Visual Analog Scale Leg Research Articles

Efficacy and safety of unilateral biportal endoscopy versus other spine surgery: A systematic review and meta-analysis.

BackgroundThis study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery.MethodsElectronic databases were systematically searched up to February 2022. The authors used Review Manager 5.3 to manage the data and perform the review.ResultsAfter the preliminary selection of 239 studies from electronic databases, the full inclusion criteria were applied; 16 studies were found to be eligible for inclusion. These 16 studies enrolled 1,488 patients: 653 patients in the UBE group, 570 in the microendoscopic discectomy group, 153 in the percutaneous endoscopic lumbar discectomy group, and 70 in the posterior lumbar interbody fusion group. UBE was superior to microendoscopic discectomy regarding 1-day Visual Analog Scale(VAS) back pain scores (P < 0.00001). No difference was found between UBE and microendoscopic discectomy regarding 1-day Visual Analog Scale leg pain scores (P = 0.25), long-term VAS back pain scores (P = 0.06), long-term VAS leg pain scores (P = 0.05), Oswestry Disability Index scores (P = 0.09) or complications (P = 0.19). Pooled analysis indicated that UBE was similar to percutaneous endoscopic lumbar discectomy regarding 1-day VAS back pain scores (P = 0.71), 1-day VAS leg pain scores (P = 0.37), long-term VAS back pain scores (P = 0.75), long-term VAS leg pain scores (P = 0.41), Oswestry Disability Index scores (P = 0.07) and complications (P = 0.88). One study reported no difference between UBE and posterior lumbar interbody fusion regarding long-term VAS back pain, long-term VAS leg pain, or Oswestry Disability Index scores.ConclusionsUBE is superior to microendoscopic discectomy to relieve back pain 1 day postoperatively. However, these two procedures are similar regarding 1-day leg pain relief, long-term effects, and safety. UBE and percutaneous endoscopic lumbar discectomy are similar regarding 1-day pain relief, long-term effects and safety. More evidence is needed to evaluate the efficacy and safety of UBE versus posterior lumbar interbody fusion.

Assessment of the psoas muscle changes following the oblique lateral interbody fusion (OLIF) approach: A prospective observational study

BackgroundTraditional open posterior fusion techniques involve stripping of the posterior paraspinal muscles with protracted retraction, which can lead to ischemia and denervation. This may result in poor clinical outcomes despite a well-performed surgery. Oblique lumbar interbody fusion (OLIF) is a minimally invasive modified retroperitoneal anterior approach in the corridor between the psoas major (PM) and great vessels. The purpose of this research was to study changes in psoas properties and clinical outcomes in terms of the loss of hip flexion in patients undergoing OLIF surgery. MethodsPatients with lumbar pathologies who underwent instrumented OLIF at our center were included. These patients were examined clinically at baseline and 6 months postoperatively. The Oswestry disability index (ODI) and visual analog scale (VAS) scores for back pain and leg pain were noted. Magnetic resonance imaging (MRI) scans were obtained preoperatively and postoperatively (minimum 6 months) to compare the cross-sectional areas (CSAs) of the PM. ResultsIn total, 17 patients (male: female = 8:9) with a mean age of 46.06 ± 10.49 years were included. The operation time was 154.94 ± 32.33 min, estimated blood loss was 190 ± 56 mL, and mean CSAs of the right and left psoas were, respectively, 9.94 ± 3.19 and 10.65 ± 3.74 cm2 preoperatively and 10.00 ± 3.06 and 8.53 ± 2.81 cm2 at follow-up. Qualitative measurements revealed that muscle atrophy on the left side (approach side) was 19.12% ± 3.14% and fatty degeneration had occurred in 13 of 17 (76.5%) patients. Postoperatively, all patients had significant improvement in the VAS (back and leg) and ODI scores. Furthermore, 3 of 17 (17.6%) patients had mild hip weakness (4/5) on the left side immediately postoperatively, but it resolved in 6 months. Moreover, 2 of 17 (11.8%) patients complained of paraesthesia. ConclusionOLIF does cause injury to the PM but it is clinically insignificant according to MRI scans and clinical evaluations.

Static versus Expandable Interbody Fusion Devices: A Comparison of 1-Year Clinical and Radiographic Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Retrospective cohort study. To compare the radiographic and clinical outcomes of static versus expandable interbody cages in transforaminal lumbar interbody fusion using minimally invasive surgery (MIS-TLIF). Expandable interbody cages may potentially improve radiographic and clinical outcomes following MIS-TLIF compared to static pages, but at a potentially higher cost and increased rates of subsidence. A retrospective chart review of 1- and 2-level MIS-TLIFs performed from 2014 to 2020 was reviewed. Radiographic measurements were obtained preoperatively, 6 weeks postoperatively, and at final follow-up. Patient-reported outcome measures (PROMs) including the Oswestry Disability Index, Visual Analog Scale (VAS) back, and VAS leg were evaluated. Multivariate linear regression analysis determined the effect of cage type on the change in PROMs, controlling for demographic characteristics. Alpha was set at 0.05. A total of 221 patients underwent MIS-TLIF including 136 static and 85 expandable cages. Expandable cages had significantly greater anterior (static: 11.41 mm vs. expandable: 13.11 mm, p <0.001) and posterior disk heights (static: 7.22 mm vs. expandable: 8.11 mm, p <0.001) at 1-year follow-up. Expandable cages offered similar improvements in segmental lordosis at 6 weeks (static: 1.69° vs. expandable: 2.81°, p =0.243), but segmental lordosis was better maintained with expandable cages leading to significant differences at 1-year follow-up (static: 0.86° vs. expandable: 2.45°, p =0.001). No significant differences were noted in total complication (static: 12.5% vs. expandable: 16.5%, p =0.191) or cage subsidence rates (static: 19.7% vs. expandable: 22.4%, p =0.502) groups at 1-year follow-up. Expandable devices provide greater improvements in radiographic measurements including anterior disk height, posterior disk height, and segmental lordosis, but this did not lead to significant improvements in PROMs, complication rates, subsidence rates, or subsidence distance.

Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion.

Retrospective case-control study. To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion. SSI is among the most common healthcare-associated complications. As healthcare systems increasingly emphasize the value of delivered care, there is an increased need to understand the clinical impact of SSIs. A retrospective 3:1 (control:SSI) propensity-matched case-control study was conducted for adult patients who underwent thoracolumbar fusion from March 2014 to January 2020 at a single academic institution. Exclusion criteria included less than 18 years of age, incomplete preoperative and one-year postoperative patient-reported outcome measures, and revision surgery. Continuous and categorical data were compared via independent t tests and χ 2 tests, respectively. Intragroup analysis was performed using paired t tests. Regression analysis for ∆ patient-reported outcome measures (postoperative minus preoperative scores) controlled for demographics. The α was set at 0.05. A total of 140 patients (105 control, 35 SSI) were included in final analysis. The infections group had a higher rate of readmission (100% vs. 0.95%, P <0.001) and revision surgery (28.6% vs. 12.4%, P =0.048). Both groups improved significantly in Physical Component Score (control: P =0.013, SSI: P =0.039), Oswestry Disability Index (control: P <0.001, SSI: P =0.001), Visual Analog Scale (VAS) Back (both, P <0.001), and VAS Leg (control: P <0.001, SSI: P =0.030). Only the control group improved in Mental Component Score ( P <0.001 vs. SSI: P =0.228), but history of a SSI did not affect one-year improvement in ∆MCS-12 ( P =0.455) on regression analysis. VAS Leg improved significantly less in the infection group (-1.87 vs. -3.59, P =0.039), which was not significant after regression analysis (β=1.75, P =0.050). Development of SSI after thoracolumbar fusion resulted in increased revision rates but did not influence patient improvement in one-year pain, functional disability, or physical and mental health status.

Full-Endoscopic versus Minimally Invasive Lumbar Interbody Fusion for Lumbar Degenerative Diseases : A Systematic Review and Meta-Analysis.

ObjectiveAlthough full-endoscopic lumbar interbody fusion (Endo-LIF) has been tried as the latest alternative technique to minimally invasive transforaminal lumbar interobody fusion (MIS-TLIF) since mid-2010, the evidence is still lacking. We compared the clinical outcome and safety of Endo-LIF to MIS-TLIF for lumbar degenerative disease. MethodsWe systematically searched electronic databases, including PubMed, EMBASE, and Cochrane Library to find literature comparing Endo-LIF to MIS-TLIF. The results retrieved were last updated on December 11, 2020. The perioperative outcome included the operation time, blood loss, complication, and hospital stay. The clinical outcomes included Visual analog scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI), and the radiological outcome included pseudoarthosis rate with 12-month minimum follow-up. ResultsFour retrospective observational studies and one prospective observational study comprising 423 patients (183 Endo-LIF and 241 MIS-TLIF) were included, and the pooled data analysis revealed low heterogeneity between studies in our review. Baseline characteristics including age and sex were not different between the two groups. Operation time was significantly longer in Endo-LIF (mean difference [MD], 23.220 minutes; 95% confidence interval [CI], 10.669–35.771; p=0.001). However, Endo-LIF resulted in less perioperative blood loss (MD, -144.710 mL; 95% CI, 247.941–41.478; p=0.023). Although VAS back pain at final (MD, -0.120; p=0.586), leg pain within 2 weeks (MD, 0.005; p=0.293), VAS leg pain at final (MD, 0.099; p=0.099), ODI at final (MD, 0.141; p=0.093) were not different, VAS back pain within 2 weeks was more favorable in the Endo-LIF (MD, -1.538; 95% CI, -2.044 to -1.032; p<0.001). On the other hand, no statistically significant group difference in complication rate (relative risk [RR], 0.709; p=0.774), hospital stay (MD, -2.399; p=0.151), and pseudoarthrosis rate (RR, 1.284; p=0.736) were found. ConclusionRelative to MIS-TLIF, immediate outcomes were favorable in Endo-LIF in terms of blood loss and immediate VAS back pain, although complication rate, mid-term clinical outcomes, and fusion rate were not different. However, the challenges for Endo-LIF include longer operation time which means a difficult learning curve and limited surgical indication which means patient selection bias. Larger-scale, well-designed study with long-term follow-up and randomized controlled trials are needed to confirm and update the results of this systematic review.

The Effect of State-Level Prescription Opioid Legislation on Patient Outcomes After Lumbar Tubular Microdecompression.

In the United States, a statewide legislation titled the Strengthen Opioid Misuse Prevention (STOP) Act was enacted in 2017 to limit prescription opioid use and reduce dependence. The impact of state legislation curbing opioid prescription on outcomes after spine surgery is unknown. Case series. Data from consecutive patients undergoing lumbar tubular microdecompression for symptomatic lumbar spine stenosis from June 2016 to June 2019 were retrospectively analyzed. Cases between June 2016 and December 2017 represent the group before the STOP act (pre-STOP), while cases between January 2018 and June 2019 represent the group after legislation enactment (post-STOP). Preoperative and postoperative patient functional scores including the EuroQol-Five Dimensions Index, Oswestry Disability Index (ODI), and the visual analog scale (VAS) for back and leg pain were compared between both groups. The meaningful clinically important difference (MCID) was calculated for each score and was compared between both groups as well. A total of 147 patients met inclusion criteria, with 86 in the pre-STOP group and 61 in the post-STOP group. Analysis of postoperative scores demonstrated statistically lower VAS leg pain score averages in the post-STOP group (P < 0.05). Higher trends in achieving MCID among the post-STOP group were observed; however, the differences between both groups were not statistically significant (P > 0.05 for all). Additionally, there were no statistical differences in rates of unplanned pain-related clinic visits and emergency department (ED) visits, as well as no differences in the number of pain-related calls within 90 days after surgery between both groups. The enactment of state legislation to curb the prescribing of opioids for postoperative pain did not negatively affect the rate of achieving clinically meaningful outcomes among patients undergoing lumbar tubular microdecompression for spinal stenosis. Additionally, decreasing the amount of opioids prescribed for postoperative pain does not increase the number of unplanned clinic or ED visits due to pain within 90 days after surgery.

Effect of Preoperative Parameters on Outcomes of Lumbar Microdiscectomy: A Retrospective Analysis.

Objective The objective of this study was to characterize the effect of preoperative variables on outcomes after minimally invasive lumbar microdiscectomy. Materials and Methods This study was done from January 2019 to May 2020. This included medical records of all patients who were diagnosed with lumbar disc herniation and treated surgically by microdiscectomy. The medical records of such patients from January 2016 to January 2018 were included in this study. Postoperative outcomes were analyzed by Oswestry Disability Index (ODI), visual analog scale (VAS) leg, and VAS back scores, that were noted at preoperative, immediate postoperative, 6 months postoperative, and 1 year after operation. Difference in each outcomes score was calculated postoperatively with respect to the preoperative readings. Minimal clinically important difference was further calculated for each outcome score. Results On analyzing the ODI, VAS leg, and VAS back scores across various age groups, genders, body mass indexes, addictions, comorbidities, preoperative epidural steroid injection and physiotherapy, and levels of disc herniation, and it was found that there was no statistically significant difference across these categories. However, the ODI scores (∼ ODI) at all time points showed greater difference in the younger age group, that is, 18 to 30 years, males, nonsmokers, those with symptom duration of less than 6 weeks, and with disc herniation at L3 to L4. Conclusion The findings of this study will help to properly counsel patients with regard to the factors mentioned above so as to set realistic expectations, to help improve the outcomes, and for appropriate surgical decision making, that is, at which point should a surgical intervention be made.

No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain.

The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc's cross-sectional area on T2 axial MRI scans. Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared. A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093). The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient's symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform discectomy. Cite this article: Bone Joint J2022;104-B(6):715-720.

The clinical impact of lumbar epidural steroid injections prior to spine surgery for lumbar spinal stenosis

IntroductionLumbar spinal stenosis is a common finding in the adult population. Lumbar Epidural Steroid Injections (ESIs) are often used in management of this condition, with conflicting evidence regarding their efficacy. Previous research has suggested a negative impact of ESIs on the postoperative outcomes when ESIs are administered preoperatively prior to spine surgery in this population. Our retrospective study was performed to gain greater insight into the impact of preoperative ESIs on postoperative outcomes following spine surgery in management of lumbar stenosis. ObjectiveOur objective is to determine how preoperative ESIs impact postoperative outcomes following spine surgery in management of lumbar stenosis. DesignRetrospective cohort involving 95 patients (39 patients who received ESI in the preoperative timeframe and 56 patients who did not) who underwent surgical management of lumbar stenosis. Data for patients with preoperative ESI was compared to those without preoperative ESI administration. SettingInstitutional. InterventionsNot Applicable. Main outcome measuresPROMIS (Patient-Reported Outcomes Measurement Information System) scores, VAS (Visual Analog Scale) pain scores, ODI (Oswestry Disability Index), NDI (Neck Disability Index). ResultsAt baseline (time of surgery), the ESI group had significantly higher ODI, PROMIS pain, PROMIS pain interference, VAS leg and lower PROMIS physical function, but no significant difference in PROMIS satisfaction, VAS back and NDI, compared to the Non-ESI group. At 3 months after surgery, both the ESI and Non-ESI groups demonstrated a significant decrease in VAS back, VAS leg, PROMIS pain and ODI from baseline scores. The improvement in PROMIS pain at 3 months after surgery was larger in the ESI group than the Non-ESI group. ConclusionsPreoperative ESI administration did not lead to worsening of disability, function, or pain symptoms in the short-term postoperative period following surgical management of lumbar stenosis. Patients had short term improvements in radicular pain following surgical management of lumbar stenosis, regardless of preoperative ESI administration.

Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis.

BackgroundEndoscopic lumbar interbody fusion is a new technology that is mostly used for single-segment and unilateral lumbar spine surgery. The purpose of this study is to introduce percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) with unilateral laminotomy for bilateral decompression (ULBD) for lumbar spondylolisthesis and evaluate the efficacy by comparing it with open posterior lumbar interbody fusion (PLIF).MethodsTwenty-eight patients were enrolled in PE-PLIF with the ULBD group and the open PLIF group. The perioperative data of the two groups were compared to evaluate the safety of PE-PLIF with ULBD. The visual analog scale (VAS) back pain, VAS leg pain, and Oswestry Disability Index (ODI) scores of the two groups preoperatively and postoperatively were compared to evaluate clinical efficacy. Preoperative and postoperative imaging data were collected to evaluate the effectiveness of the operation.ResultsNo differences in baseline data were found between the two groups (p > 0.05). The operation time in PE-PLIF with the ULBD group (221.2 ± 32.9 min) was significantly longer than that in the PLIF group (138.4 ± 25.7 min) (p < 0.05), and the estimated blood loss and postoperative hospitalization were lower than those of the PLIF group (p < 0.05). The postoperative VAS and ODI scores were significantly improved in both groups (p < 0.05), but the postoperative VAS back pain score in the PE-PLIF group was significantly lower than that in the PLIF group (p < 0.05). The excellent and good rates in both groups were 96.4% according to MacNab’s criteria. The disc height and cross-sectional area of the spinal canal were significantly improved in the two groups after surgery (p < 0.05), with no difference between the groups (p > 0.05). The fusion rates in PE-PLIF with the ULBD group and the PLIF group were 89.3% and 92.9% (p > 0.05), respectively, the cage subsidence rates were 14.3% and 17.9% (p > 0.05), respectively, and the lumbar spondylolisthesis reduction rates were 92.72 ± 6.39% and 93.54 ± 5.21%, respectively (p > 0.05).ConclusionThe results from this study indicate that ULBD can be successfully performed during PE-PLIF, and the combined procedure is a safe and reliable treatment method for lumbar spondylolisthesis.

Presenting Mental Health Influences Postoperative Clinical Trajectory and Long-Term Patient Satisfaction After Lumbar Decompression

To compare patient-reported outcomes (PROMs), postoperative patient-reported satisfaction, and minimum clinically important difference (MCID) achievement after minimally invasive surgery lumbar decompression (MIS-LD) in patients stratified by their preoperative 12-Item Short-Form Mental Component Score (SF-12 MCS). Patients who underwent single-level/multilevel MIS-LD were included. PROMs were administered preoperatively and 6 weeks/12 weeks/6 months/1 year postoperatively. Patients were grouped by preoperative SF-12 MCS. Demographic/perioperative characteristics were compared among groups using a χ2 and Student t test for categorical and continuous variables, respectively. Mean PROM and postoperative satisfaction scores were compared using an unpaired Student t test. PROM improvement within cohorts was assessed with paired-samples t test. MCID achievement rates were compared using χ2 analysis. A total of 297 patients were included: 111 patients in SF-12 MCS <48.9 and 186 patients in the SF-12 MCS ≥48.9 cohort. Cohorts showed mean postoperative differences for visual analog scale (VAS) back score at 12 weeks, VAS leg score at 6 weeks/12 weeks, Oswestry Disability Index (ODI) at 6 weeks/12 weeks, SF-12 MCS at all postoperative time points, and 12-Item Short-Form Physical Component Score at 6 weeks/12 weeks (P < 0.022, all). Of patients in the SF-12 MCS <48.9 cohort, more achieved MCID for SF-12 MCS at all postoperative time points and ODI at 1 year (P < 0.023, all). More patients in the SF-12 MCS ≥48.9 cohort achieved MCID for VAS leg score at 12 weeks and 12-Item Short-Form Physical Component Score at 6 weeks (P < 0.038). Patients in the SF-12 MCS <48.9 cohort showed inferior postoperative satisfaction for VAS leg score at 6 weeks/12 weeks/1 year, VAS back score at 12 weeks, and ODI at all postoperative time points. Patients with inferior mental health preoperatively showed worse mean short-term postoperative clinical outcome for leg/back pain, physical function and disability, short-term and long-term postoperative satisfaction for leg pain and disability, and long-term satisfaction for sleeping/lifting/walking/standing/sex/travel.

Preoperative and postoperative diagnostic efficiency of multi-inflammatory index on pain scoring of degenerated intervertebral disc.

The inflammatory index can be useful for neurosurgeons to understand and grade pain in degenerated intervertebral disc (DIVD). The study focused on the value of the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and the inflammatory multiple indices (MIs), and aimed to compare its efficiency with the preoperative and postoperative pain scale and scoring algorithms. A total of 88 DIVD patients were included in this retrospective clinical cohort study. Visual Analogue Scale Back (VASB) and Visual Analogue Scale Leg (VASL), Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and walking distance (WD) were used to assess pain. The multiple index (MI) was calculated as MI-1 = PLR × C-reactive protein (CRP) and MI-2 = NLR × CRP. Comparing the MI with ODI, no correlation was found in preoperative values, while a positive correlation (MI-1: r = 0.398, p < 0.001; MI-2: r = 0.285; p = 0.007) was found between the postoperative measurements. A significant correlation was found for VASB and both MI-1 (preoperative: r = 0.373, p = 0.001; postoperative: r = 0.232, p = 0.041) and MI-2 (preoperative: r = 0.388, p < 0.001; postoperative: r = 0.206, p = 0.044). The MI-1 index showed 71.4% sensitivity and 73.3% specificity, while the MI-2 index exhibited 78.6% sensitivity and 68.9% specificity. MI-1 and MI-2 showed a positive correlation with preand post-operative VASB score and had strong potential to predict postoperative pain in DIVD. They are easy-to-use, noninvasive and low-cost indices; therefore, our results are promising for routine application.

Minimally invasive versus open transforaminal lumbar interbody fusion for single segmental lumbar disc herniation: A meta-analysis.

BACKGROUND: Numerous studies on the comparison of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open-transforaminal lumbar interbody fusion (O-TLIF) for the treatment of lumbar disc herniation (LDH) have been published, but there is no clear conclusion.OBJECTIVE: The aim of this study was to evaluate the efficacy of MIS-TLIF compared with O-TLIF in the treatment of LDH in the Chinese population by meta-analysis.METHODS: Studies on the treatment of LDH by MIS-TLIF versus O-TLIF were searched in Pubmed, Web of Science, Medline, Embase, CNKI, VIP and China Wanfang databases from the establishment of the databases to January 2020. The meta-analysis was used to analyze the pooled operation time, intraoperative blood loss, postoperative drainage, postoperative ground movement time, Waist and leg Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score and Japanese orthopaedic association (JOA) score. Mean difference (MD) and standard mean difference (SMD) were used as the effect size.RESULTS: Eleven studies with 1132 patients were included. The results showed that MIS-TLIF compared with O-TLIF, MD 133.82 (95% CI: 167.10 100.53, 0.05) in intraoperative blood loss, MD 114.43 (95% CI: 141.12 87.84, 0.05) in postoperative drainage, MD 3.30 (95% CI: 4.31 2.28, 0.05) in postoperative ground movement time, SMD 1.44 (95% CI: 2.63 0.34, 0.05) in postoperative low back pain VAS score, SMD 0.41 (95% CI: 0.15 0.66, 0.05) in postoperative JOA score, MD 4.12 (95% CI: 11.64 19.87, 0.05) in the average operation time, SMD 0.00 (95% CI: 0.36 0.36, 0.05) in leg pain VAS score, and SMD 0.59 (95% CI: 1.22 0.03, 0.05) in ODI score.CONCLUSION: MIS-TLIF was superior to O-TLIF in the treatment of LDH, especially in the intraoperative blood loss, postoperative drainage, postoperative ground movement time and low back pain in the Chinese population.

Application of cortical bone trajectory screw and sacral alar screw internal fixation for surgical treatment of lumbar adjacent segment degeneration

Objective: To explore the application of cortical bone trajectory screw (CBTS) and sacral alar screw (SAS) internal fixation in the treatment of lumbar adjacent segment degeneration (ASD) and evaluate its clinical effect. Methods: Data of 24 patients who were diagnosed with ASD and treated by CBTS or SAS in Beijing Chaoyang Hospital were retrospectively reviewed. There were 14 males and 10 females with a mean age of (67.9±8.2) years. The patients were followed-up for (2.6±0.4) years. Perioperative parameters including operation time, intraoperative blood loss and postoperative time on the ground were counted. All patients were followed-up for at least 2 years. Visual analogue scale (VAS) and the Oswestry disability index (ODI) were compared between pre-operation and at the last follow-up. The internal fixation-related complications, pseudarthrosis and adjacent re-degeneration were evaluated in the follow-up. Results: There were 14 proximal ASD patients, 8 distal ASD patients, 1 both ends ASD patient and 1 ASD patient in between the fusion surgeries. Bone mineral density (BMD) T score of the adjacent vertebrae was -1.98±0.91 on average. The ASD patients were re-operated with CBTS and SAS internal fixation technique. A small incision was made in the revision surgery and the original fixation was not completely cut open and removed. The mean operation time was (125±36) min, mean blood loss was (85±33) ml. The postoperative ambulation time was (3.1±1.9) days, and the hospitalization time was (9.0±2.6) days. Before the operation, the average VAS (back pain) score was 5.2±1.0, the average of VAS (leg pain) score was 6.8±1.9 and ODI was 56.6%±12.8%. VAS score was reduced to 1.4±0.6 (waist pain) and 0.9±0.4 (leg pain). ODI was improved to 13.8%±6.3%. All the difference between preoperative and the last follow-up was statically significant (all P<0.01). No internal fixation failure, pseudarthrosis and adjacent re-degeneration were observed in the final follow-up. Conclusion: The application of CBTS and SAS internal fixation techniques in the surgical treatment of lumbar ASD has the advantages of less trauma, faster postoperative recovery, reliable internal fixation, and fewer complications, especially in patients with low bone mineral density.

Clinical Evaluation of Paraspinal Mini-Tubular Lumbar Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis Grade I with Lumbar Spinal Stenosis: A Cohort Study.

ObjectiveTo investigate the clinical outcome data and difference in efficacy between paraspinal mini-tubular lumbar decompression (PMTD) and minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the treatment of degenerative lumbar spondylolisthesis grade I with lumbar spinal stenosis (DLS-I-LSS).MethodsPatients with DLS-I-LSS, who underwent PMTD or MIS TLIF from September 2017 to March 2020, were included retrospectively. The follow-up period was 24 months after surgery. Outcome measurements included the Oswestry disability index (ODI) score, visual analog scale (VAS) low back pain score, VAS leg pain score, surgical data, and adverse events.ResultsA total of 104 patients with DLS-I-LSS were included in this study. The average improvement in ODI at 12 months (2.0%, 95% CI, −5.7% to 1.8%; p = 0.30) and 24 months (1.7%, 95% CI, −2.7% to 6.1%; p = 0.45) after surgery between the two groups were not statistically significant. The improvement in VAS low back pain score after 24 months and improvement in VAS leg pain score were not significantly different between the two groups. Compared with the PMTD group, the MIS TLIF group had more estimated blood loss and longer hospital stays. The cumulative reoperation rates were 5.66% and 1.96% in the MIS TLIF and PMTD groups, respectively (p = 0.68). The results of multivariate analysis showed that BMI, diabetes, and baseline ODI score were the main factors influencing the improvement in ODI in patients with DLS-I-LSS after minimally invasive surgery, accounting for 50.5% of the total variance.ConclusionsThe clinical effectiveness of PMTD was non-inferior to that of MIS TLIF for DLS-I-LSS; however, there was a reduced duration of hospital stay, operation time, blood loss, and hospitalization costs in the PMTD group. BMI, presence or absence of diabetes and baseline ODI score were influencing factors for the improvement of ODI (Trial Registration: ChiCTR2000040025).

Obesity and Workers’ Compensation in the Setting of Minimally Invasive Lumbar Decompression

To investigate the influence of body mass index (BMI) on perioperative outcomes, postoperative patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement among workers' compensation (WC) claimants undergoing minimally invasive lumbar decompression (MIS-LD). WC patients diagnosed with herniated nucleus pulposus undergoing single-level MIS-LD were identified. Patients were divided into 3 groups: Non-obese (<30 kg/m2), Obese I (≥30 and <35 kg/m2), and Obese II/III (≥35 kg/m2). PROMs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years postoperatively. The predictive influence of BMI grouping on mean PROM scores was computed using simple linear regression. To compare PROMs between groups, post hoc pairwise comparisons of adjusted means were utilized. MCID achievement was compared between groups with χ2 analysis. A total of 81 patients were in the Non-obese cohort, and 43 and 45 in the Obese I and Obese II/III cohorts, respectively. Visual analog scale (VAS) leg, Oswestry Disability Index (ODI), and 12-Item Short Form Physical Composite Score (SF-12 PCS) were worse in the Obese I cohort at 12 weeks, and SF-12 PCS was lower in the Obese I vs. Obese II/III subgroup analysis (P ≤ 0.045, all). MCID achievement rates for ODI were higher for the Non-obese group at 12 weeks and overall (P ≤ 0.049, both). MCID attainment for VAS back was higher among the Non-obese cohort at 6-weeks (P= 0.022). Patients with higher levels of obesity were more likely to experience longer length of stay and delayed discharge following MIS-LD. Increasing BMI was generally not a significant predictor of postoperative pain, disability, or physical health PROMs at most timepoints. MCID achievement rates for disability relief were significantly higher for non-obese patients.

Severe Comorbidity Burden Does Not Influence Postoperative Clinical Outcomes and Trajectory for Back Pain, Leg Pain, Physical Function, or Disability in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion: Cohort-Matched Analysis

To compare perioperative outcomes, patient-reported outcome measures (PROMs), and minimum clinically important difference achievement after single-level transforaminal lumbar interbody fusion (TLIF) in patients stratified by preoperative comorbidity burden. PROMs were administered preoperatively/postoperatively and included Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), visual analog scale (VAS), Oswestry Disability Index (ODI), and 12-Item Short-Form Physical Composite Score (SF-12 PCS). Patients were grouped according to preoperative Charlson Comorbidity Index (CCI) <5 (mild to moderate comorbidity) or preoperative CCI ≥5 (severe preoperative comorbidity). A 3:1 propensity score match for age, gender, insurance status, smoking status, and preoperative spinal disease was used to control for significant demographic differences between cohorts. After propensity score matching, 255 patients were included (135 in the CCI <5 cohort; 120 in the CCI ≥5 cohort). The CCI ≥5 cohort showed significantly reduced postoperative VAS back pain score on the day of surgery (P< 0.001, all). Mean PROM differences were noted for postoperative PROMs: VAS back and ODI 6 months, both instances favoring the CCI ≥5 cohort (P < 0.038). The CCI <5cohort improved from baseline to 1 year for all postoperative PROMs except SF-12 PCS 6 weeks and 12 weeks and SF-12 Mental Composite Score 6 weeks (P < 0.034, all). The CCI ≥5 cohort reported significant improvement from preoperative baseline to 1 year for all postoperative PROMs except ODI 6 weeks, SF-12 Mental Composite Score 6 weeks and 1 year, SF-12 PCS 6 weeks, and PROMIS-PF 6 weeks (P < 0.017, all). Both cohorts reported >50% overall minimum clinically important difference achievement rate for VAS leg, VAS back, ODI, SF-12 PCS, and PROMIS-PF. The results suggest that patients undergoing MIS TLIF with severe comorbidities can expect a similar postoperative trajectory for disability, leg and back pain, and physical function. However, long-term (1 year) mental health improvement from preoperative baseline was noted only in the mild to moderate comorbidity group.

Only Surgical Decompression Is Sufficient for Multilevel Lumbar Spinal Stenosis with Calcified Disc Protrusion and Vacuum Disc: Case Reports

The purpose of this report was to share our successful cases of only surgical decompression for symptomatic multilevel lumbar spinal stenosis, by assessing treatment outcomes and perioperative complications. Two patients who had only surgical decompression for symptomatic multilevel lumbar spinal stenosis in March and May 2021 were investigated. They were preoperatively diagnosed with the calcified disc protrusion and vacuum disc in the intervertebral space by magnetic resonance imaging (MRI) and computed tomography (CT). The chief complaints were severe low back pain and bilateral sciatica 2 or 3 months ago. The patients reported also reported difficulty walking due to sciatica, for which they were admitted to Daegu Wooridul Spine Hospital. Under general anesthesia unilateral laminotomy for bilateral decompression (ULBD) was performed and discectomy was not done on the stenosis levels. Treatment outcomes were analyzed by preoperative and postoperative visual analog scale (VAS) for low back pain and sciatica (Back VAS and Leg VAS), improvement in walking, and postoperative MRI. Treatment outcomes were favorable: Low back pain and bilateral sciatica showed a VAS score improvement (Back VAS=3, Leg VAS=3), the patient’s walking was improved, and on a postoperative MRI of the two patients, the thecal sac was released sufficiently. The patients developed no perioperative complications. Only surgical decompression is an effective method for symptomatic multilevel lumbar spinal stenosis with calcified disc protrusion and vacuum disc in not the spinal canal but the intervertebral space.

Differential Agnostic Effect Size Analysis of Lumbar Stenosis Surgeries.

A meta-analysis of 89 randomized prospective, prospective, and retrospective studies on spinal endoscopic surgery outcomes. The study aimed to provide familiar Oswestry Disability Index (ODI), visual analog scale (VAS) back, and VAS leg effect size (ES) data following endoscopic decompression for sciatica-type back and leg pain due to lumbar herniated disc, foraminal, or lateral recess spinal stenosis. Higher-grade objective clinical outcome ES data are more suitable than lower-grade clinical evidence, including cross-sectional retrospective study outcomes or expert opinion to underpin the ongoing debate on whether or not to replace some of the traditional open and with other forms of minimally invasive spinal decompression surgeries such as the endoscopic technique. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 31 December 2019 identified 89 eligible studies on lumbar endoscopic decompression surgery enrolling 23,290 patient samples using the ODI and VAS for back and leg pain used for the ES calculation. There was an overall mean overall reduction of ODI of 46.25 (SD 6.10), VAS back decrease of 3.29 (SD 0.65), and VAS leg reduction of 5.77 (SD 0.66), respectively. Reference tables of familiar ODI, VAS back, and VAS leg show no significant impact of study design, follow-up, or patients' age on ES observed with these outcome instruments. There was no correlation of ES with long-term follow-up (P = 0.091). Spinal endoscopy produced an overall ODI ES of 0.92 extrapolated from 81 studies totaling 12,710 patient samples. Provided study comparisons to tubular retractor microdiscectomy and open laminectomy showed an ODI ES of 0.9 (2895 patients pooled from 16 studies) and 0.93 (1188 patients pooled from 5 studies). The corresponding VAS leg ES were 0.92 (12,631 endoscopy patients pooled from 81 studies), 0.92 (2348 microdiscectomy patients pooled from 15 studies), and 0.89 (1188 open laminectomy patients pooled from 5 studies). Successful clinical outcomes can be achieved with various lumbar surgeries. ESs with endoscopic spinal surgery are on par with those found with open laminectomy and microsurgical decompression. This article is a meta-analysis on the benefit overlap between lumbar endoscopy, microsurgical decompression, laminectomy, and lumbar decompression fusion.

Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity.

Previous studies have demonstrated the short-term radiographic and clinical benefits of circumferential minimally invasive surgery (cMIS) and hybrid (i.e., minimally invasive anterior or lateral interbody fusion with an open posterior approach) techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. This study evaluated the 2- and 3-year outcomes of cMIS and hybrid correction of ASD. A multicenter database was retrospectively reviewed for patients undergoing cMIS or hybrid surgery for ASD. Patients were ≥ 18 years of age and had one of the following: maximum coronal Cobb angle (CC) ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic incidence-lumbar lordosis mismatch (PI-LL) ≥ 10°, or pelvic tilt (PT) > 20°. Radiographic parameters were evaluated at the latest follow-up. Clinical outcomes were compared at 2- and 3-year time points and adjusted for age, preoperative CC, levels operated, levels with interbody fusion, presence of L5-S1 anterior lumbar interbody fusion, and upper and lower instrumented vertebral level. Overall, 197 (108 cMIS, 89 hybrid) patients were included with 187 (99 cMIS, 88 hybrid) and 111 (60 cMIS, 51 hybrid) patients evaluated at 2 and 3 years, respectively. The mean (± SD) follow-up duration for cMIS (39.0 ± 13.3 months, range 22-74 months) and hybrid correction (39.9 ± 16.8 months, range 22-94 months) were similar for both cohorts. Hybrid procedures corrected the CC greater than the cMIS technique (adjusted p = 0.022). There were no significant differences in postoperative SVA, PI-LL, PT, and sacral slope (SS). At 2 years, cMIS had lower Oswestry Disability Index (ODI) scores (adjusted p < 0.001), greater ODI change as a percentage of baseline (adjusted p = 0.006), less visual analog scale (VAS) back pain (adjusted p = 0.006), and greater VAS back pain change as a percentage of baseline (adjusted p = 0.001) compared to hybrid techniques. These differences were no longer significant at 3 years. At 3 years, but not 2 years, VAS leg pain was lower for cMIS compared to hybrid techniques (adjusted p = 0.032). Those undergoing cMIS had fewer overall complications compared to hybrid techniques (adjusted p = 0.006), but a higher odds of pseudarthrosis (adjusted p = 0.039). In this review of a multicenter database for patients undergoing cMIS and hybrid surgery for ASD, hybrid procedures were associated with a greater CC improvement compared to cMIS techniques. cMIS was associated with superior ODI and back pain at 2 years, but this difference was no longer evident at 3 years. However, cMIS was associated with superior leg pain at 3 years. There were fewer complications following cMIS, with the exception of pseudarthrosis.