Symptomatic Post-Discectomy Pseudocyst after Endoscopic Lumbar Discectomy
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Abstract:
The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them.Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI).Among 1,503 cases of all male soldiers, the MRIs showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach (p=0.001). The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP.Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach.Keywords:
Oswestry Disability Index
Discectomy
Conservative Management
Thirty-two (N= 32) full-time working subjects between the ages of 20 and 55 years participated in a 12-week exercise intervention study. Subjects were randomly divided into a control group receiving conservative exercises and low intensity back school and an experimental group receiving aggressive-progressive exercises and high intensity back school . Pain and disability were measured with the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). The ODI is used to determine the impact of low back pain on the activities of daily living. Results showed that both groups improved significantly from baseline, but there was no significant difference between the groups. The experimental group improved from 54.44 to 17 and the control group improved from 52.57 to 13.40 for the VAS and from 23.72 to 8 for the experimental group and from 20.7 to 11.00 for the control group for the ODI respectively. The results from the experimental group were compared to results from similar studies to obtain an indication of results achieved versus those achieved in developed countries. In conclusion, the VAS and ODI results achieved by the South African subjects were equal to or better than those achieved by patients in developed countries.
Oswestry Disability Index
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To observe the effects of application of cybernetics (theories of communication). This is an open level prospective study, involving patients with chronic low back pain of more than 3 months. Assessment were done before the start of therapy and after the completion of therapy every day for consecutive 6 days of treatment protocol. A total of 8 patients were enrolled (4 male, 4 female). The Visual Analogue Scale (VAS) was used to assess pain, Oswestry Disability Scale (ODI) was applied for scoring disability. ODI was scored at the start of treatment on 1st day and at the end of the treatment on 6th day. Mean VAS reduced from 8.12 to 6.93 after 1st day, which was also statistically significant (p < .01) .This trend continued and there was very significant reduction (p < .001) of VAS in the end when means were compared with pretreatment value. Mean Oswestry disability index reduced from 49.875 to 18.44 at the end of treatment which was statistically very significant (p < 0.001). There were significant improvements in all the outcome measured after Scrambler therapy.
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Abstract
Objective: The aim of this study was to compare the effect of dry needling and sustained pressure in the lumbar paraspinal trigger points in terms of pain threshold and muscle length.
Methodology: 50 patients were randomly allocated in experimental and control group having lumbar paraspinal muscle trigger points. Experimental and control groups received dry needling and sustained pressure along with stretching and strengthening exercises. Patients were assessed at 1st pre and 4th post session using Oswestry disability index, paraspinal muscle length, visual analogue scale and pain pressure threshold using algometer.
Results: Pain pressure threshold and visual analogue scale showed significant results whereas Oswestry disability index and paraspinal muscle length showed no significant results (P>0.01). Analysis within the group showed significant difference from pre to post intervention level (P<0.01) in terms of pain pressure threshold, paraspinal muscle length, Oswestry disability index and visual analogue scale in experimental and control group.
Conclusion: Pain was improved using dry needling. However, no significant improvement was seen in patient’s disability and lumbar paraspinal muscle length.
Key words: Dry needling, Oswestry disability index, Paraspinal muscle, Trigger points, Visual analogue scale.
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Background This study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery. Methods Electronic databases were systematically searched up to February 2022. The authors used Review Manager 5.3 to manage the data and perform the review. Results After the preliminary selection of 239 studies from electronic databases, the full inclusion criteria were applied; 16 studies were found to be eligible for inclusion. These 16 studies enrolled 1,488 patients: 653 patients in the UBE group, 570 in the microendoscopic discectomy group, 153 in the percutaneous endoscopic lumbar discectomy group, and 70 in the posterior lumbar interbody fusion group. UBE was superior to microendoscopic discectomy regarding 1-day Visual Analog Scale(VAS) back pain scores ( P < 0.00001). No difference was found between UBE and microendoscopic discectomy regarding 1-day Visual Analog Scale leg pain scores ( P = 0.25), long-term VAS back pain scores ( P = 0.06), long-term VAS leg pain scores ( P = 0.05), Oswestry Disability Index scores ( P = 0.09) or complications ( P = 0.19). Pooled analysis indicated that UBE was similar to percutaneous endoscopic lumbar discectomy regarding 1-day VAS back pain scores ( P = 0.71), 1-day VAS leg pain scores ( P = 0.37), long-term VAS back pain scores ( P = 0.75), long-term VAS leg pain scores ( P = 0.41), Oswestry Disability Index scores ( P = 0.07) and complications ( P = 0.88). One study reported no difference between UBE and posterior lumbar interbody fusion regarding long-term VAS back pain, long-term VAS leg pain, or Oswestry Disability Index scores. Conclusions UBE is superior to microendoscopic discectomy to relieve back pain 1 day postoperatively. However, these two procedures are similar regarding 1-day leg pain relief, long-term effects, and safety. UBE and percutaneous endoscopic lumbar discectomy are similar regarding 1-day pain relief, long-term effects and safety. More evidence is needed to evaluate the efficacy and safety of UBE versus posterior lumbar interbody fusion.
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본 연구는 만성 요통 환자에게 요부 안정화 운동과 저주파 EMS 적용에 따른 효과를 분석하는 것이다. 이를 위하여 50대 만성 요통 환자 12명을 대상으로 하여 4주간의 요부 안정화 운동과 저주파 EMS(Electrical Muscle Stimulation) 를 적용하였으며, 효과 분석을 위한 측정항목으로 요통 VAS(visual analogue scale, VAS)와 오스웨스트리 기능적 장애 지수(Oswestry Disability Index, ODI)를 이용하였다. 이에 연구 결과는 다음과 같다. 요통 VAS에서 요부 안정화 운동 과 저주파 EMS 적용 전에 비해 적용 후에 유의하게 낮게 나타났다(p<.05). 오스웨스트리 기능적 장애지수와 관련된 8가지 항목과 장애지수에서도 요부 안정화 운동과 저주파 EMS 적용 전에 비해 적용 후에 유의하게 낮게 나타났다 (p<.05). 이처럼, 만성 요통 환자에게 요부 안정화 운동과 저주파 EMS 적용은 요통 VAS와 오스웨스트리 기능적 장애지 수의 감소에 효과가 있음을 확인할 수 있었다. 본 연구를 통해 만성 요통 환자에게 요부 안정화 운동과 저주파 EMS 적용의 근거를 확인하였다는 점에서 본 연구의 의미를 둘 수 있을 것이다.
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ABSTRACT
Background:
Expandable devices for transforaminal or posterior lumbar interbody fusion (TLIF and PLIF, respectively) may enable greater restoration of disc height, foraminal height, and stability within the interbody space than static spacers. Medial-lateral expansion may also increase stability and resistance to subsidence. This study evaluates the clinical and radiographic outcomes from early experience with a bidirectional expandable device.Methods:
This was a retrospective analysis of a continuous series of patients across 3 sites who had previously undergone TLIF or PLIF surgery with a bidirectional expandable interbody fusion device (FlareHawk, Integrity Implants, Inc) at 1 or 2 contiguous levels between L2 and S1. Outcomes included the Oswestry Disability Index (ODI), a visual analog scale (VAS) for back pain or leg pain, radiographic fusion by 1 year of follow-up, subsidence, device migration, and adverse events (AE).Results:
There were 58 eligible patients with radiographs for 1-year fusion assessments and 45 patients with ODI, VAS back pain, or VAS leg pain data at baseline and a mean follow-up of 4.5 months. The ODI, VAS back pain, and VAS leg pain scores improved significantly from baseline to final follow-up, with mean improvements of 14.6 ± 19.1, 3.4 ± 2.6, and 3.9 ± 3.4 points (P < .001 for each), respectively. In addition, 58% of patients achieved clinically significant improvements in ODI, 76% in VAS back pain, and 71% in VAS leg pain. By 1 year, 96.6% of patients and 97.4% of levels were considered fused. There were zero cases of device subsidence and 1 case of device migration (1.7%). There were zero device-related AEs, 1 intraoperative dural tear, and 3 subsequent surgical interventions.Conclusions:
The fusion rate, improvements in patient-reported outcomes, and the AEs observed are consistent with those of other devices. The bidirectional expansion mechanism may provide other important clinical value, but further studies will be required to elucidate the unique advantages.Level of Evidence:
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이 연구는 척추안정화운동과 도수치료가 급성기 또는 아급성기 허리통증 환자의 통증지수와 장애지수에 미치는 영향을 알아보기 위해 시행되었다. 23명의 허리통증 환자가 자발적으로 참여하였고 무작위로 분류되었다. 도수치료(10명)와 척추안정화운동(13명)은 총 4주간 주 3회, 15분/1회 적용되었다. 각각의 치료 전에 전통적인 치료를 30분간 적용하였다. 치료 전과 후에 시각사상척도와 한국어판 오스웨스트리를 측정하였다. 치료 전에 비해 치료 후 두 치료 모두에서 통중지수와 장애지수가 유의하게 감소하였다(p<.05). 통증지수의 변화율은 도수치료보다 척추안정화운동 시 유의하게 높았지만(p<.05), 장애지수의 변화율은 유의한 차이가 없었다(p>.05). 이상으로 볼 때, 척추안정화운동은 아급성기 또는 급성기 허리통증 환자에서도 통증을 안전하게 줄이는데 도움이 됨을 확인하였다. 따라서 아급성기 이하의 허리통증 환자에서도 통증과 장애를 줄이는데 척추안정화운동이 유용하리라 사료된다. The purpose of this study was to investigate effect of type of physical therapy (spinal stabilization exercise and manual therapy) on pain index and disability index in acute and subacute patients with low back pain (LBP). 23 patients with LBP participated and were randomly assigned. Manual therapy and spinal stabilization exercise was applied for 15-minute sessions occurred 3 sessions a week, for 4 weeks. All subjects received conservative therapy for 30-minute. Visual analogue scale (VAS) and Korean version of Oswestry disability index (ODI-K) were measured before and after treatment. There was significant difference in VAS and ODI-K between before and after both treatment (p<.05). There was significant difference in change rate of VAS between manual therapy and spinal sabilization exercise (p<.05), but not in change rate of ODI-K (p>.05). Thus, it is suggested that spinal stabilization exercise is helpful to reduce pain safely in acute and subacute patients with LBP.
Oswestry Disability Index
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Back Pain
Exercise therapy
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A retrospective clinical study.This study sought to retrospectively compare the mid-term to long-term outcomes between unilateral pedicle screw (UPS) and bilateral pedicle screw (BPS) augmented transforaminal lumbar interbody fusion (TLIF) in lumbar degenerative diseases.Recently, UPS fixation has been applied in TLIF, for its satisfactory clinical outcome, less implants and less invasiveness. However, only short-term outcome has been reported, the mid-term to long-term outcome has not been well characterized.From June 2007 to February 2011, 215 of 348 consecutive patients suffering from lumbar degenerative diseases were operated in our hospital and accomplished a minimum of 4-year follow-up. These patients were divided into 2 groups according to the operative techniques: UPS group (n=109), and bilateral pedicle screw group (n=106). Operative time, blood loss, length of hospital stay, hospital bill, fusion status, and complications were recorded and analyzed statistically. Visual analog scale, Oswestry disability index, and Japanese Orthopaedic Association scores were used to assess the preoperative and postoperative pain and functional outcome.The mean follow-up duration was 52.2 months. A significant decrease occurred in operative time, blood loss, and hospital bill in unilateral group, compared with bilateral group (P<0.05). The average postoperative visual analog scale, Oswestry disability index, and Japanese Orthopaedic Association scores improved significantly in each group than the preoperative counterparts (P<0.05); however, there were no significant difference between groups at any follow-up time point (P>0.05). No statistically difference was detected regarding fusion rate and complication rate between the 2 groups (P>0.05), except the cage migration rate (P<0.05).UPS fixation could achieve satisfactory clinical outcome similar to bilateral fixation in TLIF at a mid-term to long-term follow-up. To avoid cage migration, bullet-shaped cages should not be used in the unilateral group.
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