Preoperative Visual Analog Scale Score Research Articles

A prospective study of vertebroplasty with reverse designed unilateral targeted puncture for osteoporotic thoracolumbar compression fractures

To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups ( n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups ( P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group ( P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased ( P<0.05). And there was no significant difference in VAS score between the two groups at each time point ( P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups ( P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation ( P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation ( P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation ( P>0.05). Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.

Osteochondral lesions of the talus (OLT) are common following ankle trauma. Operative treatment is often required, with osteochondral autografting frequently performed for large or cystic lesions, or following failed primary surgery. The aim of this systematic review was to evaluate the current evidence for osteochondral autograft transfer system (OATS) in the management of OLT. A systematic search of the PubMed, EMBASE, Scopus, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Study quality was assessed using the modified Coleman Methodology Score (CMS). Meta-analysis was carried out using RevMan, version 5.4 (The Cochrane Collaboration, 2020). A total of 23 studies were included. The mean modified CMS was 48.1±7.47. Fourteen studies reported preoperative and postoperative Visual Analog Scale (VAS) and American Orthopaedic Foot & Ankle Score (AOFAS). The aggregate mean preoperative and postoperative VAS scoreacross 14 studies was 6.47±1.35 and 1.98±1.18, respectively. Meta-analysis of seven studies on 210 patients found that OATS resulted in a significant reduction in VAS score compared to baseline (Mean Difference {MD} -4.22, 95% Confidence Interval {CI} -4.54 to -3.90, P < 0.0001). The aggregate mean preoperative and postoperative AOFAS scores across 14 studies were 56.41±8.52 and 87.14±4.8, respectively. Based on eight studies on 224 patients, OATS resulted in a significant improvement in AOFAS score compared to baseline (MD 29.70, 95% CI 25.68 to 33.73, P = < 0.0001). Donor site pain occurred in 9% of cases. Current evidence from low-quality studies suggests that OATS is a safe and effective treatment option for OLT, though it is associated with a risk of donor site morbidity.

The analgesic efficacy of ultrasound-guided thoracic paravertebral block in pulmonary tumor ablation surgery: a prospective single-arm study.

Local thermal ablation is a rapidly developing minimally invasive treatment for lung tumors. This technique has the advantages of less trauma, ease and convenience of the operation, fast recovery, and fewer complications. Thoracic paravertebral block (TPVB) has been demonstrated can provide sufficient pain relief with high safety. This study aimed to evaluate the efficacy of TPVB for anesthesia management during the ablation surgery of lung tumors. In our study, a total of 30 patients undergoing Local thermal ablation surgery were enrolled. All patients received TPVB anesthesia before CT positioning starting. Analgesics and rescue drugs were used according to the patient's condition during operation. The main observation and assessment outcome were intraoperative and postoperative Visual Analog Scale (VAS) score. Other outcomes were total dose of analgesics and rescue drugs, incidences of adverse events, and the patients' and surgeons' satisfaction degrees. All patients successfully received ablation surgery under TPVB anesthesia. None of the patients were switched to general anesthesia. There were no statistically differences were found between the preoperative VAS score (0.54±1.12) and the intraoperative VAS score (0.58±1.15) (P>0.05). No adverse events occurred and no rescue drugs were used during operation. The satisfaction scale of both patients and surgeons was 3 points or above, and all patients were discharged from the hospital. TPVB is an effective and safe anesthesia management technique which can provided adequate pain relief in local thermal ablation therapy for lung tumors. This discovery could provide a better anesthesia protocol for anesthetists in lung tumors ablation surgery, especially when patients have a poor cardiopulmonary function and combined with serious underlying diseases.

Sinuvertebral nerve block treats discogenic low back pain: a retrospective cohort study.

Discogenic low back pain (DLBP) is considered the most common type of chronic low back pain (CLBP). Sinuvertebral nerve block (SVNB) is a rapid and precise intervention performed under local anesthesia to treat DLBP induced CLBP. Thus, in this study, we aimed to explore the clinical efficacy of SVNB for DLBP. We retrospectively included 32 DLBP patients from July 2020 and April 2021. Inclusion criteria: The patients had chronic pain, diagnosed as single-segment disc degeneration induced DLBP, and suffered from one-year ineffective conservative treatment. SVNB was performed and the patients were followed up at 3 and 7 days, and at 1 and 3 months after SVNB. The basic clinical characteristics, including age and gender, were collected. The measurements of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were assessed. The average age was 49.31±14.37 years, and females vs. males was 20 (62.50%) vs. 12 (37.50%). The preoperative VAS and ODI score were 5.75±1.41 and 32.59±21.56, respectively. The VAS score was reduced to 2.50±1.46, 2.63±1.60, 3.53±2.17, and 3.78±2.18 at 3 and 7 days, and 1 and 3 months after SVNB, respectively (P<0.05). The improvement rates in the VAS score were 56.52%, 54.34%, 38.61%, and 34.26% at 3 and 7 days, and 1 and 3 months after SVNB, respectively. 18 patients (56.25%) experienced varying degrees of pain recurrence within 3 months. The ODI score was reduced by 17.28±13.06, 16.84±13.51, 19.63±17.12, and 21.44±19.03 points at 3, 7 days and 1, 3 months after SVNB, respectively (P<0.05). At 3 day and 3 month after SVNB, the ODI scores of 22 patients (68.75%) and 20 patients (62.50%) decreased to ≤20, respectively. The ODI improvement rates were 46.98%, 48.33%, 39.80%, and 34.24% at 3, 7 days and 1, 3 months after SVNB, respectively. We conducted a retrospective study of the clinical efficacy of SVNB for DLBP. As a rapid and cost-effective minimally invasive treatment, SVNB provided some assistance for the short-term pain relief and physical functional improvement of DLBP. SVNB could be a good choice for the treatment of DLBP.

Contralateral inclinatory approach for decompression of the lateral recess and same-level foraminal lesions using unilateral biportal endoscopy: A technical report.

Unilateral biportal endoscopic (UBE)surgery is being increasingly adopted as a minimally invasive technique. The purpose of the current study was to introduce a novel surgical technique for lateral recess and same-level foraminal decompression by the contralateral inclinatory approach with unilateral biportal endoscopy(CIA-UBE) at the lumbar level. Between January 2020 and February 2022, 10 patients suffering from lateral recess and same-level foraminal stenosis at the lumbar level underwent UBE surgery by contralateral inclinatory approach (CIA-UBE). Magnetic resonance imaging (MRI) scans were examined after surgery to measure the cross-sectional area (CSA) of the spinal canal (CSA-SC), the CSA of the intervertebral foramen (CSA-IVF), and the CSA of the facet joint (CSA-FJ). Postoperative radiologic images using computed tomography (CT) were obtained to investigate the existence of facet joint violation. Clinical outcomes were assessed using Oswestry Disability Index (ODI) scores and visual analogue scale (VAS) scores for buttock and radicular pain. Ten levels were decompressed, and the mean age of the patients was 56.92 ± 13.26 years. The mean follow-up period was 7.60 ± 4.47 months. The average operative time was 85.14 ± 25.65 min. Postoperative CT and MRI revealed ideal neural decompression of the treated segments in all patients. CSA-IVF and CSA-FJ improved significantly, indicating good foraminal and lateral recess decompression with less damage to facet joints. Preoperative VAS and ODI scores improved significantly after surgery. CIA-UBE may be an effective surgical treatment of the lateral recess and same-level foraminal stenosis at the lumbar level, which provides successful surgical decompression for traversing and exiting nerve roots with a better operative view and easier surgical manipulation. This approach may also help to maximize the preservation of the facet joint.

Efficacy and safety of sympathetic radiofrequency thermocoagulation in the treatment of cold hypersensitivity.

Cold hypersensitivity (CH) is a sensation of cold in the limbs and (or) body of a patient in an environment that is not considered cold by unaffected people, or a strong feeling of cold at a relatively low temperature. However, the currently available treatments are limited and often unsatisfactory. This study aimed to evaluate the clinical efficacy and safety of the sympathetic radiofrequency thermocoagulation (RF-TC) technique in patients with CH disorder. The study is a retrospective analysis. A total of 71 were entered into the final analysis and all patients underwent computed tomography-guided thoracic (lumbar) sympathetic nerve RF-TC on an elective basis. The values of terminal temperature (T) and perfusion index (PI) of patients before and after treatment were recorded. Patients were followed up clinically at regular intervals and their Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) scores were recorded to detect postoperative complications and assess patient satisfaction with the treatment. All patients completed the radiofrequency treatment. Compared with the preoperative period, VAS and PSQI scores were significantly lower at all postoperative time periods (P < 0.001). Patients had significantly higher postoperative terminal temperatures and perfusion indices on the right and left sides than before surgery (P < 0.001). The overall patient satisfaction score was 4 (3-5) at 3 years of postoperative follow-up. There were 20 recurrences (28.2%). The main postoperative complications were postoperative local pain and compensatory hyperhidrosis. No other adverse events or deaths were observed. RF-TC for CH could be a feasible, effective, and safe treatment option to improve patients' symptoms of cold sensation. Yet, more researches are needed to verify this potentially efficient and standardized treatment.

Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results.

Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation. This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications. Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m2 (mean BMI of 27.5 kg/m2 ). The preoperative claudication distance was 160.00 ± 68.96 m (range 70-250 m), which was significantly extended on the 3-month and 1-year follow-up (1020.00 ± 407.70 m and 1040.00 ± 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 ± 0.97 (range 4-7) and 6.40 ± 0.97 (range 5-8). The score on postoperative month 3 was 1.60 ± 0.52 (range 1-2) and 1.20 ± 0.79 (range 0-2), and the 1-year follow-up score was 1.90 ± 0.74 (range 1-3) and 1.60 ± 0.70 (range 1-3), respectively. The preoperative ODI was 72.23 ± 6.30 (range 64.4-82.2), the 3-month follow-up ODI was 31.12 ± 4.20 (range 24.4-35.6), and the 1-year follow-up ODI was 29.33 ± 5.92 (range 20.0-37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 ± 32.5min vs. 214.9 ± 60.0 min) but the amount of blood loss decreased significantly (113.3 ± 26.7ml vs. 366.8 ± 298.2ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1-year follow-up. OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice.

Comparative analysis of unilateral biportal endoscopic discectomy, percutaneous endoscopic lumbar discectomy, and fenestration discectomy in treatment of lumbar disc herniation

To investigate the effectiveness of unilateral biportal endoscopic discectomy (UBED), percutaneous endoscopic lumbar discectomy (PELD), and traditional fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed. They were divided into FD group (160 cases), PELD group (86 cases), and UBED group (101 cases) according to operation methods. There was no significant difference in gender, age, surgical level distribution, disease duration, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between groups ( P>0.05). The operation time, hospitalization stay, treatment cost, and incidence of surgery-related complications were recorded and compared between groups. The patients' pain and functional recovery were evaluated by VAS score and ODI before and after operation. The operation time of FD group was significantly shorter than that of PELD group and UBED group, and the hospitalization stay was significantly longer than that of PELD group and UBED group ( P<0.05); there was no significant difference between PELD group and UBED group ( P>0.05). The treatment cost in UBED group was significantly higher than that in PELD group, and in PELD group than in FD group ( P<0.05). All the patients were followed up 6-24 months, with an average of 14.6 months. VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation ( P<0.05). At 1 day after operation, VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group ( P<0.05), but there was no significant difference between PELD group and FD group ( P>0.05). There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation ( P>0.05). The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group ( P<0.05), and there was no significant difference between FD group and UBED group ( P>0.05). Incidence of surgery-related complications in FD group (20.0%) was significantly higher than that in PELD group (12.8%) and UBED group (6.9%), and PELD group was significantly higher than UBED group ( P<0.05). All the incision infection occurred in FD group (12 cases), symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group. UBED, PELD, and FD have similar effectiveness on lower extremity pain in early LDH. Compared with FD, UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.

Comparison of effectiveness of unilateral biportal endoscopy technique and the interlaminar uniportal endoscop technique for treatment of L 5, S 1 lumbar disc herniation

To compare the effectiveness of unilateral biportal endoscopy (UBE) technique with the interlaminar uniportal endoscopy (IUE) technique for the treatment of L 5, S 1 lumbar disc herniation. The clinical data of 69 patients with L 5, S 1 lumbar disc herniation who met the selection criteria between January 2020 and December 2020 were retrospectively analysed. The patients were divided into UBE group (30 cases) and IUE group (39 cases) according to endoscopic surgical technique. The general data, such as gender, age, body mass index, disease duration, and preoperative visual analogue scale (VAS) scores of low back/leg pain and Oswestry disability index (ODI), was not significantly different between the two groups ( P>0.05). Perioperative outcomes [estimated blood loss (EBL), total operation time, extracanal operation time, intracanal decompression time, intraoperative radiation exposure dose, incision length, operative related complications, and postoperative hospitalization stay] and clinical outcomes (VAS score of low back/leg pain before operation and at 3 days, 3 months, 6 months, and 12 months after operation as well as the ODI before operation and at 3 months, 6 months, and 12 months after operation) were recorded and compared between the two groups. All patients completed the surgery successfully. The incision length, EBL, and extracanal operation time in UBE group were significantly longer than those in IUE group ( P<0.05), and the intracanal decompression time in UBE group was significantly shorter than that in IUE group ( P<0.05). There was no significant difference in the total operation time, intraoperative radiation exposure dose, and postoperative hospitalization stay between the two groups ( P>0.05). Patients in both groups were followed up 12-15 months (mean, 13.3 months). Dural tear ocurred in 1 patient of the UBE group, and recurrence ocurred in 1 patient of the IUE group, the others of both groups had no surgery-related complications and recovered well after operation. The VAS scores of low back/leg pain and ODI in both groups at each time point after operation significantly improved when compared with those before operation ( P<0.05); there was no significant difference in VAS scores and ODI at each time point after operation between two groups ( P>0.05). The effectiveness of UBE technique in the treatment of L 5, S 1 lumbar disc herniation is similar to that of IUE technique, and the efficiency of intraspinal operation is better than that of IUE technique. Although UBE technique is inferior to IUE technique in terms of surgical trauma, there is no significant difference in postoperative recovery between the two techniques.

Clinical Outcomes of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: an Analysis of Injury Location, Age, and Body Mass Index

Category: Sports; Other Introduction/Purpose: Extracorporeal Shock Wave Therapy (ESWT) is one of the major advances in orthopedics over the last 20 years as a method for orthopedic surgeons to conservatively treat tendon pathologies such as Achilles tendinopathy (AT). Unfortunately, previous studies involve only a small number of cases, relatively short duration of symptoms, and simple measures of pain. The purpose of this study is to evaluate the impact of age, body mass index (BMI), and location of AT (Insertional (IAT) or Non-Insertional (nIAT)) on clinical outcomes and return to sport (RTS) time after ESWT. Methods: This is a retrospective cohort study that included existing clinical data from 40 patients from a single academic institution. Patients greater than 18 years of age who underwent ESWT for Achilles tendinopathy in the office setting between 8/1/2019 to 8/30/2021 were included. Clinical outcomes of patients were evaluated through the self-reported Visual Analogue Scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores for assessing pain and functional outcomes of Achilles Tendinopathy. Descriptive statistics were used to provide an overview of the patient characteristics, including sex, age, laterality of injury, BMI, duration of symptoms, RTS time, and follow-up. For these data, mean and standard deviation were calculated, and paired samples T-tests and Welch's T-tests were performed on clinical outcome scores. Results: This study included 48 patients (62 heels), with an average age of 50.8+-14.2 years, BMI of 27.3+-5.3, follow-up of 6.41+- 6.9 months, and RTP time of 5.39+-5.3 weeks. Patients with a BMI &lt;25.0 had significantly higher post-operative VISA-A scores (p=0.007) compared to those with a BMI &gt;25.0, and post-operative VAS scores displayed this trend without significance (p=0.07). Patients &lt;=50 years old had significantly higher post-operative VISA-A scores (p=0.02) compared to those &gt;50 years old, and post-operative VAS scores displayed this trend without significance (p=0.1). Pre- and post-operative VISA-A scores, and post- operative VAS scores, were not significantly different between IAT and nIAT cohorts, except for pre-operative VAS scores where nIAT was higher (p=0.03). Additionally, we found significant improvements in pre-operative to post-operative scores for VAS scores for IAT and nIAT cohorts (p&lt;0.0001), as well for VISA-A for the IAT cohort (p=0.008), but no significant improvement in VISA for the nIAT cohort (p=0.119). Conclusion: Increased BMI and age are determinant factors that significantly adversely affect functional scores (VISA-A) in patients with AT treated with ESWT, but no significant differences were found for these risk factors in terms of pain improvement (VAS). Additionally, we found that the nIAT cohort had significantly higher pre-operative pain than IAT, and no significant improvement in VISA-A scores (though there was a trend of functional improvement). This aligns with the fact that the mid- substance of the Achilles tendon is a watershed area with relatively low vascularity compared to the insertional portion, where lower perfusion weakens the healing benefits of ESWT.

Comparison of Femoral Nerve Block with Dexmedetomidine and Adductor Canal Block with Dexmedetomidine for Postoperative Analgesia for Total Knee Arthroplasty

Background : Analgesia post knee arthroplasties are crucial in early postoperative recovery and discharge . The objective of this study was to compare the analgesic efficacy of Adductor canal block with that of femoral nerve block in patients undergoing knee arthroplasties. Methods : 140 participants aged 18 years &amp; above under American Society of Anaesthesiologists 1 and 2 physical status undergoing knee arthroplasty under spinal anaesthesia were included and were divided into 2 groups – Adductor canal block and femoral nerve block who were administered blocks under ultrasound guidance. The preoperative Visual Analog Scale score, haemodynamic variables and postoperative Visual Analog Scale scores were recorded. Results : The Visual Analog Scale scores between the two groups were not statistically significant however, a significant difference in the time taken by the Adductor canal block participants to request analgesia and to ambulate. Conclusion: Adductor canal block with Dexmedetomidine was equally efficacious when compared to Femoral nerve block with Dexmedetomidine in patients undergoing Total knee arthroplasty.

Study on the Relationship between the Use of Bisphosphonates for Antiosteoporosis and Vertebral Re-Fracture after Vertebroplasty.

Objective To explore the effect of bisphosphonates after vertebroplasty in patients with osteoporotic vertebral compression fractures (OVCF), and to analyze the relationship between the use of bisphosphonates and vertebral refracture. Methods A total of 150 patients with OVCF were selected from the pain department of our hospital from January 2018 to May 2020. All patients received vertebroplasty after admission, and were divided into the surgery group (62 cases) and combined with the bisphosphonates group (combined group, 88 cases) according to whether patients had used bisphosphonates after surgery. Before surgery, 1 month, 3 months, 6 months, and 1 year after surgery, visual analogue scale (VAS), Oswestry disability index (ODI), vertebral body and femoral neck bone mineral density (BMD), and Cobb Angle were collected, and the differences among groups were compared to analyze the treatment effect. After the follow-up, patients were divided into two groups according to whether vertebral refracture occurred during the follow-up period. Clinical characteristics, general information, and surgical indicators of patients in the two groups were collected, and related factors of postoperative vertebral refracture were analyzed. Results There were no significant differences in preoperative VAS score, ODI index, BMD value, and Cobb angle between the two groups (P > 0.05). At 12 months after surgery, VAS score, ODI index, and Cobb angle decreased, while BMD value increased in both groups. The VAS score, ODI index, and Cobb angle in the combined group were lower than those in the operation group, while the BMD value was higher than that in the operation group, and the difference was significant (P < 0.05). The results of multivariate regression analysis showed that in BMD, no postoperative antiosteoporosis treatment, bone cement leakage, and poor cement diffusion were independent risk factors for vertebral refracture after vertebroplasty in patients with vertebral compression fractures. Conclusion In order to avoid recurrent fractures in OVCF patients, attention should be paid to BMD, whether patients take antiosteoporosis drugs, whether bone cement permeation occurs and the diffusion of bone cement, etc. The above factors are the main influencing factors leading to recurrent fractures after PKP and PVP in the clinic.

Effectiveness of modified orthopedic robot-assisted percutaneous kyphoplasty in treatment of osteoporotic vertebral compression fracture

To evaluate the effectiveness of orthopedic robot with modified tracer fixation (short for modified orthopedic robot) assisted percutaneous kyphoplasty (PKP) in treatment of single-segment osteoporotic vertebral compression fracture (OVCF). The clinical data of 155 patients with single-segment OVCF who were admitted between December 2017 and January 2021 and met the selection criteria was retrospectively analyzed. According to the operation methods, the patients were divided into robot group (87 cases, PKP assisted by modified orthopedic robot) and C-arm group (68 cases, PKP assisted by C-arm X-ray fluoroscopy). There was no significant difference in gender, age, body mass index, T value of bone mineral density, therapeutic segment, grade of vertebral compression fracture, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups (P>0.05). The effectiveness evaluation indexes of the two groups were collected and compared. The clinical evaluation indexes included the establishment time of working channel, dose of intraoperative fluoroscopy, the amount of injected cement, VAS score before and after operation, and the occurrence of complications. The imaging evaluation indexes included the degree of puncture deviation, the degree of bone cement diffusion, the leakage of bone cement, the midline vertebral height and the Cobb angle before and after operation. The establishment time of working channel in robot group was significantly shorter than that in C-arm group, and the dose of intraoperative fluoroscopy was significantly larger than that in C-arm group (P<0.001). There was no significant difference in the amount of injected cement between the two groups (t=1.149, P=0.252). The patients in two groups were followed up 10-14 months (mean, 12 months). Except that the intraoperative VAS score of the robot group was significantly better than that of the C-arm group (P<0.05), there was no significant difference between the two groups at other time points (P>0.05). No severe complication such as infection, spinal cord or nerve injury, and pulmonary embolism occurred in the two groups. Five cases (5.7%) in robot group and 7 cases (10.2%) in C-arm group had adjacent segment fracture, and the difference in incidence of adjacent segment fracture between the two groups was not significant (χ2=1.105, P=0.293). Compared with C-arm group, the deviation of puncture and the diffusion of bone cement at 1 day after operation, the midline vertebral height and Cobb angle at 1 month after operation and last follow-up were significantly better in robot group (P<0.05). Eight cases (9.1%) in the robot group and 16 cases (23.5%) in the C-arm group had cement leakage, and the incidence of cement leakage in the robot group was significantly lower than that in the C-arm group (χ2=5.993, P=0.014). There was no intraspinal leakage in the two groups. Compared with traditional PKP assisted by C-arm X-ray fluoroscopy, modified orthopedic robot-assisted PKP in the treatment of single-segment OVCF can significantly reduce intraoperative pain, shorten the establishment time of working channel, and improve the satisfaction of patients with operation. It has great advantages in reducing the deviation of puncture and improving the diffusion of bone cement.

Comparison of short-term effectiveness of Prodisc-C Vivo artificial disc replacement and Zero-P fusion for treatment of single-segment cervical spondylosis

To compare the short-term effectiveness and the impact on cervical segmental range of motion using Prodisc-C Vivo artificial disc replacement and Zero-P fusion for the treatment of single-segment cervical spondylosis. The clinical data of 56 patients with single-segment cervical spondylosis who met the selection criteria between January 2015 and December 2018 were retrospectively analyzed, and they were divided into study group (27 cases, using Prodisc-C Vivo artificial disc replacement) and control group (29 cases, using Zero-P fusion) according to different surgical methods. There was no significant difference between the two groups in terms of gender, age, type of cervical spondylosis, disease duration, involved segments and preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), surgical segments range of motion, upper and lower adjacent segments range of motion, overall cervical spine range of motion, and cervical curvature (P>0.05). The operation time, intraoperative blood loss, postoperative hospitalization stay, time of returning to work, clinical effectiveness indicators (VAS score, JOA score, NDI, and improvement rate of each score), and imaging indicators (surgical segments range of motion, upper and lower adjacent segments range of motion, overall cervical spine range of motion, and cervical curvature, prosthesis position, bone absorption, heterotopic ossification, etc.) were recorded and compared between the two groups. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05); the postoperative hospitalization stay and time of returning to work in the study group were significantly shorter than those in the control group (P<0.05). Both groups were followed up 12-64 months, with an average of 26 months. There was no complication such as limb or organ damage, implant failure, and severe degeneration of adjacent segments requiring reoperation. The VAS score, JOA score, and NDI of the two groups at each time point after operation significantly improved when compared with those before operation (P<0.05); there was no significant difference in the above scores at each time point after operation between the two groups (P>0.05); there was no significant difference in the improvement rate of each score between the two groups at last follow-up (P>0.05). The surgical segments range of motion in the study group maintained to varying degrees after operation, while it in the control group basically disappeared after operation, showing significant differences between the two groups (P<0.05). At last follow-up, there was no significant difference in the upper and lower adjacent segments range of motion in the study group when compared with preoperative ones (P>0.05), while the upper adjacent segments range of motion in the control group increased significantly (P<0.05). The overall cervical spine range of motion and cervical curvature of the two groups decreased at 3 months after operation, and increased to varying degrees at last follow-up, but there was no significant difference between groups and within groups (P>0.05). At last follow-up, X-ray films and CT examinations showed that no prosthesis loosening, subsidence, or displacement was found in all patients; there were 2 cases (7.4%) of periprosthetic bone resorption and 3 cases (11.1%) of heterotopic ossification which did not affect the surgical segments range of motion. Both the Prodisc-C Vivo artificial disc replacement and Zero-P fusion have satisfactory short-term effectiveness in treatment of single-segment cervical spondylosis. Prodisc-C Vivo artificial disc replacement can also maintain the cervical spine range of motion to a certain extent, while reducing the occurrence of excessive motion of adjacent segments after fusion.

Arthroscopic anterior talofibular ligament repair with Internal Brace and lasso-loop technique for chronic ankle lateral instability.

To introduce the surgical technique and clinical outcomes of arthroscopic anterior talofibular ligament (ATFL) repair using the Internal Brace and lasso-loop technique for chronic ankle lateral instability. A retrospective study was performed on 29 patients who underwent all-arthroscopic ATFL repair with the Internal Brace and lasso-loop technique from January to August 2020. The patients included 24 males and five females, with a mean age of 30.17years. Through the accessory anterolateral (AAL) portal, we drilled the bone tunnels and fixed the tape with 4.75mm and 3.5mm "SwiveLock" anchors and reattached the torn ligament by the lasso-loop technique. All 29 patients underwent all-arthroscopic procedures smoothly without serious complications, such as infection and important nerve or vessel injuries. There were eight cases of lateral malleolar avulsion fractures and ten cases of talus cartilage injury. The visual analog scale (VAS), Karlsson-Peterson, Tegner, and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the clinical consequences. All the patients were followed up for 18.66 ± 4.85months on average. The average pre-operative VAS score was 4.69 ± 1.04, which was significantly higher than the average post-operative VAS score of 1.14 ± 1.56. At the final follow-up appointments, the averages of Karlsson-Peterson, AOFAS, and Tenger scores were 75.83 ± 9.44, 88.31 ± 6.81, and 6.93 ± 1.79, respectively, which was significantly higher than that before the operation. This arthroscopic anterior talofibular ligament repair with the Internal Brace and lasso-loop technique achieves satisfactory clinical outcomes with the benefits of high safety and reliability for chronic ankle lateral instability.

Surgical Outcomes of Full-Endoscopic Lumbar Discectomy in the Early Adoption Phase.

Background We adopted full-endoscopic lumbar discectomy (FELD) in 2019 with the assistance of the Japanese Society for Minimally Invasive and Endoscopic Techniques of Spinal Neurosurgery (JASMETS). This study analyzed short-term outcomes in our initial FELD cases and compared them with microdiscectomy cases performed during the same period. Methods FELD was performed in 21 patients over a period of 2 years and 6 months (15 men and 6 women; mean age, 57.0±17.0 years). The transforaminal approach was performed in 8 patients, the posterolateral approach in 3, and the interlaminar approach in 10. During the same period, microdiscectomy was performed in 30 patients. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores, operation time, blood loss volume, complications, and incidence of lumbar disc herniation recurrence were compared between the groups. Results Preoperative VAS and JOA scores did not significantly differ between the FELD and microdiscectomy groups. JOA and VAS scores significantly improved in both groups after surgery. Operation time and incidence of recurrence rate did not differ. Conclusion Spine surgeons who adopt FELD can achieve good surgical outcomes similar to those of microdiscectomy, even in the early period. Participation in JASMETS seminars and training and proctoring by a certified endoscopic spine surgeon were instrumental in our experience.

Risk Factors Involved in the Early and Medium-Term Poor Outcomes of Percutaneous Endoscopic Transforaminal Discectomy: A Single-Center Experience.

ObjectiveTo investigate the risk factors involved in the early and medium-term poor outcomes of percutaneous endoscopic transforaminal discectomy (PETD) treatment of lumbar disc herniation (LDH) at the L4-5 level.MethodsBetween January 2015 and May 2020, we recruited 148 LDH patients at the L4-5 level who underwent PETD surgery. The patients were divided into Groups A and B, according to the surgical outcomes. Good and excellent outcomes were categorized into Group A, and generally good and poor outcomes were categorized into Group B. Clinical parameters (age, gender, symptom duration, hospital stay, operation time, blood loss, straight-leg raising (SLR), visual analog scale (VAS), Oswestry Disability Index (ODI) score and modified MacNab criteria) and radiologic parameters (foraminal height (FH), intervertebral height index (IHI), intervertebral angle (IVA), sagittal range of motion (sROM), and lumbar lordosis (LL)) were collected and analyzed using univariate and multiple logistic regression analyses.ResultsAt the 6-month follow-up post operation, univariate analysis revealed that the symptom duration, SLR, IHI, and sROM were strongly associated with poor outcomes. However, multiple logistic regression analysis demonstrated that prolonged symptom duration, large SLR angel, and large sROM were independent risk factors for poor outcomes. At the 2-year follow-up post operation, univariate analysis suggested that advanced age, prolonged symptom duration, large preoperative VAS score, small FH, small IHI, and large sROM were potential risk factors for poor outcomes. However, multiple logistic regression analysis demonstrated that prolonged symptom duration, small IHI, and large sROM were independent risk factors for poor outcomes.ConclusionOur study demonstrated that prolonged symptom duration, large SLR angel, and large sROM were independent risk factors for poor outcomes immediately following PETD at the L4-5 level. However, prolonged symptom duration, small IHI, and large sROM were independent risk factors for poor outcomes at medium-term post PETD at the L4-5 level.

AOFAS and Karlsson-Peterson scales in evaluating patients treated with modified Broström-Gould and suture tape augmentation for ankle instability: a performance analysis

Objective: The objective of this study was to evaluate the performance of the American Orthopedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson scales in patients with lateral ankle instability treated with modified Bröstrom-Gould (MBG) plasty and suture tape augmentation. Methods: This retrospective, bicentric, cohort study involved consecutive patients with lateral ankle instability treated with MBG plasty and suture tape augmentation. The Visual Analog Scale (VAS), AOFAS scale, and Karlsson-Peterson scale were used in pre-/postoperative assessments. Results: Fifty-five patients who underwent MBG plasty and suture tape augmentation were included. Mean preoperative and postoperative VAS scores were 7.1 ± 1.4 and 1.3 ± 1.6 (p&lt;0.001), respectively. Mean AOFAS scores were 61.3 ± 21.1 and 95.4 ± 8.4, respectively (p&lt;0.001). Mean Karlsson-Peterson scale scores were 46.8 ± v14.3 and 95.2 ± v7.9 (p&lt;0.001), respectively. Conclusions: The Karlsson-Peterson scale showed a better performance than the AOFAS scale in the clinical and functional evaluation of patients with ankle instability treated with MBG plasty and suture tape augmentation. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

Male Gender and Competitive Athlete Status Are Associated With Better Outcomes Following Hip Arthroscopy In Patients With Global Acetabular Retroversion

PurposeTo evaluate outcomes of hip arthroscopy in patients with global acetabular retroversion and to identify correlations between sex, radiographic measurements, athlete status, and return to play with patient-reported outcomes (PROs).MethodsRetrospective study of patients with global acetabular retroversion who underwent arthroscopic femoroacetabular impingement (FAI) surgery was performed. Global acetabular retroversion was defined by 3 criteria: the crossover sign, ischial spine sign, and posterior wall sign on an anteroposterior (AP) pelvic radiograph. Radiographs were used to measure lateral center edge angle, alpha angle, and anterior and posterior wall indices. Femoral version was measured with 3-dimensional computed tomography. Demographics included age, gender, athlete status, return to play, and reoperation. PROs included modified Harris Hip Score, Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score, visual analog scale (VAS), and Veterans RAND-12. Spearman correlation determined correlation with perioperative PROs. Generalized estimating equation determined independent predictors. Significance was set at P = .05.ResultsFrom 2013 to 2019, 149 patients (65.0% female) with 160 hips with FAI and global acetabular retroversion underwent hip arthroscopy. Follow-up averaged 29.6 months. All PROs demonstrated significant improvement with the exception of the Veterans RAND-12 Mental. Female patients scored significantly lower on most postoperative PROs and had greater VAS scores (P = .0002-0.0402). A greater proportion of male subjects met the minimum clinically important difference for the modified Harris Hip Score (88.00% vs 78.79%) Low femoral version correlated with greater HOS ADL, HOS Sport, and Hip Disability and Osteoarthritis Outcome Score Sport scores (P = .0077-0.0177). Athletes reported lower preoperative VAS scores, and higher perioperative scores in multiple PROs (P = .0004-0.0486). Nine hips (5.63%) underwent reoperation.ConclusionsPatients with global acetabular retroversion and FAI undergoing hip arthroscopy report good outcomes at short-term follow-up. Male subjects and athletes had superior outcomes compared to female subjects and nonathletes. Radiographic measurements did not correlate with outcomes with exception of low femoral version. Athletes reported lower preoperative pain scores and greater postoperative PROs than nonathletes.Level of EvidenceLevel IV, therapeutic case series.

Comparison of the clinical outcomes of chronic rupture, arthroscopic tenotomy and tenodesis of proximal biceps tendon

Biceps tendon disorders are substantial cause of intense shoulder pain, and thus they require a careful medical attention. We compared the clinical outcomes of chronic rupture, tenotomy and tenodesis of proximal biceps tendon of patients underwent arthroscopic shoulder surgery. We included 98 patients over 50 years-old who underwent arthroscopic surgery for rotator cuff tears and grouped as tenotomy, tenodesis and chronic rupture of biceps tendon. Preoperative and postoperative 24-months follow-up Visual Analog Scale (VAS) score and the University of California–Los Angeles (UCLA) Shoulder Scale scores were compared. Chronic biceps rupture was the most common pathology in massive rotator cuff rupture group (75.9%). As tenotomy, tenodesis and chronic rupture groups were compared in terms of VAS and UCLA score improvements (preoperative and postoperative change); tenotomy showed better outcomes and there was a statistically significant difference between tenotomy and tenodesis groups in terms of improvements in VAS and UCLA scores (p = 0.036, p = 0.010, respectively). No statistically significant difference between chronic rupture and tenodesis in terms of VAS and UCLA scores improvements were observed (p = 1.000, p = 0.250, respectively). Also, tenotomy showed superior VAS score improvement than chronic tendon rupture (p=0.024) however no statistically significant difference was observed in UCLA score improvement between tenotomy and chronic rupture (p = 0.527). According to our study, tenotomy seems to be a more appropriate surgical method than tenodesis in massive and full-thickness rotator cuff tears with severe biceps tendon degeneration, and also it is not necessary to perform tenodesis in cases with chronic biceps rupture.