Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial

Objective

Chronic low back pain (CLBP) imposes considerable financial and social burden with poor response to medical and surgical treatments. Alternatively, acupuncture and venesection(Fasd) are traditionally used to alleviate nociceptive and musculoskeletal pains. This study aimed to evaluate the effectiveness and the safety of acupuncture and venesection on CLBP and patient functionality.

Methods

The current study was a single-blinded, randomized clinical trial with balanced allocation, conducted in the Department of Physical Medicine & Rehabilitation Medicine, in 2022. One hundred five CLBP patients who had no back pain-attributable structural or major diseases were randomly allocated into three parallel arms and received either physical therapy (PTG), acupuncture (APG), or venesection (VSG). Pain severity and functional aspects were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) during the study. VAS and ODI scores were defined as the primary outcomes.

Results

Ninety-five patients were reviewed in the final analysis (PTG=33, APG=30, VSG=31). Demographic data showed equal group distribution. Statistical analysis showed all procedures had reduced VAS score immediately after the first session, after the last session, and after follow-up; however, APG and VSG values were significantly lower (P<0.05). Pain reduction results in follow-up period were more sustainable in APG and VSG as compared to PTG (P<0.01). ODI results revealed global improvement after the last session of the treatment in all groups, while APG had more significant results (P<0.05). During the follow-up period, ODI still tended to decrease in VSG, non-significantly increased in APG, and significantly increased in PTG. Only two patients reported fainting after receiving venesection.

Conclusion

Considering the pain and functional scores, both acupuncture and venesection can reproduce reliable results. Acupuncture and venesection both have sustained effects on pain and daily function of the patients even after treatment termination, while physical therapy had more relapse in pain and functional limitations.

Optimizing Physiotherapeutic Approaches in Parkinson's Disease Post-spinal Fixation Surgery: A Case Report

Patients with Parkinson's disease (PD) exhibit both a severe neuromuscular disorder and low bone quality at presentation. These issues are made worse by inactivity and a chairbound state. Each and every pathologic and degenerative process that affects the naturally aging spine also affects these individuals. Stooped posture is a symptom of a disease and can easily cause spinal degeneration. PD is associated with many physical abnormalities that cause a unique and specific need for rehabilitation. Patients' experiences highlight the challenges doctors face in diagnosis, treatment, and rehabilitation. This case report details the rehabilitation of a 67-year-old patient with PD who underwent spinal fixation for spinal stenosis and presented with complaints of weakness in both lower limbs. An advanced rehabilitation program was devised, primarily emphasizing strength training to enhance overall functionality. Pre- and post-intervention assessments were conducted, encompassing range of motion (ROM), manual muscle testing (MMT), Oswestry Disability Index, Functional Independence Measure, Lower Limb Functional Scale, and Berg Balance Scale, all of which demonstrated noteworthy improvements in joints ROM, strength, functional independence, balance, and lower limb function. This case report underscores the significance of rehabilitation programs in such cases, highlighting their important role in enhancing overall functioning.

Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy

Background

For recurrent lumbar disc herniation, many experts suggest a repeat discectomy without stabilization due to its minimal tissue manipulation, lower blood loss, shorter hospital stay, and lower cost, recent research on the role of instability in disc herniation has made fusion techniques popular among spinal surgeons. The authors compare the postoperative outcomes of posterior lumbar interbody fusion (PLIF) and repeat discectomy for same-level recurrent disc herniation.

Methods

The patients included had previously undergone discectomy and presented with a same-level recurrent lumbar disc herniation. The patients were placed into two groups: 1) discectomy only, 2) PLIF based on the absence or presence of segmental instability. Preoperative and postoperative Oswestry disability index scores, duration of surgery, blood loss, duration of hospitalization, and complications were analyzed.

Results

The repeat discectomy and fusion groups had 40 and 34 patients, respectively. The patients were followed up for 2.68 (1-4) years. There was no difference in the duration of hospitalization (3.73 vs. 3.29 days P=0.581) and operative time (101.25 vs. 108.82 mins, P=0.48). Repeat discectomy had lower intraoperative blood loss, 88.75 ml (50-150) versus 111.47 ml (30-250) in PLIF (P=0.289). PLIF had better ODI pain score 4.21 (0-10) versus 9.27 (0-20) (P-value of 0.018). Recurrence was 22.5% in repeat discectomy versus 0 in PLIF.

Conclusion

PLIF and repeat discectomy for recurrent lumbar disc herniation have comparable intraoperative blood loss, duration of surgery, and hospital stay. PLIF is associated with lower durotomy rates and better long-term pain control than discectomy. This is due to recurrence and progression of degenerative process in discectomy patients, which are eliminated and slowed, respectively, by PLIF.

Psoas muscle index and psoas muscle density are associated with functional status in patients with degenerative lumbar spinal stenosis

BACKGROUND

The factors affecting lumbar spinal function in patients with degenerative lumbar spinal stenosis (DLSS) are still unclear.

OBJECTIVE

This study explored psoas major muscle morphology in patients with DLSS and its association with their functional status.

METHODS

A retrospective study was conducted on 288 patients with DLSS and 260 control subjects. Psoas major muscle evaluation included three morphometric parameters at the L3/4 disc level: psoas major index (PMI), muscle attenuation, and psoas major morphological changes (MPM). The association between psoas major morphology and functional status was assessed using the Oswestry disability index (ODI).

RESULTS

Both female and male patients with DLSS had a higher PMI and lower muscle attenuation. PMI and muscle attenuation were inversely correlated with age in the DLSS group. After multivariable analyses, the PMI and psoas major muscle attenuation were positively correlated with patients' functional status.

CONCLUSION

The PMI and muscle attenuation were positively correlated with functional status in patients with DLSS. These findings have important implications for physiotherapy programs of postoperative rehabilitation and conservative management of DLSS.

A 2-Year Outcomes and Complications of Various Techniques of Lumbar Discectomy: A Multicentric Prospective Study

STUDY DESIGN

Prospective Study.

OBJECTIVES

There are numerous techniques for performing lumbar discectomy, each with its own rationale and stated benefits. The authors set out to evaluate and compare the perioperative variables, results, and complications of each treatment in a group of patients provided by ten hospitals and operated on by experienced surgeons.

METHODS

This prospective study comprised of 591 patients operated between February-2017 to February-2019. The procedures included open discectomy, microdiscectomy, tubular microdiscectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy and Destandau techniques with a follow-up of minimum 2 years. VAS (Visual Analogue Score) for back and leg pain, ODI (Oswestry Disability Index), duration of surgery, hospital stay, length of scar, operative blood loss and peri-operative complications were recorded in each group.

RESULTS

Post-operatively, there was a significant improvement in the VAS score for back pain as well as leg pain, and ODI scores spanning all groups, with no significant distinction amongst them. When compared to open procedures (open discectomy and microdiscectomy), minimally invasive surgeries (tubular discectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy, and Destandau techniques) reported shorter operative time, duration of hospital stays, better cosmesis, and lower blood loss. Overall, the complication rate was reported to be 8.62%. Complication rates differed slightly across approaches.

CONCLUSION

Minimally invasive surgeries have citable advantages over open approaches in terms of perioperative variables. However, all approaches are successful and provide comparable pain relief with similar functional outcomes at long term follow up.

Lateral Lumbar Spinal Stenosis: Associations With the Oswestry Disability Index, Visual Analogue Scale, and Magnetic Resonance Imaging

Introduction Degenerative lumbar spinal stenosis is a communal problem in the sixth decade of life involving L4/L5 and L5/S1 levels. Lateral spinal stenosis is often underestimated because of no established relationship between the clinical symptoms and MRI findings. We conducted a study to establish an association between the degree of anatomical lateral stenosis, posterior disc height, and disc degeneration from MRI with the daily disability and pain severity for lateral lumbar spinal stenosis. Methods This was a cross-sectional study involving 121 patients with distinct clinical symptoms of lateral lumbar spinal stenosis evaluated from February 2018 to December 2019. The clinical data were evaluated using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), while magnetic resonance imaging (MRI) was assessed qualitatively for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. Statistical analysis for the correlation between posterior disc height and ODI and VAS scores was evaluated using Pearson's correlation test via SPSS version 23.0 (IBM Inc., Armonk, New York), and the association between the extent of lateral stenosis and disc degeneration on MRI with ODI and VAS scores was determined by the Fisher Exact Test via STATA version 14.0 (StataCorp LLC, College Station, Texas). The association was considered statistically significant with a P-value of less than 0.05. Results The analysis of 121 patients showed the mean age of the patients was 58.7 ± 7.1 years old. The number of female patients was higher compared to male patients, 52.9% and 47.1%, respectively. 97.5% of the patients were married or cohabiting, and 76.0% had an abnormal body mass index. The mean score of ODI and VAS was 62.2 ± 10.7% and 79.3 ± 8.6 respectively. 49.6% of the patient presented with a crippling disability with ODI assessment, while 59.5% presented with high pain intensity with VAS assessment. MRI assessment of anatomical grading lateral stenosis of L4/L5 level revealed that 45.5% of the patients had grade 2 lateral recess stenosis, 63.6% had grade 2 foraminal stenosis, and 44.6% had extraforaminal stenosis. L5/S1 level analysis showed that 43.0% had grade 2 lateral recess stenosis, 62.0% had grade 2 foraminal stenosis, and 29.8% had extraforaminal stenosis. 64.5% of patients had grade 4 disc degeneration of L4/L5 with mean posterior disc height of 7.0mm ±1.7mm while 59.5% had grade 4 disc degeneration of L5/S1 with mean posterior disc height of 6.3mm ±1.8mm. However, no statistically significant association between clinical symptoms and MRI findings was found.  Conclusions There was no significant association between the clinical symptoms of pain and disability and the MRI findings for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. A comprehensive clinical evaluation remains essential for an accurate diagnosis, emphasizing the necessity of appropriately correlating MRI findings with their clinical significance.

Cross-cultural adaptation and validation of the Spanish version of the Oswestry disability index for Mexican population

PURPOSE

This study aimed to adapt a Spanish translation of the Oswestry Disability Index (ODI) into a cross-cultural version for the Mexican population. The objectives were to verify the validity and reliability of the adapted ODI and to compare pain perception between patients with and without obesity.

MATERIAL AND METHODS

We included 102 patients with low back pain from two neurosurgery departments in Mexico. The ODI questionnaire was translated and culturally adapted. Validity and construct were evaluated using exploratory factor analysis, and the external convergent validity was assessed by correlating ODI scores with pain intensity, age, and obesity. Test-retest reliability was calculated using the intraclass correlation coefficient, and confirmatory analysis was employed to validate the factorial structure.

RESULTS

Patients with obesity were older and had higher pain scores than patients without obesity. The exploratory analysis of the ODI in Mexican Spanish showed good reliability (Cronbach's alpha of 0.923) and validity (factorial loading range, 0.681 - 0.818). The confirmatory analysis showed almost null or very low discrepancy between the proposed model and the real data.

CONCLUSIONS

A Spanish translation of ODI was cross-culturally adapted for the Mexican population. The Mexican version of the ODI showed good reliability and validity in Mexican culture.

Outcomes of Incidental Durotomy Repair in Thoracolumbar Spine Surgery: An Institutional Experience With Orthopedic Residents

Background The occurrence of incidental durotomies (IDs) following spinal operations is a widely recognized issue. Complications such as poor outcomes, extended hospitalization, prolonged immobilization, infections, and revision surgeries are all potential consequences of inadequate durotomy management during the initial surgery. This study aims to describe the outcomes of ID repair in thoracolumbar spine surgery in terms of the Oswestry Disability Index (ODI) score and visual analog scale (VAS) when performed with the active involvement of orthopedic residents in the surgical procedure. Methodology Between April 2021 and April 2023, a hospital-based observational study was conducted among 110 patients hospitalized in the orthopedic ward at R.L. Jalappa Hospital and Research Center in Kolar, Karnataka, who required IDs due to an accidental dural tear or a postoperative CSF fluid leak following thoracolumbar spine procedures. Patients with a previous history of thoracolumbar spine surgery, vertebral tumors, spinal metastasis, infections, e.g., spondylodiscitis, or Pott's spine were excluded. The ODI score and VAS score were calculated on the postoperative day, one month, and three months following surgery. Results The mean age of the study participants was 62.81 + 10.49 years, with a male preponderance of 67.2% among the study participants. The mean BMI of study participants was 23.77 kg/m2. Approximately 24.5% of participants had a prior history of spinal surgery. Among 110 patients, 32 had postoperative complications. Six patients reported experiencing urinary retention, followed by five with CSF leakage and one with a postural headache (five cases). Based on the ODI score, mild disability was seen in 32.7% of the study samples at three months of follow-up. Based on the VAS score, moderate pain was seen among all the study samples at three months of follow-up. The ANOVA test revealed statistically significant differences in ODI and VAS score reductions between the immediate postoperative period and the one-month and three-month follow-up periods (p = 0.001 and p = 0.0247, respectively). Conclusion Less than one-third of the samples had postoperative complications. At three months, ODI scores showed mild disability in one-third of the study samples. At three months, all study samples had moderate VAS pain. The improvement in ODI and VAS scores from the day after surgery through the one-month and three-month follow-up periods was statistically significant.

Determining threshold values for success after surgical treatment of lumbar spondylodiscitis using quality of life scores

OBJECTIVE

This study aimed to determine threshold values of validated quality of life (QoL) scores, including Oswestry Disability Index (ODI) and Core Outcome Measures Index (COMI), for predicting a successful outcome following surgical treatment of lumbar spondylodiscitis (LS).

METHODS

Patients with lumbar spondylodiscitis (LS) undergoing surgery in a tertiary referral hospital were included prospectively from 2008-2019. Data were collected both before surgery (T0) and one year after surgery (T1). QoL was measured using ODI and COMI. The successful clinical outcome was defined by the combination of the following four criteria: no recurrence of spondylodiscitis, back pain ≤4 on visual analogue scale or relief of ≥3 points, absence of LS-related neurological deficit, and radiological fusion of the affected segment. For subgroup analysis, group 1 consisted of patients with a favorable treatment outcome (meeting all four criteria), while group 2 included patients with unfavorable treatment outcome (meeting ≤3 criteria).

RESULTS

Ninety-two LS patients (median age = 66 years; age range = 57-74) were analyzed. QoL scores improved significantly. Threshold values for the ODI and COMI were calculated at 35 and 4.2 points, respectively. The area under curve for the ODI was 0.856 (95%-CI 0.767- 0.945; P<0.001) and 0.839 (95% CI-0.749-0.928; P<0.001) for the COMI score. Eighty percent of patients achieved a favorable outcome.

CONCLUSION

Objective measurement and evaluation of successful surgical treatment of spondylodiscitis require defined thresholds of quality of life scores. We were able to define such thresholds for Oswestry Disability Index and Core Outcome Measures Index. These can be useful to assess clinically relevant changes and therefore allow a more precise estimation of the post-surgical outcome.

LEVEL OF EVIDENCE

Level II, Prognostic study.

Preoperative Oswestry Disability Index Cannot Reliably Predict Patient Satisfaction After Single and Double Level Lumbar Transforaminal Interbody Fusion Surgery

Introduction

The role of patient-reported outcomes in preoperative assessment is not well studied. There is recent interest in studying whether Patient-reported outcomes scores can be used either independently, or in conjunction with clinical findings, in the assessment of patients for surgery.

Aims

To investigate if improvement in clinically significant scores correlate with post-operative patient satisfaction in 1-2 level transforaminal lumbar interbody fusion (TLIF) surgery. We also aim to define a threshold Oswestry Disability Index (ODI) which correlate with achieving post-operative MCID and patient satisfaction.

Methods

1001 patients who underwent single or double level TLIF (Minimally invasive and Open) in our institution with at least 2 years follow up were included in this study. We studied self-reported measures including patient satisfaction and ODI score.

Results

At 2-year follow-up, the overall mean ODI score improved from 49.7 ± 18.3 to 13.9 ± 15.2 (P < 0.001) with 74.6% of patients meeting the MCID. Patient satisfaction was achieved in 95.3% of all patients. In the MIS group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.72 (95% CI 0.65-0.86). In the open group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.70 (95% CI 0.62-0.77). Using the preoperative cut-offs found, there was no significant difference in patient satisfaction in both MIS and open groups.

Conclusions

Overall, our patients undergoing TLIF had good 2-year ODI score improvement and patient satisfaction after surgery. While meeting the MCID for ODI score correlates with patients' satisfaction postoperatively, 75% of patients not meeting the MCID for ODI score remained satisfied with the surgery. We are unable to define a threshold pre-operative ODI which correlates with achieving post-operative MCID and patient satisfaction.

Effectiveness of self-management of dry and wet cupping therapy for low back pain: A systematic review and meta-analysis

BACKGROUND

Low back pain (LBP) can significantly affect a person's quality of life. Cupping has been used to treat LBP. However, various cupping methods are typically included in evaluating the efficacy of cupping therapy. Therefore, the objectives of this study were to evaluate the evidence from the literature regarding the effects of dry and wet cupping therapy on LBP in adults. Dry and wet cupping therapy are analyzed categorically in this study.

METHODS

We searched for randomized clinical trials with cupping in LBP published between 2008 and 2022. In dry or wet cupping clinical studies, pain intensity was assessed using the Visual Analogue Scale and present pain intensity, and the quality of life intensity was measured using the Oswestry disability index.

RESULTS

The 656 studies were identified, of which 10 studies for 690 patients with LBP were included in the meta-analysis. There was a significant reduction in the pain intensity score with present pain intensity using wet cupping therapy (P < .01). In addition, both cupping therapy groups displayed significant Oswestry disability index score reduction compared to the control group (both P < .01). The patients with LBP have a substantial reduction by using wet cupping but have not shown a considerable decrease by using dry cupping (P = .19). In addition, only wet cupping therapy groups displayed a significantly improved quality of life compared to the control group. The study had a very high heterogeneity (I2 > 50%). It means there is no standardization in the treatment protocol in randomized clinical trials. In the meta-regression, there was statistically significant evidence that the number of treatment times and intercepts were related (P < .01).

CONCLUSION

The present meta-analysis shows that wet cupping therapy effectively reduces the pain intensity of LBP. Furthermore, both dry wet cupping therapy improved patients with LBP quality of life.

Alpha lipoic acid with pulsed radiofrequency in treatment of chronic lumbosacral radicular pain: A prospective, randomized study

BACKGROUND

The effect of adding alpha lipoic acid (ALA) to pulsed radiofrequency (PRF) for treatment of lumbar-sacral pain was evaluated.

OBJECTIVE

to evaluate the effect of using ALA as an adjuvant therapy with PRF for treatment of chronic lumbosacral radicular pain caused by herniated disc.

METHODS

One hundred twenty patients with lumbo-sacral radicular pain allocated into 2 groups. Group I: treated with PRF at 42°C for 120 seconds. Group II: treated as in group I, plus oral ALA 600 mg (Thiotacid 600 mg, EVA PHARMA, Egypt) three times per day (1800 mg/day) for 3 weeks then 600 mg once daily for 2 weeks. The lumbo-sacral radicular pain evaluated using the numerical rating pain score and Oswestry Disability Index.

RESULTS

Success rate was significantly higher in group II at 3 and 6 months after intervention. The median values of the numerical rating pain score and the Oswestry Disability Index were significantly lower in group II with no significant difference in Epworth Sleepiness Scale. No major complications were reported in both groups.

CONCLUSION

The current study supports the use of ALA with PRF on the dorsal root ganglion for treating lumbosacral radicular pain.

Assessment of disability levels in patients with low back pain based on the type of lumbar spinal disorder

BACKGROUND

Low back pain (LBP) is a common health condition and the leading cause of activity limitation and absenteeism in most parts of the world. One-fifth of patients with LBP develop chronic pain disability.

OBJECTIVE

This study investigated the disability levels in patients with different types of lumbar spinal disorders.

METHODS

A total of 528 patients visiting spine clinics between June 2017 and February 2018 were enrolled in this study. A demographic checklist, the patients' medical records, the Oswestry Disability Questionnaire, and the Visual Analog Scale (VAS) were used to collect the data.

RESULTS

Non-specific LBP (29.5%) and discopathy (27%) were the most common final diagnoses. The obtained Oswestry Disability Index (ODI) was significantly higher in older patients, those with higher body mass index, more work experience, and smokers. Lower ODI was found in individuals with a history of regular exercise. Most individuals in all diagnostic groups were categorized into the high ODI group (p⩽ 0.001).

CONCLUSION

In patients with lumbar spine lesions, ODI is significantly correlated with age, BMI, work experience, smoking, and the type of disorder (discopathy, spondylolysis, and spondylolisthesis). Regular exercise is associated with lower levels of disability.

Genetic and physiological autonomic nervous system factors involved in failed back surgery syndrome: A review of the literature and report of nine cases treated with pulsed radiofrequency

BACKGROUND AND AIM

failed back surgery syndrome is one of the most important causes of chronic low back pain that involve the physiology of autonomic nervous system factors. Some genetic and molecular factor can be determinant in the development of failed back surgery syndrome and novel therapy are needed. Pulsed radiofrequency treatment could be an innovative treatment option for this syndrome.

METHODS

44 patients classified with failed back surgery syndrome from the Poliambulanza Foundation Hospital of Brescia patients were treated with standard therapy for six months; 9 of these patients who showed no improvement were candidates for pulsed radiofrequency therapy for three months.

RESULTS AND CONCLUSIONS

reduction of lumbar and radicular pain, disability and number of drug classes prescribed improved significantly (p <0.001) in patients treated with pulsed radiofrequency compared to whom that follow only the standard therapy. The role of the nervous system is important for understanding how pulsed radiofrequency can improve the health of patients with back pain. We suggest that some genetic and molecular studies are needed for better understand the role of this therapy in back pain.

The effect of preoperative degenerative spondylolisthesis on postoperative outcomes of degenerative lumbar spinal stenosis: A single-center cohort study protocol

BACKGROUND

Most degenerative lumbar spinal stenosis (DLSS) patients primitively received the conservative treatment to control symptoms. In order to develop an optimal surgical treatment strategy, it is very significant to understand how the degenerative lumbar spondylolisthesis (DS) affects the effect of decompression in the DLSS. Thus, the aim of this current study was to explore whether the concomitant DS would affect the effect of decompression alone in the patients with DLSS.

METHODS

The current study was carried out at our hospital and it was approved through our institutional review committee of General Hospital of Ningxia Medical University. During the period from January 2015 to December 2017, in our study, we identified consecutive patients who received the minimally invasive laminectomy to treat the DLSS. The inclusion criterion included radicular leg pain or neurogenic claudication with the neurological symptoms associated with DLSS syndrome, magnetic resonance imaging of the lumbar spine reveals at least 1 level of serious stenosis, the conservative treatment failed for at least 3 months, and patients agreed to provide the postoperative details. The major outcomes of this present research was Oswestry Disability Index. Secondary outcomes of this current study involved visual analog score, short form-36, surgical revision rate as well as complications.

RESULTS

We assumed that previous DS possessed a negative effect on the postoperative results of the DLSS patients.

TRIAL REGISTRATION

researchregistry5943.

Algo-Functional Indexes and Spatiotemporal Parameters of Gait after Sacroiliac Joint Arthrodesis

Aims of the study were to evaluate the reliability and validity of the Italian version of the Majeed and Iowa questionnaires and to investigate the long-term surgical outcomes following sacroiliac joint arthrodesis. Twenty one patients who underwent a sacroiliac joint arthrodesis and 21 healthy subjects were evaluated. The experimental procedure consisted of gait analysis and a physical activity assessment (in both groups) and of administration of outcome questionnaires and pain assessment (in the patient group). The Majeed and Iowa questionnaires showed excellent reliability, excellent (for the Majeed questionnaire) and good (for the Iowa questionnaire) construct validity, and poor convergent validity (for both questionnaires) relative to walking speed. Most of the patients reported no pain and minimum pain-related disability and their physical activity profile was comparable to healthy controls. Patients showed an impaired walking performance (i.e., they walked slower and using shorter steps) compared with healthy controls. Long-term walking pattern abnormalities following sacroiliac joint arthrodesis may occur despite excellent clinical results. Given their excellent reliability and construct validity, the Majeed and Iowa questionnaires can be used in combination with the assessment of spatiotemporal gait parameters for the prognostic assessment and/or follow-up of surgical patients.

A hybrid therapeutic approach for decreasing postoperative complications in patients with adult lumbar degenerative scoliosis

To decrease postoperative complications in patients with adult lumbar degenerative scoliosis (ALDS), short-segment fusion surgery was used in this study. However, the incidence of adjacent segment disease was found to be remarkable. Therefore, we applied the hybrid treatment (short-segment fusion for responsibility levels plus nonfusion stabilization of lumbar segments, which was called the Wallis system, for the proximal level) to patients enrolled into this study. The purpose of this study was to investigate the feasibility of a novel hybrid therapeutic approach for treating patients with ALDS.From January 2011 to January 2017, a retrospective study was conducted consisting of 16 patients with ALDS who were treated with hybrid treatment. All patients were treated with short-segment decompression and fusion for responsibility levels and nonfusion stabilization of lumbar segments for the proximal levels. The imaging outcomes were evaluated preoperatively and at the time of follow-up.The mean visual analog score for back pain decreased from 6.1 ± 2.0 preoperatively to 2.1 ± 0.7 at 2-year follow-up (P < .05), and the mean visual analog score for leg pain reduced from 8.1 ± 0.6 preoperatively to 1.3 ± 0.8 at 2-year follow-up (P < .05). The Oswestry disability index scores improved from 65.4 ± 16.3% preoperatively to 18.3 ± 5.6% at 2-year follow-up (P < .05). The mean Cobb angle was 22.1 ± 6.2° preoperatively, and 13.8 ± 6.8° at 2-year follow-up (P < .05). The lumbar lordosis changed from -40.4 ± 14.8° to -43.5 ± 11.2° at 2-year follow-up (P < .05). Solid fusion was achieved in all the patients, and no incidence of adjacent segment disease was noted as well.The proposed hybrid treatment for patients with ALDS can achieve favorable clinical outcomes and a lower incidence of ALDS. However, the correction of deformity is still limited that highlights the necessity of further study.

Limited correction of lumbar lordosis in the treatment of degenerative scoliosis

BACKGROUND

Patients suffering from degenerative scoliosis (DS) were commonly associated with coronal and sagittal imbalance which made deformity correction surgery necessary. The study aimed to explore the efficacy and feasibility of the limited correction of lumbar lordosis (LL) in the treatment of patients with DS.

METHODS

This was a retrospective study including 58 DS patients who underwent spinal deformity correction surgery and were followed up at least 2 years between January 2013 and January 2017. According to the difference of postoperative LL, the patients were divided into 2 groups: the limited correction group: Pelvic incidence(PI)-18°≤ LL<PI-9° and the control group: PI-9°≤ LL<PI+9°. There were 31 patients in the limited group, and 27 patients in the control group. The clinical and radiographic outcomes were compared preoperatively and at the last follow-up evaluation.

RESULTS

There was no significant difference between the 2 groups preoperatively (P > .05). In terms of surgery, the limited group had less intra-operative blood loss and operation time (P < .05). At the last follow-up, significant differences were found in terms of LL(-38.2 ± 4.7° and -46.9 ± 4.7°), PT (18.8 ± 5.2° and 11.1 ± 3.6°), sacrum slope (33.7 ± 7.0° and 41.4 ± 6.1°) (P < .05), while there were no significant differences in terms of lumbar Cobb angle (10.5 ± 9.3°and 8.3 ± 6.7°), Oswestry Disability Index scores (25.6 ± 10.2 and 26.4 ± 12.1), and JOA scores (23.6 ± 5.2 and 22.3 ± 5.7) (P > .05).

CONCLUSION

Limited correction of LL in the treatment of DS patients can achieve favorable clinical outcomes including effective Cobb angle correction with less blood loss and operative time.

Natural history and aggravating factors of sagittal imbalance in marked sagittal deformity compared with mild to moderate sagittal deformity: A prospective cohort study

Sagittal imbalance is a multifactorial complex deformity that can arise from a variety of causes such as spinal stenosis, sarcopenia, vertebral fracture, and neuromuscular diseases. Furthermore, there is lack of research regarding spinal and general conditions that precede the development of sagittal imbalance. Our aim was to evaluate aggravating factors, such as natural history, for sagittal imbalance in a cohort comprising elderly individuals by conducting various examinations.We recruited 96 participants who had a sagittal vertical axis (SVA) larger than 50 mm in a sagittal imbalance study. Finally, 69 participants were followed up and enrolled this study after 2 years. We evaluated full spine radiographs, magnetic resonance imaging (MRI), bone mineral density, and health-related quality of life from patients survey and analyzed factors associated with aggravation of sagittal imbalance. Aggravation was defined by an SVA > 30 mm and T1 pelvic angle (T1PA) > 3° in the third year compared to SVA and T1PA values of the first year.Eighteen participants of the follow-up group had a sagittal imbalance aggravation. According to the deformity severity in the first-year evaluations, the marked deformity group (38 participants) defined as Schwab classification had 11 (28.9%) participants presenting with sagittal imbalance aggravation. These participants had larger mean values of Schwab sagittal modifiers and T1PA compared with the nonaggravation participants. Logistic regression analysis showed a higher pelvic incidence (PI) (OR = 1.201, 95% CI = 1.015-1.422, P = .033) and a small multifidus (MF) volume (OR = 0.991, 95% CI = 0.983-1.000, P = .043) correlated with sagittal imbalance aggravation.From the follow-up group, 18 (26%) subjects of total 69 participants presented a deteriorated sagittal imbalance. A higher PI and smaller MF volume correlated with the aggravation of sagittal imbalance. We should consider that high PI and small MF volume are associated with aggravation of sagittal imbalance.

Therapeutic effect of kyphoplasty and balloon vertebroplasty on osteoporotic vertebral compression fracture: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

This study aimed to assess the treatment effects of kyphoplasty (KP) compared with percutaneous vertebroplasty (VP) in patients with osteoporotic vertebral compression fracture, based on evidence from randomized controlled trials (RCTs).

METHODS

The electronic databases PubMed (from 1966), EmBase (from 1974), and Cochrane Library (including Cochrane Central Register of Controlled Trials and Cochrane Reviews) were searched systematically to identify relevant studies published up to August 31, 2019. Meta-analyses were conducted for subjective pain as measured using visual analogue scale (VAS), disability function as measured by Oswestry disability index (ODI), and cement leakage. For VAS and ODI, mean change from the baseline and standard deviation were used; for cement leakage, numbers of events and patients in each group were used. The random-effects model was applied to summarize the effects across trials.

RESULTS

Previous reviews and meta-analysis included non-RCTs, which brought (for those studies) a higher risk of bias. Therefore, 6 RCTs involving 1077 patients were included in the meta-analysis. No between-group difference was found. The weighted mean difference was -0.19 (95% confidence interval [CI], -0.39-0.01; P = .057) for VAS and -3.51 (95% CI, -8.70-1.67; P = .184) for ODI. However, KP had numerically lower rates of cement leakage across trials in a consistent fashion (relative risk, 0.83; 95% CI, 0.74-0.94; P = .004).

CONCLUSIONS

Both KP and VP had clinically meaningful beneficial effects on pain and disability, and the effects were stable and similar. KP had significantly fewer cement leakages.

Surgical Outcome of Decompression and Fixation of Degenerative Lumbosacral Spondylolisthesis Surgery in Pakistani Population

Background

Spondylolisthesis is characterized by the slipping of one vertebra, compared with the underlying one, due to structural and degenerative changes. Its origin is multifactorial which includes disc degeneration, facet joint anatomic orientation, iliolumbar configuration, and ligament hyperlaxity. The most common operative treatment is decompression and may require an individualized surgical plan. However, only decompression may progress the slippage which can result in pain or recurrence of neurological complaints. Therefore, lumbar fusion and fixation are considered appropriate to stabilise the spine and prevent delayed deterioration. The aim of our study was to find out the outcome of posterior decompression, with reduction and fixation of lumbosacral spondylolisthesis by Oswestry Disability Index (ODI) to improve further our results.

Methods

This study was conducted from July 2013 to February 2017 including 94 patients with lumbosacral spondylolisthesis. The Meyerding classification was used to grade the extent of vertebral slippage. The assessment was done using the ODI.

Results

There were 50 (53.19%) males and 54 (46.80%) females with a mean age of 44 years ± 10.49 SD. Backache was present in all patients and claudication in 85 (90.42%) patients. There were 10 (10.63%) patients with spondylolisthesis at L3-L4, 36 (38.29%) at L5-S1 and 48 patients (51.06%) at L4-L5 level. In 48 patients with L4-L5 level, 38 (79.16%) were in grade II while six (12.5%) were in grade III. According to the preoperative ODI score, 38 patients were placed in moderate disability, 42 patients were severely disabled while four patients were disabled.

Good outcome was achieved in a total of 79 (84.04%) patients. In 40 (42.55%) patients, with complete reduction, the good outcome achieved in 35 (83.33%) while in 22 (23.40%) patients there was no reduction and a good outcome was achieved in 17 (77.27%) patients. In 38 (40.42%) patients with moderate disability, 32 (84.04%) patients had a good outcome. Post-operative cerebrospinal fluid (CSF) leak occurred in five (5.31%) and wound infection in seven (7.44%) patients while there was no mortality.

Conclusion

Reduction with decompression can have a good outcome in spondylolisthesis, and ODI should be used as a predictor of outcome. It also shows that proper decompression is required and not a complete reduction.

Frequency of Severity of Disability in Patients with Grade III Lumbar Neural Foraminal Stenosis on Magnetic Resonance Imaging

Background

Low back pain is a common condition and carries substantial socioeconomic implications. Magnetic resonance imaging (MRI) is the imaging modality of choice with lumbar neural foraminal stenosis being one of the most common causes of lower back pain syndromes. Studies have shown a lack of correlation between patients’ severity of disability and radiologically determined nerve root constriction. Therefore, the goal of this study will be to determine the frequency of severity of disability in patients with severe (i.e., grade III) lumbar neural foraminal stenosis on MRI to ascertain the impact of MRI diagnosis on clinical outcomes.

Materials and methods

Two hundred fifty patients of either gender with a history of backache referred for MRI were included by purposive sampling. Of these 250 patients, 27 patients had grade II lumbar neural foraminal stenosis, and 21 had grade I neural foraminal stenosis on MRI and were excluded. Thirty-two patients had a spinal infection (e.g., tuberculosis), and 24 patients had a history of trauma. Further, 31 patients were having follow-up scans for previously diagnosed lumbar neural foraminal stenosis. Hence, after excluding these cases, 115 patients were enrolled in this cross-sectional study with grade III lumbar neural foraminal stenosis on MRI.

Results

The mean age was 51 years (range: 20 to 82 years). Most of the patients (55.6%) were older than 50 years. The most common site of grade III lumbar neural foraminal stenosis was L4-L5 (56.5%). According to the Oswestry disability index, 47 patients (40.9%) had a severe disability, 32 (27.8%) had a moderate disability, 16 (13.9%) were diabled, 14 (12.2%) had a mild disability, and six (5.2%) were bedridden.

Conclusions

While MRI is the imaging modality of choice in degenerative lumbar spinal stenosis, clinical disabilities can be more extensive than what radiological findings may indicate in approximately 40% of the cases. Therefore, lumbar spinal stenosis should be a neuro-radiological diagnosis, and surgical decisions should be based on clinical scenarios in addition to MRI findings.

Validation of Patient Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Tests (CATs) in the Surgical Treatment of Lumbar Spinal Stenosis

STUDY DESIGN

Prospective, cohort study.

OBJECTIVE

Demonstrate validity of Patient reported outcomes measurement information system (PROMIS) physical function, pain interference, and pain behavior computer adaptive tests (CATs) in surgically treated lumbar stenosis patients.

SUMMARY OF BACKGROUND DATA

There has been increasing attention given to patient reported outcomes associated with spinal interventions. Historical patient outcome measures have inadequate validation, demonstrate floor/ceiling effects, and infrequently used due to time constraints. PROMIS is an adaptive, responsive National Institutes of Health (NIH) assessment tool that measures patient-reported health status.

METHODS

Ninety-eight consecutive patients were surgically treated for lumbar spinal stenosis and were assessed using PROMIS CATs, Oswestry disability index (ODI), Zurich Claudication Questionnaire (ZCQ), and Short-Form 12 (SF-12). Prior lumbar surgery, history of scoliosis, cancer, trauma, or infection were excluded. Completion time, preoperative assessment, 6 weeks and 3 months postoperative scores were collected.

RESULTS

At baseline, 49%, 79%, and 81% of patients had PROMIS pain behavior (PB), pain interference (PI), and physical function (PF) scores greater than 1 standard deviation (SD) worse than the general population. 50.6% were categorized as severely disabled, crippled, or bed bound by ODI. PROMIS CATs demonstrated convergent validity through moderate to high correlations with legacy measures (r = 0.35-0.73). PROMIS CATs demonstrated known groups validity when stratified by ODI levels of disability. ODI improvements of at least 10 points on average had changes in PROMIS scores in the expected direction (PI = -12.98, PB = -9.74, PF = 7.53). PROMIS CATs demonstrated comparable responsiveness to change when evaluated against legacy measures. PROMIS PB and PI decreased 6.66 and 9.62 and PROMIS PF increased 6.8 points between baseline and 3-months post-op (P < 0.001). Completion time for the PROMIS CATs (2.6 min) compares favorably to ODI, ZCQ, and SF-12 scores (3.1, 3.6, and 3.0 min).

CONCLUSION

PROMIS CATs demonstrate convergent validity, known groups validity, and responsiveness for surgically treated patients with lumbar stenosis to detect change over time and are more efficient than legacy instruments.

LEVEL OF EVIDENCE

2.

Efficacy and safety of electromagnetic acupuncture using an electromagnetic therapy stimulator (Whata153) for the treatment of chronic low back pain: Study protocol for a single-center, parallel-arm, randomized clinical trial

BACKGROUND

Chronic low back pain is one of the major conditions causing serious personal and social difficulties in modern society. There are several noninvasive therapies for chronic low back pain; however, the effects of electromagnetic acupuncture have not been studied. Here, we describe the protocol for a study that will investigate the efficacy and safety of electromagnetic acupuncture for patients with chronic low back pain.

METHODS

The study has been designed as a double-blind, single-center, parallel-arm, sham-controlled, randomized clinical trial. A total of 104 patients with chronic low back pain who meet the criteria for selection and exclusion will be enrolled in a 1:1 ratio in an electromagnetic acupuncture group or a sham group. Sterilized disposable needles will be inserted at 6 acupoints, following which stimulation via an electromagnetic (Whata153) or a placebo (sham) stimulator will be applied. The 2 groups will receive a total of 6 treatment sessions over 3 weeks, with 1 follow-up visit within 3 days after the final treatment. The primary outcome will be the change in the visual analog scale (VAS) score for pain from baseline (visit 1, first treatment session) to the follow-up visit (visit 7, after treatment completion). The secondary outcomes will be as follows: changes in the VAS score for pain from baseline (visit 1) to visits 3 (third session) and 5 (fifth session); changes in the VAS score for pain at all assessment points from baseline (visit 1) to the follow-up visit (visit 7); changes in the Oswestry Disability Index (ODI) from visit 1 to visits 3, 5, and 7; and the change in ODI at all assessment points from visit 1 to visit 7.

DISCUSSION

The results of this trial are expected to provide important clinical information on the efficacy and safety of electromagnetic acupuncture for patients with chronic low back pain.

Correlation of Functional Outcomes and Sagittal Alignment After Long Instrumented Fusion for Degenerative Thoracolumbar Spinal Disease

STUDY DESIGN

A retrospective function and radiography study of the patients who have received long instrumented thoracolumbar fusion.

OBJECTIVE

To investigate the correlation between the sagittal spinopelvic alignment and the functional outcomes after long instrumented fusion for degenerative thoracolumbar spinal disease.

SUMMARY OF BACKGROUND DATA

Restoring better sagittal alignment is known as a key factor to spine fusion surgeries. The relationship between function and radiographic results in the elderly group is barely known.

METHODS

Between 2009 and 2013, data of 120 patients with multilevel degenerative thoracolumbar spinal disease who underwent long instrumented fusion were collected retrospectively. Perioperative radiographic and functional parameters were measured and analyzed for their correlations. Receiver operating characteristic (ROC) method was used to define ideal cutoff points of postoperative spinopelvic alignment to avoid poor outcome.

RESULTS

Oswestry disability index (ODI) more than or equal to 20 or Visual analogue scale (VAS) more than or equal to 4 were defined as poor functional outcomes. The optimal cutoff points of the radiographic parameters were found as below: the mismatch between pelvic incidence and lumbar lordosis was 16.2°, sagittal vertical axis was 38.5 mm, and pelvic tilt was 23.4°. Poor functional outcomes were significantly correlated with bad sagittal alignment, older age, and poor preoperative function.

CONCLUSION

Postoperative functional outcomes were highly impacted by the spinopelvic sagittal alignment.

LEVEL OF EVIDENCE

4.

Comparison of Decompression Alone Versus Decompression with Fusion for Stenotic Lumbar Spine: A Systematic Review and Meta-analysis

The first line of treatment for lumbar spinal stenosis (with or without lumbar degenerative spondylolisthesis) involves conservative options such as anti-inflammatory drugs and analgesics. Approximately, 10%-15% of patients require surgery. Surgical treatment aims to decompress the spinal canal and dural sac from degenerative bony and ligamentous overgrowth. Different studies have given conflicting results. The aim of our study is to clear the confusion by comparing two surgical techniques. This meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted of the Ovid Embase, Scopus, Pubmed, Ovid Medline, Google Scholar, and Cochrane library databases. A quality and risk of bias assessment was also done. The analysis was done using Revman software (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014, Copenhagen, Denmark). A total of 76 studies were extracted from the literature search and 29 studies with relevant information were shortlisted. Nine studies were included in the meta-analysis after a quality assessment and eligibility. Fusion with decompression surgery was found to be a better technique when compared to decompression alone for spinal stenosis in terms of the Oswestry Disability index and the visual analog pain scale for back and leg pain. On the basis of the meta-analysis of the recent medical literature, the authors concluded that decompression with fusion is a 3.5-times better surgical technique than decompression alone for spinal stenosis.

Posterior paraspinal muscle versus post-middle approach for the treatment of thoracolumbar burst fractures: A randomized controlled trial

BACKGROUND

This randomized controlled trial (RCT) aimed to compare the clinical outcomes of thoracolumbar burst fractures (TLBFs) treated with open reduction and internal fixation via the posterior paraspinal muscle approach (PPMA) and the post-middle approach (PA).

METHODS

Patients with a traumatic single-level TLBFs (T10-L2), treated at our hospital between December 2009 and December 2014, were randomly allocated to Group A (PPMA) and Group B (PA). Sex, age, time from injury to surgery, the American Spinal Injury Association Impairment Scale score (ASIAIS), comorbidities, vertebral level, pre- and postoperative kyphotic angle (KA), visual analog scale (VAS) pain score, and the Oswestry Disability Index (ODI) scores were included in the analysis. Operative time, intraoperative blood loss, x-ray exposure time, postoperative drainage volume, superficial infection, and occurrence of deep infection were documented. The patients were followed up at 2 weeks; 1, 3, and 6 months; 1 and 2 years; and every 6 months thereafter. Radiological assessments were performed to assess fracture union and detect potential loosening and breakage of the pedicle screws and rods at each follow-up. Postoperative VAS and ODI scores were used to evaluate the clinical outcomes.

RESULTS

A total of 62 patients were enrolled (30 in Group A and 32 in Group B, respectively). The operative time (P < .001) and x-ray exposure time (P < .001) in Group A were significantly longer than those in Group B. However, compared to Group B, there were less intraoperative blood loss (P < .001), lower postoperative drainage volume (P < .001), lower VAS scores (2-week (P = .029), 1-month (P = .023), 3-month (P = .047), and 6-month follow-up (P = .010)), and lower ODI scores (2-week, P = .010; 1-month, P < .001; 3-month, P = .028; and 6-month follow-up, P = .033) in Group A.

CONCLUSIONS

Although PPMA required a longer operative time and x-ray exposure time, PPMA provided several advantages over PA, including less intra-operative blood loss and lower postoperative drainage volume, and greater satisfaction with postoperative pain relief and functional improvement, than PA, especially at the 6-month follow-up after surgery. Further high-quality multicenter studies are warranted to validate our findings.

A review of culturally adapted versions of the Oswestry Disability Index: the adaptation process, construct validity, test-retest reliability and internal consistency

The Oswestry Disability Index (ODI) is a self-report-based outcome measure used to quantify the extent of disability related to low back pain (LBP), a substantial contributor to workplace absenteeism. The ODI tool has been adapted for use by patients in several non-English speaking nations. It is unclear, however, if these adapted versions of the ODI are as credible as the original ODI developed for English-speaking nations. The objective of this study was to conduct a review of the literature to identify culturally adapted versions of the ODI and to report on the adaptation process, construct validity, test-retest reliability and internal consistency of these ODIs. Following a pragmatic review process, data were extracted from each study with regard to these four outcomes. While most studies applied adaptation processes in accordance with best-practice guidelines, there were some deviations. However, all studies reported high-quality psychometric properties: group mean construct validity was 0.734 ± 0.094 (indicated via a correlation coefficient), test-retest reliability was 0.937 ± 0.032 (indicated via an intraclass correlation coefficient) and internal consistency was 0.876 ± 0.047 (indicated via Cronbach's alpha). Researchers can be confident when using any of these culturally adapted ODIs, or when comparing and contrasting results between cultures where these versions were employed. Implications for Rehabilitation Low back pain is the second leading cause of disability in the world, behind only cancer. The Oswestry Disability Index (ODI) has been developed as a self-report outcome measure of low back pain for administration to patients. An understanding of the various cross-cultural adaptations of the ODI is important for more concerted multi-national research efforts. This review examines 16 cross-cultural adaptations of the ODI and should inform the work of health care and rehabilitation professionals.

Clinical study of lumbar spine stenosis treated by using acupotomy combined with oriental medical treatments

Objectives:

The aim of this study is to evaluate the effect of acupotomy in patients with degenerative lumbar spine stenosis.

Methods:

A total of 437 patients who had been diagnosed as having lumbar spine stenosis and who had been admitted to Daejeon Oriental hospital from June 1, 2008, to September 31, 2012, were included in this study. The patients underwent acupotomy once, twice or three times on the lumbar spine, according to their symptoms. Then, the patients were asked to complete the verbal numeric rating scale (VNRS) and the oswestry disability index (ODI) before and after acupotomy and underwent a global assessment. The resulting data were analyzed.

Results:

The gender ratio of the participants was 1:1.54, and the mean age was 65 ± 10.0 yr. The number of patients over the age of 65 yr was less than that of the patients under the age of 65 yr in the ratio of 1:1.3. The average disease period was 30.17 ± 56.63 months. The verbal numeric rating scale (VNRS) significantly decreased from 10 to an average of 7.10 ± 2.50 after one acupotomy, 6.30 ± 2.60 after two acupotomies, and 5.50 ± 2.50 after three acupotomies. The ODI was significantly decrease from 20.60 ± 8.70 to 17.80 ± 8.60 after once acupotomy, 17.10 ± 8.50 after two acupotomies, and 16.70 ± 8.60 after three acupotomies. High scores were also observed on the global assessment.

Conclusion:

These results provide evidence that acupotomy is effective to relieve pain and to improve quality of life in patients with degenerative lumbar spinal stenosis.

Skew-symmetric Random Effect Models with Application to a Preventive Cohort Study: Improving Outcomes in Low Back Pain Patients

BACKGROUND

To investigate the respective contribution of various biologic and psychosocial factors, especially Health Related Quality of Life (HRQOL) as a main outcome, in the natural history of acute low back pain (LBP) and to evaluate the impact of this condition on HRQOL.

METHODS

In a prospective cohort study For 24 weeks, 150 patients were assessed at an outpatient clinic in Korea consulting for low back and confirmed disc herniation duration at inclusion and treated with treatment package comprised of herbal medicines, acupuncture, bee venom acupuncture, and a Korean version of spinal manipulation (Chuna). Study participants were evaluated at baseline and every 4 weeks for 24 weeks. Low back intensity levels were measured on a visual analog scale (0-10), back function was evaluated with the Oswestry Disability Index (0-100), disability assessed by HRQOL assessed by the short form 36 health survey (0-100 in 8 different sub-categories).

RESULTS

Out of 150 patients, 128 completed the 24 weeks of traditional therapy. Patients reported improvements SF-36 outcome measures. At the completion of the study, low back pain scores improved by a mean of 3.3 (95% CI = 2.8 to 3.8). According to the results of our modeling, low back intensity level, back function and BMI measures had significant effects on quality of life during study. Interpreting the coefficients of modeling, the impact of the decreasing acute LBP episode on HRQOL by VAS and ODI outcomes, was high and important.

CONCLUSIONS

This study highlights the large contribution of integrative package therapy as an effective preventive method for improving LBP patient's HRQOL.

Predicting SF-6D utility scores from the Oswestry disability index and numeric rating scales for back and leg pain

STUDY DESIGN

Cross-sectional cohort.

OBJECTIVE

The purpose of this study is to provide a model to allow estimation of utility from the Short Form (SF)-6D using data from the Oswestry Disability Index (ODI), Back Pain Numeric Rating Scale (BPNRS), and the Leg Pain Numeric Rating Scale (LPNRS).

SUMMARY OF BACKGROUND DATA

Cost-utility analysis provides important information about the relative value of interventions and requires a measure of utility not often available from clinical trial data. The ODI and numeric rating scales for back (BPNRS) and leg pain (LPNRS), are widely used disease-specific measures for health-related quality of life in patients with lumbar degenerative disorders. The purpose of this study is to provide a model to allow estimation of utility from the SF-6D using data from the ODI, BPNRS, and the LPNRS.

METHODS

SF-36, ODI, BPNRS, and LPNRS were prospectively collected before surgery, at 12 and 24 months after surgery in 2640 patients undergoing lumbar fusion for degenerative disorders. Spearman correlation coefficients for paired observations from multiple time points between ODI, BPNRS, and LPNRS, and SF-6D utility scores were determined. Regression modeling was done to compute the SF-6D score from the ODI, BPNRS, and LPNRS. Using a separate, independent dataset of 2174 patients in which actual SF-6D and ODI scores were available, the SF-6D was estimated for each subject and compared to their actual SF-6D.

RESULTS

In the development sample, the mean age was 52.5 +/- 15 years and 34% were male. In the validation sample, the mean age was 52.9 +/- 14.2 years and 44% were male. Correlations between the SF-6D and the ODI, BPNRS, and LPNRS were statistically significant (P < 0.0001) with correlation coefficients of 0.82, 0.78, and 0.72, respectively. The regression equation using ODI, BPNRS,and LPNRS to predict SF-6D had an R of 0.69 and a root mean square error of 0.076. The model using ODI alone had an R of 0.67 and a root mean square error of 0.078. The correlation coefficient between the observed and estimated SF-6D score was 0.80. In the validation analysis, there was no statistically significant difference (P = 0.11) between actual mean SF-6D (0.55 +/- 0.12) and the estimated mean SF-6D score (0.55 +/- 0.10) using the ODI regression model.

CONCLUSION

This regression-based algorithm may be used to predict SF-6D scores in studies of lumbar degenerative disease that have collected ODI but not utility scores.

Oswestry Disability Index scoring made easy

INTRODUCTION

Low back pain effects up to 80% of the population at some time during their active life. Questionnaires are available to help measure pain and disability. The Oswestry Disability Index (ODI) is the most commonly used outcome measure for low back pain. The aim of this study was to see if training in completing the ODI forms improved the scoring accuracy.

PATIENTS AND METHODS

The last 100 ODI forms completed in a hospital's spinal clinic were reviewed retrospectively and errors in the scoring were identified. Staff members involved in scoring the questionnaire were made aware of the errors and the correct method of scoring explained. A chart was created with all possible scores to aid the staff with scoring. A prospective audit on 50 questionnaires was subsequently performed.

RESULTS

The retrospective study showed that 33 of the 100 forms had been incorrectly scored. All questionnaires where one or more sections were not completed by the patient were incorrectly scored. A scoring chart was developed and staff training was implemented. This reduced the error rate to 14% in the prospective audit.

CONCLUSIONS

Clinicians applying outcome measures should read the appropriate literature to ensure they understand the scoring system. Staff must then be given adequate training in the application of the questionnaires.

Outcome assessment: recommendations for daily practice

The choice of instruments for the assessment of outcome in spinal surgery is bewildering. For day-to-day practice, however, consideration of the purpose for which information is required allows construction of simple strategies for data collection. Recommendations are made for short and convenient data sets for use in personal audit, clinical governance, benchmarking, patient selection and business planning. No simple data set can measure in detail every aspect of practice, but use of these recommendations will provide information that will be of great value to the spinal surgeon and ultimately to his patients.