A Prospective Study on the Role of Neurophysiological Studies in Predicting Functional Outcome After Lumbar Discectomy

Background and Aim: Lumbar intervertebral discs are complex anatomical structures essential for the mobility of intervertebral joints. There is general consensus for some indications for surgery, including acute or progressive neurological deficit(s), cauda equine syndrome, or refractory pain unresponsive to conservative treatments. However, controversy exists regarding the optimal management of cases with the disparity between radiological and clinical findings, which includes a great proportion of patients. This study examines whether neurophysiological studies can be used to identify subgroups with improved post-operative outcomes. Methods and Materials/Patients: This prospective cohort study was conducted on 60 patients with clinical and imaging evidence in favor of Lumbar Disc Herniation (LDH). The pre-operative radiological assessment was the lateral X-rays in flexion and extension positions, and lumbar spine Magnetic Resonance Imaging (MRI). Pre-operative clinical assessment was done by the Oswestry Low Back Pain Disability Questionnaire and Visual Analog Scale (VAS). Neurophysiological studies were done at least one month after the onset of radiculopathy. Surgery was performed at the level suggested by neuroimaging. In all patients, we found an abnormal disc, which was removed along with any loose disc material. The patients were followed up for 1 year with intervals of 3 months for post-operative assessments. Results: In the two study arms with abnormal or normal pre-operative electrodiagnostic studies, a significant decrease was observed in the percentages of visual analog scale reduction (73.69% and 95.59%, respectively) and Oswestry disability score (65.3% and 76.2%, respectively) at the month 12 post-operative (P=0.993 to 0.002 and P=0.200 to 0.037, respectively). Conclusion: Neurophysiological studies could be regarded as helpful adjuncts to distinguish a subgroup of patients with LDH, who may experience a favorable outcome after surgical intervention.

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STANDARD OPEN MICRODISCECTOMY VERSUS MINIMAL ACCESS TROCAR MICRODISCECTOMY

Neurosurgery ◽

10.1227/01.neu.0000311075.56486.c5 ◽

2008 ◽

Vol 62 (1) ◽

pp. 174-182 ◽

Cited By ~ 71

Author(s):

Yu-Mi Ryang ◽

Markus F. Oertel ◽

Lothar Mayfrank ◽

Joachim M. Gilsbach ◽

Veit Rohde

Keyword(s):

Blood Loss ◽

Visual Analog Scale ◽

Oswestry Disability Index ◽

Operative Time ◽

Short Form ◽

Lumbar Disc ◽

Complication Rates ◽

Minimal Access ◽

Analog Scale ◽

Short Form 36

Abstract OBJECTIVE Minimal access surgery as a less invasive alternative to standard macro- and microsurgical approaches is becoming increasingly popular in the management of traumatic and degenerative spine diseases. However, data is lacking if minimal access spine surgery is indeed beneficial. This prospective randomized study was conducted to compare efficiency, safety, and outcome of standard open microsurgical discectomy (SOMD) for lumbar disc herniation with microsurgical discectomy using an 11.5 mm trocar system for minimal access to the spine. METHODS Sixty patients were randomized to two groups of 30 patients each. Group 1 was treated by SOMD, and Group 2 was treated by minimal access microsurgical discectomy (MAMD). Perioperative parameters and pre- and postoperative clinical findings including sensory or motor deficits and pain according to the visual analog scale, Oswestry Disability Index scores, and Short Form-36 results were assessed. All patients were followed for at least 6 months postoperatively (mean, 16 mo). RESULTS Preoperatively, no statistically significant intergroup differences could be detected proving the comparability of both groups. Postoperatively, significant improvement of neurological symptoms and pain as measured by the visual analog scale, Oswestry Disability Index, and Short Form-36 scores could be achieved in both groups. In regard to operative time, intraoperative blood loss, and complication rate, slightly better results were observed in the MAMD group. CONCLUSION SOMD and MAMD allow achievement of significant improvement of pain and neurological deficits in patients with lumbar disc herniations. Differences in operative time, blood loss, and complication rates were statistically not significant in MAMD compared with SOMD, indicating that, at least in lumbar disc surgery, minimal access trocar techniques are a viable alternative to standard spinal approaches.

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Clinical Study of Hydraulic Perfusion Pump and Traditional Water Jet Irrigation for Percutaneous Endoscopic Lumbar Discectomy

10.21203/rs.3.rs-141483/v1 ◽

2021 ◽

Author(s):

Jian wu ◽

Yuehong Guan

Keyword(s):

Visual Analog Scale ◽

Lumbar Disc ◽

Operation Time ◽

Postoperative Recurrence ◽

Water Jet ◽

Analog Scale ◽

Perfusion Pump ◽

Pain Visual Analog Scale ◽

Endoscopic Lumbar Discectomy

Abstract Objective: To compare clinical outcomes of hydraulic perfusion pump and traditional water jet irrigation in percutaneous endoscopic lumbar discectomy by a prospective randomized controlled study. Methods: From January 2016 to December 2018, 72 patients with lumbar disc herniation and failed conservative treatment were enrolled in this study. According to the odd number of the last digit of the hospitalization number, the patients were randomly divided into a hydraulic perfusion pump group and a traditional water jet irrigation group, 36 cases in each group. There were no significant differences in gender, age, prominent segment, clinical classification, preoperative pain visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores between two groups (P>0.05). The same surgeon performed all operations. These operations were performed by hydraulic perfusion pump flushing and traditional water flushing assisted surgery. The patients were followed up for 12 to 24 months (mean 15.7 months). The operation time, blood loss, hospital time, visual analog scale (VAS) for follow-up pain after one day and two weeks, and the last follow-up JOA scores. The type and incidence of postoperative complications were compared between two groups.Results: Compared with the traditional water flushing group, the operation time of the hydraulic perfusion pump group was short [(65.5±21.3) min vs. (74.8±19.9) min, t=9.465, P=0.003]. Blood loss was less [(21.2±12.9) ml vs. (27.4±14.1) ml, t=8.331, P=0.012]; there was no statistical difference in hospitalization time. The pain visual analog scale (VAS) and the last follow-up JOA scores in one day, two weeks were better than preoperative, but there was no statistical difference between the groups (P>0.05). In the traditional water flushing group, the symptoms of increased intracranial pressure like headache and neck pain occurred during the operation, which was forced to shorten the operation time in 5 cases, nerve root adventitia injury in 4 cases, and postoperative recurrence in 4 cases. In the hydraulic perfusion pump group, no patient had the symptoms of increased intracranial pressure like headache and neck pain, and nerve root adventitia injury in 1 case and 2 cases of postoperative recurrence. The incidence of complications in the hydraulic perfusion group was lower than that in the traditional water flow group. Conclusion：Hydraulic perfusion pump and traditional water-flow irrigation assisted percutaneous endoscopic lumbar disc herniation can achieve satisfactory clinical results. However, the former has short operation time, clear vision in operation, less bleeding, and less in-operation and postoperative complications.

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Assessment of low back pain and leg pain using Visual Analog Scale in patients with lumbar disc herniation after microendoscopic discectomy

The Journal of Japanese Society of Lumbar Spine Disorders ◽

10.3753/yotsu.13.175 ◽

2007 ◽

Vol 13 (1) ◽

pp. 175-179 ◽

Cited By ~ 1

Author(s):

Takatoshi SHIMOMURA

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Visual Analog Scale ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Low Back ◽

Analog Scale ◽

Microendoscopic Discectomy

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Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_294_18 ◽

2019 ◽

Vol 10 (02) ◽

pp. 225-233

Author(s):

Mantu Jain ◽

Rabi Narayan Sahu ◽

Sudarsan Behera ◽

Rajesh Rana ◽

Sujit Kumar Tripathy ◽

...

Keyword(s):

Visual Analog Scale ◽

Vertebral Body ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

X Rays ◽

Analog Scale ◽

Bony Fusion ◽

Universal Approach ◽

The Mean

ABSTRACT Background: Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach. Settings and Design: A retrospective case study series in a tertiary level hospital. Aims: The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a “universal approach” in tubercular spondylodiscitis of variable presentation. Materials and Methods: The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period. Statistical Analysis Used: The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired t-test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis. Results: The mean number of vertebrae involved was 3.29 ± 0.86 (2–6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause. Conclusions: The procedure in safe and has satisfactory results in variable group affection of Pott’s spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.

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Short-term Clinical and Radiographic Results of the Salto Mobile Total Ankle Prosthesis

Foot & Ankle International ◽

10.1177/1071100717737988 ◽

2017 ◽

Vol 39 (2) ◽

pp. 155-165 ◽

Cited By ~ 5

Author(s):

Dong Dong Wan ◽

Woo Jin Choi ◽

Dong Woo Shim ◽

Yeokgu Hwang ◽

Yoo Jung Park ◽

...

Keyword(s):

Range Of Motion ◽

Visual Analog Scale ◽

Case Series ◽

Clinical Success Rate ◽

Radiographic Evaluation ◽

Analog Scale ◽

Ankle Osteoarthritis ◽

Disability Score ◽

Ankle Prosthesis

Background: The mobile-bearing Salto total ankle prosthesis has been reported to have promising outcomes. However, clinical reports on this prosthesis are few, and most have been published by the inventors and disclosed consultants. Methods: We retrospectively reviewed 59 patients who received Salto prosthesis unilaterally. The average follow-up was 35.9 (range, 6-56) months. Clinical and radiologic results were evaluated. Clinical results were evaluated according to visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS) pain and disability score, and ankle range of motion (ROM) in dorsiflexion/plantarflexion. In the radiographic evaluation, we measured the tibial angle (TA), talar angle (TAL), tibial slope, and talocalcaneal angle (TCA) on weightbearing radiographs. Results: By the last follow-up, 7 of 59 patients (11.9%) had undergone reoperation, and 3 of 59 implants (5.1%) had been removed. The prosthesis survival was 94.9% (95% CI, 89.1%-100%). With any reoperation as the endpoint of follow-up, the clinical success rate was 88.1% (95% CI, 79.4%-96.9%). The mean postoperative visual analog scale score, AOFAS ankle-hindfoot score, and Ankle Osteoarthritis Scale pain and disability score improved significantly ( P < .001). The ankle range of motion also improved from preoperative 33.4 ± 16.6 to 40.3 ± 15.5 postoperatively ( P < .001); however, there was no statistically significant change in plantarflexion ( P = .243). Radiolucent areas and osteolysis were found in 28 (47.5%) and 27 (45.8%) patients, respectively. Heterotopic ossification was observed in 13 patients (22.0%). Conclusions: In this series, early clinical and radiographic outcomes of this prosthesis were promising. We believe the early radiolucent lines were probably due to the gap at the implant and bone interface, and they disappeared at the time of osseous integration. However, longer follow-up is necessary to determine the long-term durability and survivorship of this implant, particularly given the high incidence of postoperative osteolysis. Level of Evidence: Level IV, case series.

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Full-Endoscopic Lumbar Discectomy for Two Contiguous Level Adolescent Lumbar Disc Herniation

10.21203/rs.3.rs-34230/v1 ◽

2020 ◽

Author(s):

lu mao ◽

Bin Zhu ◽

Xiaotao Wu ◽

Feng Wang ◽

Cong Zhang ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Visual Analog Scale ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Analog Scale ◽

One Stage ◽

Interlaminar Approach ◽

Endoscopic Lumbar Discectomy

Abstract Background: Symptomatic lumbar disc herniation is rarely seen among adolescents. Adolescent lumbar disc herniation (ALDH) accounts for 0.5% to 6.8% of all those treated. Evidently, to our knowledge, no studies have emphasized the operative technique to treat two contiguous level adolescent lumbar disc herniation simultaneously. In this study, we aim to investigate the feasibility and advantages of one-stage full-endoscopic lumbar discectomy（FELD）for two contiguous level ALDH. This is the first paper, to my knowledge, dealing with two contiguous level ALDH simultaneously with one-stage full-endoscopic lumbar discectomy.Methods: Between January 2014 and December 2019, patients received FELD surgery for lumbar disc herniation (LDH) in 2 main minimally invasive spine center of China were selected for screening of this study. Data of 5877 cases were retrospectively analyzed (2780 cases and 3097 cases, respectively). The inclusion criteria were patient under 21-year old, two contiguous level symptomatic lumbar disc herniation received one-stage 2 level PELD surgery. Visual analog scale (VAS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results.Results: 11 patients were enrolled in this study (0.19%,11/5877), 8 patients were male and 3 were female. 9 patients with LDH in the same side underwent single-incision 2 level FELD surgery via transforaminal approach. 2 patients with LDH in different side underwent FELD surgery via combined transforaminal and interlaminar approach. There were no immediate perioperative complications. The visual analog scale (VAS) decreased significantly in both early and late follow-up evaluations and these score demonstrated significant improvement in late follow-up (P <0.01). For the modified MacNab criteria, the final outcome results were excellent in 9 patients (81.8%), good in 1 patients (0.9%), fair in1 patients (0.9%), and the overall success rate was 90.9%.Conclusion: One-stage full-endoscopic lumbar discectomy for 2 level symptomatic ALDH is an effective and less invasive method, which can be considered as an alternative good technique for selected adolescent patients.

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Randomized Trial Comparing Self-Gripping Mesh with Polypropylene Mesh in Female Lichtenstein Hernioplasty

The American Surgeon ◽

10.1177/000313482008600229 ◽

2020 ◽

Vol 86 (2) ◽

pp. 110-115

Author(s):

Dianchen Wang ◽

Hui Zhang ◽

Ting Lei ◽

Jianmin Chen ◽

Yake Chen ◽

...

Keyword(s):

Foreign Body ◽

Visual Analog Scale ◽

Short Form ◽

Operation Time ◽

Analog Scale ◽

Lichtenstein Hernioplasty ◽

Operative Outcomes ◽

Significant Difference ◽

One Year

Several randomized trials comparing self-gripping mesh with polypropylene (PL) mesh in Lichtenstein hernioplasty revealed that the self-gripping mesh significantly reduced the operation time. In these studies, some enrolled only male patients, and in others, the proportion of women was extremely low. The aim of this research was to compare outcomes after self-gripping mesh repair with PL mesh secured with sutures in female Lichtenstein hernioplasty. Female patients with primary unilateral inguinal hernia were assigned randomly to undergo Lichtenstein hernioplasty with a self-gripping ProGrip (PG) mesh or a sutured PL mesh, followed-up at one week, one month, three months, one year, and two years. Demographics, hernia characteristics, and operative outcomes data were analyzed. Pain was assessed with a visual analog scale (0–10), and quality of life (QOL) was estimated by a 36-item short-form general survey (0–26). Forty eight patients in the PG group and 51 participants in the PL group completed the follow-up. The operation time of the PG (54.1 ± 12 minutes) group was significantly shorter than that of the PL (60.9 ± 11.3 minutes) group ( P = 0.045). At the one-month follow-up, the incidence of foreign body feeling in the PG group was significantly higher than that in the PL group ( P = 0.031), whereas no significant difference was observed in visual analog scale ≥3 and QOL. In a follow-up of three months, one year, and two years, there was no significant difference in foreign body feeling, chronic pain, QOL, and recurrence between two groups. The surgical outcomes of self-gripping mesh are comparable to those of the ordinary PL mesh with a reduced operation time in female Lichtenstein hernioplasty. Registration number: ChiCTR1800017360 ( http://www.chictr.org.cn ).

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Full-endoscopic lumbar discectomy for two contiguous level adolescent lumbar disc herniation

10.21203/rs.3.rs-24175/v1 ◽

2020 ◽

Author(s):

lu mao ◽

Bin Zhu ◽

Tao xiao Wu ◽

Feng Wang ◽

Cong Zhang ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Visual Analog Scale ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Analog Scale ◽

One Stage ◽

Interlaminar Approach ◽

Endoscopic Lumbar Discectomy

Abstract Background Symptomatic lumbar disc herniation is rarely seen among adolescents. Adolescent lumbar disc herniation (ALDH) accounts for 0.5–6.8% of all those treated. Evidently, to our knowledge, no studies have emphasized the operative technique to treat two contiguous level adolescent lumbar disc herniation simultaneously. In this study, we aim to investigate the feasibility and advantages of one-stage full-endoscopic lumbar discectomy(FELD)for two contiguous level ALDH. This is the first paper, to my knowledge, dealing with two contiguous level ALDH simultaneously with one-stage full-endoscopic lumbar discectomy. Methods Between January 2014 and December 2019, patients received FELD surgery for lumbar disc herniation (LDH) in 2 main minimally invasive spine center of China were selected for screening of this study. Data of 5877 cases were retrospectively analyzed (2780 cases and 3097 cases, respectively). The inclusion criteria were patient under 21-year old, two contiguous level symptomatic lumbar disc herniation received one-stage 2 level PELD surgery. Visual analog scale (VAS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Results 11 patients were enrolled in this study (0.19%,11/5877), 8 patients were male and 3 were female. 9 patients with LDH in the same side underwent single-incision 2 level FELD surgery via transforaminal approach. 2 patients with LDH in different side underwent FELD surgery via combined transforaminal and interlaminar approach. There were no immediate perioperative complications. The visual analog scale (VAS) decreased significantly in both early and late follow-up evaluations and these score demonstrated significant improvement in late follow-up (P < 0.01). For the modified MacNab criteria, the final outcome results were excellent in 9 patients (81.8%), good in 1 patients (0.9%), fair in1 patients (0.9%), and the overall success rate was 90.9%. Conclusion One-stage full-endoscopic lumbar discectomy for 2 level symptomatic ALDH is an effective and less invasive method, which can be considered as an alternative good technique for selected adolescent patients.

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Dreierkombination (Thomapyrin®) ist wirksamer bei Kopfschmerzen als Monosubstanzen und Zweierkombination

Nervenheilkunde ◽

10.1055/s-0038-1629992 ◽

2005 ◽

Vol 24 (07) ◽

pp. 626-639 ◽

Cited By ~ 1

Author(s):

V. Pfaffenrath ◽

L. Pageler ◽

H. Peil ◽

B. Aicher ◽

H. C. Diener

Keyword(s):

Pain Intensity ◽

Visual Analog Scale ◽

A Priori ◽

Intensity Difference ◽

Visuelle Analogskala ◽

Analog Scale ◽

Pain Intensity Difference

ZusammenfassungDie Wirksamkeit, Sicherheit und Verträglichkeit einer Einzelgabe von zwei Tabletten der fixen Dreierkombination mit 250 mg Azetylsalizylsäure (ASS) plus 200 mg Paracetamol plus 50 mg Koffein (Thomapyrin®) gegenüber zwei Tabletten mit 500 mg ASS, oder zwei Tabletten mit 500 mg Paracetamol, oder zwei Tabletten mit 50 mg Koffein beziehungsweise Plazebo wurde in einer klinischen Studie an 1 743 Patienten geprüft, die ihre episodischen Kopfschmerzen vom Spannungstyp oder ihre Migräne mit und ohne Aura üblicherweise erfolgreich mit verschreibungsfreien Analgetika behandeln. Die Dreierkombination war im a priori definierten primären Endpunkt “Zeit bis zu 50% Schmerzreduktion” sowohl der Zweierkombination aus ASS plus Paracetamol (p = 0,0181), als auch den Monoanalgetika ASS (p = 0,0398) und Paracetamol (p = 0,0016), sowie auch der Monotherapie mit Koffein (p < 0,0001) und Plazebo (p < 0,0001) überlegen. Alle Behandlungen außer der Koffein-Monotherapie waren der Plazebobehandlung überlegen (p < 0,0001). Die überlegene Wirksamkeit der Dreierkombination gilt auch für alle sekundären Endpunkte wie beispielsweise der “Verringerung der Kopfschmerzen auf 10 mm VAS (visual analog scale = visuelle Analogskala zur Schmerzmessung), dem gewichteten % SPID (sum of pain intensity difference = aufsummierte Schmerzintensitätsdifferenz gegenüber dem Ausgangsschmerz in Prozent), dem Ausmaß der Beeinträchtigung der alltäglichen Aktivitäten und der globalen Beurteilung der Wirksamkeit durch die Patienten. Alle Behandlungen waren gut verträglich, die Inzidenz von unerwünschten Begleiterscheinungen war gering.

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Perceived Tension, Movement, and Pleasantness in Harmonic Musical Intervals and Noises

Music Perception An Interdisciplinary Journal ◽

10.1525/mp.2020.37.4.298 ◽

2020 ◽

Vol 37 (4) ◽

pp. 298-322 ◽

Cited By ~ 3

Author(s):

Marco Costa ◽

Mattia Nese

Keyword(s):

Visual Analog Scale ◽

Energy Content ◽

High Pitch ◽

Analog Scale ◽

Psychophysical Procedure ◽

Preliminary Study

Perceived valence, tension, and movement of harmonic musical intervals (from the unison to the octave presented in a low- and high-register) and standard noises (brown, pink, white, blue, purple) were assessed in two studies that differed in the crossmodal procedure by which tension and movement were rated: proprioceptive device or visual analog scale. Valence was evaluated in both studies with the visual analog scale. In a preliminary study, the proprioceptive device was calibrated with a psychophysical procedure. Roughness of the stimuli was included as covariate. Tension was perceived higher in dissonant intervals and in intervals presented in the high register. The higher the high-pitch energy content in the standard noise, the higher the perceived tension. The visual analog scale resulted in higher tension ratings than the proprioceptive device. Perception of movement was higher in dissonant intervals, in intervals in the high register, and in standard noises than in musical intervals. High-pitch spectrum noises were associated with more sense of movement than low-pitch spectrum noises. Consonant intervals and low-register intervals were evaluated as more pleasant than dissonant and high-register intervals. High-pitch spectrum purple and blue noises were evaluated as more unpleasant than low-pitch spectrum noises.

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