Oswestry Disability Index Scores Research Articles

Endoscopic Joint Capsule and Articular Process Excision for the Treatment of Lumbar Facet Joint Syndrome: A Retrospective Study.

Dorsal ramus medial branch radiofrequency ablation is reported to be effective for refractory lumbar facet joint syndrome. However, as nerve fibers can regenerate, the therapeutic effect was reported to be short and last only 6 to 12 months. Previously, we reported a novel endoscopic joint capsule and articular process excision procedure. In that case, a satisfying effect was achieved by removing the culprit hyperplastic articular synovial entrapped in the joint space endoscopically. We presume this treatment is an etiologic treatment and can exert longer-term efficacy. This retrospective clinical trial aimed to elucidate the longer-term efficacy as well as the safety profile of the procedure. This was a retrospective descriptive study. The participants underwent endoscopic joint capsule and articular process excision procedures. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) before the operation, and at 3 months, 6 months, 1 year, and 2 years post-operation were recorded by reviewing medical charts and conducting telephone interviews. A total of 234 participants were evaluated in the trial. After participant screening, 13 participants were included in the final analysis. The VAS score was reduced from (median (P25, P75)) 6 (4.5, 6) at pre-operation to 2 (0, 4) at 1-year post-operation and 0 (0, 1) at 2-year pre-operation. The ODI score was reduced from 37.78 (27.09, 59.95) at pre-operation to 8.89 (2.22, 24.34) at 1-year post-operation and 6 (0.02, 11.11) at 2-year post-operation. The difference was statistically significant. Further subgroup analysis demonstrated that a narrowed intervertebral space was a possible relevant factor for poor outcomes. No procedure-related complications were reported. Endoscopic joint capsule and articular process excision is an effective and safe procedure for refractory lumbar facet joint syndrome. The effectiveness duration can last up to 1 to 2 years.

Association of Abdominal Aortic Calcification and Clinical Outcomes in LDH Patients Treated with Endoscopic Lumbar Discectomy.

To determine any significant associations between abdominal aortic calcification (AAC) and clinical manifestations of pain symptoms following endoscopic lumbar discectomy. Patients sequentially presenting with a history of unilateral radiculopathy with or without back pain, and with magnetic resonance imaging (MRI)-confirmed diagnosis of posterolateral disc herniation between August 2021 and December 2023 were eligible for inclusion in the study. All patients underwent endoscopic discectomy at our center during the study period. AAC stages were classified based on the Kauppila classification system using lateral lumbar radiographs. Between August 2021 and December 2023 a total of 120 patients were included in the study for analysis, of whom 82 (68.3%) exhibited mild AAC and 38 (31.7%) had moderate-severe AAC. Analyses using the multivariate linear regression model revealed a significant correlation between AAC comorbidity and postoperative clinical outcomes. At 1 year post-surgery, the mean change in leg pain following endoscopic lumbar discectomy was significantly less for patients with moderate-severe AAC (5.0 points) than for patients with mild ACC (p < 0.001). Even after adjusting for relevant confounders, this difference remained significant. Similar results were also observed in the postoperative improvement of back pain, the Oswestry Disability Index score, and the physical functioning, role physical, and bodily pain components of the 36-item Short Form Health Survey questionnaire. There was no significant difference in the rate of repeat surgery or post-surgical new-onset back pain between patients with different levels of severity of AAC at 1 year post-surgery. There is a significant association between the severity of AAC and clinical outcomes among patients with lumbar disk herniation who underwent endoscopic lumbar discectomy. AAC may serve as a prognostic factor in predicting surgical outcomes and guiding management strategies for patients with lumbar disk herniation following endoscopic lumbar discectomy.

The impact of smoking on patient-reported outcomes following lumbar decompression: an analysis of the Quality Outcomes Database.

Smoking has been shown to negatively impact spinal health, as well as the outcomes of spinal fusion. Published reports show conflicting data regarding whether smoking negatively impacts patient outcomes following lumbar decompression. The objective of this study was to investigate whether smoking affects the outcomes of patients undergoing lumbar decompression for spinal stenosis or herniated disc. The Quality Outcomes Database was queried for patients with spinal stenosis or lumbar disc herniation who underwent one- or two-level lumbar decompression without fusion. All patients had preoperative and 12-month outcome measures and were divided into groups of nonsmokers and current smokers. Outcomes were compared between the two groups, as well as the percentage of patients reaching the minimal clinically important difference (MCID) threshold for numeric rating scale (NRS) back and leg pain scores and the Oswestry Disability Index (ODI). Of 17,271 patients, 14,233 were nonsmokers and 3038 were current smokers. Smokers had worse baseline NRS back and leg pain, ODI, and EQ-5D scores and experienced slightly less improvement in all measures following lumbar decompression (p ≤ 0.009), although changes were largely similar, and a high percentage of patients achieved the MCID thresholds for NRS back pain (78% nonsmokers vs 75% smokers), NRS leg pain (79% nonsmokers vs 73% smokers), and ODI (74% nonsmokers vs 68% smokers). Comparison of propensity-matched cohorts did not identify any difference in outcomes in smokers versus nonsmokers. In patients undergoing lumbar decompression for spinal stenosis or herniated disc, smokers demonstrated slightly less improvement in outcomes compared with nonsmokers, and a high proportion of both groups achieved meaningful improvement with surgery. While smoking cessation should be strongly encouraged in all patients, lumbar decompression procedures for spinal stenosis and herniated disc should not be denied to smokers.

Impact of postoperative spinal malalignment on postoperative health-related quality of life after long-level fixation for degenerative lumbar scoliosis: does residual coronal angularity matter?

This study evaluates the influence of spinal malalignment on health-related quality of life (HRQOL) in a long-level fusion spine. This was a retrospective analysis of 121 consecutive patients with DLS after long-segment fusion. HRQOL and radiographic parameters were collected at final follow-up. For postoperative residual Cobb angle (CA), patients were divided as follows: group (0) (CA < 10°), group (+) (CA 10°∼20 °), and group (++) (CA > 20°). For postoperative coronal vertical axis (CVA), patients were separated as follows: group (0) (CVA < 2cm), group (+) (CVA 2 ∼ 3cm), and group (++) (CVA > 3cm). Patients were also grouped by the sagittal modifiers as group (0), group (+), and group (++) according to the Scoliosis Research Society (SRS)-Schwab classification, respectively. Visual analog scale (VAS) for back was significantly lower in CA 10°∼20° group compared to other groups. Patients with remnant CA > 20° showed worse Oswestry Disability Index (ODI), SRS-22 and the 36-item Short Form Health Survey (SF-36) - physical component scores (PCS). Sagittal vertical axis (SVA) showed significant correlation with HRQOLs after surgery, and the statistical significance of ODI, SRS-22 and SF-36 scores was observed among subgroups. In long-level fused spine, residual CA > 20° resulted in worse clinical outcomes and was recommended to avoid during surgery. And 10° to 20° residual CA was acceptable in DLS patients and even better than Cobb angle < 10° in several HRQOLs, therefore strictly pursing upright alignment seems unnecessary. SVA also showed effectiveness in assessing HRQOL in the fixed spine.

Do Obese Patients Have Worse Outcomes in Adult Spinal Deformity Surgeries? A Meta-Analysis.

Meta-Analysis. This meta-analysis evaluates the difference in surgical outcomes between obese and non-obese patients undergoing adult spinal deformity (ASD) corrective surgery. ASD encompasses a wide range of debilitating spinal abnormalities. Concurrently, obesity is on the rise globally and has been shown to influence the outcomes of ASD management. The relationship between obesity and surgical outcomes in ASD has been the focus of recent studies, yielding various results. We conducted a comprehensive search of PubMed, Cochrane, and Google Scholar (page 1-20) through June of 2024. The surgical outcomes assessed included post-operative complications, revision rates, wound infections, thromboembolic events, implant-related complications, and non-home discharge. Surgical parameters such as operative time, length of stay (LOS), and estimated blood loss (EBL), as well as functional outcomes like the Oswestry Disability Index (ODI) and pain scores were analyzed. Nine studies met inclusion criteria. Non-obese patients exhibited a lower rate of implant-related complications (OR=0.25; 95% CI: 0.12-0.52, P=0.0002) and non-home discharge (OR=0.52; 95% CI: 0.32-0.84, P=0.007). Additionally, non-obese patients had reduced LOS (MD=-0.29; 95% CI: -0.53 - -0.05, P=0.02) and EBL (SMD=-0.68; 95% CI: -1.19 - -0.18, P=0.008). No statistically significant differences were observed for the remaining outcomes. Non-obese patients undergoing ASD corrective surgery are associated with fewer implant-related complications, a lower EBL, shorter LOS, and a higher likelihood of being discharged home compared to their obese counterparts.

Comparison of Oswestry Disability Index Scores Between Surgical Candidates and General Population: Insights into Evaluation Criteria for Spine Surgery.

A mixed-methods investigation with both retrospective and prospective components. Determine the mean Oswestry Disability Index (ODI) scores for individuals who underwent surgical intervention compared to a non-surgical population and identify threshold values that distinguish between these groups. The Oswestry Disability Index (ODI) quantifies disability in patients with low back pain and commonly serves as a significant determinant in lumbar spine pathology and surgical outcomes. An empirically established ODI threshold can aid in optimizing surgical decision-making processes. This study retrospectively analyzed 557 patients who consulted with a spine surgeon and subsequently underwent lumbar spine surgery from 2019 to 2023. Additionally, ODI scores were surveyed from 797 individuals in the general American population using the CloudResearch Connect platform, with participants matched for age and sex according to US census data. Mean ODI scores stratified by age group and sex were calculated for each cohort. Receiver Operating Characteristic (ROC) analysis was utilized to ascertain ODI cutoff values for different demographics. The retrospective cohort demonstrated a higher disability level with an overall mean ODI of 34.7 (95% CI [33.1, 36.2]) for ages 18-89. In contrast, the general population surveyed had a mean ODI of 14.4 (95% CI [13.3, 15.4]). An ROC-derived ODI threshold of 16.5 within the comprehensive age group of 18-89 exhibited a sensitivity of 0.84 and a specificity of 0.68. The ODI values identified in this study offer benchmarks that can assist in the evaluation process for spine surgery. These findings highlight the importance of considering ODI scores as part of a comprehensive clinical evaluation, rather than as standalone indicators for surgical intervention. Further prospective validation of these findings and their integration into clinical practice is recommended for future research.

Risk Factors of Unsatisfactory Outcomes Requiring Additional Intervention Following Oblique Lateral Interbody Fusion.

Oblique lateral interbody fusion (OLIF) is a minimally invasive procedure for stabilizing the spine and indirectly decompressing the neural elements. There is sparse data on unsatisfactory outcomes that require additional interventions (surgery or intervention) after OLIF. This study aimed to identify the causes, and risk factors of these reintervention. This was a single-center retrospective study of the patients who underwent the OLIF procedure from June 2016 to March 2023. Several clinical and radiographic parameters were studied. We also analyzed associations between several potential risk factors and the reintervention following OLIF. A total of 231 patients were included. Over an average of 2.5 years of follow-up, 28 patients (12.1%) required a reintervention. Adjacent segment disease (ASD) was the most common cause of reintervention. The risk factors associated with reintervention were previous surgery (adjusted odds ratio [aOR], 4.44; 95% confidence interval [CI], 1.21-16.33; p=0.02) and high preoperative Oswestry Disability Index (ODI) scores (aOR, 1.04; 95% CI, 1.00-1.08; p=0.03). Although increasing the duration of follow-up was not statistically significant, the 95% CI was consistent with an increased risk of reintervention with longer follow-up (OR, 1.18; 95% CI, 0.94-1.50). This study showed that patients with prior lumbar surgery and high preoperative ODI scores were more likely to require additional intervention after the OLIF procedure. In addition, an increasing duration of follow-up was associated with an increased risk of reintervention. The most common reason for reintervention was ASD after OLIF.

Impact of the Disc Vacuum Phenomenon on Surgical Outcomes in Lumbar Spinal Stenosis: A Comparative Study between Endoscopic Decompression and Minimally Invasive Oblique Lateral Interbody Fusion.

Objective: This study investigated the influence of the vacuum phenomenon (VP) on surgical outcomes in patients with lumbar spinal stenosis, comparing minimally invasive oblique lateral interbody fusion (MIS OLIF) and endoscopic decompression. Methods: A cohort of 110 patients diagnosed with lumbar spinal stenosis underwent either endoscopic decompression or MIS OLIF. Patients were classified into two groups based on the presence or absence of the VP on preoperative CT scans, non-VP (n = 42) and VP (n = 68). Radiologic and clinical outcomes, including back and leg pain assessed using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the EuroQol-5 Dimension (Eq5D), were compared pre- and postoperatively over a 2-year follow-up period. Results: Preoperatively, the VP group exhibited significantly greater leg pain (p = 0.010), while no significant differences were observed in back pain or the ODI between the groups. In the non-VP group, decompression and fusion yielded similar outcomes, with decompression showing a better ODI score at 1 month (p = 0.018). In contrast, in the VP group, patients who underwent fusion showed significantly improved long-term leg pain outcomes compared to those who underwent decompression at both 1-year (p = 0.042) and 2-year (p = 0.017) follow-ups. Conclusions: The VP may indicate segmental instability and may play a role in the persistence of radiculopathy. Fusion surgery appears to offer better long-term relief in patients with the VP, whereas decompression alone is a viable option in non-VP cases. These findings suggest that the VP may be a useful factor in guiding surgical decision-making.

A retrospective comparative study of robot-assisted unilateral biportal endoscopic lumbar decompression and fusion surgery versus percutaneous endoscopic lumbar decompression and fusion surgery.

The objective of this study is to illustrate the advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression fusion and internal fixation surgery. According to the different surgical methods, we divided the 26 patients into 2 groups, robot-assisted unilateral biportal endoscopy for lumbar interbody fusion (R-ULIF) group and percutaneous endoscopic lumbar decompression and interbody fusion (Endo-LIF) group, with a 1:1 ratio. Gender, disease course, lesion site, fluoroscopy times, operative time, blood loss, postoperative hospital stay, screw placement success rate, fusion rate, complications rate, postoperative pain visual analog scale (VAS) (The VAS score is used only to evaluate pain in the lower back and legs.) Oswestry Disability Index (ODI) (The ODI score can serve as a reference indicator for evaluating the effectiveness of treatment for patients with low back pain, and has good responsiveness in assessing patients with chronic low back pain), and MacNab (The MacNab standard is divided into 4 levels: excellent, good, fair, and poor, which can be used to evaluate the therapeutic efficacy of certain spinal surgeries) standard efficacy evaluation were analyzed and compared between the 2 groups. All patients successfully completed the surgery. Compared with the Endo-LIF group, the R-ULIF group had fewer fluoroscopy procedures, less intraoperative blood loss, and shorter postoperative hospital stay (P < .05). The VAS scores and ODI scores of both groups significantly decreased at all-time points (P < .05). The ODI scores of the R-ULIF group were better than the Endo-LIF group at 1 month and 3 months after surgery (P = .017/P = .047), but there was no statistically significant difference between the groups before surgery and 1 week after surgery (P > .05). The efficacy was evaluated using the MacNab criteria at 6 months after surgery. The R-ULIF group has an excellent and good rate of 84.6%, while the Endo-LIF group has an excellent and good rate of 76.9% (P = 1.000). Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has shown short-term clinical efficacy in the treatment of lumbar disc herniation combined with lumbar instability, surpassing endoscopic lumbar interbody fusion surgery. Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has demonstrated high success rate in screw placement, minimal radiation exposure, less intraoperative blood loss, shorter hospital stay, and thus deserves further clinical promotion.

Motor improvement and spasms recovery with high-frequency 10kHz spinal cord stimulation in a patient with spastic tetraparesis: beyond pain relief.

To describe the clinical outcomes beyond pain relief of high-frequency spinal cord stimulation at 10kHz (10kHz SCS) in a patient with cervical myelopathy and drug-resistant chronic neuropathic pain with spastic tetraparesis. A patient with C3-C6 myelomalacia and spastic tetraparesis previously treated with decompressive laminectomy underwent implantation of 10kHz SCS for pain management through a trial procedure followed by permanent implantation. Due to the presence of epidural fibrotic scar tissue in the area of the previous C3-C6 laminectomy, the leads could not be implanted at the cervical level; therefore, the leads were positioned at the thoracic level. Data were collected during routine follow-up visits up to 15 months after implantation. Since the trialing phase and during all follow-up visits, along with complete pain relief in the lower limbs, a recovery from spasms was observed with an improvement in motor function. The patient recovered from a sensation of stiffness and difficulty in movement, with a significant decrease in muscle tone, regaining confidence in walking, and no longer needing assistance even for long walking distances. Although all disabling and painful symptomatology in the upper limbs instead did not ameliorate, the Oswestry Disability Index (ODI) score decreased from 50% at baseline to 6%. To our knowledge, recovery from spasms and motor improvement in a spastic tetraparesis patient has never been reported before with 10kHz SCS and possibly this new stimulation paradigm may overcome some performance limitations of traditional low-frequency SCS (LF-SCS). Treatment eliminated spasms at the lower limbs but not at the upper ones, thus suggesting that the location of the epidural leads could affect outcomes.

Clinical outcomes of percutaneous transforaminal endoscopic decompression for the treatment of degenerative lumbar scoliosis associated with spinal stenosis in elderly individuals: a matched comparison study.

This retrospective cohort study evaluated the efficacy and safety of percutaneous transforaminal endoscopic decompression (PTED) in elderly patients with degenerative lumbar scoliosis (DLS) associated with lumbar spinal stenosis (LSS). A matched comparison study. In total, 97 patients with DLS associated with LSS who underwent PTED under local anesthesia between 2016 and 2021 were retrospectively analyzed. Using the inclusion and exclusion criteria, 24 patients aged ≥ 80 years were screened and included in the study group. Then, 24 patients aged 50-80 years were matched according to gender, date of surgery, and surgical levels were included in the control group. Clinical outcomes such as the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, modified MacNab criteria, radiological parameters, and complications were assessed. The independent sample t-test, Pearson's chi-square test and Fisher's exact test were used to compare the parameters between the study and control groups. The study group had significantly higher mean American Society of Anesthesiologists classification and age-adjusted Charlson Comorbidity Index scores than the control group (2.42 ± 0.72) vs. 5.25 ± 1.03 and 1.67 ± 0.76 vs. 3.17 ± 2.10, respectively). The VAS scores for pain in two legs and back and ODI scores significantly improved at two weeks after surgery and at the final followup (p < 0.05). The study group had higher back pain VAS and ODI scores than the control group at the final followup (p < 0.05). In addition, the complication and patient satisfaction rates were similar between the two groups (p > 0.05). The overall radiological parameters were comparable between the two groups, and there was no significant deterioration in coronal imbalance or loss of disc height between the two groups. Elderly patients (aged ≥ 80 years) with DLS associated with LSS are less fit and have a greater number of comorbidities. However, they can achieve satisfactory outcomes with PTED, which are comparable to those of patients < 80 years. PTED under local anesthesia can also be an efficient alternative to conventional open lumbar decompression surgery for treating elderly patients with comorbidities.

The use of the 360 MD Huber platform in rehabilitation of lumbar radiculopathies, chronic period

Low back pain (LBP) is a common medical condition with a negative impact on quality of life and work. It also leads to financial costs for the health system by increasing the costs of medical treatment. Numerous studies have focused on the effects of exercise, with some highlighting the role of protective studies in LBP while other studies have shown no beneficial. There is moderate-certainty evidence that therapeutic exercise is beneficial in the treatment of chronic low back pain compared with other treatment modalities. Muscle strengthening and the creation of spinal mobility through specific exercise is a recognized therapeutic approach to the prevention and treatment of LBP. The main objecvtive is to evaluate the effectiveness of a physi-cal therapy program utilizing the 360 Huber platform on the quality of life for individuals with chronic lumbar radiculopathy. A randomized controlled trial was conducted with 30 participants diagnosed with chronic lumbar radiculopathy. Participants were divided into an ex-perimental group (n=20) receiving the 360 Huber platform-based rehabilitation protocol, and a control group (n=10) continuing standard care. The intervention included 15 sessions of physical therapy on the 360 Huber platform, complemented by electrotherapy and therapeutic massage. The Oswestry Disability Index (ODI) was administered pre- and post-intervention to assess changes in functional outcomes and quality of life. The experimental group demonstrat-ed a significant reduction in ODI scores, with an average decrease of 1.85 points (10.11%) from 18.30 to 16.45. The paired t-test analysis revealed a statistically significant difference (p &lt; 0.001) and a very large effect size (1.11), indicating substantial improvements in functional outcomes. The control group showed no significant changes. The rehabilitation protocol using the 360 Huber platform, combined with electrotherapy and therapeutic massage, effectively im-proves functional outcomes and quality of life for patients with chronic lumbar radiculopathy. The study highlights the potential of integrating advanced technology with traditional physical therapy methods to enhance treatment efficacy. Future research with larger sample sizes and longer follow-up periods is recommended to confirm these findings and explore additional therapeutic modalities.

The Influence of Wait Time on Surgical Outcomes in Elective Lumbar Degenerative Spine Conditions: A Retrospective Multicentre Cohort Study.

Retrospective cohort study. The impact of delayed access to operative treatment on patient reported outcomes (PROs) for lumbar degenerative conditions remains unclear. The goal of this study is to evaluate the association between wait times for elective lumbar spine surgery and post-operative PROs. This study is a retrospective analysis of patients surgically treated for a degenerative lumbar conditions. Wait times were calculated from primary care referral to surgery, termed the cumulative wait time (CWT). CWT benchmarks were created at 3, 6 and 12months. A multivariable logistic regression model was used to measure the associations between CWT and meeting the minimally clinically important difference (MCID) for the Oswestry Disability Index (ODI) score at 12months post-operatively. A total of 2281 patients were included in the study cohort. The average age was 59.4years (SD 14.8). The median CWT was 43.1weeks (IQR 17.8 - 60.6) and only 30.9% had treatment within 6months. Patients were more likely achieve the MCID for the ODI at 12months post-operatively if they had surgery within 6 months of referral from primary care (OR 1.22; 95% CI 1.11 - 1.34). This relationship was also found at a benchmark CWT time of 3months (OR 1.33; 95% CI 1.15 - 1.54) though not at 12months (OR 1.08; 95% CI 0.97 - 1.20). Patients who received operative treatment within a 3- and 6-month benchmark between referral and surgery were more likely to experience noticeable improvement in post-operative function.

Transforaminal Endoscopic Decompression Alone Versus Limited Decompression/Fusion in the Treatment of Adult Degenerative Scoliosis: A Retrospective Study.

A retrospective study. To investigate and compare the clinical and radiographical outcomes of endoscopic decompression alone and limited decompression/fusion surgery in the treatment of adult degenerative scoliosis (ADS). Follow-up data of 53 patients with lower limb radiculopathy associated with ADS who underwent focal surgical treatment were collected (endoscope group: 31 patients treated by transforaminal endoscopic decompression alone; fusion group: 22 patients who underwent limited decompression/fusion). The following data were retrospectively analyzed and compared between the two group: the demographics, Lenke-Silva level, radiographic parameters, surgical data, visual analogue scale (VAS) for back/leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria. The mean follow-up period was 15.68 ± 3.26 months. The most frequent Lenke-Silva level was I in the endoscope group, and III in the fusion group. Preoperative Cobb angle in the endoscope group was significantly lower than that in the fusion group (23.92 ± 9.06 vs 39.58 ± 13.12, P < 0.05). All patients exhibited improved VAS and ODI scores postoperatively (P < 0.05). At the last follow-up, the Cobb angle had progressed by 1.51° in the endoscope group, whereas radiographic parameters were significantly improved in the fusion group. The reoperation and complication rate in the endoscope group were lower than those in the fusion group. The satisfaction rate post-surgery was comparable between the two groups. For patients with focal ADS, both limited decompression/fusion and transforaminal endoscopic decompression are viable treatment options. Advanced transforaminal endoscopic techniques enable effective decompression of the symptomatic foramen with minimal complication risk and negligible deformity progression, even in cases of significant scoliosis. While limited fusion surgery can achieve comparable clinical outcomes, it offers inferior deformity correction.

Impact of Lumbar Fusion Internal Fixation on Lumbar Disc Herniation in Young Patients: A Retrospective Study.

BACKGROUND Lumbar fusion and internal fixation techniques have shown promise in treating lumbar disc herniation (LDH), yet the impact on lumbar function in young patients remains unclear. This study aimed to investigate the impact of lumbar fusion on lumbar function in young patients. MATERIAL AND METHODS A retrospective analysis was conducted on 330 patients diagnosed with LDH admitted to our hospital. Patients were divided into 2 groups: a control group (n=264) that underwent a minimally invasive procedure with a keyhole lens, and a research group (n=66) that underwent lumbar fusion internal fixation. Clinical features and therapeutic outcomes were assessed using Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) Lumbar Scores before surgery and 12 months postoperatively. Additionally, intervertebral space height, degree of vertebral spondylolisthesis (grades I, II, and III), incidence of adverse effects, and treatment efficacy were measured pre-and post-surgically. RESULTS No significant difference in ODI and JOA scores was found between the groups before surgery (P>0.05). Postoperatively, the research group had lower ODI scores, higher JOA scores, and lower intervertebral space heights compared to the control group (P=0.001). While grade 1 and 2 spondylolisthesis showed slight improvement (P>0.05), a significant difference was observed in grade III spondylolisthesis between the 2 groups (P=0.001). Additionally, the research group had a lower incidence of adverse effects (P=0.049) and higher treatment efficacy, although the difference was not statistically significant (P>0.05). CONCLUSIONS Lumbar fusion with internal fixation produced better postoperative outcomes and fewer adverse effects than minimally invasive procedures in young patients with lumbar disc herniation.

Minimally-invasive trans-facet lumbar interbody fusion using a dual-dimension expandable cage: preliminary results of a multi-institutional retrospective study.

Minimally-invasive trans-facet lumbar interbody fusion (LIF) is an emerging technique that offers the advantages of being safe, enabling decompression, and facilitating patient recovery. An innovative cage that expands in two dimensions has been introduced to restore segmental lordosis and disc height while minimizing the risk of cage subsidence. This study aimed to report our surgical technique of trans-facet LIF utilizing the innovative cag and to report the early clinical outcomes. We retrospectively reviewed the medical records and radiographs of patients who underwent trans-facet LIF with dual-dimension expandable cages from two institutions: Duke University Hospital and Vail-Summit Orthopaedics and Neurosurgery. The analysis covered patient demographics, Oswestry Disability Index (ODI), visual analogue scale (VAS) for back pain, surgical data, complications, and radiographic parameters. Clinical outcomes were compared between pre- and one year post-operation, while radiographic outcomes were compared between pre- and three months post-operation. Twenty patients with a mean age of 61.2 years were included. Seventeen patients (85.0%) had spondylolisthesis, and L4/5 (68.2%) was the most common pathology level. Twelve patients (60.0%) underwent awake surgery, and the mean operative time was 164.5±36.1 minutes, with an estimated blood loss of 64.0±39.5 mL and a hospital stay of 1.75±1.2 days. Four patients (20.0%) experienced cage subsidence; however, none required additional surgery. The VAS score significantly improved from a preoperative average of 7.3±2.7 to 2.6±1.6 one year post-operation (P=0.02). The ODI score also showed a significant decrease, from 48.7±22.9 preoperatively to 16.4±11.1 one year postoperatively (P=0.03). Notably, 80% and 83.3% of patients achieved the minimum clinically important difference in VAS and ODI scores, respectively. The degree of spondylolisthesis was significantly reduced from a median of 5.9 mm preoperatively to 0 mm postoperatively (P<0.001). Additionally, both anterior and posterior disc heights significantly increased after surgery, from 9.8±4.7 to 15.1±2.6 mm (anterior) and from 4.9±3.3 to 10.5±2.2 mm (posterior) (P<0.001 for both). The mean segmental lordosis increased by 2.9 degrees and was associated with cage height (P=0.03), while spinopelvic parameters remained unchanged. Minimally-invasive trans-facet LIF with dual-dimension expandable cages demonstrates a substantial capacity for spondylolisthesis reduction and disc height restoration, and provides good short-term clinical outcomes. It may be the most appropriate method for deploying this large cage as it allows for a large, unobstructed pathway to the disc. However, future studies are needed to determine the long-term outcomes, including the arthrodesis rate.

Comparison of two surgical approaches in treating children with thoracolumbar junction tuberculosis: a multicenter study

ObjectivesWe conducted a multicenter retrospective analysis to compare the clinical outcomes and complications associated with the posterior-anterior and posterior-only approaches in treating Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children aged 3–10 years.MethodsHerein, 52 TLJ TB patients (age range = 3–10 years; mean age = 6.8 ± 2.2 years; females = 22; males = 30) treated with debridement, fusion, and instrumentation were recruited from two hospitals in China between May 2008 and February 2022, and their clinical data were reviewed retrospectively. Among them, 24 group A patients and 28 group B patients underwent the posterior-anterior and posterior-only approaches, respectively. The two groups were assessed for surgical time, blood loss, hospitalization duration, operative complications, inflammatory indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, kyphosis angles, and neurologic functions. Results or differences with P < 0.05 were considered statistically significant.ResultsThe average follow-up period was 37.5 ± 23.3 months. Compared to group A patients, group B patients exhibited significantly lower surgical time, blood loss amount, time it took to stand, and hospitalization duration, as well as fewer complications. Notably, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values of patients in both groups returned to normal one year post-surgery. Furthermore, compared to the preoperative values, patients’ VAS and ODI scores, as well as neurological functions and kyphosis angles, were significantly improved postoperatively and at the final follow-up, but with no statistically significant differences between the two groups. Moreover, there was no internal fixation failure or TB recurrence, and all patients exhibited solid bone fusion at the last follow-up.ConclusionFor pediatric TLJ TB involving no or at most two segments, both posterior-anterior and posterior-only approaches could effectively remove lesions and decompress the spinal cord, restore spinal stability, correct kyphosis, and prevent deformity deterioration. Nonetheless, the posterior-only approach can more effectively shorten the surgical time, reduce related trauma and complications, and promote rapid recovery, making it a safer and highly preferable minimally invasive approach.

Clinical effect of posterior-only approach debridement, intervertebral fusion, and internal fixation for upper thoracic tuberculosis.

This study aimed to evaluate the effectiveness and feasibility of the posterior-only approach for debridement, interbody fusion, and internal fixation in treating upper thoracic tuberculosis. This study retrospectively analysed the clinical and radiographic data of 8 patients diagnosed with upper thoracic tuberculosis. All patients underwent posterior approach debridement, interbody fusion, and internal fixation. We conducted pre- and postoperative assessments of the visual analog scale (VAS), Oswestry disability index (ODI) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA score, and kyphotic Cobb angle. Back pain and lower limb weakness were the most common presenting symptoms. The mean duration of surgery, amount of blood loss, and volume of postoperative drainage were 262.5 ± 43.3 min, 625.0 ± 333.8 mL, and 285.0 ± 118.1 mL, respectively. Patients were followed up for 36 to 48 months. Three months after surgery, there was a significant improvement in VAS and ODI scores, which further improved until the final follow-up. A statistically significant difference was observed between the preoperative and postoperative periods (P < .05). At the final follow-up, lower extremity function had fully returned to normal in all 5 paralyzed patients. The ESR and CRP returned to normal, 18.1 ± 7.3 mm/h and 9.95 ± 5.41 mg/L, respectively, within 3 months postoperatively. There were statistical differences between the preoperative and postoperative periods (P < .05). The average kyphotic correction rate was (71.5 ± 7.3)%, and the average loss of correction angle was (3.5 ± 1.4)°. Intervertebral bone fusion was achieved by all patients within 15 months (mean 8.3 ± 3.2 months) postoperatively. The posterior-only approach seems an effective, safe, and reliable treatment method for upper thoracic tuberculosis, with favourable clinical and radiological outcomes. Level IV, Therapeutic study.

Lumbar fusion efficacy with local bone grafting and platelet-rich plasma: a clinical investigation in treating degenerative lumbar spinal stenosis in the elderly.

The focus of this study was to comprehensively assess the clinical outcomes of lumbar fusion utilizing autogenous bone grafting and platelet-rich plasma (PRP) for the management of degenerative lumbar spinal stenosis (DLSS) in elderly individuals. A cohort of 40 senior individuals diagnosed with DLSS, who underwent treatment at our hospital between January 2020 and March 2022. The control group consisted of 20 participants who underwent local bone grafting for intervertebral fusion, while the observation group comprised 20 individuals who received a combination of local bone grafting and PRP for lumbar fusion. MRI imaging was employed for a comprehensive assessment of spinal structure. The efficacy of spinal fusion was evaluated through MRI imaging. Clinical treatment outcomes were assessed using the Japanese Orthopaedic Association (JOA) and Oswestry Disability Index (ODI) scoring systems. Postoperative low back pain was quantified using a Visual Analog Scale (VAS). During the final follow-up, the observation group demonstrated a significant increase in the inner diameter of the spinal canal and the height of the disc space compared to the control group (P < 0.05).Moreover, the observation group displayed a larger spinal canal than the control group (P < 0.05).A reduced lesion score in the bone grafting region was observed in the observation group compared to the control group during the final follow-up (P < 0.05). Furthermore, the observation group displayed a higher intervertebral fusion continuity score than the control group (P < 0.05).The JOA score in the observation group was significantly higher than in the control group (P < 0.05), while the ODI score was significantly lower (P < 0.05). Of note, the back pain VAS score in the observation group was lower than in the control group at both the three months post-surgery mark and the final follow-up (P < 0.05).The satisfaction rate and overall satisfaction rate in the observation group were significantly higher than those in the control group (P < 0.05), while the dissatisfaction rate in the observation group was evidently lower than in the control group (P < 0.05). In the management of DLSS in elderly individuals, the utilization of local bone grafting and PRP in lumbar spinal fusion yields notable outcomes.

Comparison of the Effectiveness of Traditional Motorized Traction and Non-surgical Spinal Decompression Therapy Added to Conventional Physiotherapy for Treatment of Chronic Low Back Pain.

There are a limited number of studies comparing traditional motorized traction and non-surgical spinal decompression with other treatment options such as conventional motor traction in the treatment of low back pain caused by lumbar discopathy. This retrospective study aimed to compare the effectiveness of these treatments. The retrospective data of patients diagnosed with lumbar discopathy who underwent physical therapy in our clinic were reviewed. Demographic data, duration of their symptoms, physical examination findings, lumbosacral magnetic resonance imaging (MRI) reports, method and duration of treatment, and visual analog scale (VAS) and Oswestry Disability Index (ODI) results were recorded. A total of 160 patients met the inclusion criteria. Their mean age was 44.6±12.4 (range 21-65) years, 57.5% (n=92) were female, and 42.5% (n=68) were male. There were no differences between the conventional physiotherapy, motorized traction, and spinal decompression groups in terms of age, duration of symptoms, and the number of sessions (p>0.05). In all three groups, the mean scores of VAS and ODI were significantly decreased in the pre-and post-treatment comparisons (p<0.005). The rates of change in VAS and ODI were higher in the traction group and spinal decompression group compared to the conventional treatment (p<0.005). In patients with subacute and chronic lumbardiscopathies, motorized traction and spinal decompression treatments added to conventional treatment were found to be more effective than conventional treatment alone. The results of spinal decompression and conventional motorized traction treatments appear to be similar.