Low Back Pain Scale Research Articles

The limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis with instability

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ± 10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients’ functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients’ functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.

Impact of Sarcopenia on Clinical Outcomes of Minimally Invasive Lumbar Decompression Surgery

The purpose of this study was to clarify the clinical impact of sarcopenia on the outcome of minimally invasive lumbar decompression surgery. The records of 130 patients who were >65 years and underwent minimally invasive lumbar decompression surgery were retrospectively reviewed. We collected the Japanese Orthopaedic Association (JOA) score before surgery and at the final follow-up and measured appendicular muscle mass using bioimpedance analysis, hand-grip strength and gait speed. We diagnosed the patients with sarcopenia, dynapenia and normal stages using the European Working Group on Sarcopenia in Older People definition and used cutoff thresholds according to the algorithm set by the Asian Working Group for Sarcopenia. The average age of patients undergoing surgery was 76.9 years old. The JOA score improved from 12.6 points preoperatively to 24.3 points at final follow up. The prevalence of the sarcopenia, dynapenia and normal stages was 20.0, 31.6 and 43.8%. Clinical outcomes, such as JOA score, JOA score improvement ratio, visual analog scale for low back pain, leg pain and numbness, were not significantly different among each group. Multiple regression analysis showed that preoperative JOA score and low physical performance (low gait speed) were independently associated with poor clinical outcomes. The JOA score improved after minimally invasive lumbar decompression surgery even when the patients were diagnosed as being at different stages of sarcopenia. Low physical performance had the greater clinical impact on the clinical outcome of lumbar surgery than low skeletal muscle index.

Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Surgical Management of Post-Discectomy Syndrome.

Study DesignThis was a prospective case series of 30 patients with post-discectomy syndrome with an average of 18 months of follow-up (level IV).PurposeThe efficacy of post-discectomy syndrome managed by minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) was evaluated.Overview of LiteratureIn post-discectomy syndrome wherein conservative treatment had failed, the best surgical treatment modality still remains controversial.MethodsPatients were functionally assessed using the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain (LP) and Oswestry Disability Index (ODI). Radiological fusion was confirmed with plain X-rays and when indicated with computed tomography scan at 12 months postoperatively. A total of 30 patients with 37 operated at lumbar levels with failed discectomy surgery who met our inclusion criteria were treated with MIS-TLIF.ResultsThe ODI of all patients showed significant improvement from a mean of 73.78% preoperatively to 16.67% at 1 month and 14.13% at 12 months postoperatively. The preoperative LBP VAS score (mean, 4.37) showed a significant decrease (p<0.001) to 1.90 at 1 month and 1.10 at 12 months. Preoperative LP VAS score of limb pain averaged 7.53 and showed a significant (p<0.001) decrease to 3.47 at 1 month and 1.10 at 12 months. All patients attained radiological fusion at 12 months.ConclusionsMIS-TILF constitutes a valid and effective treatment option for patients with post-discectomy syndrome.

Gender Differences in Pre- and Postoperative Health-Related Quality of Life Measures in Patients Who Have Had Decompression Surgery for Lumbar Spinal Stenosis.

Study DesignRetrospective chart audit.PurposeThis study aimed to investigate the gender difference in pre- and postoperative health-related quality of life (HRQOL) in patients who have had decompression surgery for lumbar spinal stenosis (LSS).Overview of LiteratureGender differences may contribute to variations in disease presentations and health outcomes. The influence of gender on pre- and postoperative HRQOL in spinal disorders remains unclear.MethodsWe reviewed 125 patients (79 men and 46 women) who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed the following clinical information: Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain (LBP), leg pain, and leg numbness; Zurich Claudication Questionnaire; JOA Back Pain Evaluation Questionnaire; Roland- Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as HRQOL. We compared the HRQOLs of men and women pre- and postoperatively.ResultsAlthough the preoperative NRS results for LBP were significantly higher in women (p <0.05), there were no significant differences in clinical outcomes between men and women postoperatively. For HRQOL, the RMDQ scores were significantly worse in women preoperatively (p <0.05), but no significant differences were found postoperatively between men and women. Similarly, the SF-8 mental health score was also significantly lower in women preoperatively (p <0.05), but no significant differences were noted between the two groups postoperatively.ConclusionsLSPSL greatly reduced LBP, leg pain, and leg numbness in both genders. There were limited differences in pain and several HRQOL questionnaire responses between men and women after surgery. We found that women had greater sensitivity to and/or lower tolerance for pain than men, which led to lower HRQOL mental health scores preoperatively.

Opioid Exposure Negatively Affects Antidepressant Response to Venlafaxine in Older Adults with Chronic Low Back Pain and Depression.

Serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly co-prescribed with opioids for chronic pain. The purpose of this study was to describe pain and mood response to venlafaxine among older adults with chronic low back pain (CLBP) and depression relative to opioid exposure. Secondary analyses were collected from a randomized clinical trial testing a stepped-care approach to comorbid pain and depression in older patients: the Addressing Depression and Pain Together study (ADAPT: 2010-2016). University-based late-life mental health research clinic. Two hundred twenty-seven adults aged 65+ years with CLBP and depression. Participants received six weeks of lower-dose venlafaxine (≤150 mg/d). Pain and depression were measured each week. Response for both pain and depression at the end of six weeks was defined by a ≥30% improvement on a 0-20 numeric rating scale for low back pain and a Patient Health Questionnaire-9 score ≤5. Opioid exposure was analyzed as prescribed (yes or no) and by morphine equivalent dosing (MED). Patients co-prescribed an opioid were less likely to report a pain response to venlafaxine. MED was negatively correlated with pain response. Depression response was not impacted. Opioids are negatively associated with older adults' early analgesic response to lower-dose venlafaxine. These findings suggest that clinicians may wish to consider either nonopioid or alternative antidepressant approaches to pain management in these complex patients. It is reassuring that opioids do not prevent depression response. Future research should examine both longer duration of treatment and a wider range of doses.

The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?

The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?

The Effectiveness of Mindfulness-Based Stress Reduction on the Depression, Anxiety, Stress, and Pain Perception in Females with Obstructed Labour-Induced Chronic Low Back Pain

Objectives The present study aimed to investigate the effectiveness of Mindfulness-Based Stress Reduction (MBSR) on the severity of depression, anxiety, stress, and the perception of low back pain after childbirth. Methods This was a quasi-experimental research with a pre-test, post-test and a control group and one-month follow-up design. The statistical population included all females with chronic postpartum low back pain in Tehran City, Iran. Forty of them were selected by convenience sampling method and were assigned into the experimental (20) and control (20) groups. The study instruments included Depression Anxiety Stress Scale (DASS-21) and Ossourichr('39')s low back pain scale. The samples were followed-up one month after conducting the intervention. A mindfulness training program based on stress reduction was carried out in 8 120-minute sessions once a week for the experimental group. The collected data were analyzed using SPSS. Results The study findings suggested a significant difference between the mean post-test scores of the experimental and control groups. Thus, mindfulness training on chronic low back pain perception had a significant effect at P&lt;0.01. Additionally, mindfulness training had a significant effect on reducing depression, anxiety, and stress. Conclusion Mindfulness exercises are associated with increasing the awareness of the thoughts, feelings, and senses of the patients and their admission. Moreover, these techniques reduced their level of depression, anxiety, stress, and lower chronic back pain perception. Therefore, they can help in designing better healthcare programs for therapists, counselors, and psychologists.

Transforaminal percutaneous endoscopic discectomy for lumbar disc herniation in athletes under the local anesthesia

BackgroundPercutaneous endoscopic discectomy (PED) has been reported to be less invasive and effective procedure for lumbar disc herniation (LDH). Damage to the back muscle is considered minimal, which is particularly important for athletes. However, the results of PED for LDH in athletes have not been reported well. The purpose of this study was to evaluate the clinical outcomes of PED for LDH in athletes. MethodsWe retrospectively analyzed 21 athlete patients with LDH who had undergone PED. All patients received athletic rehabilitation immediately after surgery. The clinical outcomes were evaluated from the visual analogue scale (VAS) for leg pain and low back pain (LBP), the Oswestry Disability Index (ODI), complications and periods of return to sport. ResultsThere were 18 men and 3 women, and the mean age at the time of surgery was 22.9 years (range: 15–43 years). The mean VAS scores for leg pain before and after surgery were 64.3 ± 2.7 mm and 12.4 ± 1.4 mm, respectively. The mean VAS scores for LBP before and after surgery were 62.1 ± 2.2 mm and 10.5 ± 1.1 mm, respectively. The mean ODI scores before and after surgery were 31.3 ± 14.0% and 14.6 ± 7.1%, respectively. The VAS for leg pain, as well as the LBP and ODI, significantly improved after surgery. There were no complications related to the surgery. Ninety-five percent (20/21) returned to play sports at the same performance level as before the procedure by an average of 9.2 weeks after PED. ConclusionsPED is a minimally invasive and effective procedure for patients with LDH, especially in athletes. Not only the patients' leg pain but also their discogenic LBP improved. PED has the benefits of preservation of normal posterior structures and a faster return to sports.

64. Unfolding the outcomes of surgical treatment of lumbar spinal stenosis: a prospective 5- and 10-year follow-up study

BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) is the leading cause for spinal surgery with the elderly population. In recent years, we have witnessed the surgical rate of LSS increase. Regardless of the increased number of surgeries, little is known of its long-term outcomes from prospective studies. PURPOSE To obtain satisfaction rate to surgical outcome in patients with LSS after 5 and 10 years postoperatively and to gather information on the natural cause of the condition. STUDY DESIGN/SETTING A prospective observational study. PATIENT SAMPLE The original patient sample consisted of 100 LSS patients who underwent decompressive surgery between 2001 and 2004. Of these, 72 patients participated in the 10-year follow-up. OUTCOME MEASURES Satisfaction with the surgical outcome, Oswestry disability index (ODI), visual analog scale (VAS) for overall pain, Numeric Rating Scale (NRS-11) for low back pain at rest and leg pain while walking, and walking ability quantified in meters. METHODS The study patients completed questionnaires preoperatively (baseline, BL) and 3 months, 5 and 10 years postoperatively. Statistical analyses for the outcomes were made by using linear mixed models. RESULTS Satisfaction rate with the surgical outcome was 68% at the 5- and 10-year follow-up points. Interestingly, VAS scores increased 9.8 mm at 5-year (mean 35.3±3.3mm) and 7.8 mm at 10-year (33.3±3.4mm) follow-up points compared to 3 months after the surgery (25.5±2.2mm, p CONCLUSIONS After 10 years from the decompressive surgery, patients with LSS experienced more disability and pain compared to 3-month postoperative time point. Nevertheless, all outcome values showed significant improvement from the baseline, and patients were still satisfied with the results of surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

SCOUT IDE Investigation: 1-Year Clinical Findings for a Conforming Porous Polymeric Lumbar Interbody Fusion Device

Abstract INTRODUCTION This clinical investigation evaluates a novel conforming mesh device for single-level lumbar interbody fusion (IBF) treating degenerative disc disease. The device placed in the prepared disc space through a small portal and filled with bone graft in situ creates an endplate conforming large loadsharing footprint. Early/sustained improvements in pain and function are essential patient-centric metrics. These parameters combined with bone growth and safety must be demonstrated to warrant device use and future adoption. METHODS This prospective multicenter investigation of 102 subjects yielded 99 subjects with 12-mo data. Mean age/BMI are 57/30.6, respectively, with balanced gender. Primary measures include Visual Analog Scale (VAS) for low back pain (LBP), Oswestry Disability Index (ODI) for low back function, fusion assessed by CT scan, and safety. RESULTS Clinically relevant improvements are demonstrated in pain and function. At 12-mo postop, mean LBP VAS change from baseline is −50.3 mm (preop: 74.1, 12-mo: 23.6). This is improved over the 6-wk change from baseline of −45 mm. Similar trends are observed for lower extremity pain scores. Clinically relevant improvements in ODI also occur by 6-wk and continue to improve over time where the 6-wk mean ODI change from baseline is −16.9 compared 12-mo of −31.4 (pre-op: 53.6, 12 mo 21.8). Fusion rate of 96.9% (94/97). No investigation device-related serious adverse events occurred. High patient satisfaction rates reported early with 85.9% (85/99) rating satisfaction as Excellent/Good at 6-wk and maintained through 12-mo (89.7%, 87/97). CONCLUSION Observed early clinical improvements by 6-wk postop are maintained and/or continue to improve over time. Combined with high fusion rates, demonstrated device safety to date, and compelling levels of patient satisfaction, these results are highly positive and support use of this device for IBF. Sustained results at 2-yr postop are both anticipated and forthcoming.

The influence of preoperative mental health on clinical outcomes after laminectomy in patients with lumbar spinal stenosis

ObjectiveThe influence of preoperative mental health on health-related quality of life (HRQOL) in patients with lumbar spinal stenosis (LSS) remains unclear. This study aims to investigate the influence of preoperative mental health HRQOL after laminectomy in patients with LSS. Patients and MethodsWe retrospectively reviewed 122 patients who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed clinical information; Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain, for leg pain, and for leg numbness; Zurich Claudication Questionnaire (ZCQ); JOA Back Pain Evaluation Questionnaire (JOABPEQ); Roland-Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as patient reported outcomes. Patients were divided into two groups (Group L ≤ 36.2 points and Group NL > 36.2 points) based on the results of the preoperative mental health (MH) score in SF-8 to examine the influence of MH in LSS. We compared the HRQOL between the two groups postoperatively. ResultsThe JOA score, NRS, and ZCQ score significantly improved after surgery. HRQOL outcomes including JOABPEQ, RMDQ, and SF-8 showed that the LSPSL improved not only the physical but also the mental function in patients with LSS. All HRQOL outcomes in Group L exhibited significantly worse scores preoperatively; however, no significant differences between two groups were found postoperatively. ConclusionsLSPSL greatly reduced low back pain, leg pain, and leg numbness. LSPSL resulted in a significant improvement based on HRQOL questionnaires even in patients with preoperative depressive mood. Not only the physical status but also the mental health may improve after LSPSL even in patients with LSS with a depressive mood preoperatively.

Correlation of Lower Instrumented Vertebra With Spinal Mobility and Health-related Quality of Life After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

This is a retrospective single-center and single-surgeon study. We investigated the correlation between lower instrumented vertebra (LIV) and spinal mobility 2 years after posterior spinal fusion with pedicle screws for adolescent idiopathic scoliosis (AIS) for optimal LIV selection. Spinal motion can become limited in scoliosis patients who undergo posterior spinal fusion. However, few reports exist on spinal mobility after posterior spinal fusion for AIS and the relationship between the LIV and mobility is unknown. We hypothesize that mobility limitation increases as the LIV is moved inferiorly. Of 72 consecutive patients who received posterior spinal fusion using pedicle screws for AIS between October 2009 and August 2015, 66 patients (5 male and 61 female, mean age: 14.9 y) were enrolled. In total, 66 patients were retrospectively reviewed after stratification according to LIV level. Follow-up rate was 91.7%. Patients were examined for the fingertip-to-floor distance (FFD) before and 2 years after surgery. FFD was measured from the tips of the middle fingers to the floor with the barefoot subject bent maximally forward and the feet together and knees straight. Clinical outcome was assessed using Scoliosis Research Society-22 patient questionnaire (SRS-22r) scores and a visual analog scale for low back pain before and at 2 years postoperatively. The median number of fused vertebrae was 9 (range: 4-15). The LIV was T11-12 in 15 patients, L1 in 11 patients, L2 in 10 patients, and L3 in 30 patients. The median decrease in FFD according to LIV at 2 years after surgery was T11-12: 0 cm, L1: 0 cm, L2: 5.5 cm, and L3: 10 cm. Thus, limited FFD became significantly more severe as the LIV was moved downwards (P<0.01). There were no significant correlations between limited FFD and SRS-22r or pain visual analog scale scores at 2 years postoperatively. FFD became significantly more restricted as the LIV was moved inferiorly but clinical results appeared unaffected by limited FFD.

Quality of life changes after lumbar decompression in patients with tandem spinal stenosis

ObjectiveTandem spinal stenosis (TSS) is a degenerative spinal condition characterized by spinal canal narrowing at 2 or more distinct spinal levels. It is an aging-related condition that is likely to increase as the population ages, but which remains poorly described in the literature. Here we sought to determine the impact of primary lumbar decompression on quality-of-life (QOL) outcomes in patients with symptomatic TSS. Patients and methodsWe retrospectively reviewed 803 patients with clinical and radiographic evidence of TSS treated between 2008 and 2014 with a minimum 2-year follow-up. The records of patients with clinical and radiographic evidence of concurrent cervical and lumbar stenosis were reviewed. Prospectively gathered QOL data, including the Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9), EuroQOL-5 Dimensions (EQ-5D), and Visual Analogue Scale (VAS) for low back pain, were assessed at the 6-month, 1-year, and 2-year follow-ups. ResultsOf 803 identified patients (mean age 66.2 years; 46.9% male), 19.6% underwent lumbar decompression only, 14.1% underwent cervical + lumbar decompression, and 66.4% underwent conservative management only. Baseline VAS scores were similar across all groups, but patients undergoing conservative management had better baseline QOL scores on all other measures. Both surgical cohorts experienced significant improvements in the VAS, PDQ, and EQ-5D at all time points; patients in the cervical + lumbar cohort also had significant improvement in the PHQ-9. Conservatively managed patients showed no significant improvement in QOL scores at any follow-up interval. ConclusionLumbar decompression with or without cervical decompression improves low back pain and QOL outcomes in patients with TSS. The decision to prioritize lumbar decompression is therefore unlikely to adversely affect long-term quality-of-life improvements.

A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain

BACKGROUND CONTEXTCurrent literature suggests that degenerated or damaged vertebral endplates are a significant cause of chronic low back pain (LBP) that is not adequately addressed by standard care. Prior 2-year data from the treatment arm of a sham-controlled randomized controlled trial (RCT) showed maintenance of clinical improvements at 2 years following radiofrequency (RF) ablation of the basivertebral nerve (BVN). PURPOSEThe purpose of this RCT was to compare the effectiveness of intraosseous RF ablation of the BVN to standard care for the treatment of chronic LBP in a specific subgroup of patients suspected to have vertebrogenic related symptomatology. STUDY DESIGN/SETTINGA prospective, parallel, open label RCT was conducted at 20 U.S. sites. PATIENT SAMPLEA total of 140 patients with chronic LBP of at least 6 months duration, with Modic Type 1 or 2 vertebral endplate changes between L3 and S1, were randomized 1:1 to undergo either RF ablation of the BVN or continue standard care. OUTCOME MEASURESOswestry Disability Index (ODI) was collected at baseline, 3, 6, 9, and 12-months postprocedure. Secondary outcome measures included a 10-point Visual Analog Scale (VAS) for LBP, ODI and VAS responder rates, SF-36, and EQ-5D-5L. The primary endpoint was a between-arm comparison of the mean change in ODI from baseline to 3 months post-treatment. METHODSPatients were randomized 1:1 to receive RF ablation or to continue standard care. Self-reported patient outcomes were collected using validated questionnaires at each study visit. An interim analysis to assess for superiority was prespecified and overseen by an independent data management committee when a minimum of 60% of patients had completed their 3-month primary endpoint visit. RESULTSThe interim analysis showed clear statistical superiority (p<.001) for all primary and secondary patient-reported outcome measures in the RF ablation arm compared with the standard care arm. This resulted in a data management committee recommendation to halt enrollment in the study and offer early cross-over to the control arm. These results are comprised of the outcomes of the 104 patients included in the intent-to-treat analysis of the 3-month primary endpoint, which included 51 patients in the RF ablation arm and 53 patients in the standard care arm. Baseline ODI was 46.1, VAS was 6.67, and mean age was 50 years. The percentage of patients with LBP symptoms ≥5 years was 67.3%. Comparing the RF ablation arm to the standard care arm, the mean changes in ODI at 3 months were −25.3 points versus −4.4 points, respectively, resulting in an adjusted difference of 20.9 points (p<.001). Mean changes in VAS were −3.46 versus −1.02, respectively, an adjusted difference of 2.44 cm (p<.001). In the RF ablation arm, 74.5% of patients achieved a ≥10-point improvement in ODI, compared with 32.7% in the standard care arm (p<0.001). CONCLUSIONSMinimally invasive RF ablation of the BVN led to significant improvement of pain and function at 3-months in patients with chronic vertebrogenic related LBP.

Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire.

Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment. This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ). Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version. The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP. A scale for assessing disability in LBP is made available for use in Nigeria and similar populations. None declared.

Efficacy of lumbar orthoses after posterior lumbar interbody fusion-a prospective randomized study.

Lumbosacral orthoses (LSOs) are used as standard care after lumbar fusion surgery though their efficacy is unknown. The purpose of this prospective randomized controlled study was to elucidate the clinical and radiographic efficacies of LSO treatment in patients who underwent posterior lumbar interbody fusion (PLIF) of less than 3 segments. Seventy-three patients who underwent PLIF were randomly allocated to 3 groups: 1 with custom-made LSO with metallic stays (C group); 1 with ready-made LSO without metallic stays (R group), and 1 without LSO (N group). The patients in the C and R groups were instructed to wear LSO postoperatively for 3 months. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, JOA-back pain evaluation questionnaire (JOABPEQ), Roland-Morris Disability Questionnaire, and 100-mm visual analog scale for low back pain. Radiographic evaluation included intervertebral fusion rates and loss of correction postoperatively at 2 years. A significant difference in the clinical outcomes was observed only for the lumbar dysfunction domain of JOABPEQ postoperatively at 1 month (N vs C groups; 45% vs 10%, P = .03). Radiographic outcomes were not different between the groups. No effect of orthosis treatment for less than 3 segments in PLIF was observed on clinical and radiographic outcomes. The type of orthosis also did not influence the outcomes. These results suggest that the use of LSO for PLIF can be simplified or is omissible except in patients with severe osteoporosis.

The Role of Full-Endoscopic Lumbar Discectomy in Surgical Treatment of Recurrent Lumbar Disc Herniation: A Health-Related Quality of Life Approach.

ObjectiveTo investigate the utility of full-endoscopic lumbar discectomy (FELD) in surgical treatment of recurrent lumbar disc herniation (RLDH). MethodsForty-five patients were prospectively studied. All patients were subjected to FELD for RLDH. They were assessed preoperatively and in regular intervals at 6 weeks and 3 months, 6 months, and 12 months postoperatively. Evaluation was conducted with visual analogue scale for leg (VAS-LP) and low back (VAS-BP) pain. Short-Form 36 Health Survey Questionnaire was utilized for health-related quality of life assessment. ResultsAll studied parameters featured statistically significant amelioration at all follow-up intervals. Maximal improvement was in general at 6 weeks observed, with subsequent lesser improvement until 6 months and stabilization until the end of follow-up. Comparative assessment indicated that VAS-BP displayed quantitatively lower improvement, whereas physical function, bodily pain, and role-emotional parameters demonstrated greater amelioration. ConclusionFELD is associated with a favorable impact in postoperative daily life of patients with RLDH.

ISSLS PRIZE IN CLINICAL SCIENCE 2019: clinical importance of trunk muscle mass for low back pain, spinal balance, and quality of life-a multicenter cross-sectional study.

A multicenter cross-sectional study. To clarify the relationship of trunk muscle mass with low back pain, spinal sagittal balance, and quality of life. Few reports have investigated the relationship of trunk muscle mass with lumbar spine function and spinal balance, and the clinical significance of trunk muscle mass remains unclear. Patients attending spinal outpatient clinics at 10 different medical institutions were enrolled in this study. Patient demographics, trunk muscle mass and appendicular skeletal muscle mass (ASM) measured by bioelectrical impedance analysis (BIA), body mass index (BMI), Charlson Comorbidity Index (CCI), the Oswestry Disability Index (ODI), visual analog scale (VAS) for low back pain, sagittal vertical axis (SVA), and EuroQol 5 Dimension (EQ5D) score were investigated. Multivariate nonlinear regression analysis was used to investigate the association of trunk muscle mass with the ODI, VAS score, SVA, and EQ5D score. Of 2551 eligible patients, 1738 (mean age 70.2 ± 11.0years; 781 men and 957 women) were enrolled. Trunk muscle mass was significantly correlated with the ODI, VAS score, SVA, and EQ5D score (P < 0.001) when adjusted for age, sex, BMI, ASM, CCI, and history of lumbar surgery. Patient deterioration was associated with a decrease in trunk muscle mass, and the deterioration accelerated from approximately 23kg. Trunk muscle mass was significantly associated with the ODI, VAS score, SVA, and EQ5D score. Trunk muscle mass may assume an important role to elucidate and treat lumbar spinal dysfunction and spinal imbalance. These slides can be retrieved under Electronic Supplementary Material.

The Natural Course of Compensatory Lumbar Curves in Nonoperated Patients With Thoracic Adolescent Idiopathic Scoliosis.

A retrospective, long-term follow-up study. We investigated the natural course of compensatory lumbar curves in patients with primary thoracic adolescent idiopathic scoliosis (AIS). The natural course of compensatory lumbar curves in primary thoracic AIS remains unknown. Inclusion criteria were right-sided primary thoracic AIS ≥30° with a Lenke lumbar modifier of A or B at skeletal maturity and ≥30 years of age at the time of the survey. Fifty-one patients (mean age, 40.2 yr) returned for a follow-up evaluation (follow-up rate, 34.2%). Patients were classified into three groups based on the lumbar modifier (A or B) and direction of L4 tilt [right (R) or left (L)] (AR, n.11; AL, n.18; and B, n.22). At the time of the survey, 42 patients underwent radiological examinations and 37 underwent lumbar magnetic resonance imaging. Quality of life questionnaires were completed in all patients and in a 1:1 matched control group (no history of scoliosis). The thoracic curves had significantly progressed in all patient groups, while the compensatory lumbar curve progressed only in the B group. The C7 translation and L4 tilt shifted to the right in the AR and AL groups, but did not change in the B group. As a result, the L4 tilt (median, 11°) and C7 translation (18.6 mm) tended to be the greatest in the AR group. The incidences of Modic changes at L4/5 discs and ≥3 cm on the visual analogue scale for low back pain were significantly higher in the AR group (77.8% and 54.5%, respectively) compared with that in the other groups. The natural course of compensatory lumbar curves is dependent on the lumbar modifier and direction of L4 tilt. Adolescent patients with right-sided primary thoracic AIS (≥30°) with L4 tilted to the right should be considered for periodic follow-ups into adulthood. 4.

Clinical application of minimal invasive arthroscope on patella fracture surgery

&lt;p class="p1"&gt;The aim of the research is to perform the application of minimal invasive arthroscope on patella fracture surgery. A total of 100 patients with the cases of patella fracture were selected from our hospital and the Second Xiangya Hospital’s Orthopaedic Ward. These patients were divided into ‘Observation Group’ and ‘Comparison Group’. The former was treated with traditional open surgery whereas the latter used the arthroscopic surgery. The postsurgical score indicated statistically significant differences (P &amp;lt; 0.05) in the Lysholm Knee and Oswestry Low Back pain scale. By performing arthroscopic surgery on patella fractures, the patients’ recovery was accelerated while the pain was greatly reduced, which in turn, improved the quality of patients’ life and provided valuable clinical value. &lt;/p&gt;