Medium- to long-term retrospective evaluation of clinical and radiographic outcome in the treatment of degenerative lumbar diseases with hybrid posterior fixation.
Methods
Thirty patients were included with the mean age of 47.8 years (range 35 to 60 years). All patients underwent posterior lumbar instrumentation using hybrid fixation for lumbar stenosis with instability (13 cases), degenerative spondylolisthesis Meyerding grade I (6 cases), degenerative disc disease of one or more adjacent levels in six cases and mild lumbar degenerative scoliosis in five patients. Clinical outcomes were evaluated using Oswestry disability index (ODI), Roland and Morris disability questionnaire (RMDQ), and the visual analog scale (VAS) pain scores. All patients were assessed by preoperative, postoperative and follow-up standing plain radiographs and lateral X-rays with flexion and extension. Adjacent disc degeneration was also evaluated by magnetic resonance imaging (MRI) at follow-up.
Results
At a mean follow-up of 6.1 years, we observed on X-rays and/or MRI 3 cases of adjacent segment disease (10.0 %): two of them (6.6 %) presented symptoms and recurred a new surgery. The last patient (3.3 %) developed asymptomatic retrolisthesis of L3 not requiring revision surgery. The mean preoperative ODI score was 67.6, RMDQ score was 15.1, VAS back pain score was 9.5, and VAS leg pain score was 8.6. Postoperatively, these values improved to 28.1, 5.4, 3.1, and 2.9, respectively, and remained substantially unchanged at the final follow-up: (27.7, 5.2, 2.9, and 2.7, respectively).
Conclusions
After 5-year follow-up, hybrid posterior lumbar fixation presented satisfying clinical outcomes in the treatment of degenerative disease.
Lumbar spinal stenosis in the presence of degenerative spondylolisthesis is generally treated by means of surgery. The role of lumbar decompression without fusion is not clear. Therefore, the aim of this study was to assess whether patients who undergo decompression alone have a favourable outcome without the need for a subsequent fusion.
Methods
This is a prospective cohort study with single blinding of 83 consecutive patients with lumbar stenosis and degenerative spondylolisthesis treated by decompression, without fusion, using a spinous process osteotomy. Blinded observers collected pre- and post-operative Oswestry Disability Index (ODI), EuroQol Five Dimensions (EQ-5D), and visual analogue scale (VAS) for back and leg pain scores prospectively. Failures for this study were those patients who required a subsequent lumbar fusion procedure at the decompressed levels. Statistical analysis was performed using paired t test and Mann–Whitney test.
Results
There were 36 males and 47 females with a mean age of 66 years (range 35–82). The mean follow-up was 36 months (range 19–48 months). The mean pre-operative ODI, EQ-5D, and VAS scores were 52 [standard deviation (SD) 18], 0.25 (SD 0.30), and 61 (SD 22), respectively. All mean scores improved post-operatively to 38 (SD 23), 0.54 (SD 0.34) and 36 (SD 27), respectively. There was a statistically significant improvement in all scores (p ≤ 0.0001). Nine patients (11 %) required a subsequent fusion procedure and five patients (6 %) required revision decompression surgery alone.
Conclusion
Our study’s results show that a lumbar decompression procedure without arthrodesis in a consecutive cohort of patients with lumbar spinal stenosis with degenerative spondylolisthesis had a significant post-operative improvement in ODI, EQ-5D, and VAS. The rate of post-operative instability and subsequent fusion is not high. Only one in 10 patients in this group ended up needing a subsequent fusion at a mean follow-up of 36 months, indicating that fusion is not always necessary in these patients.
The outcome of surgery for degenerative lumbar scoliosis was studied in the Swedish Spine register.
Methods
209 patients (mean age 66 years) were identified; 45 had undergone decompression and/or fusion of one segment (minor group) and 164 had undergone fusion of two or more segments, with or without decompression (major group).
Results
VAS back pain, VAS leg pain, ODI and EQ-5D index improved after surgery in both groups (p < 0.05), with medium to large effect sizes of surgery. Global assessment for back pain and satisfaction was significantly better in the major group than in the minor group (p < 0.05) at the 2-year follow-up. Additional spine surgery was observed in 57 out of the 209 patients during a mean period of 5.4 years.
Conclusion
Surgery for degenerative lumbar scoliosis improves quality of life with medium to large effect sizes, but carries a high risk of additional surgery.
Lumbar total disc replacement (TDR) has shown satisfactory clinical outcomes with few complications and reoperations at short-term follow-up, but the mid- to long-term results are not clear.
Purpose
The objective of this study was to evaluate the mid- to long-term clinical outcomes of artificial TDR for lumbar degenerative disc diseases.
Patients and methods
A systematic search was conducted using the PubMed database to identify studies of TDR surgery that included at least 3?years of follow-up. The search keywords were as follows: lumbar, total disc replacement, and arthroplasty. The following data were extracted: patient demographics, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, satisfactory rate, clinical success rate, complications, and reoperations.
Results
Thirteen studies, including eight prospective studies and five retrospective studies, met the criteria. A total of 946 patients were identified who reported at least 3?years of follow-up results. The artificial prostheses in these studies were ProDisc-L, Charité, AcroFlex, Maverick, and XL TDR. Patients with lumbar TDR demonstrated significant improvements in VAS scores of 51.1 to 70.5% and of ??15.6 to ??44.4 for Oswestry disability index (ODI) scores at the last follow-up. Patient satisfaction rates were reported in eight studies and ranged from 75.5 to 93.3%. Complication rates were reported in 11 studies, ranging from 0 to 34.4%. The overall reoperation rate was 12.1% (119/986), ranging from 0 to 39.3%, with eight of the 13 studies reporting a reoperation rate of less than 10%.
Conclusions
This review shows that lumbar TDR effectively results in pain relief and an improvement in quality of life at mid- to long-term follow-up. Complication and reoperation rates were acceptable. However, this study did not provide sufficient evidence to show that lumbar TDR is superior to fusion surgery. To answer that question, a greater number of high-quality randomized controlled trials (RCTs) are needed.
The purpose of this study was to evaluate the efficacy and safety of percutaneous pedicle screw fixation at the fractured vertebra in the treatment of thoracolumbar fractures.
Methods
Thirty-two consecutive patients were enrolled in the study. All patients received percutaneous pedicle screw fixation, and they were randomly divided into two groups to undergo either the placement of pedicle screws into the fractured vertebra (fractured group) or not (control group). The operation time and intra-operative blood loss were recorded. Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS) as clinical assessments were quantified. Radiographic follow-up was defined by the vertebral body index (VBI), anterior vertebral body height (AVBH), and Cobb angle (CA).
Results
No significant difference was observed in the operation time and intra-operative blood loss between the two groups. Clinical results (VAS and ODI scores) showed no significant difference during all the follow-up periods. In the fractured group, there were better correction and less loss of AVBH and VBI compared with the control group. However, post-operative correction of the CA immediately after surgery and the correction loss at the final follow-up showed no significant difference between the two groups.
Conclusion
Percutaneous screw fixation combined with intermediate screws at the fractured vertebra could more effectively restore and maintain fractured vertebral height, and is an acceptable, minimally invasive surgical choice for patients with type A thoracolumbar fractures.
This report compares the clinical, radiographic, and functional outcomes of fusion from thoracolumbar region terminating at L5 or at sacrum and pelvis in elderly patients with spinal deformity.
Methods
Ninety-four elderly patients who underwent spinal deformity surgery at our institution were evaluated. Patients were divided into two groups. The group L included 43 patients who underwent fusion of lumbar curve from thoracolumbar region to L5. The group P consisted of 51 patients who were treated using fusion from lower thoracic region to S1 extending to the pelvis. Radiographic outcomes, health-related to the quality of life (HRQOL) parameters, and complications with a 3-year minimum follow-up were analyzed and compared between two groups.
Results
In the group L, the ideal sagittal balance was not achieved. The group P showed a better restoration of global spinal alignments compared with the group L. The HRQOL scores (VAS, ODI, SRS-24) of the patients after 3 years are slightly higher in the group P, but we did not get significant difference between groups. The total number of complications was higher in the group P.
Conclusions
The research showed that fusion of lumbar curve extending to the pelvis provided good sagittal balance, global spinal alignments, and likely HRQOL parameters after 3-year follow-up. But, eventually, we obtained higher number of complications.
The most effective interbody fusion technique for degenerative disk disease (DDD) is still controversial. The purpose of our study is to compare pure lateral (LLIF) and oblique lateral (OLIF) approaches for the treatment of lumbar DDD from L1–L2 to L4–L5, in terms of clinical and radiological outcomes.
Materials and methods
45 patients underwent lumbar interbody fusion for pure lumbar DDD from L1–L2 to L4–L5 through LLIF (n?=?31, mean age 62.1 years, range 45–78 years) or OLIF (n?=?14, mean age 57.4 years, range 47–77 years). Clinical evaluations were performed with ODI and SF-36 tests. Radiological assessment was based on the modification of coronal segmental Cobb angles and segmental lumbar lordosis (L1–S1).
Results
On ODI and SF-36, all patients presented good results at follow-up, with 26% the difference between the LIF and OLIF groups on ODI scale in the post-operative period, and 3.9 and 8.8 points difference on physical and mental SF-36 in favor of OLIF. Radiological parameters improved significantly in both groups. The mean correction was 6.25° for cCobb (11.3° in LIF and 1.9° in OLIF), 2.5° for sLL (2° in LLIF and 4° in OLIF).
Conclusions
LLIF and OLIF represent safe and effective MIS procedures for the treatment of lumbar DDD. LLIF had some risks of motor deficit and monitoring is mandatory, though it addressed more the coronal deformities. OLIF did not imply risks for motor deficits, but attention should be paid to vascular anatomy. It was more effective in kyphotic segmental deformities.
Graphical abstract
These slides can be retrieved under Electronic Supplementary material.
Microendoscopic discectomy (MED) is becoming an established and effective minimally invasive surgical method for the treatment of lumbar disc herniation (LDH); however, the absence of prognostic factors for long-term outcomes after MED results in a lack of specific criteria for appropriate patient selection. Therefore, we evaluated the long-term outcomes and associated predictors in patients who underwent MED for LDH.
Material and methods
Baseline and follow-up data for 664 LDH patients who suffered from sciatica and underwent primary MED were reviewed retrospectively. Variables at baseline that were analyzed as potential prognostic factors included sociodemographic characteristics, clinical findings, and imaging features. Follow-up data including improvements in the Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI), postoperative low back pain (LBP), reoperation, and excellent/good results according to the modified MacNab criteria were set as outcome variables for univariate and further multivariate logistic regression analyses.
Results
The mean follow-up period was 63.8?±?20.0 months (range 24–96 months). On average, sufficient improvements in both the VAS score (72.8%) and ODI (63.4%) were observed. In addition, a low postoperative LBP rate (23.9%), low reoperation rate (7.1%), and high rate of excellent/good clinical outcomes (89.9%) were achieved. A multivariate analysis indicated that older age, shorter disease duration, higher preoperative VAS score, lower preoperative ODI, shorter surgical time, lower severity of disc and adjacent disc degeneration, and lower severity of lumbar multifidus atrophy contributed to superior clinical outcomes.
Conclusion
Excellent long-term outcomes after primary MED were achieved and specific sociodemographic, clinical, and imaging variables were identified as prognostic factors that can be used to guide patient selection and clinical decision making.
To evaluate the results of a novel rigid–dynamic stabilization technique in lumbar degenerative segment diseases (DSD), expressly pointing out the preservation of postoperative lumbar lordosis (LL).
Materials and methods
Forty-one patients with one level lumbar DSD and initial disc degeneration at the adjacent level were treated. Circumferential lumbar arthrodesis and posterior hybrid instrumentation were performed to preserve an initial disc degeneration above the segment that has to be fused. Clinical and spino-pelvic parameters were evaluated pre- and postoperatively.
Results
At 2-year follow-up, a significant improvement of clinical outcomes was reported. No statistically significant difference was noted between postoperative and 2-year follow-up in LL and in disc/vertebral body height ratio at the upper adjacent fusion level.
Conclusions
When properly selected, this technique leads to good results. A proper LL should be achieved after any hybrid stabilization to preserve the segment above the fusion.
There are two modified TLIF, including MIS-TLIF and TLIF through Wiltse approach (W-TLIF). Although both of the two minimally invasive surgical procedures can be effective in the treatment for lumbar degenerative diseases, no comparative analysis has been made so far regarding their clinical outcomes.
Objective
To compare the clinical outcomes of MIS-TLIF and W-TLIF for the treatment for single-segment degenerative lumbar diseases.
Methods
Ninety-seven patients with single-segment degenerative lumbar disorders were included in this study. Forty-seven underwent MIS-TLIF surgery (group A). For group B, fifty patients underwent W-TLIF. The Japanese Orthopedic Association (JOA) score, the visual analog scale (VAS) of low back pain (LBP) and leg pain, MRI score and atrophy rate of CSA, interbody fusion rate were assessed during the postoperative follow-up.
Results
Incision length, blood loss, operative time, CPK, and postoperative incision pain VAS were better in group A (P < 0.05). The seconds of intraoperative fluoroscopy in groups A and B were 76 ± 9 and 7 ± 2, respectively (P < 0.05). In group B, The blood loss and CPK at L5-S1 were significantly higher than those at L4-5. Postoperative JOA scores, VAS of leg pain, and fusion rate were statistically the same between the two groups. VAS of LBP, MRI score, and atrophy rate of CSA was better in group A than in group B (P < 0.05).
Conclusion
Both methods are effective in the treatment for lumbar degenerative disease. MIS-TLIF has less blood loss, shorter surgical incision, and less lower postoperative back pain, while W-TLIF is less expensive for hospital stay with lower exposure to X-rays.
Our aim is to evaluate the safety and effectiveness of interspinous spacers versus posterior lumbar interbody fusion (PLIF) for degenerative lumbar spinal diseases.
Methods
A comprehensive literature search was performed using PubMed, Web of Science and Cochrane Library through September 2015. Included studies were performed according to eligibility criteria. Data of complication rate, post-operative back visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, estimated blood loss (EBL), operative time, length of hospital stay (LOS), range of motion (ROM) at the surgical, proximal and distal segments were extracted and analyzed.
Results
Ten studies were selected from 177 citations. The pooled data demonstrated the interspinous spacers group had a lower estimated blood loss (weighted mean difference [WMD]: ?175.66 ml; 95 % confidence interval [CI], ?241.03 to ?110.30; p?<?0.00001), shorter operative time (WMD: ?55.47 min; 95%CI, ?74.29 to ?36.65; p?<?0.00001), larger range of motion (ROM) at the surgical segment (WMD: 3.97 degree; 95%CI, ?3.24 to ?1.91; p?<?0.00001) and more limited ROM at the proximal segment (WMD: ?2.58 degree; 95%CI, 2.48 to 5.47; p?<?0.00001) after operation. Post-operative back VAS score, ODI score, length of hospital stay, complication rate and ROM at the distal segment showed no difference between the two groups.
Conclusions
Our meta-analysis suggested that interspinous spacers appear to be a safe and effective alternative to PLIF for selective patients with degenerative lumbar spinal diseases. However, more randomized controlled trials (RCT) are still needed to further confirm our results.
To investigate if bone substitutes are strictly necessary to restore the vertebral body height and improve the clinical outcome, in patients with thoracolumbar or lumbar AO type A post-traumatic vertebral fractures, managed with balloon kyphoplasty combined with posterior screw and rod system.
Methods
105 patients with post-traumatic thoracolumbar spine fracture were recruited. At baseline, the patients underwent a CT and an MRI of the spine. Clinical evaluation was performed, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), at baseline, 48 h after surgery, at 3-month follow-up (FU), 6-month FU, 48 h after the instrumentation removal and at 24-month FU. At each FU, VK, regional kyphosis (RK), central wall (MH/PH) and anterior wall (AH/PH) heights were assessed on lateral spine X-rays. At 6-month FU, a CT scan of the spine was performed to investigate the fracture healing. The posterior instrumentation was removed 7 months after surgery (range 6–10 months).
Results
A significant reduction of mean VAS (p?<?0.05) and ODI (p?<?0.05) was observed after surgery; no impairment of these scores was observed after the instrumentation removal. A significant correction of VK, RK, AH/PH and MH/PH was recorded after surgery; no significant changes of these values were noticed at subsequent FU. After the instrumentation removal, only an RK impairment was recorded, but it was not significant.
Conclusions
PMMA or bone substitutes are not necessary to keep the reduction of the endplate obtained with the balloon tamp, when BK is performed in the association with posterior percutaneous pedicle screws instrumentation.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
The treatment of symptomatic degenerative disc disease of the lumbar spine in elderly patients by standard surgical methods is often limited due to severe comorbidities (e.g., cardiopulmonary disease, hypertonia, diabetes). Minimally invasive procedures are more acceptable in this population, since they reduce surgical morbidity and the risk of complications. The percutaneous cement discoplasty (PCD) technique was introduced by the authors to treat dynamic (and angular) instability of the symptomatic lumbar segment by injecting bone cement (polymethylmethacrylate, PMMA) into the disc spaces showing vacuum phenomena via a posterolaterally positioned Jamshidi needle. The aim of this article is to describe the indication, method, and clinical results of PCD.
Method
A total of 81 patients were treated with PCD in a tertiary care referral center over a 6-year period. The current study includes the first group of 47 consecutive patients to complete a pre- and postoperative questionnaire booklet regarding leg and back pain using the visual analog scale (VAS) and the Oswestry disability index (ODI) questionnaire.
Results
A total of 130 discs in these 47 patients were treated with PCD. The majority of patients reported a reduction in their lower back and leg pain (69?% and 66?%, respectively; p?p?
Conclusion
Elderly patients with symptomatic dynamic foraminal stenosis and vacuum phenomenon in the intervertebral disc are suitable candidates for PCD, particularly if they represent high-risk patients for open surgery.
To evaluate the results of a consecutive series of patients affected by lumbar discogenic pain associated with facet pain and canal stenosis surgically treated with the PercuDyn device.
Methods
From 2009, 129 consecutive patients (96 M, 33 F, mean age 62) were treated with posterior dynamic stabilization screws (PercuDyn). Inclusion criteria were minimum follow-up of 24 months; pain localized at the lumbar spine column alone or in association to lower limb radicular pain; magnetic resonance evidence of disc degeneration associated with facet degeneration and canal stenosis. Patients were clinically studied using VAS scale and Oswestry Disability Index (ODI); CT assessment of the neuroforamina and spinal canal areas was done at 1 month of follow-up.
Results
At 24 months of follow-up, 96 patients fulfilled the inclusion criteria. 96 intervertebral spaces were treated (85 levels L5–S1, 11 levels L4–L5). The VAS scale showed a statistically significant difference at 1 month, 6 months and 2 years with respect to the pre-operative value (p < 0.001). The ODI score registered a significant difference with the same fashion (p < 0.001 both at 1- and 6-month, and 2-year follow-up with respect to the pre-operatory). At 1-month follow-up, neuroforamina and spinal canal areas were considerably wider (p < 0.05). 70 (72.5 %) patients were satisfied of the procedure.
Conclusions
In this wide cohort study, the PercuDyn ensured good clinical and radiological results, with more than 70 % of patients satisfied of the procedure. Very few complications were noted, with an immediate return to daily activities. At longer follow-ups, 10 % of patients received revision surgery.
We performed this meta-analysis of randomised controlled trials to compare the efficacy and safety of unilateral with bilateral fixation in short-segment lumbar spinal fusion.
Methods
Predefined terms were used to search electronic databases to identify relevant research. Randomised controlled trials (RCTs) published in English and Chinese during 1990–2015 investigating efficacy and safety of unilateral and bilateral fixation in short-segment lumbar spinal fusion were included. Data of fusion rate, complications, visual analogue scale (VAS), Oswestry Disability Index (ODI), estimated blood loss (EBL) and length of hospital stay were extracted and analysed. Two reviewers independently searched information sources, selected eligible research, analysed data and evaluated risk of bias.
Results
Eleven RCTs comprising 756 participants were analysed. There was no significant difference in fusion rate, device-related complication, ODI, VAS and length of hospital stay between bilateral and unilateral groups. The unilateral group had the obvious advantage of reduced blood loss [mean difference (MD)??143.57, 95 % confidence interval (Cl) -206.61 to -80.54, P?<?0.0001) and operation time (MD -52.72, 95 % Cl -73.58 to -31.87, P?<?0.00001).
Conclusion
Unilateral pedicle screw fixation is equally as effective as bilateral pedicle screw fixation in short-segment lumbar spinal fusion and may reduce operation time and blood loss.
To compare the outcomes of microendoscopic discectomy and open discectomy for patients with lumbar disc herniation.
Methods
An extensive search of studies was performed in PubMed, Medline, Embase, Cochrane library and Google Scholar. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), complication, operation time, blood loss and length of hospital stay. Data analysis was conducted with RevMan 5.0.
Results
Five randomized controlled trials involving 501 patients were included in this meta-analysis. The pooled analysis showed that there was no significant difference in the VAS, ODI or complication between the two groups. However, compared with the open discectomy, the microendoscopic discectomy was associated with less blood loss [WMD = ?151.01 (?288.22, ?13.80), P = 0.03], shorter length of hospital stay [WMD = ?69.33 (?110.39, ?28.28), P = 0.0009], and longer operation time [WMD = 18.80 (7.83, 29.76), P = 0.0008].
Conclusions
Microendoscopic discectomy, which requires a demanding learning curve, may be a safe and effective alternative to conventional open discectomy for patients with lumbar disc herniation.
The nerve root sedimentation sign (SedSign) is a magnetic resonance imaging (MRI) sign for the diagnosis of lumbar spinal stenosis (LSS). It is included in the assessment of LSS to help determine whether decompression surgery is indicated. Assessment of the reversibility of the SedSign after surgery may also have clinical implications for the decision about whether or not a secondary operation or revision is needed. This study investigated if lumbar decompression leads to a reversal of the SedSign in patients with LSS and a positive SedSign pre-operatively; and if a reversal is associated with more favourable clinical outcomes. If reversal of the SedSign is usual after sufficient decompression surgery, a new positive SedSign could be used as an indicator of new stenosis in previously operated patients.
Methods
A prospective cohort study of 30 LSS patients with a positive pre-operative SedSign undergoing decompression surgery with or without instrumented fusion was undertaken to assess the presence of nerve root sedimentation (=negative SedSign) on MRI at 3 months post-operation. Functional limitation (Oswestry Disability Index, ODI), back and leg pain (Visual Analogue Scale, VAS), and treadmill walking distance were also compared pre- and 3 months post-operatively. The short follow-up period was chosen to exclude adjacent segment disease and the potential influence of surgical technique on clinical outcomes at longer follow-up times.
Results
30 patients [median age 73 years (interquartile range (IQR) 65–79), 16 males] showed a median pre-operative ODI of 66 (IQR 52–78), a median VAS of 8 (IQR 7–9), and a median walking distance of 0 m (IQR 0–100). Three months post-operation 27 patients had a negative SedSign. In this group, we found improved clinical outcomes at follow-up: median post-operative ODI of 21 (IQR 12–26), median VAS of 2 (IQR 2–4), and median walking distance of 1000 m (IQR 500–1000). These changes were all statistically significant (p < 0.001). Three patients had a positive SedSign at 3-month follow-up due to epidural fat (n = 2) or a dural cyst following an intra-operative dural tear (n = 1), but also showed improvements in clinical outcomes for ODI, VAS and walking distance.
Conclusion
The reversibility of a pre-operative positive SedSign was demonstrated after decompression of the affected segmental level and associated with an improved clinical outcome. A persisting positive SedSign could be the result of incomplete decompression or surgical complications. A new positive SedSign after sufficient decompression surgery could be used as an indicator of new stenosis in previously operated patients.
There are two, principally different ways to obtain patient opinions regarding the outcome of spine surgery: using prospective multi-item questionnaires preoperatively and at follow-up, and using a retrospective single-item question at follow-up—both methods have distinct advantages and limitations. The purpose of the study was to explore the utility of using the simple transition question global assessment, GA, (“How is your back/leg pain today as compared to before the surgery?”) as an overall patient-reported outcome measure (PROM) based on the large real-life database in the Swedish spine registry (Swespine).
Methods
The correlation between GA and the score-changes and the final scores at 1 year of follow-up for the PROMs VAS, ODI, and EQ-5D was examined. The correlations between GA and item-specific domains within the ODI, EQ-5D and SF-36 as well as the discriminative ability of PROMs with GA as reference criterion were also analysed. The cohort consisted of 94,132 patients registered in Swespine who were surgically treated for disc herniation, spinal stenosis or degenerative disc disease.
Results
The correlation coefficients for GA vs. the score-changes were lower than for GA vs final scores. For VAS they ranged for the different diagnosis groups from 0.33 to 0.61 and from 0.50 to 0.79, respectively. For ODI, the corresponding values ranged from 0.43 to 0.65 and 0.63 to 0.76; for the EQ-5D from 0.32 to 0.45 and 0.54 to 0.71. Further, GA showed a somewhat stronger correlation to pain-specific PROMs than to quality-of-life PROMs.
Conclusions
The single-item outcome measure global assessment (GA) appears to be a feasible overall patient-reported outcome measure (PROM) and a useful reference for interpreting the scores of patient-reported outcome measures.
This prospective randomized trial is to determine the effectiveness of treating lumbar facet syndrome with oral diclofenac, methylprednisolone facet joint injection or both.
Methods
We enrolled lumbar facet syndrome patients treated at Srinagarind Hospital. Enrolled patients were randomly assigned to receive 100 mg/day oral diclofenac, an 80 mg injection of methylprednisolone into each symptomatic facet joint, or both. Endpoints were the Oswestry disability index (ODI) and visual analogue scale (VAS) before treatment, and at four and 12 weeks after treatment.
Results
Of the 99 patients, the mean age was 46.4 years and 48 were men. The initial ODI (mean?±?SD) for the diclofenac, methylprednisolone and combined treatment was 45.1?±?9.3, 42.9?±?15.6, and 42.2?±?11.5, respectively. The respective four week ODI was 30.1?±?8.1, 20.2?±?8.0, and 15.1?±?5.5. The 12-week ODI was 42.4?±?9.0, 32.2?±?15.6, and 26.2?±?11.7. The initial VAS was 7.1?±?1.2, 7.6?±?1.1, and 7.3?±?1.0. The four week VAS was 5.3?±?1.4, 3.6?±?0.7, and 3.3?±?1.1. The 12-week VAS was 6.1?±?1.1, 5.8?±?1.4, and 5.1?±?0.9. The four week ODI and VAS for the combined treatment and the methylprednisolone treatment were significantly less than the diclofenac alone. The combined treatment also showed better scores than the methylprednisolone injection. Within each treatment, the best treatment effect was found at four weeks after which the ODI and VAS gradually increased but were still less than the initial scores.
Conclusions
The combined treatment was more effective in reducing lumbar facet pain and improving the functional index than either treatment alone. This approach should be the preferred treatment.
To determine the safety and short-term curative effects of internal fixation using a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation (ms-LDH) with the control group treated by posterior lumbar interbody fusion (PLIF).
Methods
Forty-five patients with ms-LDH were selected as study group treated with Dynesys and 40 patients as control group with PLIF. The surgical efficacy was evaluated by comparing the visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI) scores and the ROMs of the adjacent segment before and after surgery. The postoperative complications related to the implants were identified.
Results
All patients were followed up for an average duration of over 30 months. Dynesys stabilization resulted in significantly higher preservation of motion at the index level (p < 0.001), and significantly less (p < 0.05) hypermobility at the adjacent segments. VAS for back and leg pain and ODI improved significantly (p < 0.05) with both the methods, but there was no significant difference between the groups.
Conclusions
The non-fusion fixation system Dynesys is safe and effective regarding short-term curative effects for the treatment of ms-LDH.
