Oswestry Disability Index: a psychometric analysis with 1,610 patients

Surgical results of a one-stage combined anterior lumbosacral fusion and posterior percutaneous pedicle screw fixation

OBJECTIVES

Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach.

MATERIALS AND METHODS

From June 2008 to 2012, 20 patients who had L5-S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS) and the patient's Oswestry Disability Index (ODI) score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films.

RESULTS

The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases.

CONCLUSION

The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.

A systematic review highlights the need to investigate the content validity of patient-reported outcome measures for physical functioning in patients with low back pain

OBJECTIVES

To summarize the evidence on content and structural validity of 17 patient-reported outcome measures (PROMs) to measure physical functioning in patients with low back pain (LBP).

STUDY DESIGN AND SETTING

MEDLINE, EMBASE, CINAHL, PsycINFO, SportDiscus, and Google Scholar were searched (February 2017). Records on development and studies assessing content validity or unidimensionality in patients with LBP were included. Two reviewers defined eligible studies and assessed their methodological quality with updated Consensus-based Standards for the Selection of Health Measurement Instruments standards. Evidence was synthesized for three separate aspects of content validity: relevance, comprehensiveness, and comprehensibility, and for unidimensionality, a modified GRADE approach was applied to evidence synthesis.

RESULTS

High-quality evidence showed that 24-item Roland Morris Disability Questionnaire (RMDQ-24) is a comprehensible but not comprehensive PROM. Low to very low quality evidence underpinned the content validity of the other PROMs. Unidimensionality was: sufficient for Brief Pain Inventory pain interference subscale (moderate quality evidence); inconsistent for RMDQ-23, Oswestry Disability Index 2.1a (ODI 2.1a), and Quebec Back Pain Disability Scale (moderate quality); insufficient for RMDQ-24, ODI 1.0, and RMDQ-18 (high quality) and Short Form 36 physical functioning subscale (SF36-PF, moderate quality).

CONCLUSION

The content validity of PROMs to measure physical functioning in patients with LBP is understudied. Structural validity of several widely used PROMs is problematic.

Psychometric evaluation of the Oswestry Disability Index in patients with chronic low back pain: factor and Mokken analyses

Background

Disputes exist regarding the psychometric properties of the Oswestry Disability Index (ODI). The present study was to examine the reliability, validity, and dimensionality of a Chinese version of the ODI version 2.1 in a sample of 225 adult orthopedic outpatients with chronic low back pain [mean age (SD): 40.7 (11.4) years].

Methods

We conducted reliability analysis, exploratory bifactor analysis, confirmatory factor analysis, and Mokken scale analysis of the ODI. To validate the ODI, we used the Short-Form 36 questionnaire (SF-36) and visual analog scale (VAS).

Results

The reliability, and discriminant and construct validities of the ODI was good. The fit statistics of the unidimensional model of the ODI were inadequate. The ODI was a weak Mokken scale (H_s = 0.31).

Conclusions

The ODI was a reliable and valid scale suitable for measurement of disability in patients with low back pain. But the ODI seemed to be multidimensional that was against the use of the raw score of the ODI as a measurement of disability.

Prioritized cervical or lumbar surgery for coexisting cervical and lumbar stenosis: Prognostic analysis of 222 case

BACKGROUND CONTEXT

Single-stage surgery is usually applied to improving the symptoms of coexisting cervical and lumbar stenosis. In most cases, patients' willingness, surgery affordability, surgical trauma, surgical complications and patients' tolerance to surgery all limit the application of single-stage surgery. For patients who cannot receive single-stage surgery, we hope that we can find out by weighing up merits and flaws of the two surgical sites in order to make decision of prioritize one of the two surgery, so as to bring more benefits to the patients.

OBJECTIVE

To confirm which one of prioritized cervical surgery and prioritized lumbar surgery has a better effect in alleviating the symptoms of patients with coexisting cervical and lumbar stenosis.

STUDY DESIGN

A retrospective analysis and a cohort study for 15 years.

PATIENT SAMPLE

The information of 222 patients who were diagnosed with coexisting cervical and lumbar stenosis over the past 15 years was collected, including 144 patients who underwent prioritized cervical surgery and 78 prioritized lumbar surgery, thereafter the changes in the patients' postoperative neurological functions were evaluated.

OUTCOME MEASURES

Primary outcome variables are the clinical diagnosis event and the event of surgical site positioning. Secondary variables are the event of postoperative function changes and the symptom improvement event.

METHODS

The information about 222 patients with coexisting cervical and lumbar stenosis who had a follow-up of more than 1 year during January 2000 and December 2014 was collected. The effects of prioritized staged cervical and lumbar surgeries on the prognosis for the above-mentioned patients were respectively evaluated via relevant evaluation indexes.

RESULTS

The follow-up time was 18-156 months (58.0 ± 36.5). The lumbar reoperation rate after prioritized cervical surgery was lower than the cervical reoperation rate after prioritized lumbar surgery (22.91% < 57.69%) (P < 0.01). The JOA score and Nurick grade significantly improved (P < 0.01) and the ODI score improved (P < 0.05) after prioritized cervical surgery. No obvious improvement in the JOA score and Nurick grade (P > 0.05) was shown but the ODI score markedly improved (P < 0.01) after prioritized lumbar surgery.

CONCLUSIONS

For patients with coexisting cervical and lumbar stenosis, prioritized cervical surgery is safe and effective and is superior to prioritized lumbar surgery on the improvement of cervical and lumbar symptoms, the postoperative recovery of limb function and the rate of reoperation on another site.