Visual Analogue Score Score Research Articles

Low-dose letrozole – an effective option for women with symptomatic adenomyosis awaiting IVF: a pilot randomized controlled trial

Research questionCan low-dose letrozole reduce dysmenorrhoea, menorrhagia and sonographic features in symptomatic women with adenomyosis awaiting IVF? DesignThis was a longitudinal randomized prospective pilot study to explore the effectiveness of low-dose letrozole and compare it with a gonadotropin releasing hormone (GnRH) agonist in reducing dysmenorrhoea, menorrhagia and sonographic features in symptomatic women with adenomyosis awaiting IVF. The women were treated for 3 months, either with the GnRH agonist goserelin 3.6 mg/month (n = 77) or the aromatase inhibitor letrozole 2.5 mg three times weekly (n = 79). Dysmenorrhoea and menorrhagia were evaluated at randomization and followed up monthly using a visual analogue score (VAS) and pictorial blood loss assessment chart (PBAC), respectively. A quantitative scoring method was used to assess the improvement of sonographic features after 3 months of treatment. ResultsBoth groups reported a marked improvement in symptoms after 3 months of treatment. In both the letrozole and GnRH agonist groups, VAS and PBAC scores decreased significantly over the 3 months (letrozole: P = 0.0001 and P = 0.0001 for VAS and PBAC, respectively; GnRH agonist: P = 0.0001 and P = 0.0001 for VAS and PBAC, respectively). Participants on letrozole had regular menstruation cycles, while most of the women who received the GnRH agonist were amenorrhoeic, with only four women reporting mild bleeding. Haemoglobin concentrations also improved after both treatments (letrozole P = 0.0001, GnRH agonist P = 0.0001). A quantitative assessment of sonographic features showed significant improvements following both treatments (diffuse adenomyosis of the myometrium: letrozole P = 0.015, GnRH agonist P = 0.039; diffuse adenomyosis of the junctional zone: letrozole P = 0.025, GnRH agonist P = 0.001). Women with adenomyoma also responded well to both therapies (letrozole P = 0.049, GnRH agonist P = 0.024), whereas the letrozole group responded comparatively better in focal adenomyosis when the outer myometrium was involved (letrozole P < 0.001, GnRH agonist P = 0.26). No noticeable side effects were observed in women receiving letrozole therapy. Additionally, letrozole therapy was found to be more cost-effective than GnRH agonist treatment. ConclusionsLow-dose letrozole treatment is a low-cost alternative to a GnRH agonist, with comparable effects in improving the symptoms and sonographic features of adenomyosis in women awaiting IVF.

Management of Scaphoid Pseudoarthrosis Surgery with Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Axillary Block Anesthesia: Comparison of Patient Satisfaction.

Objectives: We aimed to compare clinical and functional results of treatment of scaphoid pseudoarthrosis between patients undergoing wide-awake local anesthesia no tourniquet (WALANT) versus axillary block anesthesia. Methods: The patients diagnosed with scaphoid non-union who underwent pseudoarthoris surgery were divided into WALANT group (n = 12) and axial block group (n = 11). Visual analog scores (VAS) were measured by calling the patients via phone on postoperative days 1, 2, 3, and 7. The VASs were also measured on the 14th day during patient check-ups. At the end of 12 months, Michigan Hand Questionnaire was used to assess clinical recovery. Bone union rate and surgery time were also investigated. Radiological and clinical examinations were compared between the groups. Results: Eleven patients (91.7%) in the WALANT group and 10 patients (90.9%) in the axillary block group achieved bone union (P = .94). Although there was no significant difference in preoperative VAS score between the groups, the WALANT group had significantly lower VAS score of the first 3 days postoperatively. However, there was no significant difference in VAS score between the groups on the seventh and 14th day postoperatively. There was no significant difference between the groups regarding Michigan score, time to surgery, time to union and operation time. Conclusion: The scaphoid pseudoarthrosis surgery can be done safely with WALANT technique which has significant lower VAS score on the first 3 days postoperatively.

Intra-Articular Injection of Autologous Micro-Fragmented Adipose Tissue for the Treatment of Knee Osteoarthritis: A Prospective Interventional Study.

To investigate the efficacy and safety of autologous micro-fragmented adipose tissue (MF-AT) for improving joint function and cartilage repair in patients with knee osteoarthritis. From March 2019 to December 2020, 20 subjects (40 knees) between 50 and 65 years old suffering from knee osteoarthritis were enrolled in the study and administered a single injection of autologous MF-A. The data of all patients were prospectively collected. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee society score (KSS), hospital for special surgery (HSS) score, visual analogue score (VAS) pain score, changes in cartilage Recht grade on magnetic resonance imaging (MRI) and adverse events were analyzed before and 3, 6, 9, 12 and 18 months after injection. The WOMAC, VAS, KSS and HSS scores at 3, 6, 9, 12 and 18 months after injection were improved compared with those before injection (p < 0.05). There was no significant difference in WOMAC scores between 9 and 12 months after injection (p > 0.05), but the WOMAC score 18 months after injection was worse than that at the last follow-up (p < 0.05). The VAS, KSS and HSS scores 9, 12 and 18 months after injection were worse than those at the last follow-up (p < 0.05). The Recht score improvement rate was 25%. No adverse events occurred during the follow-up. Autologous MF-AT improves knee function and relieves pain with no adverse events. However, the improved knee function was not sustained, with the best results occurring 9-12 months after injection and the cartilage regeneration remaining to be investigated.

COMPARATIVE STUDY ON THE EFFICACY OF TOPICAL METRONIDAZOLE, TOPICAL NITROGLYCERINE, AND TOPICAL DILTIAZEM IN THE MANAGEMENT OF CHRONIC ANAL FISSURE

Background and Aims: Chronic anal fissure (CAF) is usually managed with surgical modalities but it imposes huge cost with recurrence rates. Hence, topical therapies are preferred is such cases which has a good patient acceptability rate. The present study aims to compare the topical metronidazole (MTZ), diltiazem (DTZ), and glyceryl trinitrate (GTN) in terms of healing rate and pain reduction in CAF patients. Methods: This was a randomized and prospective study conducted on 90 patients with CAF. The patients were grouped as follows (n=30), Group 1; 1% MTZ gel, Group 2; 0.2% Nitroglycerin ointment, and Group 3 (n=30): 2% DTZ ointment. The patients were evaluated at 2, 4, and 6 weeks for pain using visual analogue score (VAS) and healing rate. The results were compared and p&lt;0.05 was considered as significant. Results: The VAS scores between the groups was found to be non-significant (p&gt;0.05), however the VAS scores where markedly reduced within the group at 6 weeks. The healing rate was higher in MTZ group (90%) as compared to GTN (83.3%) and DTZ group (83.3%) but it was not significant. Regarding side effect, burning sensation was observed in MTZ and GTN, DTZ groups were devoid of side effects. Conclusion: The MTZ was more effective with good healing rate but with few side effects. Regarding the pain reduction, all the groups displayed equivocal effects. Thus topical MTZ is a suitable agent for the faster healing of CAF and thus avoids the requirement of surgical options.

Clinical efficacy of resection of extramedullary subdural tumor in thoracic spinal canal via muscle-pedicle open-door laminoplasty approach

In order to evaluate the efficacy of resecting extramedullary subdural tumors, located in the thoracic spinal canal, via the muscle-pedicle open-door laminoplasty approach, clinical data of fifteen patients with thoracic spinal tumors admitted to the Department of Spinal Surgery in the Affiliated Hospital of Qingdao University from December 2018 to June 2021 were analyzed retrospectively. All patients received surgical treatment to remove the tumors via the muscle-pedicle open-door laminoplasty approach. The clinical data of the patient was recorded. The Japanese Orthopedic Association (JOA) score, the thoracic kyphosis angle in the standing position before and after the operation, and the visual analog score (VAS) of thoracic back incision pain before and after the operation were compared. CT scan was performed three months after the surgery and at the last follow-up to measure the healing of the lamina. In addition, MRI was used to detect the healing of the posterior ligament at the last follow-up. The tumors of all fifteen patients were completely removed, the operating time was (91±15) minutes, blood loss was (117±56) ml. Cerebral spinal fluid leakage occurred in three patients, but the incisions healed smoothly following compression and no complication was observed. All patients were followed-ups for more than 6 months. The VAS score of thoracic back incision pain was (3±1.3) points at three days post operation and it dropped to (1.3±0.9) points three months post-operation. The JOA score improved significantly after the operation, it was (11.9±2.4) points before operation, and it was (14.0±1.6) points three months post operation and increased to (16.1±0.7) points at the last follow-up (both P<0.001). The Cobb angle was 10.1°±5.3° before the operation and it was 10.4°±6.2° at the last follow-up (P=0.420). Three months after operation, partial callus formation or even complete healing on the muscle pedicle side was observed on the CT scans of all patients. At the last follow-up, CT scans showed complete healing on the muscle pedicle side. There were different degrees of sclerosis and healing on the open-door side. There was no necrosis, displacement, or secondary spinal canal stenosis in any vertebral lamina. It indicated that the muscle-pedicle open-door laminoplasty approach is an effective way to resection extramedullary subdural tumors located in the thoracic spinal canal.

Early Outcomes of Proximal Humerus Fractures in Adults Treated With Locked Plate Fixation Compared with Nonoperative Treatment: An Age-, Comorbidity-, and Fracture Morphology-Matched Analysis.

To compare patient-reported outcomes (PROs), range of motion (ROM), and complication rates for proximal humerus fractures managed nonoperatively or with open reduction internal fixation (ORIF). Retrospective cohort. Academic level 1 trauma center. Four hundred thirty-one patients older than 55 years were identified retrospectively. 122 patients were excluded. 309 patients with proximal humerus fractures met inclusion criteria (234 nonoperative and 75 ORIF). After matching, 192 patients (121 nonoperative and 71 ORIF) were included in the analysis. Nonoperative versus ORIF (locked plate) treatment of proximal humerus fracture. Early Visual Analog Score (VAS), ROM, PROs, complications, and reoperation rates between groups. At 2 weeks, ORIF showed lower VAS scores, better passive ROM, and patient-reported outcomes measurement information system (PROMIS) scores ( P < 0.05) compared with nonoperative treatment. At 6 weeks, open reduction internal fixation (ORIF) had lower VAS scores, better passive ROM, and PROMIS scores ( P < 0.05) compared with nonoperative treatment. At 3 months, ORIF showed similar PROMIS scores ( P > 0.05) but lower VAS scores and better passive ROM ( P < 0.05) compared with nonoperative treatment. At 6 months, ORIF showed similar VAS scores, ROM, and PROMIS scores ( P > 0.05) compared with nonoperative treatment. There was no difference in secondary operation rates between groups ( P > 0.05). ORIF patients trended toward a higher secondary reoperation rate (15.5% vs. 5.0%) than nonoperative patients ( P = 0.053). In an age-, comorbidity-, and fracture morphology-matched analysis of proximal humerus fractures, ORIF led to decreased pain and improved passive ROM early in recovery curve compared with nonoperative treatment that normalized after 6 months between groups. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Does Percutaneous Endoscopic Lumbar Discectomy for Adolescent Posterior Ring Apophysis Fracture Accompanied with Lumbar Disc Herniation Have Better Outcome Than Lumbar Disc Herniation Alone?

This study aims to compare the efficacy of percutaneous endoscopic lumbar discectomy (PELD) in treating adolescent posterior ring apophysis fracture (APRAF) accompanied by lumbar disc herniation (LDH) and lumbar disc herniation alone. Herein we present a case series of adolescent patients who underwent PELD surgery from June 2017 to September 2021. All patients were divided into two distinct groups (ie Group A and B), based on their preoperative Computed tomography (CT) scans. Group A included patients with PRAF (type III) accompanied by LDH. Group B patients had LDH alone. The general clinical characteristics, clinical outcomes, and complications in patients from the two groups were assessed and compared. Compared to before surgery, the back and leg visual analog scores (VAS) and Oswestry Disability Index (ODI) were markedly improved in both groups' patients at all follow-ups. Notably, no significant differences were observed in the back and leg VAS scores, and ODI values between the two groups at different time points after surgery. The mean intraoperative blood loss was significantly lower in Group B, relative to Group A. The mean operation time was significantly shorter in Group B, compared to Group A. There was no statistically significant difference in complication and recurrence rates between the two groups. APRAF (type III) accompanied by LDH and LDH alone can obtain roughly equal surgical effects through PELD surgery and turns out to be a safe and effective surgical approach.

Pain Management With Topical Ibuprofen in Partial-Thickness Burn Wounds and Effects on Wound Healing: A Prospective Randomized Clinical Study

BACKGROUND: Pain management is important for patient comfort in the treatment of partial-thickness burn wounds. The topical application of ibuprofen provides analgesic and anti-inflammatory effects. PURPOSE: To evaluate the efficacy of ibuprofen-containing foam dressing in partial-thickness burns. METHODS: The study included 50 patients with superficial second-degree burn wounds. Ibuprofen-containing foam dressing was used in 25 patients and paraffin gauze dressing in 25 patients as controls. The visual analogue score (VAS) was evaluated 30 min after dressing. On the 90th day following wound healing, the Vancouver scar scale (VSS) was administered to the patients to evaluate healing and scar formation. RESULTS: The rate of wound healing significantly increased in the study (ibuprofen-containing foam dressing) group compared to control group (8.84±2.97 vs 11.32±4.39, P = 0.010), and the frequency of dressing change significantly decreased in the study group vs control group (1.36±0.49 vs 5.68±2.07, P = 0.000). The oral analgesic needs and VAS scores of the patients were also found to be statistically significantly lower in the study group (5.04 ± 2.44) than for the control group (8.64 ± 1.29, P = 0.000). In the evaluation of the VSS, the total score was lower in the study group, but no statistically significant difference was observed. CONCLUSION: The use of ibuprofen-containing foam dressing in patients with superficial second-degree burns eligible for outpatient follow-up provides effective pain management and increases patient comfort. It does not have a negative effect on wound healing. We consider that ibuprofen-containing foam dressing can be safely used in partial-thickness burns.

The importance of "time to surgery" in the management of lumbar disc herniation in patients without progressive neurological deficits.

Prolonged sciatica symptoms may result in disability and consequently, absence from work for a longer period. Up to 10% of patients may need surgery but it is difficult to predict and determine which of these patients would improve spontaneously in comparison to those who might benefit from discectomy surgery. We aimed to determine if delay in the "time to surgery" (TTS) has any adverse effects on the patient reported outcome measures (PROMs). Eighty-seven patients after exclusions were selected consecutively. PROMs were comprised of pre-operative, six weeks and six months post-operative back and leg pain visual analogue scores (VAS) and Oswestry disability index (ODI). The differences between these scores were correlated with TTS. Minimal clinically important difference (MCID) of 30% improvement for ODI scores and 33% for VAS scores from baseline were considered as significant improvement. Patients were grouped into TTS less than 6 months and TTS greater than 6 months from referral to TTS. The longest TTS was 18 months. Statistical analysis was done using JASP (Version 0.14.0) [computer software]. The TTS was on average 22.5 weeks. MCID for the leg pain VAS was achieved in 90.2% patients with TTS <6 months and in 80.8% with TTS ≥6 months. The MCID for ODI was achieved in 60.7% with TTS <6 months and in 42.0% with TTS ≥6 months. The MCID for back pain VAS was achieved in 73.8% with TTS <6 months and in 50.0% of patients with TTS ≥6 months. Those who achieved the MCID in ODI score between the two groups were analysed using chi-square test with P=0.115. Those who achieved the MCID in VAS leg pain score between the two groups were analysed using chi-square test with P=0.227. No statistical difference was found in ODI and VAS for leg for patients with TTS before or after 6 months. Lumbar discectomies had a positive impact on patient's pain and function in our local district hospital. Delayed surgery of ≥6 months did not cause statistically significant worse outcomes. In the absence of worsening neurological deficit, it may be the wrong approach to define a value for the TTS.

Initial learning curve after switching to uniportal endoscopic discectomy for lumbar disc herniations.

The purpose was to investigate the learning curve for elective endoscopic discectomy performed by a single surgeon who made a complete switch to uniportal endoscopic surgery for lumbar disc herniations in an ambulatory surgery center and determine the minimum case number required to safely overcome the initial learning curve. Electronic medical records (EMR) of the first 90 patients receiving endoscopic discectomy by the senior author in an ambulatory surgery center were reviewed. Cases were divided by approach, transforaminal (46) versus interlaminar (44). Patient-reported outcome measures (visual-analog-score (VAS) and the Oswestry disability index (ODI)) were recorded preoperatively and at 2-week, 6-week, 3-month, and 6-month appointments. Operative times, complications, time to discharge from PACU, postoperative narcotic use, return to work, and reoperations were compiled. Median operative time decreased approximately 50% for the first 50 patients then plateaued for both approaches (mean: 65min). No difference in reoperation rate observed during the learning curve. Mean time to reoperation was 10weeks, with 7(7.8%) reoperations. The interlaminar and transforaminal median operative times were 52 versus 73min, respectively (p = 0.03). Median time to discharge from PACU was 80min for interlaminar approaches and 60min for transforaminal (p < 0.001). Mean VAS and ODI scores 6weeks and 6months postoperatively were statistically and clinically improved from preoperatively. The duration of postoperative narcotic use and narcotics need significantly decreased during the learning curve as the senior author realized that narcotics were not needed. No differences were apparent between groups in other metrics. Endoscopic discectomy was shown to be safe and effective for symptomatic disc herniations in an ambulatory setting. Median operative time decreases by half over the first 50 patients in our learning curve, while reoperation rates remained similar without the need for hospital transfer or conversion to an open procedure in an ambulatory setting. Level III, prospective cohort.

Oblique Lateral Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Meta-Analysis

Introduction: Oblique lateral lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) are two commonly used procedures for the treatment of lumbar degenerative diseases, but the efficacy of the two procedures is not clear. Materials and Methods: PubMed, Embase, and Cochrane Library databases were searched for controlled studies of OLIF and TLIF in the treatment of lumbar degenerative diseases. Include all articles published before Oct 2022. Two researchers conducted quality evaluation and data extraction on the research respectively. Results: This meta-analysis finally included 27 studies. The VAS and ODI scores of the two groups decreased significantly after the operation. The decrease of the visual Analogue Score (VAS) and The Oswestry Disability Index (ODI) scores in the OLIF group was greater than that in the TLIF group within 6 months after the operation, but no difference was found in the follow-up for more than 6 months. The OLIF group was better than TLIF in restoring the lumbar lordosis angle and intervertebral height. The operation time, blood loss and hospital stay of the OLIF group were less than those of the TLIF group, and there was no significant difference between the two in terms of surgical complications and fusion rate. Conclusions: Although there was no significant difference between the OLIF and TLIF groups in terms of long-term pain relief and functional improvement, the OLIF group experienced greater short-term efficacy than the TLIF group and the surgical safety of OLIF was better than that of TLIF.

Full Endoscopic Transpedicular Technique in the Treatment of High Grade Down Migrated Herniated Disc: An Evaluation of Clinical Outcomes at 12 Months Follow-Up

High-grade migrated lumbar disc herniation (LDH) such as up-migrated and down-migrated discs are challenging pathologies to treat. High-grade migrated discs are usually sequestered and situated adjacent to the medial pedicle wall. This can be easily addressed if the pedicle is used as an access route. The authors present a retrospective case series of high-grade migrated LDH treated using a full endoscopic transforaminal approach. This is a retrospective case series. The clinical outcomes in the patients were evaluated according to improvement in the symptoms as suggested by improvement in Visual Analog Score (VAS) and Oswestry Disability Index (ODI) scores in the immediate postoperative period and at the final follow-up. The radiological outcomes were evaluated using postoperative magnetic resonance imaging and computed tomography scans. After the data were collected and tabulated, descriptive statistics were used for continuous variables. The t test was used to determine the significance of changes in the VAS and ODI scores. Statistical significance was set at P<0.05. Five patients underwent discectomy using the transpedicular technique, and the mean preoperative VAS scores for the back and leg were 7.2±0.83 and 8.4±0.54, respectively. The mean VAS scores at the final follow-up for the back was 0.2±0.4 and 0 for the leg (P < 0.05). The mean preoperative ODI score was 72±8.3, which improved to 6±4.69 at the final follow-up (P < 0.05). All patients had a hospital stay of 1day. The full endoscopic transpedicular approach is a good option for treating highly migrated LDH. Surgical planning, including pedicle morphometry and the angle of the approach, should be undertaken preoperatively for the best results.

Transforaminal Interbody Fusion Using the Unilateral Biportal Endoscopic Technique Compared With Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spine Diseases: Analysis of Clinical and Radiological Outcomes.

There has been a widespread application of minimally invasive spinal surgery techniques in the past few years. Unilateral biportal endoscopic has been successfully used in a variety of lumbar spine diseases, but there are few studies on lumbar fusion assisted by unilateral biportal endoscopy. To compare the clinical and radiological outcomes of transforaminal interbody fusion using the unilateral biportal endoscopic technique (UBEIF) and transforaminal lumbar interbody fusion (TLIF) in patients with lumbar disease. We studied 128 patients, 58 in the UBEIF group and 70 in the TLIF group. The Oswestry disability index, creatine kinase, visual analog score (VAS) for leg and back pain were used to assess clinical outcomes. Radiographic outcomes were assessed using the fusion rate, internal fixation loosening, and adjacent segment degeneration. Back and leg pain VAS scores in both groups were significantly lower 3, 6, and 12 months after surgery ( P < .05). A significant reduction in Oswestry disability index in both groups was observed 6 and 12 months after surgery ( P < .05). Compared with the TLIF group at 1 week after surgery, UBEIF patients' VAS score for back pain significantly improved ( P < .05). There was no difference in fusion rate between the 2 groups (98.27% vs 98.57%). UBEIF and TLIF have similar clinical and radiographic outcomes in the treatment of single-segment lumbar disease with lumbar instability, including improved back and leg pain, improved disability, and high fusion rates. Furthermore, with UBEIF, less blood is lost, there is better relief of early back pain, and hospital stays are shorter.

Long-Term Durability of Stand-Alone Lateral Lumbar Interbody Fusion.

The long-term durability of stand-alone lateral lumbar interbody fusion (LLIF) remains unknown. To evaluate whether early patient-reported outcome measures after stand-alone LLIF are sustained on long-term follow-up. One hundred and twenty-six patients who underwent stand-alone LLIF between 2009 and 2017 were included in this study. Patient-reported outcome measures included the Oswestry Disability Index (ODI), EuroQOL-5D (EQ-5D), and visual analog score (VAS) scores. Durable outcomes were defined as scores showing a significant improvement between preoperative and 6-week scores without demonstrating any significant decline at future time points. A repeated measures analysis was conducted using generalized estimating equations (model) to assess the outcome across different postoperative time points, including 6 weeks, 1 year, 2 years, and 5 years. ODI scores showed durable improvement at 5-year follow-up, with scores improving from 46.9 to 38.5 ( P = .001). Improvements in EQ-5D showed similar durability up to 5 years, improving from 0.48 to 0.65 ( P = .03). VAS scores also demonstrated significant improvements postoperatively that were durable at 2-year follow-up, improving from 7.0 to 4.6 ( P < .0001). Patients undergoing stand-alone LLIF were found to have significant improvements in ODI and EQ-5D at 6-week follow-up that remained durable up to 5 years postoperatively. VAS scores were found to be significantly improved at 6 weeks and up to 2 years postoperatively but failed to reach significance at 5 years. These findings demonstrate that patients undergoing stand-alone LLIF show significant improvement in overall disability after surgery that remains durable at long-term follow-up.

Long-term functional and radiological outcomes of cervical disc arthroplasty at a tertiary level spine center in India: A retrospective cohort analysis with minimum 2 years of follow-up.

Cervical disc arthroplasty (CDA) was developed for the treatment of cervical disc disease with the potential advantages of preservation of physiological motion at a discal level, thereby potentially reducing adjacent level stresses and degeneration, which were a known complication of anterior cervical arthrodesis. The objective of this study was the assessment of long-term functional and radiological outcomes overtime in all the patients who underwent CDA from 2011 to 2019 at our institute. Forty-eight patients who underwent CDA (2011-2019) with a minimum 2-year follow-up were retrospectively evaluated. The functional outcome included the Visual Analog Score (VAS) and Neck Disability Index (NDI). Radiographs were assessed for range of motion (ROM) at the index surgical level, presence of heterotopic ossification (HO), and adjacent segment degeneration. The mean follow-up was 5.79 ± 2.96 (2.16-11.75) years. Significant improvement (P < 0.05) was observed in the VAS (8.91 ± 2.52 [preoperative] to 0.89 ± 1.27 [follow-up]) and NDI (65.5% ±23.06% [preoperative] to 4.79 ± 3.87 [follow-up]) score. Motion at index level increased significantly from 5.53° preoperatively to 7.47°, and 92% of the implanted segments were still mobile (referring to the threshold of ROM > 3°). HOs are responsible for the fusion of 4/50 (8%) levels at the last follow-up. Distal and proximal adjacent disc degeneration occurred in 36% and 28% of patients, respectively. No migration of the implant was observed on the radiograph. Our study showed favorable clinical outcome of CDA with preservation of ROM at the index surgical level. CDA can be a promising alternative to anterior cervical arthrodesis when properly indicated.

Efficacy and Safety of Bupivacaine (Local Anaesthetic) Infiltration at Wound Site for Post-Operative Pain Relief in Cases Undergoing Elective Abdominal Surgery - a Randomised control trial

Objectives: The efficacy and safety of Bupivacaine infiltration at the wound site were studied for postoperative pain relief in patients undergoing elective abdominal surgery. Methods and Materials: A randomized clinical trial conducted in an institution of medical education and a tertiary care centre. A total of 90 patients who were scheduled for elective abdominal surgery were randomly assigned to one of two groups. Bupivacaine infiltration was given to Group T, while sterile water was given to Group C at the incision site just before closure of the wound. The pain intensity was measured using the Visual Analogue Score (VAS) at different time intervals after surgery. The requirements for rescue analgesic, pain VAS, patient satisfaction score, and side effects were recorded over the course of 24 hours following surgery. The data was statistically analysed and expressed as a mean +/- standard deviation. The data was analysed using the Chi-square test, Mann-Whitney U test, and Wilcoxon Test of matched pairs. *P &lt; 0.05 is considered statistically significant. Results: The difference in VAS score after 2 hrs, 4 hrs, 8 hrs, and 24 hrs was found to be significantly higher in the control group as compared to the experimental group. At the end of 24 hrs, the mean score in the control group was 3.02 ± 0.66, which is higher as compared to the experimental group, which was 2.33± 0.67 (p&lt;0.05). Conclusion: Infiltration of Bupivacaine at the incision site was extremely effective for post-operative pain control with maximum patient satisfaction. This study may provide new evidence to formulate guidelines for optimum pain management in the postoperative setting for the benefit of patients with a reduced need for analgesics.

EVALUATION OF CLINICAL VARIABLES, RADIOLOGICAL VISUAL ANALOG SCORING, AND RADIOMICS FEATURES ON CT ENTEROGRAPHY FOR CHARACTERIZING SEVERE INFLAMMATION AND FIBROSIS IN STRICTURING CROHN’S DISEASE

Abstract PURPOSE 25% of patients with Crohn’s disease (CD) develop severe stricturing disease which is non-responsive to standard-of-care medication. Early and non-invasive determination of the extent of inflammation and fibrosis within the stricture via CT enterography (CTE) could facilitate the selection of targeted therapy or earlier surgical resection to improve patient outcomes; but currently there is no validated and reliable approach for this differentiation. We present initial results for machine-reader evaluation of severe inflammation and fibrosis in CD strictures via quantitative radiomic features and expert radiologist scoring on CTE. METHODS AND MATERIALS IRB approved, retrospective, single center study. 100 patients (n=66 for discovery; n=34 for hold-out validation) confirmed with stricturing CD on histopathology and CTE within 15 weeks of surgery. Histopathological Stenosis Therapy &amp; Research (STAR) scoring of specimens (range 0-100, scores &amp;gt; 50 =severe) used as reference standard for inflammation and fibrosis each. An expert radiologist annotated the resected strictures on CTE and provided a global assessment of inflammation and chronic non-inflammatory findings (fibrosis) using a 0-100 visual analog score (VAS). Radiomics features to capture severe inflammation and fibrosis were separately extracted from the annotated strictures. Radiomics models and VAS scores evaluated against pathology-defined severe inflammation and fibrosis, via ROC analysis. RESULTS Two distinct sets of radiomic features capturing textural heterogeneity (patterns, wavelets, local entropy) within strictures were significantly associated (p&amp;lt;0.01) with severe inflammation and severe fibrosis; across both discovery (AUC=0.69, 0.69) and hold-out validation (AUCs =0.72,0.67). Radiological VAS had an AUC=0.64 for identifying severe inflammation and AUC =0.62 for identifying severe fibrosis (Figure 1). Clinical variables including sex, age, Montreal classification and stricture type were not significantly associated with severe inflammation or fibrosis, across discovery and validation groups (Table 1). CONCLUSIONS Radiomic analysis shows improved performance in identifying severe inflammation and severe fibrosis in CD strictures on CTE compared to radiological visual assessment scoring. Supplementing radiological visual assessment with quantitative radiomics could enable more accurate phenotyping of CD strictures potentially improving outcomes by personalizing treatment pathways.

A Comparative Study on Spinal Anesthesia verses General Anesthesia for Laparoscopic Cholecystectomy

Background: The main goal of anesthetic management in patients undergoing surgical procedures of laparoscopy includes the management of pneumoperitoneum. Generally, laparoscopic cholecystectomy is done under general anesthesia, but a large number of patients with major medical problems sometimes cannot tolerate such anesthesia where thoracic spinal anesthesia may be suitable. Aim of the Study: The aim of this study was to compare spinal anesthesia verses general anesthesia for laparoscopic cholecystectomy regarding the efficacy and outcomes. Methods: This prospective comparative study was conducted in the Department of Anaesthesia &amp; ICU, Mugda Medical College &amp; Hospital, Dhaka, Bangladesh during the period from January 2021 to December 2021. A total 60 patients were enrolled in this study as study population. Patients with physical status ASA I and II were selected as the study population and randomly divided to undergo laparoscopic cholecystectomy with low-tension pneumoperitoneum with CO2 under general anesthesia (n=30) or spinal anesthesia (n=30). Propofol, rocuronium, fentanyl, sevoflurane and tracheal intubation were used for general anesthesia. On the other hand, to achieve a sensorial level of T3, hyperbaric bupivacaine (15 mg) and fentanyl (20 µg) were used for the spinal anesthesia. Data regarding intraoperative parameters, postoperative pain, complications and recovery cost were compared between both groups. Results: In this study, in analyzing the perioperative comparison of mean ±SD VAS scores in both the general and spinal anesthesia groups we observed that in group 1 after 4, 8, 12 and 24 hours VAS (Visual analogue score) scores were found as 1.21±1.02, 1.62±1.35, 1.59±1.38 and 1.02±0.54 respectively which were found as 2.24±1.15, 3.29±1.62, 3.61±1.28 and 2.33±1.49 respectively in group 2. Between both the groups, in all the reading of VAS scores (4, 8, 12 and 24 hours) we found significant correlations between the groups where the P values ...........

REFRACTORY PLANTAR FASCIITIS- PRP OR LOCAL CORTICOSTEROID?

Background/Purpose: Plantar Fasciitis is often a nuisance to treat because of its intractable nature. Corticosteroid injections have been conventionally used to treat such cases.One emerging therapeutic modality is the use of PlateletRich-Plasma.We compare the efficacy of the two modalities.Methods: 60 patients with intractable plantar fasciitis were randomised to receive either autologous PRP or Corticosteroid injection. All patients were assessed with the Visual Analogue Score (VAS) for pain and the Foot &amp; Ankle Disability Index (FADI) Score.Data was collected prospectively on the cohort,pre-treatment,and at 1st,2nd,6th and 12th week post injection and the results were compared. Results:Both treatment cohorts had 30 patients, with the PRP injection group having an average age of 42.0 ± 12.98 years and Corticosteroid injection had an average age of 39.4 ± 10.09 years.PRP injection group had male to female ratio of 0.875 while corticosteroid injection group had a ratio of 0.67.Mean FADI scores and VAS scores on 2nd and 6th week of study were significantly higher in corticosteroid injection group as compared to the PRP injection group,while the mean of two scores had no significant difference between the two groups when measured on 1st and 12th week.Conclusion: Although both techniques have similar immediate and long term results,corticosteroid injection has better pain relief in short term

The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial

BackgroundHip fractures are common in elderly patients. The surgery is usually delayed due to underlying conditions, and pain control is crucial while the patient is cleared for surgery. In this randomized controlled trial (RCT) study, we hypothesized that the application of skin traction in patients with intertrochanteric fracture does not significantly change the Visual Analogue Score (VAS) of pain.MethodsThis is a prospective, single institution, parallel randomized controlled trial. Two hundred and twenty-nine patients with isolated intertrochanteric fractures were enrolled in the study. Patients with neurologic issues, drug addiction, scars or swelling, or vascular issues at the site of skin traction application were excluded from the study. Patients were divided into two groups: group A included 97 patients, and group B included 95 patients. Skin traction was applied for group A, while only a soft pillow was put beneath the patients’ knees in the other group. The VAS score was measured after the diagnosis, two hours before the operation, and 24 h after the surgery. The morphine dosage administered per day was documented for both groups.ResultsAfter excluding patients with postoperative delirium, 154 patients (55 males and 99 females) with isolated intertrochanteric fractures (69 right-sided and 85 left-sided), and a mean age of 70 ± 10 remained in the study. There were no significant differences between the two groups regarding age, gender, and mean time from injury to admission (P > .05). The mean VAS score measures and morphine dosage administered per day were not significantly different between the two groups (P > .05). Both groups experienced significant pain relief 24 h postoperatively (P < .001).ConclusionPre-operative skin traction application affected neither the patients' VAS scores nor the mean morphine dosage per day in patients with isolated intertrochanteric fractures. Our data does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures.Trial registrationThe project was registered in the Iranian Registry of Clinical Trials (registration reference: IRCT20180729040636N3, registration date: 01/07/2020).Level of evidence1.