Preoperative Oswestry Disability Index Scores Research Articles

The application of a new intraoperative assessment method of coronal balance in surgical treatment of scoliosis

Objective To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance. Methods The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method. Results Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.437, P=0.000); the average CBD correction rate was 37.45%±29.03%, and significant difference was found (t=2.607, P=0.028). In type C patients, the average Cobb angle and CBD correction rate at immediate post-operation was 72.92%±3.67% and 44.79%±5.63%, respectively, and significant difference was found (t=7.319, P=0.000; t=7.545, P=0.000). Conclusion Point-line method was a simple and effective technique for intraoperative assessment of coronal balance, which could assist surgeons to objectively evaluate the result of restoration of the coronal alignment. The use of point-line method is contributed to improve clinical outcomes of spinal deformity correction surgery, and to prevent the occurrence of postoperative coronal imbalance. Key words: Scoliosis; Intervertebral disc degeneration; Spinal fusion; Treatment outcome

Surgical Outcome of Decompression and Fixation of Degenerative Lumbosacral Spondylolisthesis Surgery in Pakistani Population

BackgroundSpondylolisthesis is characterized by the slipping of one vertebra, compared with the underlying one, due to structural and degenerative changes. Its origin is multifactorial which includes disc degeneration, facet joint anatomic orientation, iliolumbar configuration, and ligament hyperlaxity. The most common operative treatment is decompression and may require an individualized surgical plan. However, only decompression may progress the slippage which can result in pain or recurrence of neurological complaints. Therefore, lumbar fusion and fixation are considered appropriate to stabilise the spine and prevent delayed deterioration. The aim of our study was to find out the outcome of posterior decompression, with reduction and fixation of lumbosacral spondylolisthesis by Oswestry Disability Index (ODI) to improve further our results.MethodsThis study was conducted from July 2013 to February 2017 including 94 patients with lumbosacral spondylolisthesis. The Meyerding classification was used to grade the extent of vertebral slippage. The assessment was done using the ODI.ResultsThere were 50 (53.19%) males and 54 (46.80%) females with a mean age of 44 years ± 10.49 SD. Backache was present in all patients and claudication in 85 (90.42%) patients. There were 10 (10.63%) patients with spondylolisthesis at L3-L4, 36 (38.29%) at L5-S1 and 48 patients (51.06%) at L4-L5 level. In 48 patients with L4-L5 level, 38 (79.16%) were in grade II while six (12.5%) were in grade III. According to the preoperative ODI score, 38 patients were placed in moderate disability, 42 patients were severely disabled while four patients were disabled.Good outcome was achieved in a total of 79 (84.04%) patients. In 40 (42.55%) patients, with complete reduction, the good outcome achieved in 35 (83.33%) while in 22 (23.40%) patients there was no reduction and a good outcome was achieved in 17 (77.27%) patients. In 38 (40.42%) patients with moderate disability, 32 (84.04%) patients had a good outcome. Post-operative cerebrospinal fluid (CSF) leak occurred in five (5.31%) and wound infection in seven (7.44%) patients while there was no mortality.ConclusionReduction with decompression can have a good outcome in spondylolisthesis, and ODI should be used as a predictor of outcome. It also shows that proper decompression is required and not a complete reduction.

309. Patient reported allergies: a marker of preoperative pain and disability in elective spine surgery

BACKGROUND CONTEXT Previous literature has demonstrated mixed results regarding the correlation between patient reported allergies and their pain, function, and satisfaction scores with elective spine surgery. A better understanding of the correlation is important for preoperative risk factor assessment and management. PURPOSE The objective of this study was to investigate the correlation between patient reported allergies and preoperative Oswestry Disability Index (ODI), Neck Disability Index (NDI) and Patient-Reported Outcomes Measurement System (PROMIS) scores. STUDY DESIGN/SETTING Retrospective review at a single institution from May 2017-October 2018. PATIENT SAMPLE All patients undergoing elective cervical, thoracolumbar, and lumbar spine surgery at a single institution who had completed preoperative ODI, NDI, and PROMIS questionnaires. OUTCOME MEASURES The PROMIS, ODI and NDI scores were utilized. METHODS All patients undergoing elective cervical, lumbar procedures between May 2017 and October 2018 were included. Baseline demographic information was recorded, as well as all reported allergies or adverse reactions. PROMIS scores, ODI and NDI were recorded. Hierarchical multiple linear regressions were used to assess the relationship between total number of allergies and the preoperative pain and function scores. RESULTS A total of 570 patients were included (476 lumbar, 94 cervical). The mean number of allergies reported was 1.89 ± 2.32. The mean preoperative ODI and NDI scores were 46.39 ±17.67, and 43.47 ±16.51, respectively. The mean preoperative PROMIS Physical Health and PROMIS Mental Health scores were 37.21±6.54 and 43.89 ±9.26, respectively. Hierarchical multiple linear regression showed that total number of reported allergies shared a statistically significant negative relationship with all of the following scores: ODI (B = 0.83,p=.02), NDI (B = 1.45, p=.02), PROMIS Physical Health (B = -0.29, p=.013), PROMIS Mental Health (B = -0.38, p=.024). CONCLUSIONS Patient reported allergies share a statistically significant negative relationship with preoperative pain and function scores; as patients have increasing total number of allergies, the ODI/NDI scores become worse (increase), and the PROMIS scores become worse (decrease). FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Previous literature has demonstrated mixed results regarding the correlation between patient reported allergies and their pain, function, and satisfaction scores with elective spine surgery. A better understanding of the correlation is important for preoperative risk factor assessment and management. The objective of this study was to investigate the correlation between patient reported allergies and preoperative Oswestry Disability Index (ODI), Neck Disability Index (NDI) and Patient-Reported Outcomes Measurement System (PROMIS) scores. Retrospective review at a single institution from May 2017-October 2018. All patients undergoing elective cervical, thoracolumbar, and lumbar spine surgery at a single institution who had completed preoperative ODI, NDI, and PROMIS questionnaires. The PROMIS, ODI and NDI scores were utilized. All patients undergoing elective cervical, lumbar procedures between May 2017 and October 2018 were included. Baseline demographic information was recorded, as well as all reported allergies or adverse reactions. PROMIS scores, ODI and NDI were recorded. Hierarchical multiple linear regressions were used to assess the relationship between total number of allergies and the preoperative pain and function scores. A total of 570 patients were included (476 lumbar, 94 cervical). The mean number of allergies reported was 1.89 ± 2.32. The mean preoperative ODI and NDI scores were 46.39 ±17.67, and 43.47 ±16.51, respectively. The mean preoperative PROMIS Physical Health and PROMIS Mental Health scores were 37.21±6.54 and 43.89 ±9.26, respectively. Hierarchical multiple linear regression showed that total number of reported allergies shared a statistically significant negative relationship with all of the following scores: ODI (B = 0.83,p=.02), NDI (B = 1.45, p=.02), PROMIS Physical Health (B = -0.29, p=.013), PROMIS Mental Health (B = -0.38, p=.024). Patient reported allergies share a statistically significant negative relationship with preoperative pain and function scores; as patients have increasing total number of allergies, the ODI/NDI scores become worse (increase), and the PROMIS scores become worse (decrease).

P93. Semitendinosus ligament reinforcement for prevention of proximal junctional kyphosis and failure in adult spinal deformity

BACKGROUND CONTEXT Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-recognized, but incompletely understood complications that can occur following posterior spinal fusion in adult deformity surgery. PJK prevention techniques have the potential to decrease morbidity by reducing eventual development of PJF. In this study we sought to describe the clinical results of a novel technique for interspinous ligament augmentation using a semitendinosus allograft. PURPOSE To assess the incidence of PJK and PJF after augmenting the uppermost instrumented vertebra (UIV) with a semintendinous allograft in patients undergoing complex spinal deformity surgery. STUDY DESIGN/SETTING Single institution retrospective review of a case series. PATIENT SAMPLE Consecutive series of adult spinal deformity patients at a single institution treated by two surgeons between 2015-2017. OUTCOME MEASURES Oswestry Disability Index (ODI), Proximal Junctional Kyphosis, Proximal Junctional Failure, Pelvic Incidence, Pelvic Tilt, Lumbar Lordosis, PI-LL Mismatch, Sagittal Vertical Axis (SVA), Thoracic Kyphosis, T1 Sagittal Tilt, UIV + 2 Sagittal Cobb Angle. METHODS Allograft ligament augmentation was used in a consecutive series of adult spinal deformity patients at a single institution by two surgeons between 2015-2017. Patient demographics, surgical details, ODI scores and complications were recorded. Preoperative and postoperative spinopelvic parameters were measured. PJK was defined as a sagittal Cobb angle between the uppermost instrumented vertebra (UIV) and two levels above the UIV (UIV +2) ≥10°and ≥10°compared to the preoperative measurement. PJF was defined as proximal junctional fracture, fixation failure, symptomatic PJK, or requiring revision of fusion within 1 year of surgery. Preoperative and postoperative ODI scores and spinopelvic parameters were compared using a Student's t-test. RESULTS A total of 48 patients (71% female, mean age 63 years) were included with average follow-up of 10.4 months. The UIV was most commonly upper thoracic (T2-T4) (60%) or T10 (38%). Sixty percent of cases were revision surgeries and 87.5% required osteotomies. Average ODI improved from 60% preoperatively to 40% at final follow-up (P CONCLUSIONS Interspinous ligament augmentation using a semitendinosus allograft represents a novel technique for the potential prevention of PJF. In this case series of patients at high risk for developing PJF, only 1 (2.1%) required a revision surgery for PJF. The use of this novel technique to reinforce the interspinous ligament may be considered in patients undergoing adult spinal deformity surgery at high risk for developing PJF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery

BACKGROUND CONTEXTLow back pain has an immense impact on the US economy. A significant number of patients undergo surgical management in order to regain meaningful functionality in daily life and in the workplace. Return to work (RTW) is a key metric in surgical outcomes, as it has profound implications for both individual patients and the economy at large. PURPOSEIn this study, we investigated the factors associated with RTW in patients who achieved otherwise favorable outcomes after lumbar spine surgery. STUDY DESIGN/SETTINGThis study retrospectively analyzes prospectively collected data from the lumbar module of national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLEThe lumbar module of QOD includes patients undergoing lumbar surgery for primary stenosis, disc herniation, spondylolisthesis (Grade I) and symptomatic mechanical disc collapse or revision surgery for recurrent same-level disc herniation, pseudarthrosis, and adjacent segment disease. Exclusion criteria included age under 18 years and diagnoses of infection, tumor, or trauma as the cause of lumbar-related pain. OUTCOME MEASURESThe outcome of interest for this study was the return to work 12-month after surgery. METHODSThe lumbar module of QOD was queried for patients who were employed at the time of surgery. Good outcomes were defined as patients who had no adverse events (readmissions/complications), had achieved 30% improvement in Oswestry disability index (ODI) and were satisfied (NASS satisfaction) at 3-month post-surgery. Distinct multivariable logistic regression models were fitted with 12-month RTW as outcome for a. overall population and b. the patients with good outcomes. The variables included in the models were age, gender, race, insurance type, education level, occupation type, currently working/on-leave status, workers’ compensation, ambulatory status, smoking status, anxiety, depression, symptom duration, number of spinal levels, diabetes, motor deficit, and preoperative back-pain, leg-pain and ODI score. RESULTSOf the total 12,435 patients, 10,604 (85.3%) had successful RTW at 1-year postsurgery. Among patients who achieved good surgical outcomes, 605 (7%) failed to RTW. For both the overall and subgroup analysis, older patients had lower odds of RTW. Females had lower odds of RTW compared with males and patients with higher back pain and baseline ODI had lower odds of RTW. Patients with longer duration of symptoms, more physically demanding occupations, worker's compensation claim and those who had short-term disability leave at the time of surgery had lower odds of RTW independent of their good surgical outcomes. CONCLUSIONSThis study identifies certain risk factors for failure to RTW independent of surgical outcomes. Most of these risk factors are occupational; hence, involving the patient's employer in treatment process and setting realistic expectations may help improve the patients' work-related functionality.

Patient-Reported Allergies, a Marker of Preoperative Pain and Disability in Elective Spine Surgery.

Study Design:Retrospective review.Objective:Previous literature demonstrates mixed results regarding the relationship between patient-reported allergies and pain, function, and satisfaction scores. The objective of this study was to investigate the correlation between patient-reported allergies and preoperative Oswestry Disability Index (ODI), Neck Disability Index (NDI), and Patient-Reported Outcomes Measurement System (PROMIS) scores.Methods:All patients undergoing elective cervical, lumbar procedures between May 2017 and October 2018 were included. Baseline demographic information was recorded, as well as all reported allergies or adverse reactions. Preoperative PROMIS, ODI, and NDI scores were recorded. Hierarchical multiple linear regressions were used to assess the relationship between total number of allergies and the preoperative pain and function scores.Results:A total of 570 patients were included (476 lumbar, 94 cervical). The mean number of allergies reported was 1.89 ± 2.32. The mean preoperative ODI and NDI scores were 46.39 ± 17.67 and 43.47 ± 16.51, respectively. The mean preoperative PROMIS Physical Health and PROMIS Mental Health scores were 37.21 ± 6.54 and 43.89 ± 9.26, respectively. Hierarchical multiple linear regression showed that total number of reported allergies shared a statistically significant negative relationship with all of the following scores: ODI (B = 0.83, P = .02), NDI (B = 1.45, P = .02), PROMIS Physical Health (B = −0.29, P = .013), and PROMIS Mental Health (B = −0.38, P = .024).Conclusions:Patient-reported allergies share a statistically significant negative relationship with preoperative pain and function scores; as patients have increasing total number of allergies, the ODI/NDI scores become worse (increase) and the PROMIS scores become worse (decrease).

The Role of Calcium Pyrophosphate Dihydrate Deposition in the Postoperative Outcome of Lumbar Spinal Stenosis Patients.

Study DesignRetrospective study.PurposeThis study aimed to investigate the association of surgical intervention with clinical and quality of life (QoL) outcomes in patients who underwent posterior spinal surgery for lumbar spinal stenosis (LSS) with spinal calcium pyrophosphate dihydrate deposition (SCPPD) versus that in those who underwent the surgery for LSS without SCPPD.Overview of LiteratureCalcium pyrophosphate (CPP)-associated arthritis is one of the most common types of arthritis. The clinical outcomes are well studied in CPP-associated arthritis of the appendicular joints. However, few studies have investigated SCPPD.MethodsA single-institution database was reviewed. LSS patients were categorized as those who did and did not have SCPPD, based on histologic identification. Clinical presentations and postoperative results were analyzed. Disability and QoL were assessed using the Oswestry Disability Index (ODI) and the 36-item Short-Form Health Survey.ResultsThirty-four patients were enrolled, with 18 patients being allocated to the SCPPD group and 16 being allocated to the non- SCPPD group. Preoperative and postoperative pain scores were not significantly different between the groups (p=0.33 and p=0.48, respectively). The average preoperative ODI score in the SCPPD group was slightly higher than that in the non-SCPPD group (57 vs. 51, p=0.33); however, the postoperative ODI score was significantly lower (15 vs. 43, p=0.01). The postoperative physical function, vitality, and mental health of the SCPPD patients were also significantly improved (p=0.03, p=0.022, and p=0.022, respectively).ConclusionsSurgical intervention resulted in good clinical outcomes in SCPPD patients. As per our findings, total removal of CPPinvolved tissue is unnecessary. As such, surgery should be performed as indicated according to clinical presentation without considering the presence of CPPD.

Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up.

OBJECTIVEOpen spinal fusion surgery is often associated with significant blood loss, postoperative pain, and prolonged recovery times. Seeking to minimize surgical and perioperative morbidity, the authors adopted an endoscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique performed without general anesthesia. In this report, they present data on the first 100 patients treated with this procedure.METHODSThe authors conducted a retrospective review of the first 100 patients who underwent awake endoscopic MIS-TLIF at a single institution between 2014 and 2017. Surgery was performed while the patient was sedated but without intubation or the use of general anesthetic or narcotic agents. Long-lasting (liposomal) bupivacaine was used for local analgesia. The discectomy and placement of an expandable interbody graft were performed endoscopically, followed by percutaneous pedicle screw implantation. Inclusion criteria for the procedure consisted of diagnosis of degenerative disc disease with grade I or II spondylolisthesis and evidence of spinal stenosis or nerve impingement with intractable symptomatology.RESULTSOf the first 100 patients, 56 were female and 44 were male. Single-level fusion was performed in 84 patients and two-level fusion in 16 patients. The most commonly fused level was L4-5, representing 77% of all fused levels. The mean (± standard deviation) operative time was 84.5 ± 21.7 minutes for one-level fusions and 128.1 ± 48.6 minutes for two-level procedures. The mean intraoperative blood loss was 65.4 ± 76.6 ml for one-level fusions and 74.7 ± 33.6 ml for two-level fusions. The mean length of hospital stay was 1.4 ± 1.0 days. Four deaths occurred in the 100 patients; all four of those patients died from complications unrelated to surgery. In 82% of the surviving patients, 1-year follow-up Oswestry Disability Index (ODI) data were available. The mean preoperative ODI score was 29.6 ± 15.3 and the mean postoperative ODI score was 17.2 ± 16.9, which represents a significant mean reduction in the ODI score of -12.3 using a two-tailed paired t-test (p = 0.000001). In four cases, the surgical plan was revised to include general endotracheal anesthesia intraoperatively and was successfully completed. Other complications included two cases of cage migration, one case of osteomyelitis, and one case of endplate fracture; three of these complications occurred in the first 50 cases.CONCLUSIONSThis series of the first 100 patients to undergo awake endoscopic MIS-TLIF demonstrates outcomes comparable to those reported in our earlier papers. This procedure can provide a safe and efficacious option for lumbar fusion with less morbidity than open surgery. Further refinements in surgical technique and technologies will allow for improved success.

Diagnostic and Management Options of Osteoblastoma in the Spine.

BackgroundOsteoblastoma is a rare, benign, osteolytic neoplasm commonly found in the spine in early adulthood. Here, we review the clinical characteristics, radiographic findings, and surgical management of patients with spinal osteoblastoma.Material/MethodsThirteen patients with osteoblastoma who underwent surgery at our institute from June 2008 to November 2017 were enrolled in this study. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. All patients were treated with either total excision or intralesional piecemeal excision without postoperative radiotherapy. Clinical efficacy was evaluated by visual analog scale (VAS) scores, the Oswestry Disability Index (ODI) of nerve function, physical and radiographic examinations, bone fusion, and neurologic status.ResultsThe follow-up lasted 23–82 months (average, 43.8 months). The average surgical time was 178.1 minutes (range, 100–230 minutes), with an average intraoperative blood loss of 574 mL (range, 230–1100 mL). Postoperatively, VAS scores decreased from 6.2±1.7 to 0.5±0.7 (P<0.001). The preoperative and final ODI scores were 51.1±7.7 and 22.6±4.9, respectively, reflecting a significant decrease (P<0.001). According to the ASIA classification, 3 patients had grade C, 3 patients had grade D, and 7 patients had grade E disease. Three months postoperatively, 1 patient had grade D and 10 patients had grade E disease; ultimately, all cases were grade E disease. Only 1 patient experienced local recurrence and underwent en bloc marginal resection with postoperative radiotherapy. All patients remained neurologically stable without any major complications.ConclusionsAccurate intraoperative localization with complete resection is the key to preventing recurrence. Aggressive surgical resection can achieve satisfactory clinical and radiographic outcomes.

The Outcome of Radiofrequency Kyphoplasty in the Treatment of Vertebral Compression Fractures in Osteoporotic Patients.

Study DesignRetrospective study.PurposeThe study aims to assess the effectiveness and safety of radiofrequency (RF) kyphoplasty in the treatment of vertebral compression fractures (VCFs) in osteoporotic patients.Overview of LiteratureVertebroplasty and balloon kyphoplasty are established procedures for the treatment of osteoporotic VCFs. However, RF kyphoplasty is a new method which controls cement viscosity.MethodsWe reviewed the results of 41 consecutive patients with 23 thoracic and 38 lumbar VCFs who underwent RF kyphoplasty. The study population included 14 males (34%) and 27 females (66%). The mean patients age was 78 years (range, 51–89 years), and the follow-up period was 1 year. Clinical and radiographic analyses were performed during follow-up at 6 weeks, 6 months, and 1 year. All patients were assessed clinically pre- and postoperative using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological assessment with X-ray in two views preoperatively, postoperatively, and during follow-up visits.ResultsThe mean preoperative VAS was 8.7 (range, 5–10; standard deviation [SD], 1.2). Postoperatively, VAS decreased by 3.3 (range, 2–5; SD, 0.9). At the end of the follow-up, VAS decreased by 1.22 (range, 0–7; SD, 1.6). The mean preoperative ODI score was 85.9, decreasing to 9.6 postoperatively and improving to 18.4 during the 1-year follow-up. The mean local kyphotic angle was 9.04° before the procedure and decreased by a mean of 6.16° after the operation and at the end of the follow-up. The mean increase in vertebral body height was 3.3 mm postoperatively and after 1-year follow-up. The rate of cement leakage was 8% (five out of 61 levels of fracture).ConclusionsRF kyphoplasty is a safe and effective augmentation technique with an advantage of controlling the cement viscosity to minimize the risk of cement leakage. It also shortens operation time.

Lateral lumbar interbody fusion in the elderly: a 10-year experience.

OBJECTIVEElderly patients, often presenting with multiple medical comorbidities, are touted to be at an increased risk of peri- and postoperative complications following spine surgery. Various minimally invasive surgical techniques have been developed and employed to treat an array of spinal conditions while minimizing complications. Lateral lumbar interbody fusion (LLIF) is one such approach. The authors describe clinical outcomes in patients over the age of 70 years following stand-alone LLIF.METHODSA retrospective query of a prospectively maintained database was performed for patients over the age of 70 years who underwent stand-alone LLIF. Patients with posterior segmental fixation and/or fusion were excluded. The preoperative and postoperative values for the Oswestry Disability Index (ODI) were analyzed to compare outcomes after intervention. Femoral neck t-scores were acquired from bone density scans and correlated with the incidence of graft subsidence.RESULTSAmong the study cohort of 55 patients, the median age at the time of surgery was 74 years (range 70-87 years). Seventeen patients had at least 3 medical comorbidities at surgery. Twenty-three patients underwent a 1-level, 14 a 2-level, and 18 patients a 3-level or greater stand-alone lateral fusion. The median estimated blood loss was 25 ml (range 5-280 ml). No statistically significant relationship was detected between volume of blood loss and the number of operative levels. The median length of hospital stay was 2 days (range 1-4 days). No statistically significant relationship was observed between the length of hospital stay and age at the time of surgery. There was one intraoperative death secondary to cardiac arrest, with a mortality rate of 1.8%. One patient developed a transient femoral nerve injury. Five patients with symptomatic graft subsidence subsequently underwent posterior instrumentation. A lower femoral neck t-score < -1.0 correlated with a higher incidence of graft subsidence (p = 0.006). The mean ODI score 1 year postoperatively of 31.1 was significantly (p = 0.003) less than the mean preoperative ODI score of 46.2.CONCLUSIONSStand-alone LLIF can be safely and effectively performed in the elderly population. Careful evaluation of preoperative bone density parameters should be employed to minimize risk of subsidence and need for additional surgery. Despite an association with increased comorbidities, age alone should not be a deterrent when considering stand-alone LLIF in the elderly population.

Outcomes of percutaneous endoscopic trans-articular discectomy for huge central or paracentral lumbar disc herniation.

This study reports a new technique known as percutaneous endoscopic trans-articular discectomy (PETAD) for huge central/paracentral lumbar disc herniation (LDH). Sixteen patients with huge central/paracentral LDH who underwent PETAD in our department from July 2015 to July 2016 were retrospectively analyzed. Clinical outcomes were evaluated according to pre-operative and post-operative visual analog scale (VAS) and Oswestry disability index (ODI) scores and the MacNab criteria. Immediate post-operative MRI and CT were conducted to confirm complete removal of LDH along with follow-up flexion-extension X-ray to observe lumbar stability. The huge central/paracentral LDH was completely removed by PETAD in 16 patients, as confirmed by post-operative MRI and CT. Leg pain was eased after removal of the disc herniations. The satisfactory (excellent/good) results were 93.7%. The mean follow-up duration was 15.6 (range, 3-24) months. The mean pre-operative VAS and ODI scores were 5.72 ± 1.18 (range, 4-9) and 60.1 (range, 51-87), respectively, which decreased to 1.26 ± 0.81 (range, 0-3) and 18.1 (range, 10-31), respectively at the third month post-operatively and to 0.78 ± 0.62 (range, 0-1) and 7.2 (range, 0-15), respectively by the last follow-up visit. No recurrence and segmental instability was observed in any of the 16 patients during the follow-up period. PETAD could be a good alternative for treatment of huge central/paracentral LDH.

Quality of Life and Disability in Patients Candidate for Lumbar Spinal Fusion Surgery

Background: As life expectancy in the society increases, the rate of degenerative diseases of the spine surge dramatically. Therefore, the number of patients undergoing spinal fusion surgery rises; however, the effectiveness of this operation is still controversial.Objectives: The aim of this study was to investigate disability and quality of life in patients undergoing spinal fusion and compare the results with a matched general population sample.Methods: In this prospective study, which was conducted during 2015 - 2016 in Iran, data were collected from 100 patients undergoing spinal fusion surgery at Baqiyatallah and Shariati Hospitals. We also recruited 100 people from the general population in the hospital matched with the patients with regard to sex, age, and smoking status. The participants filled out the 36-item short form (SF-36) and Oswestry disability index (ODI) questionnaires. The collected data on the quality of life and disability of patients, before and three and six months after the surgery were compared.Results: The patient and general population groups were matched in terms of sex, age, educational level, body mass index (BMI), employment status, and smoking status (P > 0.05). Preoperative ODI score in the patients was 54.8 (SD 15.7), and six months after the surgery, it diminished to 24.8 (SD 9.25). ODI score in the general population sample was 17.5 (SD 8.3). Although disability improved significantly six months after surgery, it did not reach the level of the general population sample (P 0.05). They did not reach the general population sample in other subscales of SF-36 (P < 0.05).Conclusions: Despite the significant improvement in disability and all subscales of quality of life in the patients, they did not reach the general population sample in disability index, physical function, general health, physical role, social function, and pain subscales of the SF-36. However, they reached general population sample level in emotional, mental health, and vitality subscales of the SF-36.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: achieving lumbar interbody fusion: 194. The Effect of preoperative symptom duration on postoperative outcomes following transforaminal lumbar interbody fusion

BACKGROUND CONTEXT Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is commonly used in the treatment of lumbar degenerative disease. However, there exists a paucity of knowledge regarding the influence of preoperative symptom duration on patient reported outcomes (PROs) following lumbar fusion PURPOSE To examine whether the time spanning from symptom onset to surgical intervention has an effect on postoperative clinical improvement in patients undergoing MIS TLIF. STUDY DESIGN/SETTING Retrospective analysis of a prospectively managed surgical database. PATIENT SAMPLE A total of 195 patients who underwent a MIS TLIF procedure from 2013 to 2016. OUTCOME MEASURES Improvements in Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back pain, VAS leg pain, and inpatient narcotic consumption, as calculated Oral Morphine Equivalents (OMEs). METHODS A prospectively maintained surgical registry was reviewed. Patients who underwent a MIS TLIF procedure for degenerative pathology from 2013 to 2016 were identified. Patients were grouped based on preoperative symptom duration (≤6 months, >6 months). Pain was measured using the VAS, and narcotic consumption was measured using OMEs. Demographics and perioperative outcomes were compared using chi-squared analyses for categorical data and independent Student t-tests for continuous variables. PROs including ODI, VAS back and VAS leg scores were collected at preoperative and postoperative visits (6-weeks, 12-weeks and 6 months). The percentage of patients achieving minimal clinically important difference (MCID) following surgery was compared between groups. RESULTS A total of 195 patients following MIS TLIF were included in this analysis. 80% (N=156) had a symptom duration >6 months and the remaining 20% (N=39) had a symptom duration ≤6 months. No differences in demographics and comorbidity burden were identified between groups. Operative characteristics including operative time, estimated blood loss, inpatient pain, narcotic consumption and length of stay were also similar between symptom duration groups. When comparing PROs, patients with shorter symptom duration had significantly higher ODI scores preoperatively and had greater improvements in ODI scores at 6 weeks, 12 weeks, and 6 months (p CONCLUSIONS Patients undergoing MIS TLIF with shorter symptom duration exhibited significantly higher preoperative ODI scores. However, these patients demonstrated greater clinical improvement postoperatively. These findings suggest delayed surgical intervention may lead to impaired functional recovery in patients with degenerative lumbar disease. As such, further studies evaluating differences in outcomes between early and delayed surgical intervention are required to gain better understanding of the efficacy of nonoperative management of lumbar degenerative disease.

Interlaminar Percutaneous Endoscopic Lumbar Discectomy: Rotate and Retract Technique

Interlaminar percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique to treat soft disc herniation. However, the currently used single working channel does not allow for safe nerve root retraction. This study aims to describe the rotate and retract technique for safe nerve root retraction during L5-S1 interlaminar PELD. A total of 17 patients who underwent interlaminar PELD with the rotate and retract technique between November 2016 and August 2017 were retrospectively evaluated. Both pre- and postoperative visual analog scale (VAS) scores (back and leg) and Oswestry Disability Index (ODI) scores were used for clinical assessment. The mean preoperative VAS scores for back and leg pain were 3.84 ± 1.15 (range, 2-6) and 8.7 ± 0.2 (range, 8-10), respectively. The mean preoperative ODI score was 64.2 ± 13.2 (range, 48-90). The mean VAS scores for back and leg pain decreased to 1.24 ± 1.34 (range, 0-6) and 1.15 ± 0.65 (range, 0-4), respectively, at the last follow-up (P < 0.001). The mean ODI score also improved to 13.2 ± 5.1 (range, 9-29) at the last follow-up (P < 0.001). The rotate and retract technique for interlaminar PELD is an effective maneuver for the treatment of L5-S1 disc herniations in selected patients if performed by experienced surgeons.

Clinical and Radiological Outcomes of Modified Mini-Open and Open Transforaminal Lumbar Interbody Fusion: A Comparative Study.

Study DesignRetrospective cohort study.PurposeTo compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (modMOTLIF) and open TLIF (OTLIF).Overview of LiteratureMinimally invasive transforaminal lumbar interbody fusion (MTLIF) is associated with less blood loss, shorter hospital stay, and less pain. However, it has concerns like increased radiation exposure, steep learning curve, and instrumentation cost. We modified the MTLIF technique by direct freehand insertion of pedicle screws using stab incisions without tubular retractors.MethodsThe study included 24 patients in the modMOTLIF group and 27 patients in the OTLIF group. The average follow-up period was 25.6 months. Clinical outcomes were measured using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. Serial X-rays were acquired at 1, 3, 6, 12, and 24 months to assess the union and presence of instability. We also compared blood loss and length of hospital stay in both groups.ResultsAll patients showed progressive improvement in VAS and ODI scores. No differences were observed in the preoperative and postoperative ODI and VAS leg scores between the groups. The immediate postoperative VAS back score was significantly higher in the OTLIF group than in the modMOTLIF group; however, no difference was observed at 1 and 2 years. Radiological analysis showed nonunion in one and two patients in the OTLIF and modMOTLIF groups, respectively. The average blood loss was 63 mL in the mod-MOTLIF group and 254 mL in the OTLIF group. The mean hospital stay was 3 days for the modMOTLIF group and 5 days for the OTLIF group.ConclusionsmodMOTLIF was associated with reduced blood loss and shorter hospital stay compared with OTLIF. No significant differences were observed in the clinical and radiological outcomes between the groups after 2 years despite reduced back pain in the immediate postoperative period in patients who underwent modMOTLIF.

Long term results of Endoscopic Lumbar Discectomy using Side viewing Conical working tube

Abstract Object: Endoscopic discectomy is a common procure performed worldwide with various devices being used and studies have reported their long term results. In this study we present the long term results of the unique device with separate side viewing channel. Methods: 66 patients of lumbar disc herniation treated between March 2009 to April 2012 using the unique conical working tube with separate side viewing endoscopic channel. Their preoperative and postoperative Oswestry Disability Index (ODI) and Macnab scores were used to evaluate the outcome after a minimum follow of 5 years with mean follow up of 76.18 months. Results: There were 46 males and 20 females with age ranging from19-72 (mean-38.4 years). The follow up ranged from 61 months to 95 months with mean of 76.18 months. The mean preoperative ODI score was 74.7 which decreased to a mean of 7.8 and the outcome evaluated by Macnab criteria was 69.69% excellent, 17 % good, 10% fair, 3.03% poor. 2 patients underwent second surgery. None of the patient had to change their occupation due to their lumbar disc disease. Complications occurred were dural tear in 2 patients, transient foot paresis in 1 patient and 1 discitis in 1 patient which improved on medical management. Conclusion: Endoscopic discectomy using thins Conical working tube is a safe and effective technique for lumbar disc prolapse. It has the advantage for early mobilization, short hospital stay and low cost. The long term results are comparable to the conventional techniques.

Ostéosynthèse par vis pédiculaires expansives dans les déformations rachidiennes dégénératives associées à une ostéoporose : étude clinique à deux ans de recul

BackgroundOsteoporotic bone offers poor purchase for the instrumentation in patients with degenerative spinal deformity (DSD), which could lead to several complications. Recently, augmentation methods to improve pedicle screw fixation have been proposed. This retrospective study was to investigate the clinical and radiographic outcomes of expandable pedicle screws (EPS) in patients with osteoporotic DSD. HypothesisExpandable pedicle screws (EPS) provide excellent instrument fixation in patients with osteoporotic DSD, improving radiographic and clinical outcomes. Materials and methodsA total of 27 (6 males and 21 females) DSD patients who underwent orthopedics operation with EPS were retrospectively studied. Full-length standing spinal radiographs were obtained in all patients pre- and postoperatively and again at the two-year follow-up. The functional evaluations before operation and at two-year follow-up were graded with Scoliosis Research Society outcomes instrument-22 (SRS-22) and Oswestry Disability Index (ODI) scoring system. ResultsAll patients obtained good corrective outcomes on spinal deformity. The preoperative ODI score was 36.7 % and reduced to 11.9 % at two-year follow-up (P=0.0000). Before operation, the SRS-22 function, pain, appearance and mental scores were 2.7±0.4, 3±0.6, 2.7±0.5 and 2.9±0.6, respectively. The scores at two-year follow-up were significantly improved to 3.8±0.7, 4.2±0.6, 4.3±0.6 and 4.4±0.7, respectively (P=0.0000). The SRS-22 satisfaction score was 4.6±0.4 at two-year follow-up. No instances of screw breakage, loosening or pullout in any patient at follow-up. DiscussionEPS provides excellent instrument fixation in patients with osteoporotic DSD, improving radiographic and clinical outcomes at two-years’ follow-up. Type of studyRetrospective case series study. Level of evidenceIV.

Transforaminal Endoscopic Decompression for Lumbar Spinal Stenosis: A Novel Surgical Technique and Clinical Outcomes.

Transforaminal endoscopic treatment has been reported to be an effective treatment option in patients with lumbar disc herniation. However, it is rarely performed for spinal stenosis because of the limitation of endoscopic working mobility caused by the exiting nerve root and foraminous bony structure. The objective of this study was to describe a novel transforaminal endoscopic decompression technique for spinal stenosis and report the clinical results. From October 2015 to October 2016, 30 consecutive cases were diagnosed as lateral recess stenosis in our institution and underwent transforaminal endoscopic decompression. Visual analog scale (VAS) of back and leg pain and the Oswestry Disability Index (ODI) were measured preoperatively and at follow-up. The mean ± SD value of preoperative VAS leg pain score was 7.6 ± 1.17. The score improved to 2.2 ± 1.11 at 1 week postoperatively, 1.73 ± 0.96 at 4 weeks postoperatively, and 1.63 ± 0.95 at 26 weeks postoperatively (P < 0.01). The mean ± SD value of the preoperative ODI score was 65.69 ± 14.22. The score improved to 24.29 ± 11.89 at 1 week postoperatively, 21.25 ± 9.25 at 4 weeks postoperatively, and 15.62 ± 10.49 at 26 weeks postoperatively (P < 0.01). There were no patients with postoperative infection, dural tear, delayed neurologic deterioration, or conversion to open surgery. Transforaminal endoscopic decompression under local anesthesia could be an effective treatment method for the selected group of patients with spinal stenosis.

Impact of Depression on Patient-Reported Outcome Measures After Lumbar Spine Decompression.

A retrospective cohort study. The aim of this study was to investigate the effect depression has on the improvement of patient-reported outcome measures (PROMs) following lumbar decompression. Decompression without fusion is a viable treatment option for lumbar spine stenosis. Depression reportedly has a negative impact on PROMs after certain types of spine surgery, though verification of this with new, more precise outcome measures is needed. We included consecutive adult patients who underwent lumbar decompression for lumbar spine stenosis between 2016 and 2017 who had PROM information system (PROMIS) physical function, pain, depression, and Oswestry Disability Index (ODI) questionnaires completed preoperatively and at 6-month follow-up. Patients with a PROMIS depression score >50 or <50 were allocated to the depressed and not depressed groups, respectively. The cohorts were compared using unpaired t tests and repeated-measures two-way analysis of variance (ANOVA) with statistical significance taken at P < 0.05. The analysis included 55 patients without depression and 56 patients with depression. Depressed patients had worse preoperative PROMIS physical function (30.08 vs. 36.66, P = 0.005), PROMIS pain (69.36 vs. 64.69, P < 0.0001), and ODI scores (51.92 vs. 36.35, P < 0.0001). Similarly, the depressed group had worse postoperative PROMIS physical function (36.29 vs. 40.34, P = 0.005), PROMIS pain (60.16 vs. 54.87, P < 0.0001), and ODI scores (37.01 vs. 23.44, P = 0.0003). We observed a statistically significant interaction between depression status and pre to postoperative improvement in outcome for PROMIS physical function (F[1,109] = 102.5, P < 0.0001) and depression scores (F[1,109] = 15.38, P = 0.0002). No interaction was found for pain and ODI scores. Our results suggest that depressed patients experience a greater magnitude of improvement in PROMIS physical function and depression scores than nondepressed patients. Despite this, depressed patients have worse postoperative outcomes for PROMIS physical function, depression, pain, and ODI. These findings are important for risk stratifying and treating depressed patients before lumbar spine decompression. 3.