A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months

Background: Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP. Purpose: To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. Study Design: Case series; Level of evidence, 4. Methods: Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome. Results: After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction ( P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale. Conclusion: A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately. Registration: NCT03067545 (ClinicalTrials.gov identifier)

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Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

10.21203/rs.3.rs-273357/v1 ◽

2021 ◽

Author(s):

Hao Cheng ◽

Guo-dong Wang ◽

Tao Li ◽

Xiao-yang Liu ◽

Jian-min Sun

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Sagittal Balance ◽

Rating Scale ◽

Clinical Results ◽

Spinal Alignment ◽

Thoracolumbar Kyphosis ◽

Kummell’S Disease ◽

Kümmell’S Disease

Abstract Background: To evaluate the short to mid-term radiographic and clinical outcomes of the restoration of normal spinal alignment and sagittal balance in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods: Between February 2016 and May 2018,30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into two groups (A and B) according to whether the kyphosis was combined with neurological deficits.All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance.And the radiographic outcomes and clinical results of these 30 patients were retrospectively evaluated.The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS)of the whole spine before operation,immediately after operation,and the last follow-up of each group were measured and evaluated.The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups .Results: The average follow-up period of group A and B were 34.2 and 38.7 months respectively.The parameters of both groups such as SVA,TLK,and thoracolumbar Cobb angle after surgery and at the last follow-up were significantly improved compared with those before surgery.The ODI and the NRS of the two groups at the last follow-up were also significantly improved. Conclusion: In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

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Effects of gait retraining with focus on impact versus gait retraining with focus on cadence on pain, function and lower limb kinematics in runners with patellofemoral pain: Protocol of a randomized, blinded, parallel group trial with 6-month follow-up

PLoS ONE ◽

10.1371/journal.pone.0250965 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0250965

Author(s):

José Roberto de Souza Júnior ◽

Pedro Henrique Reis Rabelo ◽

Thiago Vilela Lemos ◽

Jean-Francois Esculier ◽

João Pedro da Silva Carto ◽

...

Keyword(s):

Lower Limb ◽

Intervention Group ◽

Patellofemoral Pain ◽

Control Group ◽

Gait Retraining ◽

Positive Effects ◽

Clinical Applicability ◽

Limb Kinematics ◽

Lower Limb Kinematics

Patellofemoral pain (PFP) is one of the most prevalent injuries in runners. Unfortunately, a substantial part of injured athletes do not recover fully from PFP in the long-term. Although previous studies have shown positive effects of gait retraining in this condition, retraining protocols often lack clinical applicability because they are time-consuming, costly for patients and require a treadmill. The primary objective of this study will be to compare the effects of two different two-week partially supervised gait retraining programs, with a control intervention; on pain, function and lower limb kinematics of runners with PFP. It will be a single-blind randomized clinical trial with six-month follow-up. The study will be composed of three groups: a group focusing on impact (group A), a group focusing on cadence (group B), and a control group that will not perform any intervention (group C). The primary outcome measure will be pain assessed using the Visual Analog Pain scale during running. Secondary outcomes will include pain during daily activities (usual), symptoms assessed using the Patellofemoral Disorders Scale and lower limb running kinematics in the frontal (contralateral pelvic drop; hip adduction) and sagittal planes (foot inclination; tibia inclination; ankle dorsiflexion; knee flexion) assessed using the MyoResearch 3.14—MyoVideo (Noraxon U.S.A. Inc.). The study outcomes will be evaluated before (t0), immediately after (t2), and six months (t24) after starting the protocol. Our hypothesis is that both partially supervised gait retraining programs will be more effective in reducing pain, improving symptoms, and modifying lower limb kinematics during running compared with the control group, and that the positive effects from these programs will persist for six months. Also, we believe that one gait retraining group will not be superior to the other. Results from this study will help improve care in runners with PFP, while maximizing clinical applicability as well as time and cost-effectiveness.

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Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial

Acupuncture in Medicine ◽

10.1177/0964528420912253 ◽

2020 ◽

Vol 38 (6) ◽

pp. 371-379

Author(s):

Shabnam Behrangrad ◽

Maryam Abbaszadeh-Amirdehi ◽

Amin Kordi Yoosefinejad ◽

Seyed Mokhtar Esmaeilnejadganji

Keyword(s):

Functional Status ◽

Mechanical Stimulation ◽

Rating Scale ◽

Pressure Pain Threshold ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Dry Needling ◽

Myofascial Trigger Points

Background: To compare the effectiveness of ischaemic compression (IC) applied directly to the knee versus dry needling (DN) with respect to pain, functional status and sensitivity to mechanical stimulation of vastus medialis obliquus (VMO) myofascial trigger points (MTrPs) in patients with patellofemoral pain syndrome (PFPS). Methods: A total of 54 patients with unilateral PFPS aged 20–30 years were selected randomly from patients referred to physical therapy clinics of Babol University of Medical Sciences in Iran. Twenty-seven patients were allocated to either IC or DN groups. Three sessions of treatment were applied over 1 week with follow-up at 1 week, 1 month and 3 months. Primary outcome measures comprised the Kujala questionnaire score for functional status, numerical pain rating scale (NPRS) for pain intensity and pressure pain threshold (PPT) for sensitivity to mechanical stimulation; these were measured and recorded before treatment and 1 week, 1 month and 3 months after the last treatment session. Results: There were no statistically significant differences in the between-group comparisons of any variables at the various follow-up points. Both groups (n = 27 participants each) had significant improvements (p < 0.05) in pain, functional status and PPT values at follow-up. Conclusions: There were no differences in markers of pain, function or pressure sensitivity over a 3-month follow-up period between patients with PFPS treated with DN and IC. Temporal improvements in both groups suggested that the two techniques may be similarly effective for the treatment of PFPS.

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Botulinum toxin injections as salvage therapy is beneficial for management of patellofemoral pain syndrome

Knee Surgery and Related Research ◽

10.1186/s43019-021-00121-3 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Yuval Kesary ◽

Vivek Singh ◽

Tal Frenkel-Rutenberg ◽

Arie Greenberg ◽

Shmuel Dekel ◽

...

Keyword(s):

Botulinum Toxin ◽

Physical Therapy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Post Treatment ◽

Functional Scores

Abstract Purpose Patellofemoral pain syndrome (PFPS) is a common pathology usually presenting with anterior or retropatellar pain. It is associated with a relative imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles. This can lead to considerable morbidity and reduced quality of life (QOL). This study aims to assess the long-term functional outcome of PFPS treated with VL muscle botulinum toxin A (BoNT-A) injection. Materials and methods A retrospective review was performed on 26 consecutive patients (31 knees) with a mean age of 50.1 years (± 19.7 years) who were treated with BoNT-A injections to the VL muscle followed by physiotherapy between 2008 and 2015. Pre- and post-treatment pain levels (numerical rating scale, NRS), QOL (SF-6D), and functional scores (Kujala and Lysholm questionnaires) were measured. Demographics, physical therapy compliance, previous surgeries, perioperative complications, and patient satisfaction levels were collected. Results The mean follow-up time was 58.8 ± 36.4 months. There were significant improvements in all the examined domains. The average pain score (NRS) decreased from 7.6 to 3.2 (P < 0.01), and the Kujala, Lysholm, and SF-6D scores improved from 58.9 to 82.7 (P < 0.001), 56.2 to 83.2 (P < 0.001), and 0.6 to 0.8 (P < 0.001), respectively. Similar delta improvement was achieved irrespective of gender, age, compliance to post-treatment physical therapy, or coexisting osteoarthritis. Patients who presented with a worse pre-treatment clinical status achieved greater improvement. Prior to BoNT-A intervention, 16 patients (18 knees) were scheduled for surgery, of whom 12 (75%, 13 knees) did not require further surgical intervention at the last follow-up. Conclusions A single intervention of BoNT-A injections to the VL muscle combined with physiotherapy is beneficial for the treatment of patients with persistent PFPS. Level III evidence Retrospective cohort study.

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A sequential cognitive and physical approach (SCOPA) for patellofemoral pain: a randomized controlled trial in adolescent patients

Clinical Rehabilitation ◽

10.1177/0269215518787002 ◽

2018 ◽

Vol 32 (12) ◽

pp. 1624-1635 ◽

Cited By ~ 1

Author(s):

Mitchell Selhorst ◽

William Rice ◽

Michael Jackowski ◽

Todd Degenhart ◽

Shaun Coffman

Keyword(s):

Rating Scale ◽

Treatment Algorithm ◽

Patellofemoral Pain ◽

Mean Difference ◽

Controlled Study ◽

Global Rating ◽

Physical Impairments ◽

Physical Approach ◽

Clinically Significant

Objective: To compare a sequential treatment algorithm considering psychosocial and physical impairments, with a conventional rehabilitation approach considering only physical impairments in adolescents with patellofemoral pain. Design: A randomized, single-blind, controlled study. Participants: Fifty-five adolescents (36 females; mean age 14.3 ± 1.8 years). Interventions: The sequential cognitive and physical approach (SCOPA) group ( n = 28) was treated based on sequential testing and treatment of activity-related fear, flexibility, kinematics, and strength. The comparator group ( n = 27) was treated with a non-sequential physical impairment–based approach. Both groups received treatment two times a week for up to six weeks. Measurements: Function (Anterior Knee Pain Scale), pain (Numeric Pain Rating Scale), and Global Rating of Change were assessed at baseline, three weeks, and six weeks, with a six-month follow-up. Results: Both groups had similar function (73.7 ± 9.6) and pain (6.0 ± 2.3) at baseline. A third of individuals with patellofemoral pain demonstrated elevated activity-related fear at baseline. Patients randomized to the SCOPA group had clinically significant greater improvements at six weeks in function (SCOPA, 95.0 ± 7.4 and comparator, 84.8 ± 10.4; mean difference: 10.2, 95% CI: 5.3, 15.1) and pain (SCOPA, 0.9 ± 1.9 and comparator, 2.7 ± 2.1; mean difference: 1.7, 95% CI: 0.5, 2.9). No differences were noted in Global Rating of Change. No between-group differences were noted in any outcome at six-month follow-up. Conclusion: The sequential cognitive and physical approach resulted in greater improvements in short-term function and pain. By six months, both groups demonstrated similar clinically significant improvements in all outcomes.

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Therapeutic Effects and Safety of Percutaneous Disc Decompression with Coblation Nucleoplasty in Cervical Vertigo: A Retrospective Outcome Study with 74 Consecutive Patients and Minimum 1-Year Follow-Up

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e205 ◽

2019 ◽

Vol 3 (22;3) ◽

pp. E205-E214

Author(s):

Limin Rong

Keyword(s):

Retrospective Study ◽

Neck Pain ◽

Pain Intensity ◽

Clinical Outcomes ◽

Clinical Efficacy ◽

Rating Scale ◽

Therapeutic Effects ◽

Dizziness Handicap Inventory ◽

Cervical Vertigo

Background: Surgical treatment of cervical vertigo has been rarely reported. This is the first retrospective study to evaluate the clinical outcomes of percutaneous disc decompression with coblation nucleoplasty (PDCN) for treatment of cervical vertigo. Objectives: To assess the clinical outcomes of patients with cervical vertigo who failed to improve with conservative care and who were subsequently treated with PDCN. Study Design: This study used a retrospective design. Setting: The research was conducted within an interventional vertigo management and spine practice. Methods: Seventy-four consecutive patients with cervical vertigo underwent PDCN and were followed for at least one year. Outcome measures included the dizziness intensity Visual Analog Scale (VAS), dizziness frequency, the Dizziness Handicap Inventory (DHI), and neck pain intensity. Clinical efficacy was assessed by rating scale and the modified MacNab evaluation criteria. Surgical complications during the operation and follow-up were also recorded. Results: The vertigo VAS score, frequency of dizziness, DHI, and neck pain intensity were all decreased significantly from evaluation before surgery to one week after surgery and to the last follow-up, giving a mean effective rate of 94.6% one week after surgery and 90.6% at the last follow-up. Good to excellent results were attained in 85.1% of these patients one week after PDCN and in 75.7% of the sufferers at the last follow-up (P < 0.001). There were 5 patients with transient adverse effects (6.25%) reported within the first month after surgery; they all recovered after conservative treatment. No neurological complications were found and no patient went on to spinal fusion surgery thereafter. Limitations: The rate of follow-up was 70% and a placebo effect cannot be excluded. There is no gold standard for the diagnosis and treatment of cervical vertigo so far. Conclusion: The clinical outcomes of PDCN for cervical vertigo were satisfactory in both the early and late postoperative period. PDCN is an effective, low-complication, minimally invasive procedure used to treat cervical vertigo. Further prospective randomized controlled trials are essential to verify this conclusion. Key words: Cervical vertigo, percutaneous disc decompression, coblation nucleoplasty, longterm outcome, dizziness intensity, dizziness frequency, dizziness handicap inventory, clinical efficacy, surgical complication, retrospective study

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Radiographic and clinical outcomes of surgical treatment of Kümmell’s disease with thoracolumbar kyphosis: a minimal two-year follow-up

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04640-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hao Cheng ◽

Guo-dong Wang ◽

Tao Li ◽

Xiao-yang Liu ◽

Jian-min Sun

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Sagittal Balance ◽

Rating Scale ◽

Thoracolumbar Kyphosis ◽

Postoperative Evaluation ◽

Kummell’S Disease ◽

Group A ◽

Kümmell’S Disease

Abstract Background Up to now in the surgical treatment of Kümmell’s disease combined with thoracolumbar kyphosis, little research has focused on the evaluation of the imaging and clinical outcomes of restoring the normal alignment and sagittal balance of the spine. This study aimed to evaluate the short to mid-term radiographic and clinical outcomes in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods From February 2016 to May 2018, 30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into group A and B according to whether the kyphosis was combined with neurological deficits. All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance. The radiographic outcomes and clinical outcomes of the cases were retrospectively evaluated. The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS) before operation,immediately after operation,and the last follow-up of each case were measured and evaluated. The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups. Statistical software SPSS21.0 was used to analyze the data. Results In group A: Mean SVA before operation was 75 mm and 26.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 39°, and 7.1° at the final postoperative evaluation (P = 0.000); Mean NRS before operation was 4.7, compared with 0.9 at the final postoperative evaluation (P = 0.000). In group B: Mean preoperative SVA was 62.5 mm and decreases to 30.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 33°, and 9.7° 2 years post-operation (P = 0.000); Mean NRS prior to surgery was 4.0, and 0.8 at the last follow-up evaluation (P = 0.000). The improvement of the NRS scores of groups A and B was related to the improvement of the cobb angle (P = 0.020); (P = 0.009) respectively. Conclusion In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

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Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke

Acupuncture in Medicine ◽

10.1177/0964528419882941 ◽

2020 ◽

Vol 38 (3) ◽

pp. 150-157 ◽

Cited By ~ 3

Author(s):

Ana Mendigutía-Gómez ◽

María T Quintana-García ◽

Miriam Martín-Sevilla ◽

Diego de Lorenzo-Barrientos ◽

Jorge Rodríguez-Jiménez ◽

...

Keyword(s):

Shoulder Pain ◽

Rating Scale ◽

Trigger Point ◽

Rehabilitation Program ◽

Single Session ◽

Dry Needling ◽

The Central Nervous System ◽

Post Hoc ◽

To Receive ◽

Pain Rating Scale

Objectives: To determine the presence of post-needling induced pain in subjects who had suffered a stroke and received trigger point (TrP) dry needling (DN), and to investigate the effects of including TrP-DN into a rehabilitation program for shoulder pain in this population. Methods: A randomized clinical trial was conducted. Sixteen patients who had suffered a stroke and presented with shoulder pain were randomly assigned to receive rehabilitation alone or rehabilitation combined with DN. Both groups received a neurorehabilitation session including modulatory interventions targeting the central nervous system. Patients in the DN group also received a single session of DN over active TrPs in the shoulder musculature. A numerical pain rating scale (NPRS, 0–10) was used to asses post-needling induced pain at 1 min, 24 h, and 72 h after needling. Shoulder pain (NPRS, 0–10) was assessed at baseline, and 3 and 7 days after DN in both groups. Results: Five (62%) patients receiving TrP-DN reported post-needling induced pain. Post hoc analysis found that post-needling induced pain decreased significantly at 24 and 72 h (both p < 0.001) after DN. Patients receiving TrP-DN plus rehabilitation exhibited greater decreases in shoulder pain intensity at 3 days (Δ = −4.2, 95% confidence interval (CI) = −5.8 to −2.6) and 7 days (Δ = −4.3, 95% CI = −5.9 to −2.7) after the intervention compared with those receiving rehabilitation alone (all p < 0.001). Conclusion: This trial found that 50% of stroke patients receiving DN experienced post-needling induced pain, a side effect that almost disappeared 72 h after the intervention without any additional therapeutic action. In addition, the inclusion of TrP-DN into a rehabilitation session was effective at decreasing shoulder pain in these patients.

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Subthalamic Nucleus Stimulation in Pediatric Isolated Dystonia: A 10-Year Follow-up

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.32 ◽

2020 ◽

Vol 47 (3) ◽

pp. 328-335

Author(s):

Wenying Xu ◽

Hongxia Li ◽

Chencheng Zhang ◽

Bomin Sun ◽

Yiwen Wu ◽

...

Keyword(s):

Clinical Outcomes ◽

Subthalamic Nucleus ◽

Rating Scale ◽

Motor Score ◽

Age At Surgery ◽

Short And Long Term ◽

The Mean ◽

Stn Dbs

ABSTRACT:Objective:To evaluate the short-term and long-term clinical effectiveness and safety of subthalamic nucleus deep brain stimulation (STN-DBS) for medically intractable pediatric isolated dystonia.Methods:Using a longitudinal retrospective design, we assessed the clinical outcomes of nine patients who underwent STN-DBS for treatment-refractory pediatric isolated dystonia one decade ago (mean age at surgery: 15.9 ± 4.5 years). The primary clinical outcome used was assessed by retrospective video analyses of patients’ dystonia symptoms using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Clinical assessments were performed at baseline, 1-year follow-up (1-yr FU), and 10-year follow-up (10-yr FU). Adverse side effects, including surgery-related, device-related, and stimulation-related effects, were also documented.Results:After STN-DBS surgery, the mean improvement in the BFMDRS motor score was 77.1 ± 26.6% at 1-yr FU and 90.4 ± 10.4% at 10-yr FU. Similarly, the mean BFMDRS disability score was improved by 69.5 ± 13.6% at 1-yr FU and by 86.5 ± 13.9% at 10-yr FU. The clinical improvements gained at 10-yr FU were significantly larger than those observed at 1-yr FU. Negative correlations were found between the duration of disease to age at surgery ratio (DD/AS) and the improvements in the BFMDRS motor score and total score at 1-yr FU and 10-yr FU.Conclusion:To our knowledge, this study provides the first clinical evidence for the short- and long-term effectiveness and safety of STN-DBS for pediatric isolated dystonia. Additionally, putative evidence is provided that earlier STN-DBS intervention in patients with refractory pediatric isolated dystonia may improve short- and long-term clinical outcomes.

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Lumbar Disc Herniation in Heavy Manual Workers: Conventional Microdiscectomy versus (MIS) TLIF with Unilateral Fixation

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9791 ◽

2021 ◽

pp. 32

Author(s):

Mohamed Alqazaz

Keyword(s):

Back Pain ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Rating Scale ◽

Lumbar Disc ◽

Disc Prolapse ◽

Outcome Score

Introduction: Conventional discectomy is a common surgical method for treating lumbar disc prolapse. The situation may differ in heavy manual workers who may have more pronounced degenerative spine disease, broad-based disc herniations, and are expected to be exposed postoperatively to the same preoperative manual stress. This study was aimed at comparing the clinical outcomes in patients operated for conventional discectomy versus those operated for TLIF with unilateral spinal fixation. Methodology: Sixty patients underwent surgeries for lumbar disc herniation. They were divided into two groups; the microscopic conventional discectomy group and the fusion (TLIF and unilateral TPF) group. They were operated between 2017 and 2019. Participants were evaluated pre- and postoperatively at 3, 6, 9, and 12 months’ intervals. Pain was scored by Visual Analogue Scale (VAS) for both lower limb and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale and a new outcome score. Result: The two groups of patients were fairly homogeneous and comparable. Workload exposure to repetitive vibration was the biggest risk for disc prolapse and surgery (28.3%). Fusion group showed better clinical outcomes parameter including better VAS for back pain, better Prolo economic and functional rating scale, and better new clinical outcome score. In comparison, the discectomy group showed significantly higher recurrence rate and reoperation during the follow-up period. During the 12 months’ follow-up visit, when the patients were asked if, under the same circumstances, they would undergo the procedure again, 71.6% of the patients (43 patients) answered affirmatively and this reflects their satisfaction with the results of their surgeries. This satisfaction was reported in 27 patients (90%) in the fusion group and 16 patients (53.4%) in the discectomy group. Conclusion: Heavy manual workers treated with unilateral transforaminal interbody fusion reported less pain and lower disability scores all over the follow-up period. This technique is preferable to conventional discectomy because it reduces back and leg pain while avoiding the possibility of recurrence by heavy duties and maintains stability of the lumbar spine. We proposed a new clinical outcome score to monitor the clinical outcomes of spine surgery in heavy manual workers. It relates the outcomes to the hours of work, sick leaves, and patient satisfaction with surgery. In our group of patients, it showed significant improvement in the fusion group in comparison to the discectomy group.

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