluoroscopy, improves the accuracy of screw placement, and is a more accurate and safer way of pedicle screw placement for thoracolumbar fractures.

Development of machine learning algorithms to predict achievement of minimal clinically important difference for the KOOS‐PS following total knee arthroplasty

AbstractAs cost‐effective measures become increasingly implemented in the US healthcare system, changes in patient‐reported outcome measure (PROM) scores can be utilized to indicate patient satisfaction following procedures including total knee arthroplasty (TKA). The primary aim of this study was to develop and evaluate machine learning algorithms to predict achievement of the minimal clinically important difference (MCID) for the Knee Injury and Osteoarthritis Outcome Score‐Physical Function Short Form (KOOS‐PS) at 1‐year following TKA. A retrospective review of primary TKA patients between 2016 and 2018 was performed. Variables considered for prediction included demographics and preoperative PROMs. The KOOS‐PS MCID was calculated via a distribution‐based method. Five machine learning algorithms were developed and tested by discrimination, calibration, Brier score, and decision curve analysis. Among the 744 patients who met the inclusion criteria, 385 (72.8%) patients achieved the MCID. The elastic‐net penalized logistic regression model was selected as the best performing model (c‐statistic 0.77, calibration intercept −0.02, calibration slope 1.15, and Brier score 0.14). The most important variables for MCID achievement were preoperative KOOS‐PS score, preoperative VAS Pain, preoperative opioid use, preoperative PROMIS global mental health score, age, and sex. Algorithms were incorporated into an open‐access digital application available at https://sorg-apps.shinyapps.io/tka_koos_mcid/. This study is the first to predict the probability of achieving the KOOS‐PS MCID following TKA using a machine learning‐based approach. The results were used to develop a clinical decision aid based on commonly collected predictive variables to preoperatively predict an individual patient's likelihood of attaining an acceptable outcome following TKA.

Can We Extrapolate SINS Score to Evaluate Instability in Spinal Tuberculosis?

Prospective Observational Study. To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis. Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with "indeterminate stability" were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc. Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in "indeterminate group" were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [P < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [P < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [P < .0001 for both groups]. SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.

The impact of preoperative motor weakness on postoperative opioid use after ACDF

This study aims to determine if preoperative weakness is an isolated risk factor for prolonged postoperative opioid use after anterior cervical discectomy and fusion (ACDF). Patients with preoperative weakness were significantly more likely to have prolonged and inappropriate opioid use and have a single prescription mean morphine equivalent (MME) ≥ 200. Logistic regression isolated preoperative weakness, opioid tolerance, depression, and VAS Neck pain as independent predictors of extended opioid use. High postoperative opioid dose (MME ≥ 90) correlated with opioid tolerance, younger age, male sex, greater CCI, prior cervical surgery, and preoperative VAS Neck pain on regression.