Osteoporosis and Endplate Damage Correlation Using a Combined Approach of Hounsfield Unit Values and Total Endplate Scores: A Retrospective Cross-Sectional Study.

PURPOSE: Osteoporosis and endplate damage, two primary orthopedic disorders that have adverse effects on the quality of life of older adults, may have some previously unknown relationship. The purpose of this study was to determine the potential association between osteoporosis and endplate damage with two specific imaging scoring systems and analyze the underlying mechanisms. PATIENTS AND METHODS: A cross-sectional study including 156 patients with degenerative disc disease (DDD) who visited our department in 2018 was performed. Data including age, sex, body mass index, Hounsfield unit (HU) values utilizing computed tomography (CT), and total endplate scores (TEPSs) using magnetic resonance imaging (MRI) of all patients were retrospectively collected and analyzed. The average HU value and TEPS of L1-L4 were used to represent the degrees of bone mineral density (BMD) and endplate damage, respectively. Patients with an HU value < 110 were defined as having osteoporosis and placed in the low-BMD group; otherwise, they were placed in the normal-BMD group. Multivariate logistic regression models were used to determine the independent factors of endplate damage. RESULTS: The TEPSs in the low-BMD group were significantly higher (6.4 ± 1.6 vs 5.0 ± 0.9, p < 0.001) overall and in every segment of L1-L4 (p < 0.01). A significant negative correlation was found between TEPS and HU values (p < 0.001). The HU value (odds ratio [OR] 0.221; 95% confidence interval [CI], 0.148-0.295, p < 0.001), age (OR 0.047; 95% CI, 0.029-0.224, p < 0.001), and BMD (OR 3.796; 95% CI, 2.11-7.382, p < 0.05) were independent factors influencing endplate damage. CONCLUSION: A significantly positive correlation was observed between osteoporosis and endplate damage, indicating the requirement for a more comprehensive therapeutic regimen for treating patients with DDD complicated with osteoporosis.

The effect of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk herniation.

PURPOSE: This study was conducted to determine the impact of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk hernia. DESIGN AND METHODS: The study was a nonrandomized pretest-posttest controlled quasi-experimental research and carried out in a total of 64 patients. A personal information form, the Depression Anxiety Stress Scale, the Psychological Well-Being Scale, and the Pain Beliefs Scale were used for data collection. FINDINGS: We observed a statistically significant difference between the intervention and control groups in terms of the posttest mean scores of the psychiatric symptoms, psychological well-being, and pain beliefs. PRACTICE IMPLICATIONS: The results revealed that mindfulness-based therapy has a positive impact on pain beliefs and psychological well-being.

Impact of knowledge, attitude, and practice (KAP)-based rehabilitation education on the KAP of patients with intervertebral disc herniation.

BACKGROUND: This study aims to quantify the effectiveness of knowledge, attitude, and practice (KAP)-based rehabilitation education on the KAP of patients with intervertebral disc herniation (IDH). METHODS: Seventy IDH patients undergoing conservative treatment in our center from February 2018 to December 2018 were randomly divided into the KAP group and control group by using a table of random numbers. The control group was given traditional health education, while the KAP group was offered with KAP-based rehabilitation education. Both groups were followed up for 3 months after their discharge from the hospital. A self-designed questionnaire form was used to evaluate the KAP quantities of patients. RESULTS: Before health education, the scores of knowledge in the control group and the KAP group were (15.12±3.12) and (15.20±3.28), respectively, showing no significant difference (P>0.05). After the health education, the total score of knowledge, the score of disease knowledge, the score of attitude, and the score of practice were (25.42±3.16), (7.66±0.73), (7.80±0.36), and (7.85±0.68), respectively, in the KAP group, which were significantly higher than those in the control group [(20.31±3.43), (6.83±0.92), (6.41±1.05), and (7.10±1.11), P<0.05]. After health education, the awareness rates of the disease, attitude, and behavior were significantly higher in the KAP group than in the control group (P<0.05). CONCLUSIONS: Rehabilitation education based on the KAP theory can effectively enhance the patients' awareness of the disease, increase their rehabilitation consciousness, and promote them to adopt positive rehabilitation behavior, thus achieving the goal of changing the patients' KAP.

Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life.

STUDY DESIGN: A prospective cross-sectional study. OBJECTIVE: To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination. SUMMARY OF BACKGROUND DATA: Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain. METHODS: Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale. RESULTS: 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ±â€Š11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02). CONCLUSION: Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments. LEVEL OF EVIDENCE: 2.

How I Thought Myself into Illness, Then Thought My Way Out.

When doctors couldn't find an explanation for my mysterious symptoms, including back pain, aching joints, and tingling limbs, I went on a quest to uncover the root causes. My journey took me from the West Coast to the East Coast, from physical therapists to psychiatrists, from the body to the mind, chronic pain to repressed emotions, existential crisis to posttraumatic growth.

Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Worker's Compensation Setting.

STUDY DESIGN: This study retrospectively analyzes prospectively collected data. OBJECTIVE: Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status. SUMMARY OF BACKGROUND DATA: Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients. METHODS: All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores. RESULTS: Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2-90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time. CONCLUSION: Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery. LEVEL OF EVIDENCE: 3.

A web-based platform to accommodate symptoms of anxiety and depression by featuring social interaction and animated information in patients undergoing lumbar spine fusion: a randomized clinical trial.

BACKGROUND: Approximately one-third of patients undergoing spine surgery have symptoms of anxiety and depression that correlate with pain, disability, and lower health-related quality of life. The use of web-based informative strategies before surgery and principles from cognitive behavioral therapy, have been applied in other patient groups, facilitating mobility and encouraging beneficial coping behavior. PURPOSE: To examine the effect of a web-based Spine Platform featuring Interaction and Information by Animation (w-SPIINA) on symptoms of anxiety and depression, pain, disability, and health-related quality of life. STUDY DESIGN: A single-center, two-arm, randomized controlled trial PATIENT SAMPLE: One hundred fourteen consecutive patients scheduled for instrumented lumbar spine fusion due to degenerative disc disease or spondylolisthesis. OUTCOME MEASURES: Primary outcome was the change in self-reported Hospital Anxiety and Depression Scale (HADS) scores from baseline to 3-month follow-up. Secondary outcomes were change in HADS 1-day before surgery 2days and 6 months after and changes in self-reported disability measured on the Oswestry disability index (ODI), quality of life (EQ-5D-5L questionnaire), and the low back pain rating scale (LBPRS) 2days and 3 and 6 months after surgery. METHOD: Patients were randomized to either a control group receiving a standard information regimen or an intervention group gaining access to w-SPIINA in addition to the standard regimen. The independent charity Helsefonden contributed $45,000, the Health Research Fund of the Regional Hospital Central Jutland contributed $10,000, and the Toyota foundation contributed $10,000 to remunerate a dedicated investigator. The authors have no conflict of interest to declare. RESULTS: There was no statistically significant difference within the w-SPIINA group and the control group regarding changes in HADS at 3-month follow-up (p≥.37). Approximately 40% reached minimum clinically important difference (MCID) in the w-SPIINA group on the HADS at 3 months. In the control group 50% reached MCID on anxiety subscale and 35% on the depression subscale at 3 months. No statistically significant differences were found between groups with regard to the overall outcomes at any of the predefined time points. CONCLUSION: Providing patients with access to w-SPIINA in addition to a standard information regimen had no additional effect on HADS and patient-reported outcomes1day before, 2days, 3 or 6 months after surgery. However, a high compliance and degree of interaction with w-SPIINA indicates that this mode of web-based support could be applicable in this group of patients.

The impact of health literacy on health status and resource utilization in lumbar degenerative disease.

BACKGROUND CONTEXT: Health literacy, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," has been demonstrated to affect access to care and appropriate healthcare utilization. PURPOSE: To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain. STUDY DESIGN: Cross sectional. PATIENT SAMPLE: Patients seen at a multisurgeon spine specialty clinic. OUTCOME MEASURES: Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0-10) for back and leg pain. METHODS: The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities. RESULTS: Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p = .017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8). CONCLUSIONS: Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes.

Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery.

OBJECTIVE: To investigate the predictive value of preoperative fear-avoidance factors (self-efficacy for exercise, pain catastrophizing, kinesiophobia, and depression), walking capacity, and traditional predictor variables for predicting postoperative changes in physical activity level and disability 6 months after lumbar fusion surgery in patients with chronic low back pain (LBP). METHODS: We prospectively enrolled 118 patients scheduled for lumbar fusion surgery for motion-elicited chronic LBP with degenerative changes in 1-3 segments of the lumbar spine. Associations between the predictors and the dependent variables were investigated with multiple linear regression analysis. Dependent variables were physical activity level as objectively measured with a triaxial accelerometer and disability as measured with the Oswestry Disability Index. RESULTS: Preoperative physical activity level (ß = -0.349; P < 0.001) and self-efficacy for exercise (ß = 0.176; P = 0.021) were significant predictors of the postoperative change in physical activity. Preoperative disability (ß = -0.790; P < 0.001), self-efficacy for exercise (ß = 0.152; P = 0.024), and pain catastrophizing (ß = 0.383; P = 0.033) were significant predictors for the change in the Oswestry Disability Index. CONCLUSIONS: Patients with low levels of preoperative physical activity were more likely to increase their level of physical activity after lumbar fusion surgery, especially when their self-efficacy for exercise was high. However, most of these patients still had low levels of physical activity after surgery, and they may therefore need extra support in increasing their postoperative physical activity levels.

A Novel Non-invasive Effective Method for Potential Treatment of Degenerative Disc Disease: A Hypothesis.

The pathophysiology of the intervertebral discs plays a significant role in the people's life quality. There is not adequate research done in the pathogenesis and treatment of intervertebral disc degeneration. Alternately, self-educated physiology offers a novel and noninvasive method to reverse the degenerated discs. In this single case study, report attempts have been made to highlight the effect of the self-educative physiology, on magnetic resonance imaging investigations, of progressive healing, on the degenerated intervertebral discs. Based on this novel method, an effort has been made to review literature on the degeneration of intervertebral discs and available mode of treatments and then to propose a hypothesis for the biochemical mechanisms of healing. The idea is that transforming growth factor-ß1 from seminal plasma secretions may contribute to releasing the osteogenic protein- 1 which induces nucleus pulposus and annulus fibrosus cells in intervertebral discs for repairs. In addition, the patient's medical history is presented with background information.