scholarly journals Reoperations Following Lumbar Discectomy Are Associated With Worse Clinical Outcomes and Greater Socioeconomic Burden 3 Years After the Primary Procedure

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Claudius Thomé ◽  
Ali Araghi ◽  
Jason Inzana ◽  
Jonathan Stieber ◽  
Joshua M Ammerman
Keyword(s):  
Back Pain ◽  
Clinical Outcomes ◽  
Lumbar Discectomy ◽  
Control Treatment ◽  
Control Group ◽  
Closure Device ◽  
Number Of Patients ◽  
Patient Reported ◽  
Socioeconomic Burden ◽  
Index Level

Abstract INTRODUCTION Lumbar discectomy patients with large annular defects are at significantly greater risk for symptom recurrence and revision. Previous studies suggest that outcomes following revision surgery are less positive than outcomes from primary discectomy. This analysis aimed to assess the clinical and socioeconomic outcomes associated with postdiscectomy reoperations and the utility of a bone-anchored annular closure device (ACD) for avoiding reoperations. METHODS This study was a retrospective analysis of a prospective randomized controlled trial (RCT). Lumbar discectomy patients with large (>6 mm) annular defects were treated with discectomy alone (Control; n = 278) or discectomy with an ACD (n = 272). Patient-reported outcomes included visual analog scale (VAS) for ipsilateral leg or back pain and Oswestry Disability Index (ODI). At 3 yr, clinical outcomes were available for 75% of the patients. Comparisons of outcomes were made between reoperated (n = 64) and nonreoperated (n = 351) patients, regardless of ACD or Control treatment, at 3 yr following the primary surgery. RESULTS Reoperated patients had significantly worse scores for ODI (24 ± 19 vs 11 ± 13; P < .0001), VAS leg pain (28 ± 30 vs 12 ± 19; P < .0001), and VAS back pain (36 ± 31 vs 17 ± 21; P < .0001). Significantly more nonreoperated patients were working at 3 yr (97% vs 84%; P < .001). Based on Kaplan-Meier analysis, the proportion of subjects experiencing at least 1 index-level reoperation in 3 yr was 11% in the ACD group and 19% in the Control group (P = .007). CONCLUSION Index-level reoperations following lumbar discectomy are associated with worse outcomes and greater socioeconomic burden in patients with large annular defects (>6 mm). These findings are consistent with reports from large registry analyses, including the Spine Patient Outcomes Research Trial (SPORT) and the Swedish National Spine Registry (Swespine). The ACD reduced the number of patients experiencing index-level reoperation by 43%.

Longer-Term Clinical and Economic Benefits of Offering Acupuncture to Patients with Chronic Low Back Pain Assessed as Suitable for Primary Care Management – 3 Month Clinical Outcomes from a Controlled Trial of 241 Patients

2002 ◽  
Vol 20 (2-3) ◽  
pp. 121-137
Author(s):  
H Macpherson ◽  
K Thomas ◽  
J Brazier ◽  
M Fitter ◽  
L Thorpe ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomised Controlled Trial ◽  
Clinical Outcomes ◽  
Controlled Trial ◽  
Bodily Pain ◽  
Control Group ◽  
Low Back ◽  
Randomised Controlled ◽  
Pragmatic Randomised Controlled Trial

Objectives To undertake a pragmatic randomised controlled trial to test the hypothesis that a population of patients with persistent low back pain, when given access to an acupuncture service, gain more relief from pain than those offered usual management only, for equal or less cost. Methods The study is a pragmatic randomised controlled trial (n=241). Suitable patients are identified by their general practitioners. Patients randomised to the experimental arm are offered the option of referral for up to 10 individualised treatments from one of six qualified acupuncture practitioners. The control group continues to receive usual management from their general practitioner. The primary scale used for measuring change is the Bodily Pain (SF–36) at 3 months and 12 months post randomisation. The main outcome is cost-effectiveness at 12 months. Results A total of 43 general practitioners participated in the trial and 241 patients were randomised. All patients randomised to the option of acupuncture chose to receive treatment. Clinical outcomes at 3 months show that the SF-36 Bodily Pain scores improved by 29.4 and 24.9 points in the acupuncture and normal management group respectively (p=0.125). Patients in the acupuncture group reported lower levels of worry at three months (p<0.001). Conclusions It is possible to conduct a large pragmatic randomised controlled trial of acupuncture in a primary care setting. Acupuncture is seen as an acceptable treatment by patients with low back pain. Clinical outcomes at three months suggest that the acupuncture group are in less pain than the control group.

Imatinib Plasma Levels and Its Correlation with Response in Chronic-Phase Chronic Myeloid Leukemia: Experience of One Centre.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4284-4284
Author(s):  
J. Valentin Garcia. Gutierrez ◽  
Jesús Odriozola ◽  
Pilar Herrera ◽  
Javier Lopez ◽  
Maria Calbacho ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Plasma Levels ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Plasma Concentrations ◽  
Chronic Phase ◽  
Control Group ◽  
Treatment Optimisation ◽  
Number Of Patients

Abstract Abstract 4284 Introduction Imatinib (IM), 400 mg/d. induces durable responses in chronic myeloid leukaemia (CML) in chronic phase (CP). However, although IM-biodisponibility is fairly good, its plasma levels are variable and can not be predicted. Recently, these plasma concentrations have been related both to the dose being administrated and to the cytogenetic and molecular responses. Thus, Imatinib pharmacokinetics could be an issue towards treatment optimisation in CML patients. Recent studies suggest that therapeutic IM plasma levels should be above 1040 ng/dl. Aims To evaluate the association between IM dose and throughout plasma levels with different clinical outcomes. Results In this study, we looked for an association between plasma concentrations and clinical outcomes in 16/86 CML chronic phase patients who did not achieve optimal responses following the European Leukemia Net guidelines (ELN) (table 1). Patients with optimal responses and treated with the same standard doses were also analysed as a control group. Patients receiving doses above 400 mg showed throughout plasma levels considered as appropriate. In 7 of 16 patients (47.5%) not achieving optimal responses (ELN criteria), plasma levels were below the supposed therapeutic ranges. We have found no evidence for a correlation between clinical risk factors at diagnosis and the measurement of optimal plasma levels. Conclusions IM plasma levels are well correlated with IM dose administrated in the patients studied. In almost 50% of patients who did not achieve optimal responses, IM plasma levels were under the ranges considered therapeutic. Probably these are the patients who may benefit of a dose increase. Obviously, to learn more about the practical value of these measurements a longer follow up with a larger number of patients is needed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Retrospective Comparative Study of Local Anesthesia Only and Local Anesthesia with Sedation for Percutaneous Endoscopic Lumbar Discectomy

2021 ◽  
Author(s):  
Liu Yang ◽  
Yu-Lin Pan ◽  
Chun-Zhi Liu ◽  
De-Xin Guo ◽  
Xin Zhao
Keyword(s):  
Clinical Outcomes ◽  
Local Anesthesia ◽  
Lumbar Discectomy ◽  
Control Group ◽  
Surgical Experience ◽  
Lumbar Disk Herniation ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Retrospective Comparative Study ◽  
Endoscopic Lumbar Discectomy ◽  
Surgical Duration

Abstract The purpose of this study was to compare surgical experience and clinical outcomes of lumbar disk herniation (LDH) patients treated with percutaneous endoscopic lumbar discectomy (PELD) using local anesthesia only and local anesthesia with sedation. Ninety-two consecutive LDH patients were divided into four groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Mean arterial pressure (MAP), heart rate (HR), Ramsay score and VAS score were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperative (T4). Surgical duration, hospitalization and MacNab criteria were evaluated. In control group, MAP and HR at T2 and T3 were higher than T1 (P < 0.05). In Dex, Oxy, and Dex + Oxy groups, MAP and HR at T2, T3, T4 were lower than T1, but Ramsay scores at T2, T3, T4 were higher than T1 (P < 0.05). VAS scores in all groups were improved postoperative (p>0.05). The clinical outcomes have no significant differences among the four groups (P > 0.05). We concluded that the combination of dexmedetomidine and oxycodone under local anesthesia is an effective method to improve surgical experience and reduce anxiety in suitable LDH patients.

scholarly journals Histological, radiological, and clinical outcomes of sinus floor elevation using a lateral approach for pre-/post-extraction of the severely compromised maxillary molars: a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhaoguo Yue ◽  
Qi Liu ◽  
Haidong Zhang ◽  
Jingwen Yang ◽  
Jianxia Hou
Keyword(s):  
Clinical Outcomes ◽  
Alveolar Bone ◽  
Survival Rates ◽  
Lateral Approach ◽  
Control Group ◽  
Study Cohort ◽  
Implant Survival ◽  
Sinus Floor Elevation ◽  
Patient Reported ◽  
Sinus Floor

Abstract Background The volume of residual alveolar bone is critical to the survival of dental implants. When the volume of alveolar bone in the posterior maxillary region is less than 4 mm, maxillary sinus floor elevation (MSFE) with the lateral approach is an effective option. Traditionally, this standard approach is usually conducted at 4–6 months after tooth extraction (standard MSFE). However, defective dentition due to extraction can impair mastication during the period of bone remodeling, especially if the molars on both sides are severely compromised and must be extracted. MSFE before extraction (modified MSFE) can take full advantage of residual tooth strength. However, the effectiveness and practicability of the modified MSFE procedure remain unknown. Therefore, the aim of this study was to compare the clinical outcomes of modified vs. standard MSFE, in order to provide references to periodontists. Methods/design The study cohort included 25 adult patients (50 surgery sites) recruited from Peking University Hospital and School of Stomatology who met the inclusion criteria. The two sides of each patient will be randomly divided into two groups: a test group-modified MSFE or a control group-standard MSFE. The surgical duration and patient-reported outcomes (visual analog scale for discomfort) will be documented. Clinical indicators, including implant survival rates, mucosal conditions, and complications, will be recorded every 6 months during the 5-year follow-up period. The volume of the alveolar bone and marginal bone level will be assessed radiographically (cone-beam CT and periapical films) every 6 months. Histological analysis of biopsy samples retrieved from both sides will be performed to evaluate the biological features of the bone. Discussion The current study will explore the implant survival rates, safety, reliability, effectiveness, and practicability of the modified MSFE procedure. Moreover, the extent of osteogenesis on the sinus floor will also be assessed. The results of this trial will provide strategies for the modified MSFE procedure to achieve ideal clinical outcomes. Trial registration International Clinical Trials Registry Platform ChiCTR1900020648. Registered on 1 January 2019

scholarly journals Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rui Zhang ◽  
Jiajun Lin ◽  
Fenyong Chen ◽  
Wenge Liu ◽  
Min Chen
Keyword(s):  
3D Printing ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Cochrane Library ◽  
Control Group ◽  
Total Hip ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Abstract Background This study investigates whether three-dimensional (3D) printing-assisted revision total hip/knee arthroplasty could improve its clinical and radiological outcomes and assess the depth and breadth of research conducted on 3D printing-assisted revision total hip and knee arthroplasty. Methods A literature search was carried out on PubMed, Web of Science, EMBASE, and the Cochrane Library. Only studies that investigated 3D printing-assisted revision total hip and knee arthroplasty were included. The author, publication year, study design, number of patients, patients’ age, the time of follow-up, surgery category, Coleman score, clinical outcomes measured, clinical outcomes conclusion, radiological outcomes measured, and radiological outcomes conclusion were extracted and analyzed. Results Ten articles were included in our review. Three articles investigated the outcome of revision total knee arthroplasty, and seven investigated the outcome of revision total hip arthroplasty. Two papers compared a 3D printing group with a control group, and the other eight reported 3D printing treatment outcomes alone. Nine articles investigated the clinical outcomes of total hip/knee arthroplasty, and eight studied the radiological outcomes of total hip/knee arthroplasty. Conclusion 3D printing is being introduced in revision total hip and knee arthroplasty. Current literature suggests satisfactory clinical and radiological outcomes could be obtained with the assistance of 3D printing. Further long-term follow-up studies are required, particularly focusing on cost-benefit analysis, resource availability, and, importantly, the durability and biomechanics of customized prostheses using 3D printing compared to traditional techniques.

scholarly journals Aspects Regarding the Beneficial Effect of Reflexology in Low Back Pain

2013 ◽  
Vol 5 (10) ◽  
pp. 43-48 ◽  
Author(s):  
Şerban Gligor ◽  
Silviu Istrate
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Drug Treatment ◽  
Beneficial Effect ◽  
Pain Treatment ◽  
Control Group ◽  
Entire Body ◽  
Low Back ◽  
Number Of Patients ◽  
Experimental Group

Abstract Reflexology is based on the digital pressure on certain reflex points situated on the sole of the foot, which represents a “map” of the entire body. The aim of this paper is to highlight the importance of reflexology in low back pain treatment. To accomplish the objectives of this paper, a lot of 12 patients, of both genders, with low back pain, was formed. Out of these patients, 66.67% were male and 33.33% were female, the majority coming from an urban area (75%). The average age ± the standard deviation of the patients was 43.58±13.02 years. The group of patients was subdivided into an experimental group, composed of 7 patients (58.33%), who, besides the classic drug treatment, also underwent reflexology, and a control group, composed of 5 patients (41.67%), who underwent only drug treatment. The treatment linked to reflexology was conducted by a single practitioner of reflexology, using the Morrell technique. Both in the case of the experimental group and in the control one there was a statistically significant reduction in finger to ground index (p < 0.01, respectively p< 0.05). Also, there was a highly statistically significant reduction of pain (p<0.01). Due to the small number of patients involved in the study, the data obtained cannot be generalised, as further studies are required to highlight the beneficial effect of reflexology in the case of low back pain.

scholarly journals AB0523 TAKAYASU ARTERITIS AND SACROILIITIS: A CASE-CONTROL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1559.2-1559
Author(s):  
F. Regola ◽  
G. Bosio ◽  
F. Franceschini ◽  
P. Toniati
Keyword(s):  
Back Pain ◽  
Takayasu Arteritis ◽  
Fdg Pet ◽  
Ct Scans ◽  
Inflammatory Back Pain ◽  
Control Group ◽  
Sacroiliac Joints ◽  
Pet Ct ◽  
Patient Reported ◽  
Fdg Pet Ct

Background:A possible shared immunopathogenesis between Spondyloarthritis (SpA) and Takayasu Arteritis (TA) has been hypothesized and some clinical cases about SpA in TA patients have been reported (1). In clinical practice the diagnosis of sacroiliitis may be performed by X-ray, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). In particular, CT findings of sacroiliitis include contour irregularities, joint space alterations, joint erosion, subcondral bone changes (osteoporosis or sclerosis), enthesitis, ankylosis. Meanwhile, TA patients performe routinely FDG-PET/CT scans for monitoring disease activity.Objectives:This study aims to understand if there is an increased incidence of sacroiliitis in TA patients.Methods:We collected retrospectively imaging data from FDG-PET/CT scans of 28 TA patients and 28 controls, matched for sex and age. Controls were selected among patients performing FDG-PET/CT in our Nuclear Medicine Unit, excluding patients with bone tumors, bone metastasis and thyroid cancers. The majority of controls were affected by lymphoma in complete remission. An expert rheumatologist read the CT-scans of sacroiliac joints.Results:No patients or controls demonstrated FDG-uptake in sacroiliac joints. In the control group we detected sacroiliac sclerosis in two cases: one due to degenerative changes, one to sacroiliitis (1/28, 4%). In the TA group four patients presented CT alterations suggestive for sacroiliitis: one bilateral erosion, one bilateral sclerosis, two monolateral sclerosis (4/28, 14%). One of these patients complained an inflammatory back pain.Conclusion:In our cohort of TA patients we demonstrated an increased prevalence of sacroiliitis, diagnosed by CT scan. Only one patient reported an inflammatory back pain, while three patients had radiological signs of previous sacroiliitis. These findings highlight the importance of looking for spondyloarthropathy in TA patients even if asymptomatic.References:[1]Guzel Esen S, Joint Bone Spine, 2019Disclosure of Interests:None declared

Reoperation After Primary Lumbar Discectomy with or without Implantation of a Bone-Anchored Annular Closure Device: Surgical Strategies and Clinical Outcomes

2019 ◽  
Vol 130 ◽  
pp. e926-e932 ◽  
Author(s):  
Peter D. Klassen ◽  
Geoffrey Lesage ◽  
Larry E. Miller ◽  
Robert Hes ◽  
Jasper F.C. Wolfs ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Discectomy ◽  
Closure Device ◽  
Surgical Strategies ◽  
Annular Closure Device

Dysport® for the treatment of myofascial back pain: Results from an open-label, Phase II, randomized, multicenter, dose-ranging study

2011 ◽  
Vol 2 (1) ◽  
pp. 25-33 ◽  
Author(s):  
Gerhard H.H. Müller-Schwefe ◽  
Michael A. Überall
Keyword(s):  
Back Pain ◽  
Pain Intensity ◽  
Primary Endpoint ◽  
Trigger Point ◽  
A Priori ◽  
Control Group ◽  
High Dose ◽  
Open Label ◽  
Patient Reported ◽  
Tissue Compliance

AbstractBackground and purposeBotulinum toxin type A (BoNT-A) has antinociceptive and muscle-relaxant properties. The objectives of this study were to investigate the efficacy and safety of a single BoNT-A (Dysport®) treatment in myofascial back pain.MethodsIn this randomized, open-label, multicenter study, adults with myofascial lower back pain received Dysport® injections at four trigger points (60,80 or 120 units per injection point). Patients were followed for 12 weeks. The a priori primary endpoint was a pooled evaluation, at Week 6, of seven measures of efficacy, including pain intensity (patient diary), modified Pain Disability Index (PDI) score, use of interfering concomitant analgesics, and patient-rated global efficacy. Optional assessments of pressure thresholds and tissue compliance were conducted. Safety was also assessed.ResultsA total of 202 patients were randomized to treatment and 189 patients received a low (n = 57), medium (n = 57), or high (n = 75) total dose of Dysport® at 34 centers in Germany between October 2002 and October 2003. All treated patients were included in the safety population; 8 patients were excluded from the intention-to-treat population. Patients had moderate to severe pain at baseline. At baseline, 120 patients were receiving concomitant analgesic therapy; 6.7%, 74.2% and 19.2% were considered to cause mild, moderate and severe interference with pain measurements, respectively. There was no difference between doses for the a priori combined primary endpoint. Patient-reported pain intensity scores at rest and on movement decreased significantly after treatment for all groups combined (p < 0.0001 at all visits). At Week 6, reductions in pain intensity at rest were 29%, 19% and 26% for the low-, medium- and high-dose groups, respectively; reductions in pain intensity on movement were 27%, 18% and 26%, respectively. Overall, patients who reported pain intensity reductions at Week 6 were evident within 3 weeks of treatment and were maintained for the 12 weeks of the study. In the total population, significant decreases in mean PDI sum scores from baseline were observed from Week 3 and were maintained through to the end of treatment (Week 12); no differences between the dose groups were observed. Pressure thresholds and tissue compliance also increased during the study. Adverse events were generally as expected for BoNT-A; the majority were mild or moderate in severity.ConclusionsDysport® treatment was associated with reductions in myofascial back pain and was well tolerated. Nodose-response relationship was observed; treatment with Dysport® using a four-trigger-point injection protocol at 60 units per trigger point was associated with a clinically relevant and statistically significant improvement in pain and pain-related disability; there was no additional benefit from the higher doses.ImplicationsOur findings are limited by the lack of a control group and further research is warranted to confirm the value of Dysport® for the treatment of myofascial back pain and confirm the optimum dosing in this indication.

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