Back Pain VAS Score Research Articles

MINIMALLY INVASIVE SPINE SURGERY FOR POST-TRAUMATIC KYPHOSIS: A SYSTEMIC LITERATURE REVIEW AND RETROSPECTIVE CASE ANALYSIS

Study Design: Retrospective case analysis and systematic literature review. Objective: To comprehensively review minimally invasive surgery (MIS) for post-traumatic kyphosis. Methods: A systematic PubMed search was conducted for MIS and kyphotic deformities were published between 2012 and 2022. Sixteen patients between 2017 and 2021 met the criteria. Demographic data, surgical characteristics, and full-length radiographic parameters were collected pre- and post-operatively, and at final follow-up. Results: Twenty-three articles were included. The mean age was 67 years, and the mean follow-up was 17 months. The mean operative time was 331 min and blood loss was 252 ml. Pre-operative radiographic outcomes were as follows: Lumbar lordosis (LL), 16.84± 26.40[Formula: see text]; pelvic incidence (PI), 48.95± 14.34[Formula: see text]; PI-LL mismatch, 32.11± 31.92[Formula: see text]; pelvic tilt (PT), 32.74± 10.41[Formula: see text]; and sagittal vertical axis (SVA), 95.33± 59.62 mm. At the final follow-up, LL was 19.98± 16.16[Formula: see text] ([Formula: see text] = 0.51229), PI was 50.82± 10.19[Formula: see text] ([Formula: see text] = 0.61438), PI-LL mismatch was 30.84± 17.18[Formula: see text] ([Formula: see text] = 0.74696), PT was 27.14± 10.28[Formula: see text] ([Formula: see text] = 0.00386), and SVA was 49.73± 25.51 mm ( [Formula: see text] = 0.00465). The mean ODI and VAS scores for back pain at baseline and at 96 months follow-up were 33.2–19.7 and 8.4–2.5, respectively. Conclusion: Age-adjusted MIS provides correction of sagittal alignment for posttraumatic kyphosis that satisfies patient demand.

Functional Outcome of Open Conventional Discectomy of Patients with Prolapse Lumbar Intervertebral Disc – A Prospective Observational Study

Introduction: Low back pain is one of the most common complaints in clinical practice with life time prevalence ranging from 65-80%. The annual prevalence of low back pain ranges from 15% to 45% but is largely dependent on population. Major cause of low back pain leading to severe morbidity throughout the world affecting mainly the young population is lumbar disc prolapse. Prolapsed intervertebral disc is an important cause of spondylogenic backache. Conservative treatment is often preferred for LDH, but patients who fail to respond to this are treated with surgery. Surgical treatment aims to remove the herniated nucleus pulposus to the largest extent possible to relieve nerve compression while minimizing spinal instability. Aim of the Study: The aim of this study was to assess the functional Outcome of open conventional discectomy among patients with prolapse lumbar intervertebral disc or lumbar herniated disk. Methods: This was a prospective observational study and was conducted in the Department of Orthopaedics Surgery, Square Hospitals Ltd, Dhaka, Bangladesh during the period from January 2008 to December 2020. We included 300 patients with prolapse lumbar intervertebral disc undergoing open conventional discectomy in our study. Result: In our study we found majority (36%) of our patients was aged 41-50 years and most of our study patients were male (70%) compared to female (30%). We found the mean age was 44.73 ± 8.9 years. Among all patients 78% had lower lumber problem & 22% had upper lumber problem. Most of our patients (44.5%) had L4-L5 level, followed by 31.5% had L5-S1 level. We found the mean vas score for leg pain and back pain in preoperative period significantly reduced at postoperative 2nd week, 3rd month, 6th month and 1st year. The mean ODI score was 56.24 ± 4.18 in preoperative period. At postoperative 1st year follow up the mean score significantly reduced to 3.26 ± 2.64 in our study. Majority (37%) of our patients had good outcome, followed ....

Study of single-level lumbar degenerative diseases treated by unilateral wiltse access with unilateral nail rod fixation assisted by a new automatic retraction device

ObjectiveTo evaluate the clinical efficacy of unilateral wiltse transforaminal lumbar interbody fusion (TLIF) combined with unilateral nail bar system fixation for single-level lumbar degenerative diseases with the assistance of a new automatic retraction device in a retrospective comparative study.MethodsA total of 46 patients with single-level lumbar degenerative diseases from September 2019 to December 2021 were retrospectively analyzed. Bilateral nail bar fixation with bullet-type fusion cage (ctrl group, 24 patients) and unilateral nail bar fixation on the affected side with kidney-like fusion cage (study group, 22 patients) were performed in TLIF via wiltse intermuscular approach assisted by a new automatic retraction device. The differences in intraoperative blood loss, operative time, intraoperative fluoroscopy time, postoperative drainage, bed rest, VAS score, ODI score, JOA score, serological creatine kinase (CK), the proportion of multifidus atrophy, modified Pfirrmann classification and intervertebral space height of the upper intervertebral disc were compared between the two groups based on clinical and imaging data.ResultsIntraoperative bleeding, operative time, and postoperative drainage were significantly lower in study group than ctrl group, and there were no significant differences in bed rest time and intraoperative fluoroscopy time between them. In addition, there was no statistical difference in CK between the study group and the ctrl group at 24 and 48 h postoperatively. Moreover, no statistically significant difference was found in VAS score of low back pain, VAS score of lower limb pain, ODI index, modified Pfirrmann classification of the upper intervertebral disc and intervertebral space height of the upper intervertebral disc between two groups. The atrophy ratio of multifidus muscle was significantly lower in the study group.ConclusionThe new automatic retraction device assisted unilateral TLIF surgery with wiltse approach combined with unilateral nail bar fixation is a simple, effective and easy to master surgical method for single-level lumbar degenerative diseases.

Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation

This study aimed to evaluate the clinical outcomes of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) in the treatment of symptomatic lumbar disc herniation (LDH). From January 2020 and May 2021, 128 patients with single-level LDH at L4-5 or L5-S1 received FEFLD, UBE discectomy or MD. Patients were divided into three groups according to surgical method: the FEFLD group (n = 43), the UBE group (n = 42), and the MD group (n = 43). Operative time, fluoroscopy frequency, in-bed time, length of hospital stays, total expenses, complications, visual analogue scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among three groups. There were no significant differences in VAS or ODI scores at 12months after surgery among three groups. In comparison with the MD group, the FEFLD and UBE group yield better VAS scores for back pain on the first day following surgery (P < 0.05). The FEFLD group was superior to the UBE group or MD group with less time in bed and shorter hospital stay (P < 0.05). The operation time and total expenses in the UBE group were significantly longer and higher than those in the FEFLD group or MD group (P < 0.05). FEFLD and UBE discectomy yield comparable results to conventional MD concerning pain relief and functional outcomes. In addition, FEFLD and UBE discectomy enable less back pain in the immediate postoperative period. FEFLD offers advantages in rapid recovery. Conventional MD is still an efficient and cost-effective surgical procedure.

Surgical strategy and outcomes for thoracolumbar disc herniation with Autologous Bone-Fusion or Cage-Fusion surgery: case series and literature review

ABSTRACT To analyze the clinical characteristics and surgical outcomes of TLDH with Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH. This is a retrospective multi-center clinical study, involving a total of 43 patients with TLDH who underwent surgery in our institutions from December 2013 to January 2021. In all, 15 of 43 patients (34.9%) with T10-11(2)/T11-12(5)/T12-L1 (8) TLDH underwent Autologous Bone-Fusion surgery and 28 of 43 patients (65.1%) with T12-L1(3)/L1-L2(12)/L2-L3(13) TLDH underwent Cage-Fusion surgery. Demographic data, clinical characteristics and perioperative outcomes were recorded. During the follow-up, pre- to post-operative ODI, VAS back and leg pain scores significantly decreased (P1.2 = 0.001) and the score changes had no significant difference between two groups (P3 = 0.81, 0.59, 0.68). The intraoperative blood loss and operation time showed no significant difference between two groups (P = 0.056, 0.072). The patients showed prominent improvement of hypokinesia and satisfactory rate in two groups (5/7, 71.4% VS 9/12, 75.0%, P = 0.633; 11, 73.3% VS 25, 89.3%, P = 0.281). Notably, no recurrence and severe complications were reported. The choice of surgery approach should be individualized by clinical characteristics and radiology. Selectively Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH provided adequate nerve decompression and immediate stability. The overall fusion surgical outcomes were satisfactory without major complications during follow-up.

Low Back Pain, Disability, and Quality of Life One Year following Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate.

Degenerative disc disease is a common cause of chronic low back pain. Surgical intervention is an invasive treatment associated with high costs. There is growing interest in regenerative medicine as a less invasive but direct disc treatment for chronic discogenic low back pain. To evaluate clinical improvement of primary discogenic low back pain with intradiscal injection of autologous bone marrow aspirate concentrate (BMAC). Study Design. Prospective cohort study. Setting. Single, multiphysician center. Patients. 32 adult patients undergoing intradiscal injection of autologous BMAC for the treatment of primary discogenic low back pain. Interventions. Intradiscal injection of autologous BMAC. Main Outcome Measures. Primary outcome measure is visual analog back pain scale (VAS back pain). Secondary outcome measures include ODI, VAS leg pain, and EQ-5D-5L scores. Outcomes were compared from baseline to 1 year. Thirty-two patients (56.3% male) with a mean age of 45.9 years were enrolled, giving 92 treated levels. Mean VAS back and leg pain scores improved from 5.4 to 3.0 (p < 0.001) and 2.8 to 1.3 (p = 0.005), respectively. Mean ODI scores decreased from 33.5 to 21.1 (p < 0.001), and EQ-5D-5L scores improved from 0.69 to 0.78 (p = 0.001). Using established MCID values, 59.4% had clinically significant improvement in VAS back pain, 43.8% in VAS leg pain, and 56.3% in ODI scores. Intradiscal injection of autologous BMAC significantly improved low back pain, disability, and quality of life at one year. This study suggests that intradiscal BMAC has the potential to be an effective nonsurgical treatment for chronic discogenic low back pain.

Percutaneous fully endoscopic surgical management of the ruptured epidural catheter: Rescue of the novice anesthesiologist from his dilemma.

BackgroundEpidural nerve block and analgesia are basic anesthetic techniques for anesthesia. Epidural catheter rupture and partial retention are adverse events and rare complications of epidural catheterization technique. The probability of occurrence when applied by novice doctors is high. Removal of the residual catheter by conventional surgery causes more trauma and bleeding, slows recovery, and may causes medical disputes. We hypothesized that percutaneous spinal endoscopy a safe and effective remediation technique. This study was to analyze the efficacy and safety of removing the residual dural catheter by a percutaneous full-endoscopic technique(PFET) and discuss the clinical technique and precautions.MethodsThis was a retrospective analysis of 7 patients with ruptured epidural catheters treated in our department from October 2015 to October 2019 using the PFET to remove the remaining epidural catheter. The operation time, intraoperative bleeding volume, surgical complications, and neurological symptoms before and after surgery were recorded. The Self-Rating Anxiety Scale (SAS) was used to assess the anxiety level of the anesthesiologist and the patient before and after the catheter removal operation, and the postoperative low back pain VAS score was recorded.ResultsThe remaining epidural catheter was successfully removed from all 7 patients. The operation time was 54.14 ± 14.45 (32–78) minutes, and the intraoperative blood loss was 9.134 ± 3.078 (5–15) ml. There were no cases of dural damage, cerebrospinal fluid leakage, sensorimotor dysfunction of the lower limbs, or bowel dysfunction. The anxiety symptoms of the patient and the anesthesiologist disappeared after removal of the residual epidural catheter. The patients' postoperative back pain VAS score was 0 to 2 points.ConclusionPFET is a safe and effective minimally invasive technique for removing residual epidural catheters. It causes less trauma and less bleeding, allows a faster recovery. It does not affect the recovery of patients from other surgical operations and reduces both medical risks and medical costs. At the same time, it avoids or reduces the occurrence of medical disputes and eliminates the pressure on novice anesthesiologists regarding similar adverse events.

Analysis of curative effect of percutaneous coaxial large channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis.

ObjectiveTo investigate the clinical efficacy and technical points of Percutaneous Coaxial Large-channel Endoscopic Lumbar Interbody Fusion (PCLE-LIF) in the treatment of degenerative lumbar spinal stenosis.MethodsThe clinical data of patients with single-segment degenerative lumbar spinal stenosis who underwent PCLE-LIF surgery from January 2019 to June 2021 were retrospectively analyzed. Surgery-related data included symptom duration, operation time, hospital stay, and complication rate. Functional score data included low back pain and lower extremity pain VAS score, ODI score, and MacNab criteria were used to evaluate clinical effects. The Brantigan criteria were used to evaluate the interbody fusion.ResultsThere were 62 patients in this group, including 35 males and 27 females. The surgical sites were all lower lumbar spine, including 35 cases of lumbar L4/5 and 27 cases of L5/S1. The length of hospital stay was 7.7 ± 1.4 days. All patients were followed up regularly for 1 year. The interbody fusion rate was 93.5% at 1 year after operation. There were 2 cases of numbness, 2 cases of nerve edema and pain, 1 case of cage displacement, and 1 case of pedicle screw loosening. The complication rate was 9.6%. The VAS scores of low back pain 1 day before surgery, 3 days, 3 months and 1 year after surgery were 4.48 ± 1.06, 0.84 ± 0.81, 0.40 ± 0.56, 0.39 ± 0.69, and the VAS of lower extremity pain at each time point of appeal were 5.58 ± 0.98, 0.91 ± 0.58, 0.31 ± 0.46, 0.19 ± 0.40. The ODI scores at 1 day before surgery, 3 months and 1 year after surgery were 60.01 ± 6.21, 15.58 ± 2.84, 8.82 ± 2.15. The ODI scores and VAS scores of low back pain and lower extremity pain at each follow-up time point after operation were significantly lower than those before operation (p < 0.05). The 1-year follow-up after operation was evaluated by the modified MacNab standard, and the results were excellent in 36 cases, good in 23 cases, fair in 3 cases, and poor in 0 cases, with an excellent and good rate of 95.2%.ConclusionPercutaneous coaxial large-channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis has good short-term efficacy and high safety, and is worthy of popularization.

Comparison of short-term efficacy of MIS-TLIF and Endo-LIF in the treatment of single-segment degenerative lumbar diseases.

BackgroundA prospective controlled study was conducted to compare the short-term clinical results and postoperative complications of minimally invasive transforaminal lumbar decompression and fusion (minimally invasive surgery transforaminal lumbar interbody fusion, MIS-TLIF) and percutaneous endoscope-assisted transforaminal lumbar interbody fusion (endoscopic lumbar interbody fusion, Endo-LIF) in the treatment of single-segment degenerative lumbar diseases, to provide some scientific guidance for clinicians to select surgical treatment for patients with lumbar degeneration.MethodsFrom October 2020 to October 2021, a total of 62 patients were enrolled, with 31 patients in the MIS-TLIF group and 31 patients in the Endo-LIF group. All patients were followed up for 6 months. The following information from the two groups of patients was recorded: (1) operation time, radiation exposure time, intraoperative blood loss, bed rest time, and hospital stay; (2) ODI score (The Oswestry Disability Index), low back pain VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores) 1 day before the operation; 1, 3, 6 days after operation; and 1, 3 and 6 months after operation. (3) X-ray evaluations of lumbar fusion at the last follow-up.ResultsThere were significant differences in operation time, intraoperative fluoroscopy time, and hospitalization cost between the two groups. The MIS-TLIF group was significantly better than the Endo-LIF group, and the intraoperative bleeding volume of the Endo-LIF group was significantly better than that of the MIS-TLIF group, but there was no significant difference in postoperative bed rest time and postoperative hospital stay. There was no significant difference in the scores of ODI, VAS, and JOA between the two groups before and after the operation. At the last follow-up, the fusion rate was 100% in the MIS-TLIF group and 100% in the Endo-LIF group.ConclusionsThere was no significant difference in short-term clinical efficacy and safety between Endo-LIF and MIS-TLIF in the treatment of single-segment degenerative lumbar diseases, but MIS-TLIF was significantly better than Endo-LIF in terms of the operation time, hospitalization cost, and fluoroscopy time, and Endo-LIF was significantly better than MIS-TLIF in terms of intraoperative blood loss.

77. Preoperative risk factors for patient nonsatisfaction after instrumented lumbar interbody fusion: a longitudinal study of the National Danish Spine Database, DaneSpine

<h3>BACKGROUND CONTEXT</h3> Patients with severe axial low back pain represent a challenge to spine surgeons as the surgical indications are not clear. The primary surgical treatment option consists of instrumented interbody fusion. Previous studies have found high rates of patient nonsatisfaction after instrumented lumbar fusion. Therefore, there is a need to identify patients at risk of an unsatisfactory outcome following this procedure. <h3>PURPOSE</h3> To assess preoperative clinical risk factors for patient nonsatisfaction after lumbar interbody fusion. <h3>STUDY DESIGN/SETTING</h3> This was a dual-center study over an eight-year period on patients without spondylolisthesis undergoing decompression with single-level fusion surgery with either posterior or transforaminal lumbar interbody fusion. <h3>PATIENT SAMPLE</h3> The cohort included 474 patients. <h3>OUTCOME MEASURES</h3> The primary outcome was patient-reported nonsatisfaction with treatment at two-year follow-up. We assessed the association between nonsatisfaction and preoperative variables such as pain intensity, disability (Oswestry Disability Index (ODI), duration of back pain, previous discectomy, and expectations regarding return to work after surgery. Additional patient demographics and pain profiles were also assessed. <h3>METHODS</h3> We analyzed prospectively collected pre- and postoperative data from the national Danish surgical spine database (DaneSpine). <h3>RESULTS</h3> The cohort included 474 patients of which 86 (18%) reported treatment nonsatisfaction. Preoperative data from the nonsatisfaction group demonstrated higher VAS scores for back pain (75±19 vs 68 ±21, p=0.006) and leg pain (65.3±25 vs. 58±28, p=0.004). Treatment nonsatisfaction was 13% for patients with preoperative VAS score 0-40, 15% for VAS 41-79 and 25% for VAS 80-100. There was no significant difference between the groups in terms of preoperative ODI score, age, body mass index, duration of back pain, walking distance or rate of preoperative sick leave (p>0.05). Also, there was no significant difference in terms of patient preoperative employment status or patient expectations on return to work after surgery (p>0.05). <h3>CONCLUSIONS</h3> Higher preoperative back and leg pain were risk factors for nonsatisfaction after lumbar interbody fusion. There was a substantial drop-off in satisfaction rate for patients who reported severe preoperative pain (VAS 80-100). Expectations in this patient group should be discussed preoperatively <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

158. Plasma cytokine biomarkers are predictive of chronic postsurgical pain following complex spine surgery

<h3>BACKGROUND CONTEXT</h3> Spine surgery in older adults is beneficial and often results in decreased pain. However, in a subset of older adults, surgical outcomes are less desirable, with up to 20% experiencing persistent postsurgical pain (>3 months). The physiological mechanisms underlying persistent postsurgical pain remain unclear. An emerging hypothesis focuses on the immune system's interplay with the nervous system wherein immune responses modulate the excitability of pain pathways, eventually driving chronic pain hypersensitivity. <h3>PURPOSE</h3> The aim of this study was to correlate immune activity with postoperative pain states by analyzing cytokine levels following complex spine surgery. <h3>STUDY DESIGN/SETTING</h3> Prospective, single-center cohort. <h3>PATIENT SAMPLE</h3> Fifteen patients undergoing complex spine surgery for adult spinal deformity were enrolled in this study. <h3>OUTCOME MEASURES</h3> Pearson correlation and linear regression models were used to assess the association between cytokine profile and patient reported pain outcomes at 3 months (VAS Back and PROMIS pain scores). <h3>METHODS</h3> Whole blood samples were collected at three timepoints: preoperatively, postoperative day 0 (POD0), then at postoperative day 3 (POD3). Plasma was isolated using Ficoll density centrifugation. Plasma IL-4, IL-6, IL-8, IL-10, IL-22, TNF-α; were measured using a Quanterix Multi-Plex cytokine assay. <h3>RESULTS</h3> Compared to baseline there was a 2.7-fold and 5-fold increase in IL-6 at POD0 and POD3, respectively (p<0.01). There were no statistically significant differences in other cytokines expression levels following surgery. On linear regression analysis, increase in IL-6 levels from baseline to POD3 were correlated with increased opioid utilization on POD3. At 3-months, cytokine expression levels in IL-6, IL-10 and TNF-α at POD0 were inversely correlated with 3-month VAS Back Pain scores and PROMIS scores. <h3>CONCLUSIONS</h3> Following spine surgery, patients exhibited a robust increase in IL-6, a pro-inflammatory cytokine. Patients with higher pain scores at 3-months postoperatively had a more blunted immune response immediately after surgery (POD0). Further biochemical and ex-vivo studies are needed to fully characterize immune response to surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Do all Isler's type sacral fractures necessarily require surgical fixation?

A unilateral vertical sacral fracture that exits medial or through the L5-S1 facet joint is considered to affect the lumbo-sacral integrity, and it is denoted as an indication for surgical fixation. However, no studies have analysed the outcomes after non-operative treatment of such injuries. A retrospective review of all sacral fractures treated over a five-year period was performed to identify patients with Isler's fractures. Demographic and surgical data, all pre-operative and follow-up images (AP radiographs, CT images), functional outcomes based on VAS, SF-12 and return to work were documented for all patients. The incidence of Isler's fractures was 18% (34/181). The mean age was 42.12 ± 16.3years. As per Isler's subtypes, fractures passed through L5-S1 joint in 13 (Type 2a) and medial to it in 15 (Type 2b), fractures of L5 or S1 facets in 3 (Type 1), Type 3 injuries were not detected. All patients had concomitant pelvic ring injuries. Sixteen fractures (neurologically intact, < 1cm displacement, anterior ring stable, no facetal dislocation) were treated non-operatively while 18 patients underwent surgery. At a mean of 15.2months, the fractures had united in all patients radiographically. The mean VAS score for low back pain (1.4 ± 1.01 vs 1.5 ± 0.79), ability to squat and sit cross-legged (56.3% vs 55.6%) and return to work (68.8% vs 66.7%), and Majeed score (77.2 ± 3.9 vs 79.6 ± 4.1) were similar in non-surgical and surgical groups, respectively, at the final follow-up. Our study indicates that 47% of Isler's fractures were mechanically stable and could be effectively treated non-operatively with good radiological and functional outcomes.

Comparison of pain and discomfort in supine and lateral positions after surgery for lumbar degenerative disease: A prospective randomized controlled study

IntroductionTo compare postoperative pain and discomfort between supine and lateral positions after lumbar surgery, a prospective randomized controlled study was performed. MethodsForty-three patients with lumbar degenerative disease, treated by decompression (n = 23) or fusion surgery (n = 20), were randomly assigned to be placed in either the supine (supine group: n = 21) or lateral (lateral group: n = 22) position postoperatively, and asked to maintain their position until a day after the surgery. Postoperative back pain and discomfort (visual analog scale [VAS], 0–100 mm) and the number of patients who could maintain their position were examined. ResultsThe VAS scores for back pain (supine: 64.9 ± 22.0, lateral: 55.7 ± 21.4) showed no significant difference between the positions. However, the supine group showed significantly more severe discomfort (75.6 ± 15.7) than the lateral group (64.9 ± 15.7, p = 0.039). Significantly fewer patients maintained their position in the supine group (28.2%) than in the lateral group (68.2%; p = 0.022). Among patients who underwent fusion surgery, significantly fewer patients maintained their position in the supine group (10.0%) than those in the lateral group (60.0%, p = 0.029). ConclusionPostoperative discomfort was significantly reduced in the lateral position than in the supine position; thus, the lateral position is more suitable after lumbar surgery in terms of postoperative discomfort.

A Simple New Cost-Effective Retractor System for Exposure in Lumbar Microdiscectomy: 1-Year Outcome Analysis

To introduce a new technique for retraction in lumbar microdiscectomy, the rubber band technique (RT), and compare 1-year clinical outcomes of the technique with standard microdiscectomy (SM). In this retrospective analysis, 81 consecutive patients with single-level lumbar disc herniation underwent lumbar microdiscectomy by either RT or SM. The primary outcome was Oswestry Disability Index score 1 year after surgery. Secondary outcomes included Short-Form Health Survey (SF-36) physical functioning subscale score, SF-36 bodily pain subscale score, and visual analog scale back pain and leg pain scores. Other parameters were operative time, hospital stay, skin incision, complications, and redo surgery. Of 81 patients, 93% (76 patients) had complete data up to 1-year follow up. The RT group comprised 39 patients (20 males, 19 females), and the SM group comprised 37 patients (19 males 18 females). Primary and secondary outcomes Oswestry Disability Index score, SF-36 physical functioning score, SF-36 bodily pain score, VAS back and leg pain scores, complications, and redo surgery did not differ significantly between the treatment groups at follow-up points (P > 0.05). Skin incision was smaller in the RT group compared with the SM group (P= 0.0001). Over the 1-year follow-up period, clinical outcomes of patients treated with RT were comparable to patients treated with SM. RT appears to be an alternative safe, effective, and economical approach for lumbar microdiscectomy.

Assessment of outcome of posterior dynamic stabilization system in degenerative lumbar disease

Background: Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world. The present study was conducted to assess outcome of posterior dynamic stabilization system in degenerative lumbar diseases. Materials &amp; Methods: 78 patients of degenerative lumbar diseases of both genders were divided into 2 groups of 39 each. Group I patients underwent decompression and implantation of Dynesys and group II patients underwent PLIF. ODI, VAS scores for back pain and leg pain, operation time, blood loss, and complications were compared in both groups. Results: There were 25 males and 14 females in group I and 20 males and 19 females in group II. The operative time (min) was 136.2 in group I and 172.4 in group II. Blood loss (ml) was 362.4 in group I and 438.2 in group II. Complications were dural tear seen 2 in group II, wound infection was seen in 1 in group II, screw loosening was 1 in group I and 2 in group II and back &amp; leg pain seen 3 in group I and 4 in group II. The mean ODI was 32.5 and 38.5, VAS back pain was 2.6 and 3.12.

Correlation between the pre-and post-operative sagittal parameters and the quality of life in patients with degenerative and isthmic spondylolisthesis

Objective: To assess the relationship between health-related quality of life (HRQOL) and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery, and to provide a biomechanical basis for improving the clinical prognosis of such patients. Methods: A retrospective analysis of 63 patients with lumbar spondylolisthesis who received lumbar fusion surgery in the Department of Spine Surgery, Tianjin Union Medical Center from December 2017 to June 2020 was carried out. There were 16 males and 47 females with a mean age of (59±8) years. Subgroup analyses were conducted based on disease type (degenerative lumbar spondylolisthesis (DS) and the isthmic spondylolisthesis (IS)) and HRQOL scores. Patients were evaluated post-operatively to observe the improvement of symptoms and quality of life. The relationship between operative related factors, HRQOL scores before and after surgery, and spino-pelvic sagittal parameters (including sagittal axis of the spine, lumbar lordosis angle, pelvic incidence angle, pelvic tilt angle (PT), sacral tilt angle, matching degree of pelvic incidence angle (PI) and lumbar lordosis angle (LL), lumbar 1 vertebra plumb line, upper lumbar curve, lower lumbar curve) in the two groups were analyzed. The correlation between the improvement of HRQOL scores and spino-pelvic sagittal parameters in the DS group and the IS group was analyzed and compared. Results: There were significant differences between postoperative HRQOL scores compared with those before the operation in both the DS and IS groups at three times of follow-up after the operation (all P<0.05). There was no difference in the last HRQOL score, the number of surgical segments, operation time and intraoperative blood loss between the two groups (all P>0.05). The parameters of PT and PI-LL in DS patients with VAS back pain score>3 and ≤3 were statistically different (13.7°±6.4° vs 26.6°±7.4°, 5.1°±8.2° vs 18.2°±13.1°, respectively, both P<0.05), similar results were obtained in IS patients (14.1°±6.9° vs 16.4°±8.7°, 2.9°±9.7° vs 6.8°±9.8°, respectively, both P<0.05). In addition, the parameters of PT and PI-LL between patients with ODI>20 and ≤20 were all statistically different in the two groups at the last follow-up after surgery (all P<0.05). The improvement of VAS back pain score in DS and IS groups was significantly related to the improvement of PT value, respectively (r=0.76, 0.78, both P<0.05). The PT, LL and PI-LL were significantly correlated with the ODI in the DS group (r=0.60, 0.62, 0.50, all P<0.05). There was also a correlation between the improvement of ODI and PT, LL and PI-LL in the IS group, respectively (r=0.22, 0.41, 0.76, all P<0.05). Conclusions: Certain correlation exists between the HRQOL and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery. For the treatment of lumbar spondylolisthesis and improvement of quality of life, the primary goal is to reconstruct the matching degree of the lumbar lordosis angle and PI, and to reduce the PT value to the normal range by tilting the pelvis forward.

Limited Discectomy for single level lumbar disc herniation: a retrospective study in a tertiary level hospital

Objective: To perform retrospective analysis of 1000 patients who underwent open limited discectomy (OLD) for single level lumbar disc herniation (LDH) and to assess the long- term clinical outcomes. Methods: 745 men and 255 women, with mean age of 38.03 ± 9.14 years (range 19- 55 years) who had primary LDH at L4-5 (n=640), L5-S1 (n=352), and L3-4 (n=8); underwent OLD were reviewed. Records were obtained regarding their demographic data, the side and level of disc herniation, operating time period, intraoperative blood loss, hospital stay, and perioperative complications. VAS score was measured before and after operation, for the assessment of low back pain (LBP) and radicular pain. Comprehensive outcome outcomes were measured postoperatively with the modified Macnab criteria and the Oswestry Disability Index (ODI) score. Results: The mean follows up was 24.5 (range 24-70) months. Significant improvement of mean VAS score for back and leg pain was achieved. At the two years follow-up, results were excellent in 525 (52.50%), good in 325 (32.50%), fair in 140 (14.00%) and poor in 10 (1.00%). Complications found were reherniation (n=52), discitis (n=19), superficial wound infection (n=7), dural tear (n=7) and foot drop (n=2). Conclusion: Open limited discectomy following fenestration or laminotomy is a safe and effective procedure and achieved favorable long-term outcome (e.g., low rate of recurrent LBP) and excellent patients’ satisfaction. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 37-44

A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures.

Objective Current findings suggest that percutaneous vertebroplasty (PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). However, a significant minority of patients still experience residual back pain after PVP. The present retrospective study was designed to determine the risk factors for residual back pain after PVP and provides a nomogram for predicting the residual back pain after PVP. Methods We retrospectively reviewed the medical records of patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into group N and group R according to the postoperative VAS score. Group R is described as the VAS score of residual back pain ≥ 4. Pre- and postoperative factors that may affect back pain relief were evaluated between two groups. Univariate and multivariate logistic regression analysis were performed to identify risk factors affecting residual back pain after PVP. We provided a nomogram for predicting the residual back pain and used the receiver operating characteristic curve (ROC), concordance index (C-index), calibration curve, and decision curve analyses (DCA) to evaluate the prognostic performance. Results Among 268 patients treated with PVP, 37 (13.81%) patients were classified postoperative residual back pain. The results of the multivariate logistical regression analysis showed that the presence of an intravertebral vacuum cleft (IVC) (OR 3.790, P=0.026), posterior fascia oedema (OR 3.965, P=0.022), severe paraspinal muscle degeneration (OR 5.804, P=0.01; OR 13.767, P < 0.001), and blocky cement distribution (OR 2.225, P=0.041) were independent risk factors for residual back pain after PVP. The AUC value was 0.780, suggesting that the predictive ability was excellent. The prediction nomogram presented good discrimination, with a C-index of 0.774 (0.696∼0.852) and was validated to be 0.752 through bootstrapping validation. The calibration curve of the nomogram demonstrated a good consistency between the probabilities predicted by the nomogram and the actual probabilities. The nomogram showed net benefits in the range from 0.06 to 0.66 in DCA. Conclusions The presence of IVC, posterior fascia oedema, blocky cement distribution, and severe paraspinal muscle degeneration were significant risk factors for residual back pain after PVP for OVCFs. Patients with OVCFs after PVP who have these risk factors should be carefully monitored for the possible development of residual back pain. We provide a nomogram for predicting the residual back pain after PVP.

Direct Lateral Corpectomy and Reconstruction Using an Expandable Cage Improves Local Kyphosis but Not Global Sagittal Alignment.

Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal alignment after anterior and posterior spinal fixation (APSF) using an expandable cage in elderly OVF patients. This retrospective multicenter review assessed 54 consecutive patients who underwent APSF for OVF. Clinical outcomes were compared between postoperative sagittal vertical axis (SVA) > 95 mm and ≤95 mm groups to investigate the impact of malalignment. SVA improved by only 18.7 mm (from 111.8 mm to 93.1 mm). VAS score of back pain at final follow-up was significantly higher in patients with SVA > 95 mm than SVA ≤ 95 mm (42.4 vs. 22.6, p = 0.007). Adjacent vertebral fracture after surgery was significantly more frequent in the SVA > 95 mm (37% vs. 11%, p = 0.038). Multiple logistic regression showed significantly increased OR for developing adjacent vertebral fracture (OR = 4.76, 95% CI 1.10–20.58). APSF using the newly developed cage improves local kyphotic angle but not SVA. The main cause for the spinal malalignment after surgery was postoperative development of adjacent vertebral fractures.

P22. Recurrent CSF leak following repair of incidental durotomy in lumbar spinal stenosis surgery

P22. Recurrent CSF leak following repair of incidental durotomy in lumbar spinal stenosis surgery