Responsiveness and minimum important change of the Oswestry Disability Index in Italian subjects with symptomatic lumbar spondylolisthesis

The Effectiveness of Ultrasound-Guided Infiltrations Combined with Early Rehabilitation in the Management of Low Back Pain: A Retrospective Observational Study

Background and Aims: Low back pain is a prevalent condition affecting 60-85% of individuals during their lifetime. Despite various proposed mechanisms, the etiology of low back pain remains unclear. This study aims to evaluate the effectiveness of combining ultrasound-guided infiltrations with early rehabilitation in reducing pain and improving functional limitations in patients with chronic nonspecific low back pain. Methods: A retrospective observational study was conducted, reviewing data from January to April 2024 involving 40 patients with chronic nonspecific low back pain. Each patient received two cycles of ultrasound-guided lidocaine and corticosteroid infiltrations at the level of the posterior lower iliac spine, followed by 10 rehabilitation sessions. Patients were assessed at baseline (T0), after the first treatment cycle (T1), and after the second cycle (T2) using the Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland Disability Questionnaire, and Numeric Rating Scale. Results: Significant improvements were observed across all assessment scales. The ODI scores decreased from 33.5 at baseline to 3.5 after treatment (p < 0.001). Similar reductions were noted in the QBPDS (from 61.5 to 10.3), RDQ (from 18 to 3.4), and NRS (from 7.4 to 1.3). The combination of ultrasound-guided infiltrations and early rehabilitation resulted in a significant reduction in pain and disability, with the most notable improvements occurring after the second treatment cycle. Conclusions: The integration of ultrasound-guided infiltrations with early rehabilitation is highly effective in managing chronic nonspecific low back pain, significantly reducing both pain and functional limitations.

Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Quebec Back Pain Disability Scale: Responsiveness and Minimal Clinically Important Changes in Iranian People with Lumbar Disc Herniation Following Physiotherapy

Objectives

The present study aimed to investigate the responsiveness of the Persian version of the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Quebec Back Pain Disability Scale (QBPDS) and detect minimal clinically important changes (MCICs) of these questionnaires in people with lumbar disc herniation.

Methods

Ninety-two patients with lumbar herniated disc completed the Persianversion of the ODI, RMDQ, and QBPDS before and after the physiotherapy intervention. Additionally, they completed a global rating of change scale after the final physiotherapy session to give an account of non-improved and improved outcomes. The responsiveness of these three disability questionnaires was represented by Receiver Operating Characteristic (ROC) and correlation analyses. The MCIC was defined as the best cut-off when sensitivity and specificity were optimally balanced.

Results

Area under the ROC curves are in the acceptable range for ODI and QBPDS (0.78 and 0.70, respectively). Moreover, ODI, RMDQ, and QBPDS have significant positive fair to moderate correlation with the external anchor (P<0.001). The MCIC values for ODI, RMDQ, and QBPDS were 13, 5.5, and 14.5 points, respectively.

Conclusion

Our results revealed that the ODI and QBPDS questionnaires have adequate responsiveness to detect improvements in the functional status of lumbar herniated disc patients following a physiotherapy treatment. Therefore, the ODI and QBPDS seem to be superior to the RMDQ for use in randomized clinical trials and clinical settings in patients with herniated lumbar discs. The MCIC scores of 13 and 14.5 obtained for the ODI and QBPDS can help to identify important changes in the clinical status of an individual patient and treatment efficacy.

Autologous conditioned serum for chronic pain in patients with osteoarthritis: A feasibility observational study

Background

Autologous conditioned serum is a product of blood origin, with fragmented evidence of therapeutic properties in osteoarthritis chronic pain. This pilot observational prospective study aimed to evaluate the feasibility of a treatment with conditional autologous serum (ACS) in patients with severe chronic pain and grade I-III osteoarthritis and to describe its cytokine content.

Methods

We prospectively collected data on consecutive patients affected by osteoarthritis grade I to III and treated with four weekly injections of ACS at our outpatient pain service. The primary outcome was pain intensity, measured with the visual analogic scale (VAS). Additional outcomes were symptoms evaluated using joint district-specific scales. The study also evaluated concentrations of 48 cytokines and chemokines involved in the balance pro-inflammation/anti-inflammation and tissue repair in the ACS.

Results

We included 26 patients, mostly female (65.4%), with a median age of 63.5 years [IQR 58.25-73]. A median reduction of VAS of -3 cm [-5; -1.25] was observed 6 months after the first injection of ACS. The analysis showed a statistically significant difference between the values of VAS (p < .01; X2 = 69.6; df = 6, N = 26) at the different time points. No adverse events were observed or reported by patients during the entire study period.

Conclusions

Conditional autologous serum may be a feasible option for patients with chronic pain due to grade I-III osteoarthritis refractory to other treatments. These preliminary findings should be confirmed in studies with adequate design.

Comparison between Decompression Alone and with Additional Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis

Introduction

Degenerative lumbar spondylolisthesis affects approximately 10% of adults over 40. Although decompression has been the treatment of choice, some surgeons note possible instability development after decompression alone (D). Previous studies show that decompression with fusion (DF) has similar complication rates but is better at preventing slip progression and reducing pain. However, others stated the additional instrumentation does not result in superior functional outcomes and has higher costs and complication rates. This study aims to provide an objective, two-arm comparison of the two treatments using systematic review and meta-analysis.

Methods

The study design was a systematic review and meta-analysis of relevant randomized controlled trials and nonrandomized comparative studies. A systematic search was conducted from April 2021 to September 2021 to identify relevant studies using PubMed, Google Scholar, EMBASE, and Cochrane databases based on PRISMA guidelines.

Results

This systematic review included 8 studies (6,669 patients); 7 (6,569 patients) were included in the meta-analysis, with a follow-up period of up to 143 months. The most commonly affected level was L4-5, with females being more affected than males. Visual Analog Scale improvement on back pain was significantly better in DF group (Heterogeneity, I²=32%; WMD -0.72; 95% Confidence Interval (CI), -1.35 to -0.08; P=0.03), as well as postoperative back pain (I²=96%; WMD 0.87; 95% CI, 0.19 to 1.55; P=0.01). The leg pain, Oswestry Disability Index (ODI), satisfaction rate, complication rate, and revision rate were comparable between the two procedures.

Conclusions

Current systematic review and meta-analysis proved that DF is better than D in terms of back pain improvement, and the two procedures are comparable in terms of leg pain, ODI, satisfaction rate, complication rate, and revision rate.

Prediction of Long-Term Recovery From Disability Using Hemoglobin-Based Models: Results From a Cohort of 1,392 Patients Undergoing Spine Surgery

Hemoglobin and its associated blood values are important laboratory biomarkers that mirror the strength of constitution of patients undergoing spine surgery. Along with the clinical determinants available during the preadmission visit, it is important to explore their potential for predicting clinical success from the patient's perspective in order to make the pre-admission visit more patient-centered. We analyzed data from 1,392 patients with spine deformity, disc disease, or spondylolisthesis enrolled between 2016 and 2019 in our institutional Spine Registry. Patient-reported outcome measure at 17 months after surgery was referred to the Oswestry disability index. High preoperative hemoglobin was found to be the strongest biochemical determinant of clinical success along with high red blood cells count, while low baseline disability, prolonged hospitalization, and long surgical times were associated with poor recovery. The neural network model of these predictors showed a fair diagnostic performance, having an area under the curve of 0.726 and a sensitivity of 86.79%. However, the specificity of the model was 15.15%, thus providing to be unreliable in forecasting poor patient-reported outcomes. In conclusion, preoperative hemoglobin may be one of the key biomarkers on which to build appropriate predictive models of long-term recovery after spine surgery, but it is necessary to include multidimensional variables in the models to increase the reliability at the patient's level.

Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment

INTRODUCTION

There is weak relationship between the presence of lumbar spondylolisthesis [SPL] and low back pain that is not always associated with instability, either at the involved lumbar segment or at different spinal levels. Therefore patients with lumbar symptomatic SPL can be divided into stable and unstable, based on the level of mobility during flexion and extension movements as general classifications for diagnostic and therapeutic purposes. Different opinions persist about best treatment (conservative vs. surgical) and among conservative treatments, on the type, dosage, and progression of physical therapy procedures.

PURPOSE AND IMPORTANCE TO PRACTICE

The aim of this Masterclass is to provide clinicians evidence-based indications for assessment and conservative treatment of SPL, taking into consideration some subgroups related to specific clinical presentations.

CLINICAL IMPLICATIONS

This Masterclass addresses the different phases of the assessment of a patient with SPL, including history, imaging, physical exam, and questionnaires on disability and cognitive-behavioral components. Regarding conservative treatment, self- management approaches and graded supervised training, including therapeutic relationships, information and education, are explained. Primary therapeutic procedures for pain control, recovery of the function and the mobility through therapeutic exercise, passive mobilization and antalgic techniques are suggested. Moreover, some guidance is provided on conservative treatment in specific clinical presentations (lumbar SPL with radiating pain and/or lumbar stenosis, SPL complicated by other factors, and SPL in adolescents) and the number/duration of sessions.

FUTURE RESEARCH PRIORITIES

Some steps to improve the diagnostic-therapeutic approach in SPL are to identify the best cluster of clinical tests, define different lumbar SPL subgroups, and investigate the effects of treatments based on that classification, similarly to the approach already proposed for non-specific LBP.

[Lumbar transforaminal epidural block for treatment of low back pain with radicular pain]

OBJECTIVE

To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.

METHODS

We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.

RESULTS

The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (P=0.001). At 2 weeks after the operation, the patients receiving LTEB showed significant relief of low back pain as compared with the patients in the control group (t=2.224, P=0.034), and the difference in NRS scores for low back pain between the two groups tended to diminish over time (F=1.743, P=0.183). Treatment with LTEB resulted in obvious relief of radicular pain and significant reduction of the ODI score of the patients (P < 0.001), and such improvements became more obvious over time after LTEB (P < 0.01).

CONCLUSIONS

As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.

A Novel Technique for Spondylolysis Repair With Pedicle Screws, Rod and Polyester Band: Case Report With Technical Note and Systematic Literature Review

STUDY DESIGN

Systematic review and case report.

OBJECTIVE

Our study aims to present a new technique using three components to repair the pars defect: pedicle screws, rod and polyester band. Furthermore, we perform a systematic literature review of the previously described techniques.

SUMMARY OF BACKGROUND

Spondylolysis is a common condition in children and adolescents. Depending on the severity it may be treated either nonoperatively or surgically. Surgery is required if nonoperative treatment failed to give sustained pain relief. Several surgical techniques have been described.

METHODS

The literature review investigates the database (MEDLINE-EMBASE-Cochrane-ScienceDirect) up to May 2019 for studies presenting a surgical technique for spondylolysis.The Screw-Rod-Band (SRB) technique combines the use of pedicle screws, a rod and a polyester band to repair the spondylolysis. The horizontal rod connects the pedicle screws. The polyester band linked to the rod passes below the spinous process to apply compressive forces on the pars.

RESULTS

Twenty-one out of 982 studies described a surgical procedure. Eight main different techniques were identified: Isthmic Screw, Wiring, Butterfly-Plate, Hook-Screw Construct, Shaped-Rod, Laminar-Screw, and two combination technique (Lag Screw and Tension Band Fixation and Cortical Screws and Spinous-Process ModularLink). Our technique showed immediate postoperative clinical improvement. No surgical or perisurgical complication occurred.

CONCLUSION

The systematic literature review revealed a great number of surgical techniques for the spondylolysis, demonstrating the lack of consensus.SRB technique is an effective and simple treatment for pars fixation. The surgical procedure puts the pars under strong compression. The results are comparable with procedures present in the literature and seems capable to reduce the invasiveness and the risk of neurological injury.

LEVEL OF EVIDENCE

2.

Disability, emotional distress and well-being among patients with lumbar spondylolisthesis

AIM AND OBJECTIVE

To explore the disability, emotional distress and well-being of patients with lumbar spondylolisthesis.

BACKGROUND

Few studies have investigated the correlations between disability, emotional distress and well-being of patients with lumbar spondylolisthesis.

DESIGN

This study used a cross-sectional research design.

METHODS

Participants were 133 patients aged over 50 years who were experiencing lumbar spondylolisthesis. The research instruments included a demographic information questionnaire; the Numeric Rating Scale (NRS); the Charlson Comorbidity Index (CCI); the Chinese versions of the Oswestry Disability Index (ODI), State-Trait Anxiety Inventory-State (STAI-S) and Center for Epidemiological Study-Depression (CES-D); and the Psychological Well-being (PWB) Scale. Emotional distress was measured by the STAI-S and CES-D. Pearson's correlations coefficient, multiple linear regression and a mediating effect model were introduced to explore correlations between the variables and predictors of psychological well-being, and details of the methods are reported in coherence to STROBE criteria.

RESULTS

Eighty-six participants (64.6%) had moderate and severe anxiety, and 42 (31.6%) experienced depression. Participants reported medium to high levels of well-being; "satisfaction with interpersonal relationships" was rated the highest and "physical and mental health" the lowest. Disability, depression and anxiety had significant negative correlations with well-being. Depression and anxiety mediated the relationship between disability and well-being. Moreover, depression, family support, educational background and anxiety were predictors of well-being, accounting for 39.1% of the total variance.

CONCLUSIONS

Disability and emotional distress among patients with lumbar spondylolisthesis had a negative impact on well-being. Anxiety and depression were closely correlated with and substantially influenced well-being.

RELEVANCE TO CLINICAL PRACTICE

Health professionals will enhance the understanding of important factors influencing well-being among patients with lumbar spondylolisthesis. This study suggests the conduct of depression and anxiety evaluations at outpatient clinics and prior to surgery, so that clinicians will be aware of the emotional distress status of patients with lumbar spondylolisthesis and, therefore, enhance their well-being.

Sexual disability in patients with chronic non-specific low back pain-a multicenter retrospective analysis

[Purpose] Oswestry Disability Index includes an item (Oswestry Disability Index-8) aiming to assess sexual disability associated to low back pain. The aim of this study is to investigate the percentage of participants who answered the Oswestry Disability Index-8, and the relevance and characteristics of sexual disability due to low back pain in Italian patients. [Participants and Methods] Design: multicenter retrospective analysis. Population: six hundred and ninety-seven outpatients with non-specific low back pain. Variables: pain characteristics (amount, localization, and duration of perceived pain), disability, and psychological variables (anxiety, depression, catastrophizing, kinesiophobia, pain acceptance, and pain vigilance and awareness). [Results] Seventy-seven participants (11.05%) did not answer the Oswestry Disability Index-8. The odds of being not responding to the Oswestry Disability Index-8 item appeared related to age (odds=7.50 for over 60), gender (odds=2.65 for females), and marital status (odds=2.33 for not married). Concerning the psychological variables, Activity Avoidance (coefficient=0.071), Depression (coefficient=0.068), and Rumination (coefficient=0.031) showed a positive impact on sexual disability. [Conclusion] In Italian patients, the percentage of not-responding to Oswestry Disability Index-8 was relatively low. In addition, sexual disability was related to depression, activity avoidance, and rumination.

Bone-filling mesh container versus percutaneous kyphoplasty in treating Kümmell's disease

Kümmell's disease (eponymous name for osteonecrosis and collapse of a vertebral body due to ischemia and non-union of anterior vertebral body wedge fractures after major trauma) cannot heal spontaneously. Bone-filling mesh container (BFMC) can significantly relieve pain, help the correction of kyphosis, and may prevent cement leakage. This pilot study may provide the basis for the design of future studies.

PURPOSE

To compare the effectiveness and safety of BFMC and percutaneous kyphoplasty (PKP) for treatment of Kümmell's disease.

METHODS

From August 2016 to May 2018, 40 patients with Kümmell's disease were admitted to Guizhou Provincial People's Hospital. Among them, 20 patients (20 vertebral bodies) received PKP (PKP group) and the other 20 received BFMC (BFMC group). Operation time, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb's angle changes, and related complications were recorded.

RESULTS

All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively, with statistically significant difference (p < 0.05). Postoperative Cobb's angle of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in eight vertebrae (8/20) in the PKP group and in one vertebra (1/20) in the BFMC group. No complications such as pulmonary embolism, paraplegia, or perioperative death occurred during operation in both groups. Adjacent vertebral refractures occurred in five patients (5/20) in the PKP group and in four patients (4/20) in the BFMC group, with no significant difference in the incidence rate of refractures in both groups but the material is too small to verify statistically.

CONCLUSIONS

Both PKP and BFMC technologies can significantly relieve pain and help the correction of kyphosis while treating Kümmell's disease. Moreover, the BMFC may prevent cement leakage.