Clinical and Radiological Results of Treating Lumbar Spondylosis With Cortical Bone Trajectory Screws

Abstract Background: The cortical bone trajectory (CBT) technique is a popular minimally invasive spine surgery. Few studies have reported long-term outcomes. Here, we evaluated the complication profile and long-term follow-up of patients with lumbar degenerative disease treated with the CBT technique. Methods: This retrospective analysis included the first 40 consecutive patients that underwent the CBT technique. The indication for surgery was critical stenosis of the intervertebral foramen, which required removal of the entire intervertebral joint, on at least one side, during decompression. Results: The CBT technique was performed on one spine level, in 29 cases, and on two levels, in 11 cases. The last follow-up showed minimal clinically important differences in the numerical rating scale (NRS) of leg pain, the NRS of back pain, and the Oswestry Disability Index (ODI), in 97%, 95%, and 95% of patients, respectively. Thirty-nine patients completed long-term radiological follow-ups. Computed tomography demonstrated solid bone unions on 47 (92%) operated levels, collapsed unions on 2 (4%) levels, non-union on 1 (2%) level, and 1 (2%) lost to follow-up. Seven patients experienced complications (4 hardware-related). Three patients required four revision surgeries.Conclusions: The CBT technique effectively achieved spinal fusion; over 90% of patients achieved clinical improvement at a mean follow-up of 4.4 years (minimum 3 years in all cases).

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Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint

Hand ◽

10.1177/1558944719878841 ◽

2019 ◽

pp. 155894471987884

Author(s):

Charles A. Cefalu ◽

Philip E. Blazar ◽

Barry P. Simmons ◽

Brandon E. Earp

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Metacarpophalangeal Joint ◽

Persistent Symptoms ◽

Academic Center ◽

End Stage ◽

Implant Dislocation ◽

Thumb Metacarpophalangeal Joint

Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.

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Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00604-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Riccardo Compagnoni ◽

Alessandra Menon ◽

Simone Radaelli ◽

Francesco Lanzani ◽

Mauro B. Gallazzi ◽

...

Keyword(s):

Rotator Cuff ◽

Rating Scale ◽

Numerical Rating Scale ◽

Calcific Tendinitis ◽

Rotator Cuff Tears ◽

Radiological Evaluation ◽

Glenohumeral Osteoarthritis ◽

The Mean

Abstract Background Calcific tendinitis of the shoulder has a tendon involvement that could evolve to rotator cuff tear and shoulder osteoarthritis. This study aimed to evaluate the prevalence of glenohumeral osteoarthritis and rotator cuff tears in patients affected by calcific tendinitis at a minimum follow-up of 10 years after diagnosis. Methods Patients diagnosed with calcific tendinitis of the shoulder with a minimum follow-up of 10 years were contacted and invited for a clinical and radiological evaluation. Information on the demographics, affected and dominant side, bilateral shoulder pain, type of treatment, habits, systemic or musculoskeletal diseases, reoperation of the index shoulder, and subjective satisfaction was collected. The clinical evaluation was performed using Constant–Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), and numerical rating scale (NRS); isometric strength in forwarding flexion and abduction was also measured. Each patient also underwent an ultrasound examination to evaluate rotator cuff tendon integrity and a shoulder radiograph to evaluate osteoarthritis. Results Seventy-nine patients were available for a phone interview, and 35 agreed to be examined. The mean age was 58.89 (± 7.9) years at follow-up. The prevalence of glenohumeral osteoarthritis was 17.14% in the study population, with significant progression in 14.29% of the cases, without rotator cuff full-thickness tears. x-Ray examination showed residual calcifications in 31 patients, with a mean diameter of 5.54 mm. In 30 cases, there was a reduction of the diameter; in 4 cases, the calcification increased in size; and in 1 case, the size did not change. The mean ASES score was 74.1 (± 22.7) in the group with calcifications larger than 2 mm and 89.4 (± 8.2) in patients with smaller calcifications (p = 0.08) without correlation with the type of treatment performed. Conclusions Calcific tendinitis is a self-resolving disease without rotator cuff tears at long-term follow-up or degenerative glenohumeral progression. Level of Evidence: 3, cohort study.

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Addition of Fusion to Decompression for Grade I Degenerative Lumbar Spondylolisthesis is Associated With Greater Patient-Reported Outcome Improvements at Twenty-Four-Month Follow-Up: A Multicenter Study Using the Quality Outcomes Database

Neurosurgery ◽

10.1093/neuros/nyz310_112 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Jian Guan ◽

Erica F Bisson ◽

Mohamad Bydon ◽

Mohammed A Alvi ◽

Steven D Glassman ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Primary Outcome Measure ◽

Patient Reported Outcome ◽

Leg Pain ◽

Quality Outcomes ◽

Degenerative Lumbar Spondylolisthesis ◽

Patient Reported ◽

Lumbar Spondylolisthesis

Abstract INTRODUCTION Extensive investigation has not ascertained the ideal surgical management of grade 1 lumbar spondylolisthesis. Using the large, multicenter, prospectively collected Quality Outcomes Database (QOD), we compared 24-mo outcomes for patients undergoing decompression alone vs decompression and fusion. METHODS Patients undergoing single-level surgery from 7/1/2014 to 6/30/2016 were identified. The primary outcome measure, 24-mo Oswestry Disability Index (ODI) change, was analyzed with univariate and multivariable linear regression. EQ-5D scores, numerical rating scale (NRS) back and leg pain scores, and North American Spine Society patient satisfaction scores were also analyzed. RESULTS Of the 608 patients (85.5% with at least 24-mo follow-up) who met the inclusion criteria, 140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression and fusion. The 24-mo change in ODI was significantly greater in the fusion group than the decompression-only group (−25.8 ± 20.0 vs −15.2 ± 19.8, P < .001). Fusion remained independently associated with 24-mo ODI change in our multivariable model (B = −7.05, 95% CI 10.70-3.39, P = < .001). Patients in the fusion group were significantly more likely to reach minimal clinically important difference (MCID, 12.8 points) in ODI at 24 mo (73.3% vs 56.0%, P = < .001), and to experience significantly greater NRS back pain improvement at 24-mo follow-up (3.8 ± 3.1 vs −1.8 ± 3.9, P < .001). Fusion was also independently associated with achieving MCID for ODI at 24 mo in our logistic regression model (OR 1.767, 95% CI 1.058-2.944, P = .029). CONCLUSION The results of our study suggest that decompression plus fusion may offer superior outcomes to decompression alone in patients with grade 1 lumbar spondylolisthesis at 24 mo. Longer-term follow-up is warranted to assess whether this effect is sustained.

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Global coronal decompensation and adult spinal deformity surgery: comparison of upper-thoracic versus lower-thoracic proximal fixation for long fusions

Journal of Neurosurgery Spine ◽

10.3171/2021.2.spine201938 ◽

2021 ◽

pp. 1-13

Author(s):

Thomas J. Buell ◽

Christopher I. Shaffrey ◽

Han Jo Kim ◽

Eric O. Klineberg ◽

Virginie Lafage ◽

...

Keyword(s):

Thoracic Spine ◽

Spinal Deformity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Adult Spinal Deformity ◽

Leg Pain ◽

Sagittal Vertical Axis ◽

Upper Thoracic ◽

The Impact

OBJECTIVE Deterioration of global coronal alignment (GCA) may be associated with worse outcomes after adult spinal deformity (ASD) surgery. The impact of fusion length and upper instrumented vertebra (UIV) selection on patients with this complication is unclear. The authors’ objective was to compare outcomes between long sacropelvic fusion with upper-thoracic (UT) UIV and those with lower-thoracic (LT) UIV in patients with worsening GCA ≥ 1 cm. METHODS This was a retrospective analysis of a prospective multicenter database of consecutive ASD patients. Index operations involved instrumented fusion from sacropelvis to thoracic spine. Global coronal deterioration was defined as worsening GCA ≥ 1 cm from preoperation to 2-year follow-up. RESULTS Of 875 potentially eligible patients, 560 (64%) had complete 2-year follow-up data, of which 144 (25.7%) demonstrated worse GCA at 2-year postoperative follow-up (35.4% of UT patients vs 64.6% of LT patients). At baseline, UT patients were younger (61.6 ± 9.9 vs 64.5 ± 8.6 years, p = 0.008), a greater percentage of UT patients had osteoporosis (35.3% vs 16.1%, p = 0.009), and UT patients had worse scoliosis (51.9° ± 22.5° vs 32.5° ± 16.3°, p < 0.001). Index operations were comparable, except UT patients had longer fusions (16.4 ± 0.9 vs 9.7 ± 1.2 levels, p < 0.001) and operative duration (8.6 ± 3.2 vs 7.6 ± 3.0 hours, p = 0.023). At 2-year follow-up, global coronal deterioration averaged 2.7 ± 1.4 cm (1.9 to 4.6 cm, p < 0.001), scoliosis improved (39.3° ± 20.8° to 18.0° ± 14.8°, p < 0.001), and sagittal spinopelvic alignment improved significantly in all patients. UT patients maintained smaller positive C7 sagittal vertical axis (2.7 ± 5.7 vs 4.7 ± 5.7 cm, p = 0.014). Postoperative 2-year health-related quality of life (HRQL) significantly improved from baseline for all patients. HRQL comparisons demonstrated that UT patients had worse Scoliosis Research Society–22r (SRS-22r) Activity (3.2 ± 1.0 vs 3.6 ± 0.8, p = 0.040) and SRS-22r Satisfaction (3.9 ± 1.1 vs 4.3 ± 0.8, p = 0.021) scores. Also, fewer UT patients improved by ≥ 1 minimal clinically important difference in numerical rating scale scores for leg pain (41.3% vs 62.7%, p = 0.020). Comparable percentages of UT and LT patients had complications (208 total, including 53 reoperations, 77 major complications, and 78 minor complications), but the percentage of reoperated patients was higher among UT patients (35.3% vs 18.3%, p = 0.023). UT patients had higher reoperation rates of rod fracture (13.7% vs 2.2%, p = 0.006) and pseudarthrosis (7.8% vs 1.1%, p = 0.006) but not proximal junctional kyphosis (9.8% vs 8.6%, p = 0.810). CONCLUSIONS In ASD patients with worse 2-year GCA after long sacropelvic fusion, UT UIV was associated with worse 2-year HRQL compared with LT UIV. This may suggest that residual global coronal malalignment is clinically less tolerated in ASD patients with longer fusion to the proximal thoracic spine. These results may inform operative planning and improve patient counseling.

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A Randomized Clinical Trial Comparing the Effectiveness of Electroacupuncture versus Medium-Frequency Electrotherapy for Discogenic Sciatica

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2017/9502718 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Xue Zhang ◽

Yang Wang ◽

Zhao Wang ◽

Chao Wang ◽

Wentao Ding ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Rating Scale ◽

Leg Pain ◽

Secondary Outcome ◽

Low Back ◽

Medium Frequency

Objective. To investigate the short- and long-term effects of electroacupuncture (EA) compared with medium-frequency electrotherapy (MFE) on chronic discogenic sciatica.Methods. One hundred participants were randomized into two groups to receive EA (n=50) or MFE (n=50) for 4 weeks. A 28-week follow-up of the two groups was performed. The primary outcome measure was the average leg pain intensity. The secondary outcome measures were the low back pain intensity, Oswestry Disability Index (ODI), patient global impression (PGI), drug use frequency, and EA acceptance.Results. The mean changes in the average leg pain numerical rating scale (NRS) scores were 2.30 (1.86–2.57) and 1.06 (0.62–1.51) in the EA and MFE groups at week 4, respectively. The difference was significant (P<0.001). The long-term follow-up resulted in significant differences. The average leg pain NRS scores decreased by 2.12 (1.70–2.53) and 0.36 (−0.05–0.78) from baseline in the EA and MFE groups, respectively, at week 28. However, low back pain intensity and PGI did not differ significantly at week 4. No serious adverse events occurred.Conclusions. EA showed greater short-term and long-term benefits for chronic discogenic sciatica than MFE, and the effect of EA was superior to that of MFE. The study findings warrant verification. This trial was registered under identifierChiCTR-IPR-15006370.

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Open Lift, Drill, Fill and Fix (LDFF) for Talar OCDs: 2 to 4 Year Results in 16 Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00010 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0001

Author(s):

Nienke Altink ◽

Kaj Lambers ◽

Jari Dahmen ◽

Gino Kerkhoffs

Keyword(s):

Rating Scale ◽

Bone Ingrowth ◽

Weight Bearing ◽

Numeric Rating Scale ◽

Long Term Follow Up ◽

One Year ◽

Pain At Rest ◽

Clinical And Radiological Results

Category: Ankle Introduction/Purpose: The purpose of this study was to describe the mid to long-term clinical and radiological outcomes of an open fixation technique for large primary talar osteochondral defects (OCD): Lift, Drill, Fill and Fix (LDFF). Methods: Nineteen patients underwent an open LDFF surgery. Mean follow-up was 35 months (SD 3.6). Pre-and postoperative clinical assessment included the Foot and Ankle Outcome Score (FAOS) and a numeric rating scale (NRS) on pain at rest and during weight-bearing. Remodeling and bone ingrowth were analyzed on CT at one year post-operatively. Results: 15 out of 19 patients showed remodeling and bone ingrowth after the open LDFF procedure. Patients who did not show remodeling and bone ingrowth were treated by means of an OATS procedure. In the remaining 15 patients available at mid to long-term follow-up, LDFF led to a significant improvement of all FAOS subscales; FAOS-pain improved from 65 to 74 (p=0.014), FAOS-symptoms improved from 60 to 80 (p=0.005), FAOS-ADL improved from 80 to 85 (p=001), FAOS-sport improved from 38 to 61 (p=0.017) and FAOS-QoL improved from 38 to 64 (p=0.025). The NRS of pain at rest significantly improved from 3.2 to 1.2 (p=0.009), and pain during walking significantly improved from 6.5 to 1.6 (p<0.001). No complications occurred. Conclusion: Open LDFF of a talar OCDs show promising mid to long-term clinical and radiological results. A longer follow-up period with more study power is a subsequent necessary step in order to draw firmer conclusions about the longevity of this present procedure.

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Taste and Smell Functions in Long-term Survivors after Childhood Medulloblastoma/CNS-PNET

10.21203/rs.3.rs-1160507/v1 ◽

2022 ◽

Author(s):

Kristine Eidal Tanem ◽

Einar Stensvold ◽

Petter Wilberg ◽

Anne B. Skaare ◽

Preet Bano Singh ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Subjective Ratings ◽

Significant Difference ◽

Childhood Medulloblastoma ◽

Long Term Survivors ◽

Taste And Smell ◽

Tdi Score

Abstract Purpose Our aim was to investigate taste and smell functions in survivors, with a minimum of 2 years follow-up time, after treatment of childhood medulloblastoma/CNS-PNET. Methods This cross-sectional study included 40 survivors treated ≤ 20 years of age. Taste strips with four concentrations of sweet, sour, salt, and bitter were used to assess taste function in all participants. Score from 0-16; ≥ 9 normogeusia, < 9 hypogeusia, and complete ageusia which equals no sensation. No sensation of a specific taste quality equals ageusia of that quality. Thirty-two participants conducted smell testing using three subtests of Sniffin’ sticks; threshold, discrimination, and identification. Together they yield a TDI-score from 1-48; functional anosmia ≤ 16.00, hyposmia >16.00 - < 30.75, normosmia ≥ 30.75 - < 41.50, and ≥ 41.50 super smeller. Results were compared with normative data. Survivors subjectively rated their taste and smell functions using a numerical rating scale (NRS) score 0-10. Results Forty survivors with a mean follow-up of 20.5 years, 13 (32.5 %) were diagnosed with hypogeusia, nine (22.5 %) of these being ageusic of one or more taste qualities. Seventeen (53 %) of 32 participants were diagnosed with hyposmia. Comparing survivors with hyposmia to those with normosmia, a significant difference (p<0.05) was found in TDI-score and in all the subtests. The mean NRS score of subjective ratings of functions were high.Conclusion Our study showed impaired taste and smell functions in long-term survivors of childhood MB/CNS-PNET using objective measurements. However, subjective ratings did not reflect objective findings.

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Robot assisted midline lumbar fusion with cortical bone trajectory screw

10.29007/8t2w ◽

2018 ◽

Author(s):

Da He ◽

Qiang Yuan ◽

Lin Hu ◽

Wei Tian

Keyword(s):

Back Pain ◽

Retrospective Study ◽

Cortical Bone ◽

Navigation System ◽

Lumbar Fusion ◽

Leg Pain ◽

Robot System ◽

Cortical Bone Trajectory ◽

Navigation Group

Objective: Midline lumbar fusion with cortical bone trajectory(CBT) screw is a novel technique operation, robot system is the new developed system which can help CBT insertion. In this retrospective study, we compare the CBT accuracy by the assistance of navigation system and robot system. Clinical result is also compared.Result: 55 patients were involved in this retrospective study, 29 patients are assisted by navigation system, 26 patients are by robot system. Mean follow-up is over 12 months. The mean VAS is significant improved at the final follow up for navigation group from 6.2±1.5 to 3.2±1.1(back pain), 7.5±0.9 to1.8±0.7(leg pain), same as the robot system from 6.8±1.5 to 2.9±0.8(back pain), 7.7±1.0 to 1.6±0.8 (leg pain). The JOA score pre-operation is 14.7±4.5 and 14.5±4.1 for navigation and robot system, at the final follow up, it is 24.3±4.2 and 23.9±4.4. the number of penetration cortex has no difference between 2 groups(n=0.363).Conclusion: MIDLF with CBT screw is effective for the treatment of lumbar degenerative disease. Using navigation and robot system will help the insertion of CBT screw safety and accurate, robot can release the surgeon from part of aiming work.

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Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113089 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Amnon A. Berger ◽

Ivan Urits ◽

Jamal Hasoon ◽

Jatinder Gill ◽

Musa Aner ◽

...

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Pain Control ◽

Rating Scale ◽

Pulse Generator ◽

Numerical Rating Scale ◽

Failed Back Surgery

Background: Chronic back and neck pain affects 20% of Americans. Spinal cord stimulation (SCS) is an effective therapy for otherwise refractory chronic pain. Traditional SCS relies on low-frequency stimulus in the 40 - 60 Hz range causing robust paresthesia in regions overlapping with painful dermatomes. Objectives: This study aims to determine the effect of superimposing sub-perception stimulation in patients who previously had good long-term relief with paresthesia. Methods: This is a prospective observational trial examining patients who had previously been implanted with paresthesia based SCS for failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). These patients presented for implantable pulse generator (IPG) replacement based on battery depletion with an IPG capable of combined sub-perception and paresthesia based SCS therapy. Patients were assessed immediately following the exchange and four weeks later using a telephone survey. Their pain was assessed on each follow up using a Numerical Rating scale (NRS); the primary outcome was the change in NRS after four weeks from the exchange day. Secondary outcomes included paresthesia changes, which included the subjective quality of sensation generated, the overall subjective coverage of the painful region, subjective variation of coverage with positional changes, and global perception of the percentage improvement in pain. Results: Based on our clinic registry, 30 patients were eligible for IPG exchange, 16 were consented for follow up and underwent an exchange, and 15 were available for follow up four weeks following. The average NRS decreased from 7.47 with traditional SCS to 4.5 with combination therapy. 80% of patients reported an improvement in the quality of paresthesia over traditional SCS therapy, and in most patients, this translated to significantly improved pain control. Conclusions: Our findings suggest improved pain relief in patients who had previously had good results with paresthesia based therapy and subsequently underwent IPG exchange to a device capable of delivering combined sub-perception stimulation. The mechanism of action is unclear though there may be an additive and/or synergistic effect of the two waveforms delivered. Larger studies with long-term follow-up are needed to elucidate the durability of pain relief and the precise mechanism by which combined subperception and paresthesia based SCS may improve overall patient outcomes.

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Long-Term Follow-Up of Spinal Stenosis Inpatients Treated with Integrative Korean Medicine Treatment

Journal of Clinical Medicine ◽

10.3390/jcm10010074 ◽

2020 ◽

Vol 10 (1) ◽

pp. 74

Author(s):

Doori Kim ◽

Joon-Shik Shin ◽

Young-Joo Moon ◽

Gwanghyun Ryu ◽

Wonbin Shin ◽

...

Keyword(s):

Spinal Stenosis ◽

Functional Disability ◽

Rating Scale ◽

Numeric Rating Scale ◽

Leg Pain ◽

Korean Medicine ◽

Long Term Follow Up ◽

Lumbar Spinal

The present prospective observational study aimed to analyze the outcomes of inpatients who received integrative Korean medicine treatment in order to provide evidence on its effects on lumbar spinal stenosis (LSS). Patients with LSS who received inpatient treatment at four Korean medicine hospitals from January 2015 to December 2018 were followed up. Outcomes measured included the numeric rating scale (NRS) scores for back and leg pain, and Oswestry Disability Index (ODI). Changes in outcomes at admission, discharge, and follow-up, as well as associated predictors that could account for the improvement in outcomes were analyzed. The NRS score for back pain, NRS score for leg pain, and ODI decreased by 2.20 points (95% confidence interval (CI), −2.41 to −1.99), 2.28 points (95% CI, −2.59 to −1.96), and 17.31 points (95% CI, −19.6 to −15.02), respectively, at long-term follow-up compared with at admission. Patients with LSS who received inpatient integrative Korean medicine treatment exhibited an improvement in pain and functional disability. Further studies are required to determine the effects of integrative Korean medicine treatment.

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