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The Bone & Joint Journal
Vol. 104-B, Issue 11 | Pages 1242 - 1248
1 Nov 2022
Yang X Arts MP Bartels RHMA Vleggeert-Lankamp CLA

Aims. The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment. Methods. The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analyzed on MRI, using a four-point scale. These were dichotomized into disc bulge and disc herniation groups. Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and a visual analogue scale (VAS) for pain in the neck and arm at baseline and two years postoperatively. The perceived recovery was also assessed at this time. Results. At baseline, 46 patients had a disc bulge and 62 had a herniation. There was no significant difference in the mean NDI and SF-36 between the two groups at baseline. Those in the disc bulge group had a mean NDI of 44.6 (SD 15.2) compared with 43.8 (SD 16.0) in the herniation group (p = 0.799), and a mean SF-36 of 59.2 (SD 6.9) compared with 59.4 (SD 7.7) (p = 0.895). Likewise, there was no significant difference in the incidence of disabling arm pain in the disc bulge and herniation groups (84% vs 73%; p = 0.163), and no significant difference in the incidence of disabling neck pain in the two groups (70.5% (n = 31) vs 63% (n = 39); p = 0.491). At two years after surgery, no significant difference was found in any of the clinical parameters between the two groups. Conclusion. In patients with cervical radiculopathy, the type and extent of disc herniation measured on MRI prior to surgery correlated neither to the severity of the symptoms at presentation, nor to clinical outcomes at two years postoperatively. Cite this article: Bone Joint J 2022;104-B(11):1242–1248


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 6 - 6
1 Jun 2012
Taranu R Lakkol S Aranganathan S Bhatia CK Reddy G Friesem T
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Introduction. This study aims to evaluate the impact of associated psychological co-morbidities (Depression/Anxiety), smoking history, gender, work benefits and employment status on the clinical outcome following anterior cervical disc replacement (ACDR). Materials and Methods. We included in our study 100 patients who underwent ACDR in our Spinal Unit (between May 2006 – May 2010). We used as clinical outcome measures: Visual Analogue Score for neck pain (VAS-NP) and arm pain (VAS-AP), Neck Disability Index (NDI) and Bodily Pain (SF36-BP) component of the Short Form 36 questionnaire. Statistics were obtained using SPSS 16.0 for Windows (SPSS Inc, Chicago, IL). Independent sample t-test for normally distributed data and Man-Whitney U test for non-parametric data were used. Statistical significance was designated at p < 0.05. Results. There were 48 males and 52 females. Average age at operation was 52.96 years (Range 38-80) for males and 49.79 years (Range 31-71) for females. Average duration of follow up was 14.4 months (Range 6-35). Out of 100 patients, 28 patients had a history of anxiety/depression, 19 patients were smokers, 47 were actively working and 23 were receiving work benefits. We found that gender, smoking status, associated co-morbidities, working and benefit status had no statistically significant contribution to clinical outcome measures in the follow up period. For example, in the sub-group of non-smokers versus smokers, there was no significant difference in NDI (p=0.78), VAS-AP (p=0.12), SF-BP (p= 0.83) and VAS-NP (p=0.08). Conclusion. We conclude that in our study there was no statistically significant contribution of the associated psychosocial factors on the clinical outcomes following ACDR


The Bone & Joint Journal
Vol. 105-B, Issue 1 | Pages 64 - 71
1 Jan 2023
Danielsen E Gulati S Salvesen Ø Ingebrigtsen T Nygaard ØP Solberg TK

Aims

The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent.

Methods

This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 38 - 38
1 Sep 2019
Sikkens D Broekema A Soer R Reneman M Groen R Kuijlen J
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Introduction. Degeneration of the cervical spine can lead to neurological symptoms that require surgical intervention. Often, an anterior cervical discectomy (ACD) with fusion is performed with interposition of a cage. However, a cage substantially increases health care costs. The polymer polymethylmethacrylate (PMMA) is an alternative to cages, associated with lower costs. The reported high-occurrence of non-fusion with PMMA is often seen as a drawback, but evidence for a correlation between radiological fusion and clinical outcome is absent. To investigate if the lower rate of fusion with PMMA has negative effects on long-term clinical outcome, we assessed the clinical results of ACD with PMMA as a intervertebral spacer with a 5–10 year follow-up. Methods. A retrospective cohort study among all patients who underwent a mono-level ACD with PMMA for degenerative cervical disease, between 2007–2012, was performed. Patients filled out an online questionnaire, developed to assess clinical long-term outcome, complications and re-operation rates. The primary outcome measure was the Neck Disability Index (NDI), secondary outcome measures were re-operation and complication rates. Results. Of 196 eligible patients, 90 patients were assessed (response rate 53%). The average NDI score at follow-up (mean 7.5 years) was 19.0 points ± 18.0 points. Complications occurred in 10% and re-operation in 8.8%. Conclusion. This study provides evidence of good long-term clinical results of ACD with PMMA, as the results were similar with long-term outcomes of ACD with a cage as spacer. Therefore, the results of this study may suggest that the use of PMMA is an lower-cost alternative. No conflicts of interests. No funding obtained


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 46 - 46
1 Jun 2012
Venkatesan M Ahmed A Vishwanathan K Udwadia A Doyle J
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Background. Wallis implant was developed in 1986 to stiffen unstable operated degenerate lumbar segments while preserving some intervertebral mobility. The long-term results of first-generation Wallis implant from developers were promising. However, documentation pertaining to safety and efficacy of second generation Wallis implant is sparse in literature. Purpose. The objective of this study was to assess the clinical outcome of the second generation Wallis interspinous device for degenerative lumbar disc disease. Study design. Prospective consecutive single surgeon series. Methods. Patients were selected according to recommendations by developers of Wallis implant. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to assess patient outcomes. Implant failure was determined by disc recurrence, implant removal and revision. Results. 25 patients (13 male, 12 female) with mean age of 51 years (range 47-76) had Wallis implantation (22 one level and 3 two level). Clinical outcome data at average of 60 months (47-76) available for 24 patients (96% FU). Mean ODI scores decreased from 59.1% pre-operatively to 24.7 and 40.5% at 2 years and 5 years follow up, respectively. 34.4 points change from baseline at 2 years and 18.6 points at final follow-up. Mean VAS scores decreased from 7.2 to 3.0 and 4.8 cm for back pain at 2 and 5 years; from 6.8 to 3.8 and 4.2 cm for leg pain at 2 and 5 years follow-up, respectively. Taking a 24 point change in ODI as representing good outcome 96 % (24 patients) of study subjects achieved this at 2 years. Taking a 16 point change in ODI as representing minimum change needed for clinical success 40% (10 patients) failed to achieve this at 5 years. 2 revisions have occurred so far (8% failure rate). Conclusion. The results of our series indicate that the study device is safe and efficacious in the treatment of symptomatic lumbar degenerative discs. However, good clinical outcome obtained at early years is not maintained in medium-term. Interest Statement. There was no commercial support or funding of any sort


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_15 | Pages 34 - 34
7 Aug 2024
Alghamdi MN Sparkes V Khot S Davies J
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Background

Embodiment- and distraction-based approaches to immersive virtual reality (IVR) show promise in treating persistent low back pain (PLBP). However, which approach is more effective is unclear. This study aims to evaluate the impact of distraction- and embodiment-based IVR on pain processing and patient-reported outcome measures in PLBP.

Method

Individuals with PLBP were randomised to receive eight sessions of either distraction- or embodiment-based IVR over two weeks. Outcome measures were evaluated at baseline and after the eighth session. Pain processing was evaluated using conditioned pain modulation (CPM) and temporal summation (TS).


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 25 - 25
1 Feb 2016
Siddiqui A Asmat F Anjarwalla N
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Background:. Following lumbar spine surgery patients with a high BMI appear to have increased post-operative complications including surgical site infections (SSI), urinary complications, increased anaesthetic/operative time and a greater need for post-operative blood transfusion. There is no current evidence, however, analysing the effect of BMI on functional outcome. Purpose:. We aimed to analyse the effect of BMI on functional outcome following lumbar spine surgery. Study Design:. Retrospective Cohort Study. Patient Sample:. 131. Outcome Measures:. Outcome measures included mean post-operative Oswestry Disability Index (ODI) at six and twelve months, the incidence of SSI, mean operative time and the requirement for post-operative blood transfusion. Methods:. Patients that underwent lumbar spinal surgery between September 2010 and November 2013 were identified retrospectively and categorised into discectomy, decompression, fusion and revision is created. A BMI threshold of 30 was used to group patients as non-obese or obese. Univariate analysis was used to compare the effect of BMI on the above outcome measures. Results:. Post-operative complication rates were higher in the obese group in each category. However, there was no significant difference in the post-operative ODI at six ad twelve months post-operatively. Conclusions:. Increased BMI is related to increased post-operative complications but is not associated with a poorer functional outcome in the short to mid-term


The Bone & Joint Journal
Vol. 95-B, Issue 1 | Pages 81 - 89
1 Jan 2013
Johnsen LG Brinckmann P Hellum C Rossvoll I Leivseth G

This prospective multicentre study was undertaken to determine segmental movement, disc height and sagittal alignment after total disc replacement (TDR) in the lumbosacral spine and to assess the correlation of biomechanical properties to clinical outcomes. A total of 173 patients with degenerative disc disease and low back pain for more than one year were randomised to receive either TDR or multidisciplinary rehabilitation (MDR). Segmental movement in the sagittal plane and disc height were measured using distortion compensated roentgen analysis (DCRA) comparing radiographs in active flexion and extension. Correlation analysis between the range of movement or disc height and patient-reported outcomes was performed in both groups. After two years, no significant change in movement in the sagittal plane was found in segments with TDR or between the two treatment groups. It remained the same or increased slightly in untreated segments in the TDR group and in this group there was a significant increase in disc height in the operated segments. There was no correlation between segmental movement or disc height and patient-reported outcomes in either group. In this study, insertion of an intervertebral disc prosthesis TDR did not increase movement in the sagittal plane and segmental movement did not correlate with patient-reported outcomes. This suggests that in the lumbar spine the movement preserving properties of TDR are not major determinants of clinical outcomes. Cite this article: Bone Joint J 2013;95-B:81–9


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 12 - 12
1 Feb 2016
Fawkes C Froud R Carnes D
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Background to the study:. The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. PROMs data are often collected using hard copy questionnaires. New technology enables electronic PROM data collection. Purpose of the study:. To identify patient and practitioner perceived opportunities and challenges to implementing electronic PROM data capture as part of the process for developing a PROM phone and online app. Methods:. Interviews were undertaken with patients (N=18), and clinicians (N=46). Patients and clinicians were recruited through practice advertisement, in printed healthcare media, social media, and professional networks. Semi-structured interviews were used. Data were analysed using the Framework approach. Themes, sub-themes, and models were developed from the analysed data. Results:. Patient themes included relevance of data collection, data protection, and confidentiality. Practitioner themes included issues around patient engagement, and relevance to clinical practice. Overall patients were more enthusiastic than clinicians about using PROMs in practice. They welcomed the opportunity to provide feedback, and were prepared to use technology to achieve this. In contrast, clinicians reported concerns that patients would not want to complete PROMs, or may be unable to use electronic devices to achieve this. Other clinicians noted that this was a professional demand and part of reflective practice. Conclusion:. The patients' enthusiasm to contribute data and the clinicians' paternalistic views were contrasting and suggests a greater need for patient centred communication


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 11 - 11
1 Jun 2012
Newton Ede M Ross ERS Rischke B Joellenbeck B Hipp J Zimmers K
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Purpose. To determine if clinical outcomes are correlated with center of rotation (COR) in patients implanted with a viscoelastic total disc replacement (VTDR). Methods. Fifty patients with single-level, symptomatic lumbar DDD between L4 and S1 were enrolled in a clinical trial of a VTDR across three surgical centres. A comprehensive, independent review and statistical analysis of both clinical and radiographic outcomes was performed and analyzed for correlations. Data from preoperative through 2 years were available. The COR was calculated for the index levels and compared to data for an asymptomatic population. Each COR coordinate was classified as abnormal if outside of the 95% confidence interval for an asymptomatic population. Results. At most recent follow-up, 69% of the patients had achieved at least a 15 point Oswestry Disability Index (ODI) improvement. 76% of the patients achieved at least a 10 point improvement. At most recent follow-up, 78% of cases had a normal COR-X and 92% had a normal COR-Y. Results from three statistical tests show the association between COR-X and outcomes. 1) Based on latest available time point for each patient, the improvement in ODI score was significantly better for patients with a normal anterior-posterior (AP) coordinate of the COR (P=0.03). 2) Anterior COR corresponded with anterior placement of the device in the disc space, and patients were almost 7 times less likely to achieve at least a 15 point improvement in the ODI score if the COR was positioned too anteriorly. 3) This effect was also seen in the average AP coordinate of the COR for patients who achieved a 15 point ODI improvement. Conclusions. A viscoelastic TDR can restore a normal COR. This is the first study to show that restoration of a normal COR correlates with a significant and clinically relevant improvement in patient disability


The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 499 - 506
1 Apr 2018
Minamide A Yoshida M Simpson AK Nakagawa Y Iwasaki H Tsutsui S Takami M Hashizume H Yukawa Y Yamada H

Aims

The aim of this study was to investigate the clinical and radiographic outcomes of microendoscopic laminotomy in patients with lumbar stenosis and concurrent degenerative spondylolisthesis (DS), and to determine the effect of this procedure on spinal stability.

Patients and Methods

A total of 304 consecutive patients with single-level lumbar DS with concomitant stenosis underwent microendoscopic laminotomy without fusion between January 2004 and December 2010. Patients were divided into two groups, those with and without advanced DS based on the degree of spondylolisthesis and dynamic instability. A total of 242 patients met the inclusion criteria. There were 101 men and 141 women. Their mean age was 68.1 years (46 to 85). Outcome was assessed using the Japanese Orthopaedic Association and Roland Morris Disability Questionnaire scores, a visual analogue score for pain and the Short Form Health-36 score. The radiographic outcome was assessed by measuring the slip and the disc height. The clinical and radiographic parameters were evaluated at a mean follow-up of 4.6 years (3 to 7.5).


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 16 - 16
1 Sep 2019
Verburg K van Dulmen S Kiers H Nijhuis-van der Sanden M van der Wees P
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Aim

To develop a clinical core set of outcome measures that is accepted for relevance, feasibility and validity by stakeholders and useful for a) interaction between patient and professional, b) internal quality improvement, and c) external transparency in patients with NSLBP in primary care physical therapy.

Method

We used a consensus-driven modified RAND-UCLA Delphi technique. We conducted seven separate steps with panellists (physical therapists, patient representatives, health insurers) to select accepted outcomes. These seven steps consisted of a literature search, two online surveys, patient interviews, an experts meeting, a consensus meeting and final approval of an advisory board. Results of previous steps were discussed during the consensus meeting, and then panellists voted for inclusion per measure. The final core set was rated on relevance and feasibility on a 9-point Likert scale, when the median was ≥7 the core set was accepted.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 10 - 10
1 May 2017
Anderton M Hoggett L Khatri M
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Background

PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals.

Aims

To review PROMs to quantify leg pain, back pain, EQ5D and ODI scores.

Evaluate PROMs data collection compliance.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXI | Pages 24 - 24
1 Jul 2012
Guha A Khurana A Bhagat S Pugh S Jones A Howes J Davies P Ahuja S
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Purpose

To evaluate efficacy of blood conservation strategies on transfusion requirements in adult scoliosis surgery and establish a protocol for cross matching.

Methods and Results

Retrospective review of 50 consecutive adult scoliosis patients treated using anterior only(14,28%), posterior only(19,38%) or combined(17,34%) approaches. All patients were anaesthetised by the same anaesthetist implementing a standard protocol using cell salvage, controlled hypotension and antifibrinolytics.

Mean age was 24.6 years. BMI was 21.9. On an average 9.5(6-15) levels were fused, with an average duration of surgery of 284.6(130-550) minutes. Antifibrinolytics were used in 31(62%) of the patients which included Aprotinin in 21(42%) and Tranexamic acid in 10(20%). Patients on antifibrinolytics had a significantly (p<0.05) lower blood loss (530ml) as compared to other patients (672ml). Mean volume of the cell saved blood re-transfused was 693.8 ml and mean postoperative HB level dropped to 10.7 g/dl(7.7-15) from a mean preoperative of 13.3 g/dl(10-17).

7(42%) with combined approaches and 3(15.8%) with posterior only approach required blood transfusion, 4/50(8%) of which required intra while 6/50(12%) required intra and postoperative transfusion. None of the patients having anterior surgery alone required blood transfusion.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 23 - 23
1 Apr 2012
Mehdian H Harshavardhana N Dabke H
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8 patients with cervical myelopathy treated by French-door laminoplasty and internal fixation. A novel technique of fixation is employed to provide immediate stability, pain relief and rapid mobilisation.

To report the clinical and radiological outcomes of this new fixation device for French–door laminoplasty with minimum follow-up of 30 months.

Hardware assisted laminoplasty has the potential advantage of instant stability and prevention of recurring stenosis. The use of titanium mini-plates has been described in open-door laminoplasty and now we describe this technique in French–door laminoplasty.

8 patients with cervical myelopathy secondary to congenital stenosis (2) and multi-level spondylotic myelopathy (6) underwent 2-4 level French–door laminoplasty and mini-plate fixation. The average follow-up was 46.5 months. Autogenous iliac crest bone graft was interposed between the sagittally split spinous processes and 16-18 holed titanium mini-plates were contoured into a trapezoidal shape and secured to the posterior elements with screws. Patients then mobilised without external support.

The mean follow-up was 46.5 months. The mean improvement in NDI at final follow-up was 35% and mean improvement in VAS was 4 points. JOA score improved from a mean of 10 to a mean of 14.8 post-operatively. All patients had achieved a significant neurological improvement and pain relief. There were no post-operative hardware related complications, pseudarthrosis or neurological deterioration.

French-door laminoplasty is an excellent alternative to laminectomy for treatment of young patients with cervical myelopathy. The use of titanium mini-plates not only provides instant stability and pain relief but also seems to minimize the risk of C5 nerve root palsy. Internal fixation appears to provide instant stability, early mobilisation and therefore reduces hospital stay and associated costs.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 6 | Pages 785 - 789
1 Jun 2007
Ross R Mirza AH Norris HE Khatri M

Between January 1990 and December 2000 we carried out 226 SB Charité III disc replacements for lumbar disc degeneration in 160 patients. They were reviewed at a mean follow-up of 79 months (31 to 161) to determine the clinical and radiological outcome. The clinical results were collected by an independent observer, who was not involved in patient selection, treatment or follow-up, using a combination of outcome measures, including the Oswestry Disability Index. Pain was recorded using a visual analogue score, and the most recent radiographs were reviewed.

Survival of the device was analysed by the Kaplan-Meier method and showed a cumulative survival of 35% at 156 months when radiological failure was taken as the endpoint. The mean improvement in the Oswestry disability index scores after disc replacement was 14% (6% to 21%) and the mean improvement in the pain score was 1.6 (0.46 to 2.73), both falling below the clinically significant threshold. Removal of the implant was required in 12 patients, four because of implant failure.

These poor results indicate that further use of this implant is not justified.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 30 - 30
1 Feb 2014
Morris T Hee SW Stallard N Underwood M Patel S
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Background

We have developed a LBP (low back pain) repository with IPD (individual patient data) from therapist-delivered intervention RCT's from various institutions, nationally and internationally (19 trials, 9328 patients). We will perform IPD meta-analyses to identify and determine the most effective and cost-effective treatments for subgroups of patients. Disability due to LBP is a key outcome of interest. However, there was no common disability measurement that was used in all the RCT's. We report here our assessment as to whether different disability measures are sufficiently comparable to allow pooling across trials.

Method

We used data from seven trials (n = 5015 patients) that had at least two of the following measurements: RMDQ (Roland Morris Disability Questionnaire), MVK (Modified Von Korff disability score), physical component scale of SF-12/36, Patient Specific Functional Scale, and Hannover Functional Ability Questionnaire. Within each trial, the change score between baseline and short-term follow-up was computed. These change scores were then converted from one outcome measure to another with linear regression and ridge-reroughed linear models. They were also tested for correlation and responsiveness (the ability to detect changes in condition, measured by standardised response means).


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 2 | Pages 244 - 249
1 Mar 2003
Debnath UK Freeman BJC Gregory P de la Harpe D Kerslake RW Webb JK

We studied prospectively 22 young athletes who had undergone surgical treatment for lumbar spondylolysis. There were 15 men and seven women with a mean age of 20.2 years (15 to 34). Of these, 13 were professional footballers, four professional cricketers, three hockey players, one a tennis player and one a golfer. Preoperative assessment included plain radiography, single positron-emission CT, planar bone scanning and reverse-gantry CT. In all patients the Oswestry disability index (ODI) and in 19 the Short-Form 36 (SF-36) scores were determined preoperatively, and both were measured again after two years in all patients. Three patients had a Scott’s fusion and 19 a Buck’s fusion.

The mean duration of back pain before surgery was 9.4 months (6 to 36). The mean size of the defect as determined by CT was 3.5 mm (1 to 8) and the mean preoperative and postoperative ODIs were 39.5 (sd 8.7) and 10.7 (sd 12.9), respectively. The mean scores for the physical component of the SF-36 improved from 27.1 (sd 5.1) to 47.8 (sd 7.7). The mean scores for the mental health component of the SF-36 improved from 39.0 (sd 3.9) to 55.4 (sd 6.3) with p < 0.001. After rehabilitation for a mean of seven months (4 to 10) 18 patients (82%) returned to their previous sporting activity.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 45 - 45
1 Jun 2012
Pulavarti R Vadhva M Wellington K Khatri M
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Aim

Assess efficacy of caudal epidural injection with epidurogram with validated outcome measures.

Introduction

The administration of local steroids and other drugs into caudal epidural space has been well established procedure in the management of low back pain with or without leg symptoms. Various studies have been done to assess the efficacy of the different routes of administration of epidural injections. However, only a few published prospective studies have been done on performing caudal epidural injections under fluoroscopic guidance with validated outcome measures.


Bone & Joint Open
Vol. 5, Issue 10 | Pages 886 - 893
15 Oct 2024
Zhang C Li Y Wang G Sun J

Aims. A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS approach and OSF for AL. Methods. A total of 39 patients diagnosed with AL who underwent surgery from January 2004 to December 2022 were retrospectively screened for eligibility. Patients with AL were divided into an MIS group and an OSF group. The primary outcomes were union of the lesion on radiograph and CT, as well as the visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores immediately after surgery, and at the follow-up (mean 29 months (standard error (SE) 9)). The secondary outcomes were total blood loss during surgery, operating time, and improvement in the radiological parameters: global and local kyphosis, sagittal vertical axis, sagittal alignment, and chin-brow vertical angle immediately after surgery and at the follow-up. Results. Data for 30 patients with AL were evaluated: 14 in the MIS group and 16 in the OSF group. All patients were followed up after surgery; no nonunion complications or instrumentation failures were observed in either group. No significant differences in the VAS and ODI scores were identified between the two groups. Mean ODI improved from 51 (SE 5) to 17 (SE 5) in the MIS group and from 52 (SE 6) to 19 (SE 5) in the OSF group at the follow-up. There were significant improvements in total blood loss (p = 0.025) and operating time (p < 0.001) between the groups. There was also no significant difference in local kyphosis six months postoperatively (p = 0.119). Conclusion. Early MIS is an effective treatment for AL. MIS provides comparable clinical outcomes to those treated with OSF, with less total blood loss and shorter operating time. Our results support and identify the feasibility of solid immobilization achieved by posterior instrumentation without bone graft via MIS for the treatment of AL. Cite this article: Bone Jt Open 2024;5(10):886–893