The predictive value of the baseline Oswestry Disability Index in lumbar disc arthroplasty

Safety and Feasibility of Intradiscal Administration of Matrilin-3-Primed Adipose-Derived Mesenchymal Stromal Cell Spheroids for Chronic Discogenic Low Back Pain: Phase 1 Clinical Trial

Functionally enhanced mesenchymal stromal cells participate in the repair of intervertebral disc. This study aimed to assess the safety and tolerability of intradiscal administration of matrilin-3-primed adipose-derived stromal cell (ASC) spheroids with hyaluronic acid (HA) in patients with chronic discogenic low back pain (LBP). In this single-arm, open-label phase I clinical trial, eight patients with chronic discogenic LBP were observed over 6 months. Each patient underwent a one-time intradiscal injection of 1 mL of 6.0 × 106 cells/disc combined with HA under real-time fluoroscopic guidance. Safety and feasibility were gauged using Visual Analogue Scale (VAS) pain and Oswestry Disability Index (ODI) scores and magnetic resonance imaging. All participants remained in the trial, with no reported adverse events linked to the procedure or stem cells. A successful outcome-marked by a minimum 2-point improvement in the VAS pain score and a 10-point improvement in ODI score from the start were observed in six participants. Although the modified Pfirrmann grade remained consistent across all participants, radiological improvements were evident in four patients. Specifically, two patients exhibited reduced high-intensity zones while another two demonstrated decreased disc protrusion. In conclusion, the intradiscal application of matrilin-3-primed ASC spheroids with HA is a safe and feasible treatment option for chronic discogenic LBP.

Segmental Lordosis Gain Is a Prognostic Radiological Factor of Good Functional Outcome After the Implantation of a Single-Level Prosthesis or a Hybrid Construct for Lumbar Disc Degeneration

OBJECTIVE

To identify radiological factors and functional outcomes associated with good results after implantation of a single lumbar disc prosthesis or a hybrid construct (anterior lumbar interbody fusion and lumbar disc prosthesis) in the setting of painful degenerative lumbar discopathy.

METHODS

This single-center, retrospective 10-year study included 92 patients ˃18 years old with chronic low back pain evolving for at least 1 year. The patients had degenerative disc disease and had failed conservative treatment and underwent lumbar arthroplasty. Radiographic and clinical outcomes were assessed preoperatively and 1 year after surgery. Functional evaluation was based on the Oswestry Disability Index (ODI) and a numerical rating scale. Radiological analysis was based on lumbar x-rays and magnetic resonance imaging parameters. Patients were assigned to 2 groups according to the reduction in ODI score (>15 points or <15 points), and statistical analysis was done in both groups to find predictive radiological factors for a satisfactory functional outcome.

RESULTS

Clinically, 60 patients (65.2%) had a satisfactory functional result and 32 patients (34.8%) had a poor outcome according to ODI score. Radiographically, gain in segmental lordosis was statistically associated with good functional outcomes (8.9° for ODI decrease >15 vs. 3.2° for ODI decrease <15).

CONCLUSIONS

This study determined that gain in segmental lordosis is associated with a satisfactory functional outcome after a single-level lumbar disc prosthesis or a hybrid construct. Our study demonstrates that segmental lordosis gain may represent a significative useful positive predictor factor of patient outcome.

Clinical outcomes of transforaminal endoscopic lateral recess decompression by using the visualized drilled foraminoplasty and visualized reamed foraminoplasty: a comparison study

Background

Lateral recess stenosis (LRS) is a common degenerative disease in the elderly. Since the rise of comorbidity is associated with increasing age, transforaminal endoscopic lateral recess decompression (TE-LRD) is advocated. The objective of this study was to compare the clinical outcomes of TE-LRD in patients with LRS via visualized drilled foraminoplasty (VDF) or visualized reamed foraminoplasty (VRF) technique.

Methods

A total of 45 and 42 consecutive patients with limp or unilateral radiculopathy symptoms underwent TE-LRD using the VDF and VRF technique, respectively. The radiation exposure and operation time, time to return to work, and complications were compared between two groups. Their clinical outcomes were evaluated with the visual analogue scale (VAS) leg pain score, VAS back pain score, Oswestry Disability Index (ODI) and modified MacNab’s criteria.

Results

The average values of radiation exposure and operative time in the VDF group were significantly higher than those in the VRF group (P <  0.05). The postoperative VAS and ODI scores in both groups were significantly improved compared with those before the operation (P <  0.05). In addition, the VAS score of the leg pain and ODI score in the VRF group were significantly lower than those in the VDF group at the 1-week follow-up (P <  0.05). The good-to-excellent rates of the VDF group and VRF group were 88.89 and 90.48%, respectively, whereas the complication occurrence rates were 6.67 and 4.76% in the VDF group and VRF group, respectively.

Conclusions

TE-LRD performed by using VRF technique can be applied to treat LRS safely and effectively with short radiation exposure and operation time. This technique was comparable to the VDF technique with improved VAS leg pain and ODI scores in the short period after the operation. However, potential complications and risks still need to be considered.

Microendoscopic discectomy versus minimally invasive transforaminal lumbar interbody fusion for lumbar spinal stenosis without spondylolisthesis

Micoendoscopic discectomy (MED) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has become alternatives of the traditional open decompression surgery alone and decompression plus fusion surgery in the treatment of lumbar spinal stenosis (LSS). To date, there is no study focusing on the comparison of clinical outcomes after MED and MIS-TLIF for LSS without spondylolisthesis.Four hundred ninety-seven patients who underwent MED (236 cases) or MIS-TLIF (261 cases) for LSS without spondylolisthesis were included in this study. Perioperative outcomes (hospital stay, operation time and blood loss), cost, functional scores (Oswestry Disability Index, 12-item short form health survey) with a 24-month follow-up visit, complication and reoperation condition within 24 months after surgery were recorded and assessed.No significant difference of clinical outcomes over time was observed between these 2 surgical approaches. Compared with MIS-TLIF, MED was associated with greater satisfaction at 1-month time point postoperatively, whereas this effect was equalized at 3-month time point postoperatively. MED brought advantages in shorter hospital stay, shorter operation time, less blood loss, and less cost over MIS-TLIF.There was no significant difference in 24-month function scores over time between MED group and MIS-TLIF group. Compared with MIS-TLIF, MED could result in a better perioperative effect and less cost.

Revision for Endoscopic Diskectomy: Is Lateral Lumbar Interbody Fusion an Option?

OBJECTIVE

This study aims to report the clinical outcome of stand-alone lateral lumbar interbody fusion (LLIF) on recurrent disk herniation and to compare the outcome of stand-alone LLIF to that of conventional transforaminal lumbar interbody fusion (TLIF).

METHODS

A retrospective study of 47 patients with recurrent disk herniation was included from January 2008 to October 2016. The inclusion criteria were 1) with recurrent disk herniation that needs revision surgery, 2) with only 1 previous percutaneous endoscopic lumbar diskectomy surgery, 3) underwent 1-level stand-alone LLIF or 1-level TLIF surgery, and 4) with follow-up more than 1 year. Patients were asked to complete the following questionnaires for outcome evaluation: visual analog scales (VAS) for both low back pain and leg pain, the Oswestry Disability Index (ODI), and the 12-item Short-Form Health Survey.

RESULTS

Eighteen patients underwent stand-alone LLIF, and 29 patients underwent TLIF surgery. Radiographic analysis revealed a similar baseline and postoperative lumbar lordosis in both the LLIF and TLIF groups. Two weeks after surgery, the ODI and VAS scores showed a significant decrease in both groups. The TLIF group showed significantly larger postoperative VAS back pain after surgery (P = 0.03). For both VAS leg pain and ODI score during follow-up, no significance difference was found between the LLIF and TLIF groups.

CONCLUSIONS

Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with recurrent disk herniation after a previous percutaneous endoscopic lumbar diskectomy surgery. Compared with the TLIF procedure, LLIF could achieve a similar improvement of patient-reported outcome with a better VAS back pain score.

Prediction based on preoperative opioid use of clinical outcomes after transforaminal lumbar interbody fusions

OBJECTIVE

Opioid analgesics have become some of the most prescribed drugs in the world, despite the lack of long-term studies evaluating the benefits of opioid medications versus their risks associated with chronic use. In addition, long-term opioid use may be associated with worse long-term clinical outcomes. The primary objective of this study was to evaluate whether preoperative opioid use predicted inferior clinical outcomes among patients undergoing transforaminal lumbar interbody fusion (TLIF) for symptomatic lumbar degenerative disc disease.

METHODS

The authors of this observational study prospectively enrolled 93 patients who underwent 1-level to 2-level TLIFs in 2011–2014; the patient cohort was divided into 2 groups according to preoperative opioid use or no such use. Visual analog scale (VAS) scores for low-back pain and leg pain, Oswestry Disability Index scores, and the scores of the mental component summary (MCS) and physical component summary (PCS) on the 36-Item Short Form Health Survey were used to assess pain, disability, and health-related quality of life outcomes, respectively. The clinical scores for the 2 groups were determined preoperatively and at a 12-month follow-up examination.

RESULTS

In total, 60 (64.5%) patients took prescribed opioid medications preoperatively. Compared with those not taking opioids preoperatively, these patients had significantly higher VAS scores for low-back pain (p = 0.016), greater disability (p = 0.013), and lower PCS scores (p = 0.03) at the 12-month follow-up. The postoperative MCS scores were also significantly lower (p = 0.035) in the opioid-use group, but these lower scores were due to significantly lower baseline MCS scores in this group. A linear regression analysis did not detect opioid dose–related effects on leg and back pain, disability, and MCS and PCS scores, suggesting that poorer outcomes are not significantly correlated with higher opioid doses taken by the patients.

CONCLUSIONS

The use of opioid medications to control pain before patients underwent lumbar fusion for degenerative lumbar conditions was associated with less favorable clinical outcomes postoperatively. This is the first study that has demonstrated this association in a homogeneous cohort of patients undergoing TLIF; this association should be studied further to evaluate the conclusions of the present study.

Clinical trial registration no.: NCT01406405 (clinicaltrials.gov)

The Relationship between Beliefs about Pain and Functioning with Rheumatologic Conditions

Pain beliefs influence understanding of pain mechanisms and outcomes. This study in rheumatologic conditions sought to determine a relationship between beliefs about pain and functioning. Participants in Arthritis New Zealand's (ANZ) exercise and education programmes were used. Demographic data and validated instruments used included the Arthritis Impact Measurement Scale 2nd version-Short Form (AIMS2-SF) to measure functioning, and two scales of organic and psychological beliefs in Pain Beliefs Questionnaires (PBQ) to measure pain beliefs. 236 Members of ANZ were surveyed anonymously with AIMS2-SF and PBQ, with a 61% response rate; 144 responses were entered into the database. This study used α of 0.05 and a 1-β of 0.8 to detect for significant effect size estimated to be r = 0.25. Analysis revealed a significant relationship between organic beliefs scale of PBQ and functioning of AIMS2-SF, with an r value of 0.32 and P value of 0.00008. No relationship was found between psychological beliefs scale of PBQ and AIMS2-SF. Organic pain beliefs are associated with poorer functioning. Psychological pain beliefs are not. Beliefs might have been modified by ANZ programmes. Clinicians should address organic pain beliefs early in consultation. Causal links between organic pain beliefs and functioning should be clarified.