Reduction In Visual Analog Scale Research Articles

Immediate Effect of Mulligan’s Spinal Mobilization with Limb Movements on Straight Leg Raise Test in Patients with Lumbar Radiculopathy: A Randomized Controlled Trial

Context: Lumbar radiculopathy is pain which starts from the lumbar spine and radiates to one or both lower limbs. Spinal mobilization with limb movement (SMWLM) has been proposed for the treatment of lumbar radiculopathy by Brian Mulligan. Studies on SMWLM have found it to have positive effect in reducing radicular symptoms, but a comparative study of SMWLM versus sham mobilization is lacking to prove the beneficial effect of SMWLM since sham procedures more clearly differentiate the efficacy of an intervention. Aims: To compare the immediate effect of SMWLM with sham SMWLM on straight leg raise (SLR) and Visual Analog Scale (VAS) in patients with lumbar radiculopathy. Settings and Design: Single-blinded randomized controlled trial. Subjects and Methods: Twenty-eight participants with lumbar radiculopathy (mean age 40.2 ± 12.2 years) were included. The trial group (n = 14) received SMWLM and control group (n = 14) received sham SMWLM. In SMWLM a transverse glide was applied with the therapist thumb just lateral to the involved lumbar spinous process and the hip was taken into flexion. Sham SMWLM was given by placing thumb just lateral to the involved spinous process without applying any glide while the limb was taken into only 10° of hip flexion. The pre- and immediate post-SLR test angle and VAS was compared within each group and postvalues was compared between the two groups. Statistical Analysis: The data were analyzed with Wilcoxon’s signed-rank test and Mann–Whitney U-test. Results: Post intervention in the experimental group there was a significant increase in SLR test angle (P = 0.001) and reduction in VAS (P = 0.001) while in the control group only VAS decreased (P = 0.034). There was a significant difference between the groups in postintervention SLR test angle (P = 0.038) and VAS (P = 0.018). Conclusion: Through its biomechanical, neurophysiological effects, and marginal placebo effects, SMWLM can be used as an effective treatment technique for immediate improvement in pain-free SLR range in patients with lumbar radiculopathy.

Treatment of Dentinal Hypersensitivity with Diode Laser of Two Different WavelengthsA Randomised Clinical Trial

Introduction: Dentinal Hypersensitivity (DH) is one of the most prevalent dental issues that is treated by both periodontists and endodontists. Hypersensitive dentin is a sensitive or painful response that is one of the most prevalent and poorly treated chronic dental disorders. Due to the difficulty in treating cervical DH, a great range of approaches and therapeutic procedures for pain relief in have developed. Treatments with desensitising drugs have been combined with laser treatment in recent decades. The most often utilised lasers in the treatment of DH are Diode Lasers (DL). DL act on DH provoking a melting effect with crystallisation of dentine inorganic component and the coagulation of fluids contained into the dentinal tubules. Aim: To compare the effectiveness of DL of two different wavelengths in managing DH. Materials and Methods: This split-mouth randomised clinical trial conducted in the Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. The duration of the study was, from October 2021 to December 2021. A total of 12 patients with DH were selected and assigned to two groups. All the patients were subjected to desensitisation using DL of two different wavelengths 475 nm Bluelase system and 810 nm. Denlase system and parameters were evaluated 15 minutes after treatment, 7 days, 15 days and 30 days after treatment. Data were entered in Microsoft Excel and analysed using Statitical Package for Social Sciences (SPSS) version 10.5 software. Results: The mean age of the study participants was 45±3 years. There was a significant difference (p-value <0.001) in tooth sensitivity values measured at baseline, and at different time intervals in both groups. Among the two groups, Denlase group showed the greatest reduction in Visual Analogue Scale (VAS) scores from baseline to one month recall compared to Bluelase laser group. Highly significant difference was found when mean VAS scores were compared between baseline and all the other time points (p-value <0.001). Conclusion: The present study concluded that, based on the results obtained, DL of 810 nm Denlase system was effective than DL of 475 nm Bluelase system in reducing the DH. Desensitisation treatment with laser irradiation has shown to be effective in the present study.

Is there an effective way to control pain perception after free gingival graft removal? A systematic review and meta-analysis.

The literature describes multiple ways to stimulate wound healing to reduce the patient's perception of pain. This systematic review aimed to evaluate if methods that enhance wound healing can reduce the patient's perception of pain after free gingival graft removal from the palate region compared to natural healing. A systematic review protocol was written following the PRISMA checklist. Electronic searches of five databases were performed to identify randomized clinical trials (RCTs) that assessed the patient's perception of pain after the removal of a free gingival graft from the palate. The primary outcome was the visual analog scale (VAS) score assessing the patient's perception of pain 7 days after the free gingival graft removal from the palate region. Of the 1,622 potentially relevant articles retrieved from the electronic databases, 16 RCTs were selected for qualitative analysis, and of these, 6 RCTs were included in the meta-analysis. RCTs showed a significant VAS reduction associated with the use of methods to enhance wound healing. The pooled estimates revealed a significant overall VAS reduction of 2.20 (95% CI 2.32, 2.07) 7 days after surgery. The methods that presented the greatest reduction in the perception of pain were platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue. Methods that enhance wound healing, including platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue, can reduce pain perception after free gingival graft removal in the palate region. However, only 1 RCT investigated each approach, which hinders the conclusion regarding the best procedure to reduce the perception of pain.

Full-Endoscopic Lumbar Discectomy: Tips & Tricks for New Users Based on a Retrospective Observational Study of the First 100 Patients.

To report our institutional experience with full-endoscopic lumbar discectomy (FELD) and analyzed the pertinent literature. We retrospectively enrolled 100 patients who had undergone full-endoscopic discectomy for lumbar disc herniation using either an interlaminar (IL) or transforaminal (TF) approach. All patients underwent pre-operative imaging. Before and after surgery, patients' pain and disability levels were measured using visual analog scale (VAS) and Oswestry disability index (ODI) respectively. Clinical outcomes were assessed using the modified MacNab criteria. Patients were divided into two groups, Group 1 (cases 1-50) and Group 2 (cases 51-100), and their learning curve factors were compared using a Student's t-test. Sixtynine cases were operated via an IL approach and the remaining 31 cases using a TF approach. There were 4 early conversions in microdiscectomy. The mean operative time of the 96 procedures was 57 min. In Group 1, the mean operative time was 61.7 minutes (range: 35-110); in Group 2, it was 52.3 minutes (range: 25-75). The difference between the two groups was statistically significant (p=0.009). No significant differences were found in conversions, early operations, and recurrences between Groups 1 and 2. Both groups experienced a significant reduction in postoperative VAS and ODI compared to preoperative scores. The findings support previously reported information on the safety and effectiveness of the FELD. Herein, we share some practical tips and tricks based on our initial experience and on the review of the available literature, which could facilitate new users. In experienced hands endoscopic techniques make treatment of herniated discs feasible independently of patient age, anatomy, and/or targeted pathology features. Conversely, thoughtful patient selection and careful preoperative planning are highly recommended for new users.

Effectiveness of Diacerein in Primary Knee Osteoarthritis

Objective: To determine role of diacerein among the patient with primary knee osteoarthritis (KOA). Study Design: An observational cohort study. Place and Duration: Department of orthopedic surgery, Sughra Shafi Medical Complex, Narowal from June 2021 to May 2022. Materials and Methods: A total of 100 patients of either gender visiting outpatient department with primary KOA aged 50-75 years were enrolled. Patients were assessed as per Western Ontario and McMaster Universities Arthritis Index (WOMAC) and visual analogue scale (VAS). Diacerein was prescribed 100 mg two times a day for a total duration of six months. WOMAC and VAS were noted before and after completion of the 6 months follow up period. Results: In a total of 100 patients, 56 (56.0%) were female. Mean age was 63.58 ± 6.42 years while mean BMI was 29.46±3.42 kg/m2. There were 50 (50.0%) patients who belonged to middle socioeconomic status. Grade of KOA was II in 54 (54.0%) patients. Baseline WOMAC score was 45.12±6.68 while baseline VAS was noted to be 6.81±2.76. At the end of the 6-month treatment period, 83 patients completed the treatment span and so were included in the final analysis. It was found that significant reduction in both WOMAC score (p<0.0001) and VAS (p<0.0001) were found among the studied patients. Practical Implications: Diacerein seems to be a good option for relief in symptoms against patients suffering with primary knee osteoarthritis but further randomized trials should be conducted to verify the findings of this study. Conclusion: Diacerein resulted in significant improvement in the mean WOMAC and VAS scores after six months therapy. Keywords: Diacerein, improvement, Osteoarthritis Knee, VAS, WOMAC

Twelve-Month Follow-Up of Different Dentinal Hypersensitivity Treatments by Photobiomodulation Therapy, Nd:YAG and Nd:YAP Lasers.

In this retrospective study, data for three different laser-assisted approaches for the management of dentinal hypersensitivity (DH) was collected (n = 920 teeth). In total, 387 teeth were treated with photobiomodulation (PBM) therapy with 660 nm red light laser (PBM group), 327 were treated with the Nd:YAG laser (1064 nm) and 206 were treated with the Nd:YAP laser (1340 nm). To assess the effectiveness of each treatment, a visual analogue scale (VAS) was used, where zero represented no pain at all and ten represented the greatest pain. VAS was used before (T0), immediately after (T1), one week after (T2), four weeks after (T3), six months after (T4) and one year after treatment (T5). Means and standard deviations of VAS at different follow-up times were calculated. Values were compared within and between groups. Statistical significance was considered to be achieved when p-value was less than 0.05. Confidence level was proposed to be 99% with a P value lower than 0.001. Within groups, a statistically significant reduction was obtained when the mean value of VAS at T0 was compared with T5. At T5, the PBM group had the highest reduction of VAS (with mean value of 0), while the Nd:YAG and Nd:YAP groups had scores of 1.065 ± 0.674 and 4.665 ± 0.674, respectively. Conclusion: this retrospective study showed that PBM therapy and irradiation with Nd:YAG and Nd:YAP lasers are effective in managing DH pain. However, PBM therapy was the only procedure that showed complete pain relief at six and twelve months after treatment.

Comparing nebulized ketamine with Entonox for acute traumatic pain in the Emergency Department: A pilot randomized trial

Background: In this study, we compared the efficacy, patient satisfaction, and adverse effects of nebulized ketamine to those of Entonox in reducing acute traumatic pain in the Emergency Department. Methods: This was a randomized, single-centre pilot study. Eligible patients were selected from triage and divided into two groups which was nebulized ketamine and Entonox. Nebulized ketamine 50 mg (mean 0.7 mg/kg for an average adult) was administered in a concentration of 5 mL of 10 mg/mL diluted with 1 mL normal saline in a nebulizer. Entonox delivery was self-regulated by the patients. The primary outcome was efficacy of pain reduction according to the visual analogue scale (VAS) in 30 minutes. Adverse effects were monitored in both the groups. Results: A total of 26 patients were divided equally into two groups with n = 13 for each group. Mean reduction in VAS after 5 and 30 minutes was 0.62 ± 0.77 mm and 28.5 ± 12.1 mm for nebulized ketamine and 0.46 ± 0.78 mm and 30 ± 5.8 mm for Entonox. No significant difference was seen in pain reduction (5 min p = 0.616, 30 min p = 0.684). Mean satisfaction with analgesia according to a Likert scale of 1 to 6 was ketamine 4.92 ± 0.64 and Entonox 5.0 ± 0.41 (p = 0.718). No serious adverse events were reported. Conclusion: Nebulized ketamine is a comparable substitute to Entonox in managing acute traumatic pain in the Emergency Department. Further studies are required on the use of inhaled ketamine as an adjunct in managing severe pain and reducing the need for opioids.

Effect of intradiscal local anesthetic injection on intraoperative pain during percutaneous transforaminal endoscopic discectomy: A retrospective study

ObjectivePatients undergoing percutaneous transforaminal endoscopic discectomy (PTED) often complain of unbearable intraoperative pain. This study is to observe clinical effectiveness and safety of intradiscal local anesthetic injection for intraoperative pain relief. MethodsTotal 268 patients who underwent PTED were analyzed. Patients were divided into intradiscal saline injection group (group C) and intradiscal local anesthetic injection group (group L). Intradiscal mixture was consisted of saline or local anesthetic + methylene blue, the amount of injected mixture was 3 mL. Demographic data, visual analog scale (VAS) and Quebec Back Pain Disability Scale (QBPDS) scores, mean arterial pressure (MAP) and heart rate (HR), total dosage of fentanyl, satisfaction rate of anesthesia and complications were collected at different timepoints. ResultsCompared with group C (3.94 ± 0.57), there was a significant reduction of VAS in group L (2.83 ± 0.28) during fibrous annular operation phase (T2). Group L had a lower total dosage of fentanyl (71 [63, 78] μg) and a higher anesthesia satisfaction rate (95.3%) than group C (82 [70, 132] μg and 73.6%, respectively) (P < 0.001). MAP and HR were lower in group L than in group C at T2 (P < 0.001). Baseline characteristics and QBPDS scores showed no meaningful intergroup differences. Four cases of complications were reported in this study. ConclusionIntradiscal local anesthetic injection significantly alleviated intraoperative back pain and increased the satisfaction rate of anesthesia, without severe complications, indicating that this technique is a feasible method for intraoperative back pain relief for patients undergoing PTED.

A Prospective, Observational, Open-Label, Non-Randomized, Multicenter Study Measuring Functional Outcomes in a Novel Interspinous Fusion Device in Subjects with Low Back Pain: REFINE Study.

Lumbar degenerative disease and the accompanying pain and dysfunction affect a significant number of patients in the USA and around the world. As surgery and innovation are moving towards minimally invasive treatments, this study looks to explore interspinous fixation as a standalone posterior approach to treat lumbar degenerative disc disease in the presence of neurogenic claudication and spinal stenosis. This study was approved by an institutional review board (IRB) and is actively enrolling in a single-arm, multicenter, prospective, open-label fashion. Patients are followed with reporting at 3months, and 12months for primary endpoint analysis of efficacy and safety based on improved composite endpoints relative to baseline, with success defined as greater than 20mm back pain reduction in Visual Analog Scale 100mm (VAS) while standing or walking, greater than 20mmleg pain reduction in VAS while standing or walking, Zurich Claudication Questionnaire (ZCQ) improvement of 0.5 or greater in two or three domains, Oswestry Disability Index (ODI) improvement of a least 10points and no reoperations or revisions at the index level(s). Secondary endpoints included a multidimensional assessment in the Patient-Reported Outcomes Measurement Information System (PROMIS) 29 v2.1 and Patient Global Impression of Change (PGIC). In this interim 3-month analysis, 82% of patients reported they were improved from the procedure, while 65% of patients demonstrated clinical meaningful improvement in their pain and function, as defined by the VAS, ODI, and ZCQ. There was only one adverse event and no complications were identified at last clinic research follow-up visit. This interim analysis of the first 20% of the enrolled patients out to 3months was to determine safety of the procedure and report on adverse events, acknowledging the heterogeneity of surgical specialty. Further follow-up and greater numbers are needed as the study is ongoing. ClinicalTrials.gov identifier, NCT05504499.

Intravesical instillation of platelet-rich plasma for treatment of interstitial cystitis/bladder pain syndrome: A pilot study.

The aim of this study was to evaluate the feasibility of intravesical instillation of platelet-rich plasma (PRP) to treat interstitial cystitis/bladder pain syndrome (IC/BPS). Twenty PRP samples were tested in vitro for stability after exposure to urine samples with different pH. A pilot study involving 21 female patients with IC/BPS was conducted, and 6 weekly doses of autologous PRP (50 mL) were administered. Patients were followed up at the 2nd, 4th, 8th, and 12th weeks after terminating instillation. The primary endpoint was the visual analog scale (VAS) for pain, and the secondary endpoints included the IC symptom index, IC problem index of the O'Leary-Sant questionnaire and global response assessment, urine culture, and uroflowmetry. Success was defined as a reduction in VAS by 30% or more compared with basal level, and adverse events were recorded. The mean ± SD of VAS was significantly reduced compared with basal level (4.4 ± 2.6 vs. 8.8 ± 1.1, respectively, p = 0.001). Meanwhile, 80% of cases were considered successful, with a 50.1% reduction in the mean score compared with the basal level. The mean ± SD of IC symptom index and IC problem index significantly improved compared with the basal level. Global response assessment was markedly, moderately, and slightly improved in 2 (10%), 10 (50%), and 5 (25%) patients, respectively, and showed no change in 3 (15%). Three patients had positive urine cultures at follow-up, but 1 withdrew after 2 sessions because of a lack of efficacy. Repeated intravesical instillation of PRP could be considered an effective and safe approach for treating IC/BPS.

Three-Year Durability of Restorative Neurostimulation Effectiveness in Patients With Chronic Low Back Pain and Multifidus Muscle Dysfunction

BackgroundRestorative neurostimulation is a rehabilitative treatment for patients with refractory chronic low back pain (CLBP) associated with dysfunction of the lumbar multifidus muscle resulting in impaired neuromuscular control. The ReActiv8-B randomized, sham-controlled trial provided evidence of the effectiveness and safety of an implanted, restorative neurostimulator. The two-year analysis previously published in this journal demonstrated accrual of clinical benefits and long-term durability. ObjectiveEvaluation of three-year effectiveness and safety in patients with refractory, disabling CLBP secondary to multifidus muscle dysfunction and no indications for spine surgery. Materials and MethodsProspective, observational follow-up of the 204 implanted trial participants. Low back pain visual analog scale (VAS), Oswestry Disability Index (ODI), EuroQol quality of life survey, and opioid intake were assessed at baseline, six months, and one, two, and three years after activation. The mixed-effects model repeated measures approach was used to provide implicit imputations of missing data for continuous outcomes and multiple imputation for proportion estimates. ResultsData were collected from 133 participants, and 16 patients missed their three-year follow-up because of coronavirus disease restrictions but remain available for future follow-up. A total of 62% of participants had a ≥ 70% VAS reduction, and 67% reported CLBP resolution (VAS ≤ 2.5cm); 63% had a reduction in ODI of ≥ 20 points; 83% had improvements of ≥ 50% in VAS and/or ≥ 20 points in ODI, and 56% had these substantial improvements in both VAS and ODI. A total of 71% (36/51) participants on opioids at baseline had voluntarily discontinued (49%) or reduced (22%) opioid intake. The attenuation of effectiveness in the imputed (N = 204) analyses was relatively small and did not affect the statistical significance and clinical relevance of these results. The safety profile remains favorable, and no lead migrations have been observed to date. ConclusionAt three years, 83% of participants experienced clinically substantial improvements in pain, disability, or both. The results confirm the long-term effectiveness, durability, and safety of restorative neurostimulation in patients with disabling CLBP associated with multifidus muscle dysfunction. Clinical Trial RegistrationThe Clinicaltrials.gov registration number for the study is NCT02577354.

Clinical effectiveness and potential predictability of omalizumab in patients with difficult-to-treat chronic rhinosinusitis with nasal polyps and asthma based on the noninvasive markers – A real-life prospective study

BackgroundClinical studies on the effectiveness of omalizumab in patients with difficult-to-treat chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are scarce in China. Moreover, identifying potential biomarkers predicting its efficacy remains a great challenge. MethodsIn this prospective trial, all enrolled patients underwent endoscopic examination, computed tomography, blood tests, etc, and they completed a 22-item sino-nasal outcome test (SNOT-22), visual analogue scale (VAS), and asthma control test (ACT) evaluation, at baseline and after 24-week omalizumab therapy. ResultsTwenty-two patients were finally recruited. Their VAS scores were significantly better including nasal congestion, anterior rhinorrhea, postnasal drip, and loss of smell (P < 0.01). Seventeen patients reported a reduction in SNOT-22 scores of ≥8.9 and 19 patients achieved ACT scores >20. The median change in the Lund-MacKay score (LMS) was 6. Both the Lund-Kennedy score (LKS) and nasal polyp score showed significant improvement (P < 0.01). Only 3 parameters in the pulmonary function test showed evident amelioration (P < 0.05). The eosinophilic CRSwNP and the male subgroups showed better improvements in subjective and objective evaluation. A receiver operating characteristic curve indicated a cutoff value of 17.5 and 16.5 in LMS had the moderate predictive value (AUC = 0.706) for the decline in the SNOT-22 (more than 8.9 points) and reduction in anterior rhinorrhea VAS (more than 2 cm), respectively. A cutoff value of 18.5 in ACT could provide the moderate predictive value (AUC = 0.771) for the reduction of loss of smell VAS (more than 2 cm). ConclusionsThe beneficial effectiveness of omalizumab in the patients with difficult-to-treat CRSwNP and asthma was confirmed. ECRSwNP and male patients were more likely to have positive responses. The multiple cutoff values for the LMS and ACT may serve as useful predictors for improvement acceptable to difficult-to-treat CRSwNP patients.

The effectiveness of dry needling in patients with chronic low back pain: a prospective, randomized, single-blinded study

Dry needling (DN) is a standard procedure for treating musculoskeletal disorders. However, there are no clear recommendations for using DN in low back pain (LBP). Therefore, this study aimed to assess the effectiveness of the novel DN program for reducing pain intensity and improving functional efficiency in patients with chronic LBP. A group of 40 patients with chronic LBP due to the L5-S1 discopathy were eligible and randomized into experimental (n = 20) and control (n = 20) groups. The DN program was performed for the experimental group according to the Five Regulatory Systems (FRS) concept. The control group received sham therapy using placebo needles. DN sessions were performed twice a week for 4 weeks. A single needling application lasted 60 min. Both groups received standard treatment and physical exercise of LBP for 1 month. Subjective pain was measured by a visual analog scale (VAS), functional efficiency was assessed with the Oswestry Disability Index (ODI), and the lower spine range of motion was measured with the Schober test. There were significant differences in pain reduction (VAS) in both groups (p < 0.001). The strongest analgesic effect in the DN group yielded 6.45 points immediately after the therapy, 6.2 points after 1 month, and 6 points after 3 months. The DN group scored higher VAS reduction than the control group (p < 0.001). There were significant differences in the functional state (ODI) in the experimental group (p < 0.001). There was a significant ODI decrease by 18.1 points, after 1 month by 18.9 points, and after 3 months by 17.6 points. No significant differences were found in the control group (p > 0.05). Intergroup differences were observed in the functional efficiency in ODI in all measurement time-points (p < 0.001). There were significant differences in the range of motion (Schober test) in the DN group (main effect: p < 0.001). For all measurements, differences (p < 0.001) were observed in favor of DN compared to the control. In conclusion, DN program according to the FRS concept stands for the novel treatment method supplemented by an exercise program, effectively reducing pain and improving functional efficiency in LBP patients.

An Observational Study of Quality of Life in Patients of Allergic Rhinitis in a Tertiary Health Care Centre of South Gujarat.

Allergic rhinitis (AR) refers to an IgE-mediated inflammation following exposure to allergen. Often deemed as a minor inconvenience rather than a disease, AR impairs the QOL. Medical treatment has a beneficial effect. To evaluate the QOL in patients of AR. Patients of AR with ≥ 18 years age, receiving treatment in our department are included. Pre and Post treatment VAS (Visual Analogue Scale) and RSDI (Rhinosinusitis Disability Index) are compared to know the effect of disease and treatment on QOL. The patients of PAR (Persistent Allergic Rhinitis) had a greater impact on QOL. In PAR, a combination of INCS (Intranasal Corticosteroids) + oral antihistaminics result in significant reduction in VAS & RSDI scores. In IAR (Intermittent Allergic Rhinitis), Oral antihistaminics monotherapy was most effective in reducing itching while Oral antihistaminics + 1 week of intranasal decongestant was most effective in reducing sneezing, running nose and nasal blockage. Oral antihistaminics + LTRA (Leukotriene Receptor Antagonist) was most effective in reducing physical RSDI score. Oral antihistaminics + 1 week of intranasal decongestantwas most effective in reducing functional and emotional RSDI score. Functional RSDI scores had improved much higher than emotional and physical scores. All these observations were statistically significant. AR does affect the QOL while pharmacotherapy helps in improving the overall QOL. Oral antihistaminic alone or in combination with local decongestant/LTRA in IAR cases while INCS + oral antihistaminic in PAR cases are significantly effective in controlling symptom scores and QOL.

A Novel Mobile App-based Neuromuscular Electrical Stimulation Therapy for the Management of Knee Osteoarthritis: Results From an Extension Study of a Randomized, Double-blind, Sham-controlled, Multicenter Trial.

Background:Mobile app-based neuromuscular electrical stimulation (NMES) is a promising treatment of knee osteoarthritis as previously demonstrated in a 12-week, randomized, double-blind, sham-controlled, multicenter trial (parent study).Methods:Sixty-four of the 253 patients with knee osteoarthrosis who completed the 12-week parent study were enrolled in a 14-week extension study during which they continued to receive double-blind, home-based NMES (two 20-minute daily sessions, 5 d/wk) with either the original device (“active NMES”) or a low-voltage version (“sham NMES”). All subjects who enrolled in the extension study comprised the intent-to-treat population and subjects who applied NMES (compliance monitored through the mobile app and a remote portal) for at least 2,800 minutes (14-week device usage) comprised the per-protocol therapy compliant population.Results:In the per-protocol therapy compliant population, the active NMES group (n = 21) had a higher reduction in Visual Analog Scale Nominated Activity (64.7% versus 24.3%, P = 0.020) and Visual Analog Scale Nominated Activity improvement ≥50% (76.2% versus 12.5%, P = 0.002) than the sham NMES group (n = 8). Outcomes were not markedly different between groups in the intent-to-treat population.Discussion:Applying NMES therapy for an additional 14 weeks (totaling 26 weeks) resulted in notable and clinically meaningful pain relief when patients were fully compliant with NMES.

P142. Single center, randomized controlled trial of intravenous vs oral acetaminophen administration in perioperative care of 1 and 2 level LLIFs with instrumented posterior lumbar fusion: a comparative effectiveness study

P142. Single center, randomized controlled trial of intravenous vs oral acetaminophen administration in perioperative care of 1 and 2 level LLIFs with instrumented posterior lumbar fusion: a comparative effectiveness study

Lumbar Fusion for Active Duty Service Members Performed at an Overseas Military Treatment Facility: A 2-Year Retrospective Analysis.

Among U.S. Military active duty service members, low back pain (LBP) and lumbar radiculopathy are common causes of disability and effect job performance and readiness and can lead to medical separation from the military. Among surgical therapies, lumbar fusion is an option in select cases; however, elective lumbar fusion performed while serving overseas has not been studied extensively. A retrospective analysis of a prospectively collected surgical database from an overseas military treatment facility (MTF) over a 2-year period (2019-2021) was queried. Patient and procedural data were collected to include single and 2-level lumbar fusion, indications for surgery, military rank, age, tobacco use, pre- and postoperative Visual Analog Scale (VAS) scores for pain, and the presence of radiographic fusion after surgery. Chi-square and Student's t-test analyses were performed to identify variables associated with return to full duty. A total of 21 patients underwent lumbar fusion with an average follow-up of 303.2 days (110-832 days). Eleven (52.4%) were able to return to full duty without restriction. Four (19%) patients ultimately required medical separation from the military, and six (28.6%) remained in a partial or limited duty status. Three (14.3%) patients required tour curtailment and return from overseas duty prematurely. Older age (40.2 ± 5.9 years), rank of E7 or greater, and reduction in VAS of 50% postoperatively were all associated with return to full unrestricted active duty. Three surgical complications occurred; all patients were able to recover overseas within a 3-month postoperative period. Low back pain (LBP) and lumbar radiculopathy may ultimately require treatment with instrumented lumbar fusion and decompression. In this series, we demonstrate that overseas duty with treatment at a community-sized MTF does not preclude this therapy and should be considered among treatment options.

Predictors of Positive Outcomes and a Scoring System to Guide Management After Fasciotomy for Chronic Exertional Compartment Syndrome.

Background:Chronic exertional compartment syndrome (CECS) of the lower limb usually responds well to fasciotomy in patients with failed nonoperative treatment. Careful history taking and compartment pressure testing are both required to accurately diagnose CECS.Purposes:To evaluate patients with CECS after fasciotomy to establish predictive criteria of positive outcomes and to develop a scoring system to aid clinicians in their management of such patients.Study Design:Case-control study; Level of evidence, 3.Methods:We reviewed data from 28 patients who underwent fasciotomy between 2017 and 2019. All patients had undergone preoperative dynamic intracompartmental pressure (ICP) monitoring. For each patient, subjective preoperative and postoperative pain scores were gained via a questionnaire. The point biserial and Pearson correlation coefficients were used to calculate the association between multiple diagnostic criteria and a reduction in visual analog scale (VAS) pain scores after fasciotomy.Results:A reduction in VAS pain scores was strongly correlated with a peak ICP >40 mm Hg (r = 0.71; P = .0007) and an area under the receiver operating characteristic curve for an intraexercise ICP >22,000 mm Hg·s2 (r = 0.76; P = .0002). A moderate correlation was found between a history of CECS pain (r = 0.61; P = .005), a duration of symptoms of <30 minutes after stopping exercise (r = 0.60; P = .006), and a gradient in the intraexercise ICP >10 mm Hg (r = 0.60; P = .006). When combined into an objective, weighted scoring system (2 points for factors with r > 0.7; 1 point for r = 0.5-0.7), a score of ≥4 points (of 7) had a strong correlation (r = 0.85; P < .00001) with postoperative improvement in the VAS pain score. Linear regression of this score demonstrated a good fit (R 2 = 0.61; P < .0001), indicating a degree of predictive power.Conclusion:We identified diagnostic criteria in the history and examination of patients with CECS that can be used to help predict positive outcomes after fasciotomy. We propose a scoring system to aid clinicians in their management of such patients. We recommend taking these results forward in prospective trials to test the efficacy of predictive scoring.

Short-Term Outcomes and Clinical Features Analysis of Anterior Cervical Discectomy; Effect of Non-Instrumented Vs. Instrumented Fusion

Aim: To investigate the impact of instrumental and non-instrumental anterior cervical decompression and fusion procedures on various cervical degenerative diseases in terms of reducing pain and disability. Study Design: A prospective case series. Place and Duration: The study was conducted in the Neurosurgery Ward of Ayub Medical Complex, Abbottabad and Neurosurgery department of Hayatabad Medical Complex, Peshawar for duration 1 year from 1st Jan 2021 to 31st Dec 2021. Material and Methods: A total of 40 patients who underwent surgery for cervical degenerative diseases were selected and patients with more than one level segment were excluded from the study. Clinical symptoms and preoperative pain and disability were recorded using the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and the Nurick grading. Post-operative score was recorded with improvement or deterioration in VAS, JOA score, and Odom criteria. Results: 40 patients, 24 (60%) men and 16 (40%) women were enrolled in the analysis. The mean age was 56.6 years ± 6.7 SD. Mean length of symptoms was 12.05 months with 5.65 SD. The total mean span of stay in the postoperative period was 4.55 days ± 1.05 SD. 24 (62.5%) patients reported neck pain, 18 (45%) patients with symptoms of radiculopathy, and 12 (30%) sensory deficits. In the study, 13 (32.5%) patients had features of cervical myelopathy. There was hand weakness in 11 (27.5%) cases and reduced range of neck motion in 15 (37.5%) cases. Anterior cervical decompression and fusion (ACDF) were performed in 24 (60%) patients, and anterior cervical discectomy (ACD) was performed in only 16 (40%) patients. The median of pre-operative VAS was 7.9 (mean 7.2) ± 1.35 SD, and the median of post-operative VAS after 2 weeks of follow-up was 3.00 (mean 3.04) ± 0.64 SD and 2.00 (mean 1.91) ± 0.94 SD after 3-month follow-up. Similarly, the median pre-operative JOA score was 15.20 (mean: 12.7) ± 3.30 SD, and after 3 months of follow-up, it was 16.00 (mean: 15.5) ± 1.01 SD. The reduction of the median VAS (Z = -4.46) and JOA (Z = -4.22) scores for both intervention groups was statistically significant after 3 months of follow-up (p &lt;0.001). Conclusions: Anterior cervical procedures are associated with excellent short-term outcomes in reducing pain and disability. ACDF requires longer operative time, but the length of postoperative stay was comparable in both groups. Keywords: Anterior cervical discectomy and fusion, Cervical spondylosis and Surgical result

Transarterial Chemoembolization with Doxorubicin Eluting Beads for Extra-Abdominal Desmoid Tumors: Initial Experience.

To evaluate the feasibility, efficacy, and safety of doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) as an alternative local treatment for extra-abdominal desmoid tumors (DTs). Eleven adult female patients (mean age = 40.1years) with symptomatic, progressively enlarging extra-abdominal DTs were determined ineligible for cryoablation after failing observation or systemic therapy and treated with a single session doxorubicin DEB-TACE. Six rectus sheath, one chest wall, three axilla, and one upper extremity DTs were included. The median follow-up was 155.0 ± 52.3days. Treatment response was assessed by MRIs and maximum visual analog scale (VAS). All procedures were technically successful without immediate complications. The average size of treated DT was 161.8ml (range: 28.3-420.0ml). The mean doxorubicin dose was 13.3mg/m2. All patients experienced skin changes which improved over time without treatments. No higher-grade adverse events were observed. Initial one-month follow-up MRI demonstrated partial to near-complete tumor necrosis, ranging from 1.4 to 97.6% (mean: 36.4%). Additional follow-up revealed a further reduction of overall tumor volume (mean: - 38.1%, p < 0.0001) and maximum VAS (mean: - 2.6, p = 0.0026) in 10 out of 11 patients (90.9%). After the first month, the residual tumors exhibited continued volume reduction in 10 out of 11 patients (mean: - 16.5%, p = 0.0230). There was also a significant decrease of T2 signal intensity within residual tumor on the latest follow-up (mean: - 29.6%, p = 0.0217), suggesting a reductionin tumor cellularity. DEB-TACE may be a safe and effective local treatment alternative in DT patients.