VAS Index Research Articles

Expandable Intravertebral Titanium Implants for Thoracolumbar Burst Fractures Without Neurological Deficits

Objective: A thoracolumbar burst fracture (TLBF) is defined as the failure of the anterior and middle columns of the vertebra due to high-energy trauma, such as motor vehicle collisions and falls from heights. Debate has continued for decades regarding the standard treatment, especially for TLBFs without neurological deficits (TLBF-WONDs). The aim of this study was to understand the role of expandable intravertebral titanium implants (EITIs) in treating TLBF-WONDs.Methods: We included patients aged 18–65 years who presented at our hospital Emergency Department with severe back pain (visual analogue scale [VAS] score ≥ 8), were neurologically intact, were diagnosed with TLBF-WOND by either computed tomography or magnetic resonance imaging, underwent percutaneous bilateral transpedicular EITI implantation, and were followed-up for ≥12 months. Radiological and clinical outcomes were analyzed.Results: Thirty patients satisfied the study inclusion criteria, including 9 men and 21 women, with an average age of 48.2 years. Thirteen A3 and 17 A4 burst fractures were included. The mean duration of hospitalization was 3.3 days. The mean follow-up period was 4.4 years. All patients exhibited significant improvements in radiographical (anterior, middle, and posterior vertebral heights); vertebral kyphotic angle (p<0.001); and functional outcomes (VAS and Oswestry Disability Index scores, p<0.001). One case of cement leakage into the paraspinal muscle was observed; however, no major complications occurred.Conclusion: Percutaneous bilateral transpedicular EITI placement with cement augmentation under local anesthesia may be an effective strategy for the treatment of high-energy traumatic TLBFs with neurological integrity.

Safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in knee osteoarthritis: a randomized, triple-blind, placebo-controlled clinical trial

BackgroundKnee osteoarthritis causes pain and disability in many people worldwide, for which no definitive treatment has yet been proposed. In this study, we investigated the safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in patients with knee osteoarthritis.MethodsThis triple-blind, randomized clinical trial included patients suffering from bilateral knee osteoarthritis with grade 2 or 3. The knees of each patient were randomized to intervention and control. For the intervention knee, 5 cc of placental mesenchymal stromal cells-derived extracellular vesicles were injected, and for the control knee, 5 cc of normal saline was injected. The patients’ symptoms were evaluated before the intervention and 2 and 6 months after the intervention using VAS, WOMAC questionnaire, and Lequesne index. MRI was performed before the intervention and 6 months after the intervention to evaluate retropatellar and tibiofemoral cartilage volume, medial and lateral meniscal disintegrity, ACL injury, and effusion-synovitis.Results62 knees (31 patients) were enrolled in this study. There were 31 knees as intervention and 31 knees as control. Finally, the data of 58 knees (29 patients) were analyzed, including 28 women and 1 man. The mean age of the patients was 55.38 ± 6.07 years. No statistically significant difference was detected between the two groups in clinical outcomes (including VAS, WOMAC, and Lequesne scores) before treatment and 2 and 6 months after treatment. Also, no statistically significant difference was detected between the two groups in MRI findings before treatment and 6 months after treatment. No systemic complications or severe local reactions occurred in the patients.ConclusionA single intra-articular injection of placental mesenchymal stromal cells-derived extracellular vesicles (5 cc, 7 × 109 particles/cc) is safe, but does not improve clinical symptoms or MRI findings in knee osteoarthritis beyond placebo. The protocol of this study was approved on 11 May 2022 with registration number IRCT20210423051054N1.

ThP2.17 - Efficacy of Mesenchymal Stem Cells in the Treatment of Osteonecrosis of Femoral Head

Abstract Introduction Osteonecrosis of the femoral head (ONFH) has substantial morbidity and impacts patient populations worldwide. Mesenchymal stem cells (MSCs) are implicated for their potential in ONFH treatment. The objective of this study is to examine the effectiveness of MSC when compared to existing surgical options in the treatment of ONFH. Method A literature search is conducted through Pubmed, MedlineOvid, and Cochrane. The studies were selected using PRISMA and ROBVIS. Four randomised controlled trials and two preliminary studies with a total of 599 participants were included in the study. Results Progression to advanced stages of ONFH was reduced in bone marrow mesenchymal stem cells (BMMSC) applied in conjunction with core decompression (CD) when compared to CD alone (3.77% vs. 22.7%, p<0.05) and reduced femoral head collapse (28% vs. 72%). Improvement in Hip Harris Score (HHS) when compared to CD alone (31.85 vs. 19.72 control, p = 0.03) was also observed. The joint preservation rate of applying BMMSC in tantalum rod insertion with vascularized iliac grafting in end-stage ONFH patients was greater than that of vascularized iliac grafting alone (83.33% vs. 57% in stage IV patients) and associated with a better outcome (HHS 6.29±6.11 to 77.23±14.75). Improvement in WOMAC, VAS and Lequesne index was also observed when comparing CD with bone grafts and CD, bone grafts and BMMSC. Conclusion The use of MSC applications along with current surgeries has been shown to improve post-operative outcomes and progression to advanced ONFH stages in the treatment of ONFH compared to surgeries done alone.

Developing an 8-Week, Tele-Education Weight Control and Exercise Programme, and Evaluating Its Effects on Weight and Pain Reduction in Patients With Obesity and Knee Osteoarthritis: A Double-Blinded Randomised Clinical Trial.

Knee osteoarthritis (OA) is a leading cause of disability among the elderly and is often exacerbated by obesity. Research supports weight loss and exercise therapy as key strategies for managing knee OA-related disability. Concurrently, telemedicine is becoming a popular healthcare approach. This study aimed to develop and evaluate an 8-week tele-education programme's impact on weight control and knee OA outcomes. Participants with knee OA and obesity were included. Baseline data on pain (VAS index), physical activity (GPAQ questionnaire), and quality of life (EQ5D and KOOS questionnaires) were collected. Performance tests, including the 30-second Chair Stand test (30CST) and the Timed Up-and-Go test (TUG), were recorded. Participants were randomly divided into two groups: a control group receiving oral advice on diet and exercise, and an intervention group receiving educational videos on nutrition, lifestyle changes, physical activity, individualised exercises, and psychosocial support. Evaluations were repeated after 8weeks. Data from 25 of 30 participants were analysed. In the intervention group, body composition, waist, and abdominal circumference decreased significantly (p<0.05). The KOOS questionnaire showed significant improvements in pain, activity, and daily tasks (p=0.00). The EQ5D questionnaire and health satisfaction also showed positive results within the intervention group (p=0.00) and between groups (p=0.008). The pain index improved significantly within (p=0.00) and between groups (p=0.02). Functional test results were significant within the intervention group (p=0.00) and between groups (p=0.017 for 30CST and p=0.004 for TUG). An 8-week tele-education programme for weight control and exercise therapy in knee OA patients significantly improved body composition, quality of life, and functional performance. Given the costs of obesity and knee OA on both people and the health system, tele-education can be a cost-effective treatment strategy.

Combined Physiotherapy and Cognitive Behavioral Therapy for Functional Movement Disorders

Functional movement disorders (FMDs) are frequent and disabling neurological disorders with a substantial socioeconomic impact. Few randomized studies have analyzed the effectiveness of combined physiotherapy and psychotherapy in patients' quality of life. To assess the efficacy of multidisciplinary treatment (physiotherapy plus cognitive behavioral therapy) in FMDs. This was a parallel, rater-blinded, single-center, randomized clinical trial. Recruitment took place from June 2022 to April 2023, and follow-up visits were performed at months 3 and 5, concluding in October 2023. Participants were recruited from a national referral center for movement disorders: the Movement Disorders Unit from the Hospital Universitario Virgen Rocio in Seville, Spain. Patients had to be 18 years or older with a confirmed FMD diagnosis and capable of giving consent to participate. Patients who did not meet eligibility criteria or refused to participate were excluded. Any uncontrolled psychiatric disorder was considered an exclusion criterion. Patients were randomly assigned, in a ratio of 1:1 to multidisciplinary treatment (physiotherapy plus cognitive behavioral therapy), or a control intervention (psychological support intervention). Primary outcomes: between-group differences in changes from baseline to month 3 and month 5 in patients' quality of life (EQ-5D-5L score: EQ Index and EQ visual analog scale [EQ VAS]; and 36-Item Short-Form Survey Physical Component Summary [SF-36 PCS] and SF-36 Mental Component Summary [MCS]). Linear mixed models were applied, controlling by baseline severity and applying Bonferroni correction. Of 70 patients screened with an FMD, 40 were enrolled (mean [SD] age, 43.5 [12.8] years; age range, 18-66 years; 32 female [80%]; mean [SD] age at FMD onset, 38.4 [12.1] years), and 38 completed all the follow-up visits and were included in the analysis for primary outcomes. Multidisciplinary treatment improved SF-36 PCS with a mean between-group difference at 3 months of 4.23 points (95% CI, -0.9 to 9.4 points; P = .11) and a significant mean between-group difference at 5 months of 5.62 points (95% CI, 2.3-8.9 points; P < .001), after multiple-comparisons adjustment. There were no significant differences in other quality-of-life outcomes such as SF-36 MCS (mean between-group difference at 3 and 5 months: 0.72 points; 95% CI, -5.5 to 7.0 points; P = .82 and 0.69 points; 95% CI, 2.3-8.9 points; P = .83, respectively), EQ VAS (9.34 points; 95% CI, -0.6 to 19.3 points; P = .07 and 13.7 points; 95% CI, -1.7 to 29.0 points; P = .09, respectively) and EQ Index (0.001 point; 95% CI, -0.1 to 0.1 point; P = .98 and 0.08 points; 95% CI, 0-0.2 points; P = .13, respectively). At months 3 and 5, 42% and 47% of patients, respectively, in the multidisciplinary group reported improved health using the EQ-5D system, compared with 26% and 16% of patients, respectively, in the control group. Results show that multidisciplinary treatment (physiotherapy plus cognitive behavioral therapy) effectively improves FMD symptoms and physical aspects of patients' quality of life. Further studies must be performed to evaluate the potential cost-effectiveness of this approach in FMD. ClinicalTrials.gov Identifier: NCT05634486.

A method of treating discoloration in persons associated with exposure to harmful industrial factors

INTRODUCTION. The search for the optimal bleaching method that minimizes the side effects of bleaching and prolongs the result of bleaching is an urgent task of dentistry.AIM. To study the effectiveness of the method of treating discoloritis in people exposed to harmful industrial factors.MATERIALS AND METHODS. 40 somatically healthy patients aged 23 to 45 years old, working at the plant, with harmful production factors, were identified. Of these, 22 were women and 18 were men who had teeth whitening. Tooth shade was determined using the VITA SYSTEM 3D-MASTER® scale before, after, 14 days, 3, 6, 12 months after bleaching.RESULTS. Examination of patients before the procedure of professional teeth whitening revealed the absence of hyperesthesia in all subjects (100 %), immediately after bleaching, the appearance of hypersensitivity in all patients was noted, based on clinical examination data and dynamics of the values of the IIGZ, IRGZ, Schiff and VAS indices, which creates the need for the use of remineralizing in persons working in hazardous production therapy. The assessment of the color shade of teeth after whitening revealed a change in color intensity in 100 % of cases, while the change in color lightness on the VITA SYSTEM 3D-MASTER scale was 1–2 steps. The use of the infiltration method after bleaching led to the restoration of the structure of hard tissues.CONCLUSION. The conducted research indicates the appearance of 100 % dental hyperesthesia during the professional whitening procedure in persons exposed to harmful industrial factors.

EFFECT OF RESISTANCE TRAINING THROUGH IN-PERSON AND TELECONFERENCING SESSIONS IN REHABILITATION OF ACUTE STROKE PATIENTS.

To determine whether application of a strength training regimen yields measurable results on stroke survivors and compare different methods for the proposed intervention. Ninety stroke patients were recruited from the neurological clinic of a local third-level clinic. Sixty patients participated in a strength training regimen with trainings taking place 3 times a week for 12 weeks with the use of resistance bands. Thirty of these patients were given face-to-face sessions and 30 patients were given trainings through an on-line platform. The last 30 patients who comprised the control group only followed usual care after the stroke. The applied strength regimen had a statistically significant effect on Visual Analog Scale scores of stroke patients who received it (p = 0.009), as well as in the teleconferencing group (p = 0.004). The measured arteriovenous oxygen difference was elevated for stroke patients who received the intervention as a whole (p = 0.007). Patients who were trained in person and the ones who were trained via teleconferencing yielded similar results as evaluated through the VAS index. Administration of strength training 3 times weekly for 12 weeks to stroke patients yielded measurable results in terms of general function and quality of life.

Effect of an upper body exoskeleton for surgeons on postoperative neck, back, and shoulder complaints.

Surgeons are exposed to high levels of physical stress while working in the operating room. In industry, so-called exoskeletons are used to support the back and shoulder area. The aim of this study was to investigate the feasibility and effects of an upper body exoskeleton on postoperative physical complaints of surgeons. Surgeons from a university hospital in the fields of orthopedics, trauma, and visceral surgery performed 2 operations of the same type and planned length on 2 different days. The first operation was performed without an exoskeleton, the second with an exoskeleton. The participants completed questionnaires on shoulder pain (Shoulder Pain and Disability Index [SPADI]), neck pain (Visual Analogue Scale [VAS] and Neck Disability Index [NDI]), and back pain (VAS and Oswestry Disability Index [ODI]) before and after the procedure. A total of 25 participants were included and performed 50 surgeries with a mean surgery duration of 144minutes without and 138minutes with the exoskeleton. Without the exoskeleton, the activity of the operation resulted in a significant increase of the VAS neck by 1.0 point (SD 1.2; P < .001), NDI by 4.8 (SD 8.6; P = .010), VAS back by 0.7 (SD 1.0; P = .002), and ODI by 2.7 (SD 4.1; P = .003). With the exoskeleton the participants reported significantly fewer complaints after the surgery (VAS neck: P = .001; NDI: P = .003; VAS back: P = .036; ODI: P = .036; SPADI: P = .016). An upper body exoskeleton can significantly reduce the discomfort in the neck, shoulder, and back caused to surgeons by surgery.

THE COMPARATIVE STUDY FOR THE SAFETY AND EFFICACY OF KETOPROFEN AND DIACEREIN IN OSTEOARTHRITIS OF KNEE JOINTS

Objective: Osteoarthritis is a prevalent arthritis that significantly impacts quality of life. This study aims to compare the efficacy and safety of Diacerein, a disease-modifying agent, with Ketoprofen, a symptomatic non-steroidal anti-inflammatory drug, in osteoarthritis patients. Methodology: The Comparative observational study has been performed on total 60 patients (4 withdrawn) suffering from mild to moderate Osteoarthritis of knee joint were included from orthopedic ward of Chaudhary Muhammad Akram Hospital Lahore. 28 patients received Diacerein cream (1%w/w) and 28 patients were given Ketoprofen cream (1% w/w) for 15 days and patient responses were measured using VAS and Lequesne index, before and after drug treatment. Patient consents were obtained and ADRS were evaluated. Results: The VAS Scale was reduced from 7.321 ± 0.9449 to 4.75 ± 1.146 (Mean± SD) for Diacerein cream and 6.821 ±1.1564 to 4.321±1.1564 for Ketoprofen cream. The Lequesne scale was reduced from 6.0±1.054 to 4.21±1.0923 for Diacerein and 6.0±0.8819 to 3.839±1.0475 for Ketoprofen cream. Difference in VAS and Lequesne scale between the Diacerein and Ketoprofen were 0.757 and 0.099 respectively (p &gt;0.05). There was not any Adverse Event reported. Conclusion: Both the drugs, Diacerein and Ketoprofen creams were individually and equally effective and safe in Osteoarthritis.

Efficacy of treatment of patients with psoriasis with anxiety and depression with interleukin‑23 inhibitor guselkumab

Psoriasis is a chronic immune-mediated systemic disease that is closely associated with comorbid depression and anxiety disorders. Today, a new direction of therapy is represented by biological therapy. One of the effective and safe drugs is the IL‑23 inhibitor guselkumab.Purpose of the study. To study the effectiveness of therapy with the interleukin‑23 inhibitor (guselkumab) and the dynamics of indicators of symptoms of anxiety and depression in patients with moderate and severe psoriasis.Material and methods. A retrospective study of 25 patients diagnosed with widespread vulgar psoriasis was conducted. Initial indicators were assessed using the PASI, BSA, sPGA, DLQI, and VAS (itching scale) indices. Anxiety and depression scores were assessed using the HADS and GAD‑7 scales. All patients received treatment with guselkumab according to the standard regimen. The effectiveness of therapy was assessed by the dynamics of PASI, BSA, sPGA, DLQI, VAS, HADS, GAD‑7 indicators after 12 weeks of therapy with the interleukin‑23 inhibitor (guselkumab).Results. Biological therapy with guselkumab resulted in significant reductions in all parameters at 12 weeks for each patient (p &lt; 0.0001). Only improvement in PASI was significantly correlated with lower depression and anxiety scores (p &lt; 0.0050), whereas decrease in DLQI was not (p &gt; 0.9550).Conclusions. Biological therapy with the interleukin‑23 inhibitor guselkumab is highly effective in both reducing disease severity and alleviating symptoms of depression and anxiety in psoriasis.

Efficacy of topical forms of sertaconazole in treatment of mycoses of skin

Published research results indicate the high effectiveness of sertaconazole in the treatment of mycoses of the skin. According to a number of studies, it is superior to other antifungal agents in terms of cure rate and speed of action, and also has anti-inflammatory and antipruritic activity.Material and methods. The aim of the observational study was to evaluate the effectiveness of Zalain cream (sertaconazole 2%) in patients with mycosis of the smooth skin of the groin area. We observed 21 patients (13 men and 8 women) aged from 37 to 72 years with a verified diagnosis of mycosis of smooth skin, confirmed by microscopic and cultural methods. In patients, during a cultural study, a mixed fungal-bacterial infection was isolated in various combinations: 14 (66.7%) – Trichophyton rubrum and Staphylococcus, 7 (33.3%) – Candida albicans and Staphylococcus. Of the concomitant pathologies, the following diseases were most often diagnosed: hypertension (52.4%), obesity (BMI &gt; 30) (47.6%), type 2 diabetes mellitus (42.9%), gastrointestinal diseases (23.8%), diseases of the hepatobiliary system (19.1%). The effectiveness was assessed taking into account the VAS index (erythema, infiltration, desquamation, cracks, itching, burning) and special methods (microscopic and cultural) of the study at control points B1 (before therapy) and B2 (after 4 weeks of therapy). Long-term results of observations (disease relapse) were assessed after 6 months.Results. The total VAS at control point B 2 decreased by 94.9% (p &lt; 0.01). After therapy (4 weeks), in 18 (85.7%) patients, pathogenic fungi (Trichophyton rubrum, Trichophyton mentagrophytes var. interdigitale) were not sown during cultural examination. Patients with no laboratory cure were recommended to continue therapy with sertaconazole for 2–4 weeks until complete eradication of pathogenic fungi. Long-term results of observations (6 months) showed relapse of the disease in 28.6% of patients with concomitant metabolic syndrome and type 2 diabetes mellitus. Also, among patients with relapses, males predominated – 66.7%.Conclusions. Sertaconazole has a wide spectrum of antimycotic activity, which makes it possible to quickly achieve clinical and mycological recovery in patients with mycosis of smooth skin in the groin area.

Clinical Effects of the End-Love Technique in the Treatment of Recurrent Lumbar Disc Herniation 1 Year After Surgery.

The number of patients with lumbar disc herniation in China is increasing year by year. Percutaneous endoscopic lumbar discectomy (PELD) is currently the main surgical method for treating lumbar disc herniation (LDH). However, with the increase in the number of surgical cases, the number of patients with recurrent lumbar disc herniation (RLDH) is also increasing. Currently, the common method in China is lumbar fusion surgery, but this surgery would cause the loss of fusion segment mobility and considerable postoperative complications. In order to solve the problem above the following technique will be studied: the technique of posterior lumbar laminectomy and nucleus pulposus removal under fully visualized spinal endoscopy (ENDO-LOVE) to treat RLDH. Its clinical effects will be observed in this paper, too. This series includes RLDH patients treated with ENDO-LOVE technology between January 2017 and January 2021. All patients will undergo at least three follow-up visits one year after surgery. The modified MacNab standard, VAS, JOA, and ODI scores will be used to evaluate clinical efficacy, observe for cerebrospinal fluid leak, nerve root injury, and surgical site infection, and evaluate clinical safety. All 29 patients completed the surgery successfully. Three patients had postoperative pain and numbness in the area of nerve root innervation, and all patients had no serious complications. The VAS, JOA scores and ODI indices of back pain and leg pain 1-day, 3-months, and 1-year postoperatively differed statistically significantly from the preoperative scores (p < 0.05). Efficacy evaluated at 1-year postoperatively using the modified MacNab criteria showed an excellent rate of 89.7%. ENDO-LOVE technology has demonstrated good clinical efficacy and safety in the treatment of patients with RLDH. It should be considered for all patients with this condition.

Role of shockwave therapy in the treatment of pain syndrome in patients with knee ligamentitis

Relevance. Damage to the para-articular structures in the area of the joints can lead to chronic pain, which imposes mental and social restrictions on a person’s life, disrupts his/her mobility, and therefore, represents a global healthcare problem. Subject and methods. An open randomized controlled trial was conducted among patients with post-traumatic ligamentitis of the knee joint with pain in the subacute stage, aged 30.2 ± 10.4 years (n = 40). The patients were divided into two groups: group 1 (n = 10, control group) received standard drug therapy, while group 2 (n = 30, main group) additionally received SWT. To assess the intensity of the pain syndrome, we used the visual analog scale (VAS index) and the Lequesne index, which determines the daily activity of patients with injuries in the knee joint. Results and discussion. According to statistics, against the background of an increase in the number of injuries per 100,000 population in the Russian Federation, the absolute number of injuries of the knee joint and lower legs is also growing. At the same time, there was a high direct correlation between these indicators. In this observation, the patients in the 2nd (main) group who received complex treatment with the use of shockwave therapy showed positive dynamics of the VAS index score and the Lequesne index, and a strong direct correlation was noted between the indicators. Meanwhile, according to the data of correlation and regression analysis, it was possible to predict the stability of clinical improvement for two future periods. In the patients in the 1st (control) group, no pronounced clinical picture was observed. Conclusion. Thus, after complex treatment, including drug therapy and shockwave therapy, in the patients in the 2nd (main) group with knee ligamentitis with pain in the subacute period, a pronounced stable positive effect was noted, which was accompanied by a decrease in pain syndrome, an increase in motor activity, and an improvement in the quality of life of patients.

Photodynamic therapy in the treatment of vulvar lichen sclerosus et atrophicus

Lichen sclerosus (LS) is a chronic inflammatory disease that is 6–10 times more common in women than in men. LS affects between 1 in 1,000 and 1 in 300 people in the general population, but the exact prevalence is unknown since the disease is often asymptomatic. Objective: to evaluate the effectiveness of PDT in patients with LS in comparison with standard therapy methods. Material and methods: The study included 45 patients diagnosed with LS aged from 45 to 72 years (median age was 59 years). Depending on the therapy performed, the groups were divided into subgroups: Group 1A — patients with LS who were prescribed therapy with external glucocorticoids, Group 1B — patients with LS who were prescribed photodynamic therapy, Group 1C — patients with LS who were prescribed combined treatment: external glucocorticoids + PDT. Results: The study developed a special visual analogue scale to assess the objective condition of the vulva. VAS included the following parameters: pigmentation, skin pattern, turgor (skin fold straightening time), presence of cracks or erosions, and moisture. According to the data obtained, a complex treatment method using photodynamic therapy in patients with vulvar lichen sclerosus et atrophicus causes a higher effect than drug therapy and mono-PDT, which is confirmed by the dynamics of the total VAS index: 50.8 % compared with 28.2 % and 35.1 % in the comparison groups, respectively, therefore, it can be recommended for use in practical healthcare.

An algorithm for selection of full endoscopic approach for symptomatic nerve root decompression

Background ContextBoth Transforaminal (TF) and Interlaminar (IL) endoscopic approaches are established techniques of decompression for lumbar compressive radiculopathy. In the absence of adequate literature, there is always some dilemma in selecting the approach for endoscopic decompression leading to long learning curves and high chances of inadequate decompression, iatrogenic instability, dural tear, or dysesthesia. Hence authors propose a new surgical nomenclature and algorithm for selection of endoscopic approach. MethodsThis retrospective study included 396 of 626 consecutive patients who met the inclusion criteria, who underwent either TF (n=302) or IL (n=202) full endoscopic spine surgery. MRI findings of every patient were classified as per FAPDIS (Facet angle, Anterior pathology, Posterior pathology, Dorsal, Inferior, and Superior migration) algorithm. Inter-observer variations were calculated. The targeted nomenclature was used to define the selection of endoscopic TF or IL approach for symptomatic nerve root decompression. All patients were followed up for preop and postop 6 months VAS and Oswestry Disability Index score for validation of FAPDIS algorithm. ResultsMedian age: 46.8 years; Sides and levels operated 330 single-level ipsilateral, 54 multiple-level ipsilateral, 6 single-level bilateral, and 6 multiple-level bilateral. Interobserver agreement in the selection of TF approach was 0.873 and IL approach was 0.882. Interobserver variability was also calculated for each FAPDIS factor, selection of P3 and P4 pathology was the main reason for disagreement. All other FAPDIS factors show good to excellent correlation. The overall VAS score decreased from a preoperative value of 9 to 1 at 6 months follow-up (p-value < 0.001), and the overall Oswestry Disability Index score improved from 89 to 12 (p-value <.001). ConclusionsThe author's new FAPDIS surgical nomenclature and algorithm is a reliable tool for describing the symptomatic nerve root compression for the selection of endoscopic surgical approach to achieve adequate decompression of offending neural structure with minimum challenges to minimize perioperative complication rate.

The effects of Kinesio tapes on facial swelling following bimaxillary orthognathic surgery in the supraclavicular region

BackgroundSeveral osteotomies are required for orthognathic surgery to reposition the jaws correctly. This study aimed to evaluate whether Kinesiotaping can reduce swelling, pain, and trismus following orthognathic surgery of the facial skull.Materials and methodsThe present study consists of two phases. In the split-mouth phase, 16 skeletal class III patients underwent Bimax Orthognathic surgery, and Kinesiological tape (KT) was applied on one half of the face. In the prospective case–control phase, 30 patients were divided into two groups. Kinesio tape was applied on both sides of the face of the Kinesio group, and pressure dressing and ice therapy were used for the second group. The tape was parallel to the lower border of the mandible along its entire length, tangent to the labial commissure area on the studied side. The tape was placed in place for 5 days. Edema was evaluated by measuring the distance from the menton to the lower edge of the tragus. The maximum mouth-opening trismus was evaluated, and the VAS index was used to evaluate pain.ResultsThere was evidence of swelling reduction after KT; within the same study, differences between the left and right sides as well as for the same side were statistically significant (p < 0.001). As a result of tapping lymphatic Kinesio tape on the affected area, tension was reduced, and lymphatic circulation was restored. Blood and lymph microcirculation was improved, enabling the body to heal itself.ConclusionKinesio tape reduced swelling after orthognathic surgery in a positive way. As a simple, non-traumatic, economical method, Kinesio taping seems promising.

Evaluation of the effect of Echium amoenum on pain control after clinical crown lengthening surgery.

Pain after periodontal surgeries is one of the most common complications. Echium amoenum is among the important therapeutic herbs in Iranian traditional medicine. Various studies have shown its pain control properties. This study aimed to evaluate this herb's efficacy in controlling pain after periodontal surgeries. In this randomized clinical trial, 50 patients referred to Tabriz Dental School for clinical crown lengthening surgery were divided into two equal groups: control and test. In the test group (using E. amoenum), 24 hours before surgery, E. amoenum was administered to the patient at home every 12 hours, and a dose of E. amoenum was administered one hour before the procedure. The postoperative pain was assessed using VAS 30 minutes, 1 hour, and 3 hours after the surgery and verbal rating scale (VRS) 24, 48, and 72 hours postoperatively. A chi-square test was used to compare the pain severity between the two groups. The VAS index was significantly lower in the E. amoenum group compared to the control group (30 minutes, 1 hour, and 3 hours after the procedure) (P<0.05). In both groups, pain severity increased significantly up to 3 hours postoperatively (P<0.05). In the first 24 hours, the VRS index of the E. amoenum group was significantly lower than that of the control group (P<0.05), with no significant differences between the two groups at 48 and 72 hours (P>0.05). The E. amoenum herb reduced the pain severity after clinical crown lengthening surgeries.

Effect of Posteroanterior Lumber Spine Mobilization Versus McKenzie Prone Push Ups on Pain and Functional Disability in Subjects with Non-Specific Low Back Pain

85% of the population has non-specific back pain. Posteroanterior (PA) lumbar mobilization and Push-up exercises are primarily used in physical therapy for back pain. Objective: To know the outcomes of posteroanterior spinal mobilization and prone push-ups on nonspecific lower back pain. Methods: The randomized clinical trial was done with 30 subjects meeting inclusion criteria and were randomly selected by non-probability/purposive sampling technique from the Department of Physical Therapy, Mayo Hospital Lahore. The 4 weeks study was conducted in which 2 groups with 15 in each group were formed. Group I was treated with PA lumbar glide while group II was treated with prone Push-ups. VAS and functional disability index were used to evaluate pre-treatment and post-treatment. Results: A significant decrease in mean pain score was noted in both groups. Results did not show any statistically significant differences between groups for any parameter. The study has given evidence that supports the use of posteroanterior mobilization and prone push-ups to reduce pain, improve range of movement, and disability reduction in patients with nonspecific low back pain. It also showed that posteroanterior mobilization was more beneficial than prone Push-ups. Conclusion: Both PA mobilization and Push-ups can be used as effective maneuvers for the treant of non-specific low back pain

"Insert flipping technique:" An effective way of restoring segmental lordosis and disc height with tall bullet cages.

The study design was a retrospective study. The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the "Insert Flip Technique" of cage insertion and to demonstrate effective restoration of IVD height and segmental lordosis (SL) and their influence on the functional outcome postoperatively. IVD height and SL were recorded pre- and postoperatively. Each motion segment was instrumented with pedicle screws to allow segmental stabilization. Patients were called for follow-up at 6 weeks, 3 months, and 1 year postoperatively and were assessed clinically for back pain and leg pain (VAS and Oswestry Disability Index scores recorded).The bullet cages are designed such that they are lordotic in the superior-inferior plane and neutral in the mediolateral plane. Usually, the cage is inserted with superior and inferior surfaces of the cage impacting against superior and inferior end plates of the adjacent vertebral body. However, with the proposed technique, the cages were inserted such that the narrower mediolateral surfaces of the cage engaged with superior and inferior vertebral end plates. The cage was then flipped within the disc space such that the superior-inferior surfaces of the bullet cage impacted against the superior and inferior end plates of the vertebral body to create desired lordosis. There was a significant improvement seen in the postoperative Cobb's angle and disc height after placement of a tall bullet cage compared to the preoperative Cobb's angle and disc height. This modification of technique helped in gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion with no/minimal complication and also reduced the need for bone resection during insertion of the cage.

Treatment of Single Level Lumbar Spondylolisthesis with Lumbar Interbody Fusion via Oblique Lateral Approach (OLIF)

Objectives: To investigate the effect of lumbar interbody fusion via the oblique lateral approach (OLIF) in the treatment of single level lumbar spondylolisthesis. Methods: Retrospective analysis was made on 32 cases of single level lumbar spondylolisthesis treated by lumbar interbody fusion via the oblique lateral approach from July 2020 to July 2021. 14 males and 18 females; the age was (66.5 ± 11.5) years (55 - 82 years). 1) The operation time, intraoperative blood loss and complications were recorded; 2) the scores of visual analog scale. VAS and Oswestry disability index (ODI) of low back pain and lower limb pain were collected before operation and at the last follow-up; by observing the imaging data, the height of the intervertebral space, the anterior convex angle of the intervertebral space, the anterior convex angle of the lumbar spine, the sagittal diameter of the dural sac and the spondylolisthesis were measured. Results: All patients successfully completed the operation, the average operation time was (103.9 ± 21.1) min, the average intraoperative bleeding volume was (72.3 ± 16.4) ml. There was no vascular injury during the operation, no infection occurred in all surgical incisions, and Class I/A healing was achieved. The VAS scores of low back pain and leg pain before operation and at the last follow-up were lower than those before operation, and the difference was statistically significant (P the height of intervertebral foramen and the sagittal diameter of dural sac were greater than those before operation, with statistically significant differences (P than that before operation, with a statistically significant difference (P ureteral injury, retrograde ejaculation, intestinal and lumbar plexus injury. Conclusion: The early clinical effect of OLIF in the treatment of single level lumbar spondylolisthesis is significant. This surgical method is minimally invasive, safe and effective, which can significantly reduce the amount of intraoperative bleeding and reduce the risk of postoperative complications. Its main working principle is to make the annulus fibrosus, posterior longitudinal ligament and ligamentum flavum shrink and recover the height of the intervertebral space through decompression, loosening and stretching of the intervertebral space, so as to achieve the reduction of the slipped vertebral body, increase the height of the intervertebral foramen Enlarge the spinal canal volume and eliminate dynamic compression to play an indirect decompression role, improve the symptoms of low back and leg pain, and reconstruct the stability of the spine through interbody fusion.