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OBJECTIVE@#To compare the clinical efficacy on lumbar muscle strain with cold and dampness between the different operation sequences of acupuncture and cupping therapy.@*METHODS@#Seventy-six patients with lumbar muscle strain with cold and dampness were randomly divided into an acupuncture + cupping group (A + C group, 38 cases) and a cupping + acupuncture group (C + A group, 38 cases, 1 case dropped off). In the A + C group, cupping therapy was delivered 10 min after the end of treatment with acupuncture, while in the C + A group, acupuncture therapy was exerted 10 min after the end of treatment with cupping. Acupuncture was applied to Mingmen (GV 4), Yaoyangguan (GV 3), ashi point and bilateral Shenshu (BL 23), Dachangshu (BL 25), Weizhong (BL 40) and Yanglingquan (GB 34), and the needles were retained for 30 min in each intervention. Flash cupping was operated along the bilateral sides of the lumbar spine for 3 min, and the cups were retained for 10 min at bilateral Shenshu (BL 23), Dachangshu (BL 25) and ashi points. The intervention was delivered once every two days, 3 times weekly, for 3 weeks totally in each group. The scores of visual analogue scale (VAS) and Oswestry disability index (ODI), TCM syndrome score and the mean temperature of the lumbar region before and after treatment were compared between the two groups. The safety and the clinical efficacy were assessed for the interventions of the two groups.@*RESULTS@#Compared with the values before treatment, except for the sleep score of ODI, the VAS scores, ODI scores and TCM syndrome scores were decreased after treatment (P<0.01, P<0.05); while the mean temperature of the lumbar region was increased (P<0.01) in both groups. After treatment, the VAS score and the pain score of ODI in the C + A group were lower than those in the A + C group (P<0.05). The incidence rate of adverse reactions of the C + A group was lower than that of the A + C group (P<0.01). The effective rate in the A+C group was 92.1% (35/38), that in the C+A group was 94.6%(35/37), there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#Different operation sequences between acupuncture and cupping therapy obtain the similar efficacy on lumbar muscle strain with cold and dampness, but cupping therapy delivered prior to acupuncture has certain advantages in relieving pain and improving safety.
الموضوعات
Humans , Cupping Therapy , Acupuncture Therapy , Cold Temperature , Pain , Syndrome , Musclesالملخص
Objective:To observe the clinical effectiveness of manual therapy based on posture decoding for patients with lower crossed syndrome (LCS).Methods:Thirty-six LCS patients were randomly divided into an observation group and a control group, each of 18. The observation group received manual therapy based on posture decoding, while the control group was treated with proprioceptive neuromuscular facilitation (PNF), both in 20min sessions, once a week for 4 weeks. Before the experiment, after one, two and four weeks of treatment and followed-up 4 and 8 weeks later, both groups were evaluated using a visual analogue scale (VAS), the Oswestry Disability Index (ODI) and finger-floor distance (FFD). Anterior pelvic tilt angles (ASIS-PSISs), sacral slopes (SS), lumbar curve index (LCI) and surface EMG flexion-relaxation ratios (FRRs) were also recorded from both groups before and after the treatment.Results:After one and four weeks of the treatment, the average VAS, ODI, and FFD had decreased significantly in both groups, with all significantly lower in the observation group, on average. At the final follow-up, the average VAS and ODI scores of both groups were significantly lower than before the treatment, with those of the observation group significantly lower than the control group′s averages. After 4 weeks of treatment significant differences were observed also in the group′s average ASIS-PSISs, SSs and LCIs compared with before the treatment. And right after the treatment the left and right surface electromyography FRRs of the observation group were significantly higher than those of the control group.Conclusion:Manual therapy based on posture decoding can significantly improve the pelvis forward angle and lumbar motion of LCS patients, relieving back pain and relaxing back muscles.
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Objectives The relevance of spinopelvic parameters in the patients' clinical and functional outcomes has been widely studied in long spinal fusion. Yet, the importance of the spinopelvic parameters in short-segment fusion surgeries needs further investigation. We analyzed the spinopelvic parameters and surgical outcomes of patients undergoing short-segment lumbar interbody fusion. Materials and Methods An observational, prospective study was conducted between January and June 2021. We selected 25 patients with lumbar stenosis, with or without concomitant spondylolisthesis, undergoing transforaminal lumbar interbody fusion. Variables related to the patient, diagnosis, and surgery were collected. The clinical and functional outcomes were assessed using the Visual Analogue Scale for low-back and leg pain and the Oswestry Disability Index (ODI). The surgical outcomes and spinopelvic parameters were analyzed pre- and postoperatively. Results There was a significant clinical and functional improvement after surgery (p < 0.001), with a mean ODI decrease of 63.6%. The variables of obesity, concomitant spondylolisthesis, absence of osteotomy, and two-level fusion were all associated with lower levels of improvement after surgery (p < 0.05). Pelvic incidence minus lumbar lordosis (PI-LL) was the only parameter that significantly changed regarding the pre and postoperative periods (p < 0.05). Before surgery, PI-LL < 10° correlates with less low-back pain after surgery (r » 0.435; p < 0.05). Postoperatively, no correlation was found between surgical outcomes and all the spinopelvic parameters analyzed. Conclusions The clinical and functional outcomes significantly improved with the surgical intervention but did not correlate with the change in spinopelvic parameters. Patients with preoperative PI-LL < 10° seem to benefit the most from surgery, showing greater improvement in back pain.
Objetivos A influência dos parâmetros espinopélvicos nos resultados clínicos e funcionais dos pacientes tem sido amplamente estudada nas cirurgias de fusão espinhal que envolvem longos segmentos. Contudo, a literatura é escassa acerca da fusão de segmentos curtos. Analisamos assim os parâmetros espinopélvicos e os resultados cirúrgicos de pacientes submetidos a fusão intersomática lombar de segmentos curtos. Materiais e Métodos Realizou-se um estudo prospectivo observacional entre janeiro e junho de 2021. Selecionaram-se 25 pacientes com estenose lombar, com ou sem espondilolistese, submetidos a fusão intersomática lombar transforaminal. Colheram-se dados relacionados com o paciente, o diagnóstico e a cirurgia. Os resultados clínicos e funcionais foram avaliados por meio da Escala Visual Analógica para dor lombar e dos membros inferiores e pela Escala de Incapacidade de Oswestry (Oswestry Disability Index, ODI, em inglês). Os resultados cirúrgicos e os parâmetros espinopélvicos foram analisadas no pré e no pós-operatório. Resultados Verificou-se uma melhoria clínica e funcional significativa após a cirurgia (p < 0,001), com redução média do ODI de 63,6%. As variáveis obesidade, espondilolistese concomitante, ausência de osteotomia e fusão de dois níveis associaram-se a menor melhoria no pós-operatório (p < 0,05). O único parâmetro que mudou significativamente antes e após a cirurgia (p < 0,05) foi a incidência pélvica menos a lordose lombar (IP-LL). No pré-operatório, uma IP-LL < 10° correlacionou-se com menos dor lombar após a cirurgia (r » 0,435; p < 0,05). No pós-operatório, não houve correlação entre os resultados clínicos e funcionais e os parâmetros espinopélvicos. Conclusão Os resultados clínicos e funcionais melhoraram significativamente após a cirurgia, mas não se correlacionam com a mudança dos parâmetros espinopélvicos. Pacientes com IP-LL< 10° no pré-operatório apresentam maior melhoria da dor lombar no pós-operatório.
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Lumbar disc herniation is a major health problem, affecting the most productive population globally. It has closest resemblance with Gridhrasi mentioned in Ayurvedic classics. Treatments available in conventional sciences have limitations such as relapse of acute episodes. Here an effort was made to treat a case of L5-S1 disc extrusion with radiculopathy using a comprehensive Ayurveda treatment protocol. The protocol includes a set of treatment procedures along with certain internal medicines. Changes were analysed with the help of VAS scale, SLRT and Oswestry disability index and showed significant improvements. This case is an evidence to demonstrate the effectiveness of Ayurveda treatments in case of LDH with radiculopathy.
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BACKGROUND: Percutaneous curved vertebroplasty is a new method for the treatment of osteoporotic vertebral compression fractures, which can achieve a good therapeutic effect, while the distribution of bone cement has not been explored thoroughly. OBJECTIVE: To retrospectively analyze the therapeutic effect of percutaneous curved vertebroplasty and the distribution characteristics of bone cement in the treatment of osteoporotic vertebral compression fractures. METHODS: A total of 28 patients with osteoporotic vertebral compression fractures of a single thoracic or lumbar vertebrate, who were admitted to Qingdao Municipal Hospital from June 2017 to February 2018, including 2 males and 26 females, aged 62-86 years old, underwent percutaneous curved vertebroplasty and were retrospectively reviewed. The bone cement was injected at the puncture side, the middle of the vertebrate and the contralateral side respectively. The change of anterior vertebral body height of the injured vertebrae and the leakage of bone cement postoperatively were observed according to X-ray images preoperatively, 48 hours and 6 months postoperatively. The bone cement distribution within the vertebrate was observed by CT scanning. Visual analogue scale score and Oswestry disability index were recorded for the evaluation of recovery. All protocols were approved by the Ethical Committee of Qingdao Municipal Hospital. RESULTS AND CONCLUSION: (1) There were 6 out of 28 cases of bone cement leakage, including 4 cases of paravertebral leakage and 2 cases of intervertebral space leakage, and no clinical symptoms were observed in all the 6 cases. CT scanning showed that the bone cement was mainly distributed in the anterior 2/3 of the vertebral body. The maximum distribution area of bone cement was (4.5±0.9) cm2, with the contralateral area (2.0±0.5) cm2 and the puncture side area (2.5±0.7) cm2, which makes the ratio of the puncture side area versus contralateral area 0.85±0.27. (2) The anterior vertebral body heights preoperatively showed no significant difference than those postoperatively in 28 patients (P > 0.05). (3) The visual analogue scale score and Oswestry disability index 48 hours and 6 months postoperatively were both significantly different from those before operation (P < 0.05). (4) The results showed that percutaneous curved vertebroplasty treatment of osteoporotic vertebral compression fractures has the advantages of accurate surgical effects and even distribution of bone cement.
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BACKGROUND: Percutaneous kyphoplasty (PKP) has become an effective method for the treatment of osteoporotic vertebral compression fractures, but the distribution of bone cement in the vertebral body can cause certain differences in postoperative clinical symptoms. OBJECTIVE: To investigate the clinical effect of bone cement distribution on the treatment of vertebral compression fractures in different sites after percutaneous kyphoplasty. METHODS: A retrospective analysis of eligible 339 patients with vertebral compression fractures at different sites who received treatment at the Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University from January 2017 to January 2019 were included in this study. These patients were aged 60-85 years. They were divided into a thoracic fracture group (n=144) and a lumbar fracture group (n=195). All patients received bone cement injection after percutaneous kyphoplasty. After surgery, the diffusion distribution of bone cement in the vertebral body was divided into I-V types in each group. Visual Analogue Scale score and Oswestry Disability Index were evaluated before surgery, and 3 days and 6 months after surgery. This study was approved by the Medical Ethics Committee, Affiliated Zhongshan Hospital of Dalian University, China. RESULTS AND CONCLUSION: (1) At 3 days and 6 months after surgery, Visual Analogue Scale score and Oswestry Disability Index were significantly decreased compared with before surgery (P 0.05). (3) At 6 months after surgery, there was no significant difference in Oswestry Disability Index between different distribution types of bone cement in the thoracic fracture group (P > 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in those with types IV and V bone cement distribution (P 0.05). At 6 months after surgery, Visual Analogue Scale score in patients with types I, II and III bone cement distribution was significantly lower than in that in patients undergoing types IV and V bone cement distribution (P < 0.05). (5) These results suggest that after percutaneous kyphoplasty, bone cement distributed in types I-III can lead to better pain relief than that distributed in other types.
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BACKGROUND: Percutaneous kyphoplasty (PKP) for the treatment of osteoporotic compression fractures has been widely recognized in clinical practice, but clinicians are still impelled to seek for new treatment regimens due to complications such as bone cement leakage and adjacent vertebral re-fracture. OBJECTIVE: To compare the therapeutic efficacy of facet joint injection (FJI) and PKP in the treatment of mild vertebral fragility fractures. METHODS: Forty-six patients with mild vertebral fragility fractures (osteoporotic fractures) were divided into FJI group and PKP group according to the treatment regimens. The two groups of patients were treated with FJI and PKP separately based on standardized anti-osteoporosis treatment. The data of each group were recorded before and 1 week, 1, 3, 6, and 12 months after treatment. The analgesic efficacy was evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI). Spine stability was evaluated by anterior vertebral height, kyphotic angle and lumbar spine density and the incidence of re-fracture were compared. The study protocol was implemented in line with the ethic requirements of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences in China. Informed consent was obtained from each patient. RESULTS AND CONCLUSION: Intragroup comparison: VAS and ODI scores of patients in both groups were significantly decreased in each period after treatment compared with the baseline (P 0.05). After treatment, the anterior vertebral body height and kyphosis angle in the PKP group were better than those in the FJI group (P 0.05). Standardized anti-osteoporosis treatment with either FJI or PKP can provide effective analgesia for patients with mild vertebral fragility fracture, and PKP has certain advantages in rapid analgesia and recovery of spinal stability.
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BACKGROUND: Percutaneous curved vertebroplasty is a modified surgical method of percutaneous vertebroplasty; the most prominent feature of which is that it can make the bone cement distributed symmetrically and balance the strength on both sides of the vertebral body. In theory, it can ensure the distribution of bone cement in the vertebral body, and solve the problem that the uneven distribution of bone cement in the traditional percutaneous vertebroplasty and single injection leads to poor pain relief effect in the fracture area. OBJECTIVE: To compare the clinical efficacy of percutaneous curved vertebroplasty and percutaneous vertebroplasty bone cement injection in the treatment of osteoporotic vertebral compression fractures, and to discuss the value of percutaneous curved vertebroplasty in clinical application. METHODS: Seventy patients with single vertebral osteoporotic vertebral compression fractures from the Third Affiliated Hospital of AnHui Medical University between 2017 and 2018 were selected. The patients were randomly divided into two groups. Percutaneous curved vertebroplasty group (n=35) received treatment with percutaneous curved vertebroplasty. Percutaneous vertebroplasty group (n=35) received treatment with percutaneous vertebroplasty. Distribution and leakage of bone cement were observed in the two groups. Visual analogue scale score and Oswestry disability index were assessed preoperatively and 1 day postoperatively. Postoperative follow-up was conducted for 1 year to observe the recovery of the height of the anterior edge of the injured vertebra and the occurrence of adjacent vertebral fractures. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) Compared with the percutaneous vertebroplasty group, the distribution of bone cement was more uniform and satisfactory (P0.05). (4) There was no significant difference in the incidence of adjacent vertebral fractures between the two groups (P>0.05). (5) The results showed that compared with the treatment of percutaneous vertebroplasty, the treatment of osteoporotic vertebral body compression fractures by percutaneous curved vertebroplasty can reduce the rate of bone cement leakage and improve the quality of life of patients.
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Background: Many different treatment modalities have been advocated by different authors from time to time for lumbarspondylolisthesis. Many cases, the condition can be treated conservatively. However, when the symptoms persist, surgeryneeds to be performed. The principle of underlying surgery includes stabilization of the slipping vertebrae. Various operativemethods encompassing this principle include stabilization with pedicle screw fixation and fusion which can either posterolateralor interbody fusion, anterior lumbar interbody fusion, posterior lumbar interbody fusion, or transforaminal lumbar interbodyfusion. The objective of this study was to compare the surgical efficacy in terms of stability and fusion achieved using pediclescrew-rod instrumentation with posterolateral fusion and pedicle screw-rod instrumentation with interbody fusion in lumbarspondylolisthesis and to study THE functional and clinical recovery using the Revised Oswestry Disability Index score.Materials and Methods: A prospective study was carried out to compare the clinical and radiological outcomes between Pediclescrew-rod instrumentation with either posterolateral fusion and interbody fusion after adequate decompression in patient oflumbar spondylolisthesis. All patients as per the inclusion criteria were admitted, underwent surgery between March 2010 andMarch 2012, and were included in the study.Results: The total of 50 patients was included in our study. Both male and female patients were equally distributed in both thegroups, wherein postreolateral fusion had 13 female patients and those with interbody fusion had 13 male patients. Our studyshows marked improvement in Revised Oswestry Disability score postoperatively with good-to-excellent results in both thegroups. We achieved good solid radiological fusion earliest on the 3rd month in both the groups with good stability.Conclusion: Our results showed similar clinical and functional outcome in both the groups with no significant statistical differencefound. However, we conclude that in cases where reduction is required and there is instability affecting the three column ofspine interbody fusions with pedicle screws-rod instrumentation provide a more solid mechanical construct.
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Spondylolisthesis is described as a translation of a vertebra with respect to the vertebra below without any modification or notable lesion to the pars interarticularis. Lumbar spondylolisthesis can be considered as various conditions like Kati shoola, Kati Graha, Trika Graha, Prushta Graha, Trika Shoola, Prushta Shoola, Grudrasi in Ayurveda. The present article deals with a case of diagnosed Grade 1 lumbar spondylolisthesis of L4 over L5 and got advised for surgery. The Ayurvedic diagnosis of Kati soola was made. Management included Abhyanga, Kativasti, Kshira vasti, Virechana, Vaitarana vasti and Chincha lavana sweda along with internal medications. Chincha lavana sweda is a very simple and effective Swedana procedure to cure pain in low back, especially due to Spondylolisthesis. But it is not widely used. This case report also wants to introduce the technique to Ayurvedic practitioners who are unaware of it. Before treatment, total score on Oswestry low back pain disability questionnaire was 34 (68%) and at the time of discharge, the score was 8 (16%). On Roland-Morris low back pain and disability questionnaire, the before treatment score was 17 and at the time of discharge it was reduced to 4. That means the patient showed an improvement of 76% on Roland-Morris low back pain and disability questionnaire. The present case report substantiates effectiveness of classical Ayurvedic Management in spondylolosthesis.
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OBJECTIVE@#To evaluate the predictive value of ODI, SBI and SF-36 in patients with recurrent lumbar disc herniation undergoing reoperation.@*METHODS@#The patients of recurrent lumbar disc herniation underwent surgical treatment from June 2013 to December 2015 were enrolled in the study. Patients were assigned to A, B, C groups according to the excellent, good, poor of clinical efficacy, and divided into training set and test set by 70:30 ratio according to random number table. we use ordered Logistic regression to construct prediction model, and test set to verify the effect of the model and calculate the accuracy of the model.@*RESULTS@#Both ODI and SBI were lower in group A and group B than group C, and the SF-36 scale was significantly higher than group C (<0.05). The predictive efficacy model by ordered Logistic regression construction showed that the ODI coefficient was 0.67, the SF-36 coefficient was -0.43, and the SBI coefficient was 0.52. In the group A with excellent clinical efficacy, the prediction accuracy rate of the model was 80%; in the group B with good clinical efficacy, the prediction accuracy rate was 76.92% and in the group C with poor clinical efficacy, the prediction accuracy rate was 44.44%.@*CONCLUSIONS@#Comprehensive consideration of ODI, SBI and SF-36 to construct a clinical prediction model for patients with recurrent intervertebral disc herniation after surgery can better predict patients' prognosis. It has a value for clinical application.
الموضوعات
Humans , Intervertebral Disc Displacement , Lumbar Vertebrae , Reoperation , Treatment Outcomeالملخص
STUDY DESIGN: A retrospective case-control study. PURPOSE: To evaluate the effect of nitrous oxide and anesthetic and operative factors associated with severe pain in the early postoperative period after thoracolumbar spine surgery. OVERVIEW OF LITERATURE: Thoracolumbar spine surgery is the most common procedure in spine surgery, and up to 50% of the patients suffer from moderate to severe pain. Nitrous oxide has analgesic, anxiolytic, and anesthetic effects; nevertheless, its benefits for early postoperative pain control and opioid consumption remain to be established. METHODS: The medical records of eligible participants who underwent thoracolumbar spine surgery between July 2016 and February 2017 were reviewed. Enrolment was performed consecutively until reaching 90 patients for the case (severe pain) group (patients with a pain score of >7 out of 10 at least once during the post-anesthesia care unit [PACU] admission), and 90 patients for the control (mild-to-moderate pain) group (patients with a pain score of <7 in every PACU assessment). The data collected comprised patient factors, anesthetic factors, surgical factors, PACU pain score, and PACU pain management. RESULTS: A total of 197 patients underwent thoracolumbar spine surgery with an incidence of early postoperative severe pain of 53.3%. The case-control study revealed no differences in the factors related to pain intensity. A subgroup analysis was performed for failed back surgery syndrome (FBSS), spinal stenosis, and spondylolisthesis. After multivariate analyses, only the age group of 19–65 years and the baseline Oswestry Disability Index (ODI) were found to be significant risk factors for early postoperative severe pain in the PACU (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.32–6.25; OR, 1.03; 95% CI, 1.01–1.05, respectively). CONCLUSIONS: Nitrous oxide, anesthetic agents, and surgical techniques did not affect the early postoperative pain severity. Age under 66 years and the baseline ODI were the significant risk factors for pain intensity during the early postoperative period of the FBSS, spinal stenosis, and spondylolisthesis subgroups.
الموضوعات
Humans , Analgesia, Patient-Controlled , Anesthetics , Case-Control Studies , Failed Back Surgery Syndrome , Incidence , Medical Records , Multivariate Analysis , Nitrous Oxide , Pain Management , Pain, Postoperative , Postoperative Period , Retrospective Studies , Risk Factors , Spinal Stenosis , Spine , Spondylolisthesisالملخص
OBJECTIVE@#To observe the effect of " Acupuncture" on postpartum low back pain.@*METHODS@#A total of 98 cases of postpartum low back pain were randomly divided into a control group (45 cases, 4 cases dropping) and a treatment group (47 cases, 2 cases dropping). Conventional acupuncture was treated in the control group, and " Acupuncture" was added in the treatment group on the basis treatment in the control group, acupuncture was applied at Baihui (GV 20), Neiguan (PC 6), Taichong (LR 3). The treatment was given 30 minutes each time, 5 times a week, 10 times for a total course of treatment. Before and after treatment, pain was assessed by the short-form of McGill pain questionnaire (SF-MPQ), dysfunction was assessed by Oswestry disability index (ODI), and depression was assessed by the Edinburgh postnatal depression scale (EPDS). And the changes of various indexs were observed before and after treatment.@*RESULTS@#After treatment, the pain grade index (PRI) score, visual analog scale (VAS) score and present pain intensity (PPI) score in SF-MPQ of the control group and the treatment group were significantly lower than those before treatment (all <0.001). The ODI score and EPDS score were also significantly lower than those before treatment (all <0.001). The decline scores of the treatment group before and after treatment were significantly higher than those in the control group (<0.001, <0.01).@*CONCLUSION@#" Acupuncture" combined with conventional acupuncture and conventional acupuncture can effectively improve the symptoms of pain, dysfunction and depression in patients with postpartum low back pain, and the former is significantly better than the latter.
الموضوعات
Female , Humans , Acupuncture Points , Acupuncture Therapy , Low Back Pain , Pain Measurement , Postpartum Period , Treatment Outcomeالملخص
STUDY DESIGN: Prospective observational study. PURPOSE: To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. OVERVIEW OF LITERATURE: The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI. METHODS: In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients. RESULTS: According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach's alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach's alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach's alpha=0.712, p>0.05) and pain (Cronbach's alpha=0.625, p>0.05). CONCLUSIONS: A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.
الموضوعات
Humans , Activities of Daily Living , Back Pain , Developing Countries , India , Low Back Pain , Observational Study , Prospective Studies , Sexual Behavior , Spine , Visual Analog Scale , Walking , Weight Liftingالملخص
PURPOSE: To assess the association between frailty and osteoporotic vertebral compression fracture (OVCF) and to evaluate the relationship between numbers of OVCFs and frailty. MATERIALS AND METHODS: We enrolled 760 subjects, including 59 patients (with OVCF) and 701 controls (without OVCF). Successful matching provided 56 patient-control pairs. We analyzed principal clinical and demographic information, which included sex, age, height, weight, body mass index (BMI), variable frailty phenotypes, and Oswestry Disability Index (ODI) and EuroQol 5-dimension questionnaire (EQ-5D) scores. The association between frailty and OVCF was ascertained. In addition, the degrees of disability and quality of life attributable to frailty were determined. RESULTS: The prevalence of frailty was significantly higher in the OVCF group than in the control group (p < 0.001). Most of the frailty phenotypes, such as exhaustion, physical inactivity, slowness, and handgrip strength, were also significantly observed in the OVCF group. Within the OVCF group, the participants with frailty had significantly higher disability and lower quality of life than those in a robust state (p < 0.001 for ODI and EQ-5D). In addition, the multivariate logistic regression analysis demonstrated that the patients with low BMI [odds ratio (OR)=0.704; 95% confidence interval (CI), 0.543–0.913] and ≥3 fractures (OR=9.213; 95% CI, 1.529–55.501) within the OVCF group were associated with higher odds of frailty. CONCLUSION: The present study showed significant relationships between frailty and OVCF, severity of symptoms, and disability induced by OVCF. Furthermore, frailty could be a causal and/or resulting factor of OVCFs.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Case-Control Studies , Fractures, Compression/complications , Frailty/complications , Osteoporotic Fractures/complications , Prevalence , Propensity Score , Quality of Life , Spinal Fractures/complications , Treatment Outcomeالملخص
STUDY DESIGN: A cross-sectional, case-control study. PURPOSE: To investigate associations between physical fitness measures and disabilities related to back pain and quality of life (QOL) by the presence of symptomatic lumbar spinal stenosis (LSS) in elderly Korean women. OVERVIEW OF LITERATURE: LSS leads to decreased functioning and reduced QOL. However, correlations among physical fitness, disability, and QOL have not been investigated in elderly women with LSS. METHODS: Participants included women aged 65 years and older (n=192), divided into a study group (n=38) and a control group (n=154) based on the presence/absence of LSS. All participants underwent physical function and fitness tests. Oswestry disability index (ODI) scores and EuroQol five-dimensional questionnaire (EQ-5D-5L) scores were used to assess disability and health-related QOL. RESULTS: The results for the handgrip strength, sit-and-reach, functional reach, and timed up and go (TUG) tests were significantly higher in the control group than the LSS group. ODI scores were significantly higher and EQ-5D-5L scores significantly lower in the LSS group. TUG and functional reach test scores were significantly correlated with ODI scores, and handgrip strength was strongly interrelated with ODI and EQ-5D-5L scores in the LSS group. No other physical fitness measures showed statistically significant relationships with ODI or EQ-5D-5L scores. CONCLUSIONS: In elderly Korean women with LSS, back pain-related disability and QOL are significantly associated with some physical fitness parameters such as handgrip strength. Handgrip strength reflects general muscle strength, which is significantly interrelated with the level of disability and QOL. Our results suggest that enhancing generalized muscle strength helps to reduce disability due to back pain and improve QOL in patients with LSS.
الموضوعات
Aged , Female , Humans , Back Pain , Case-Control Studies , Lumbar Vertebrae , Muscle Strength , Physical Fitness , Quality of Life , Spinal Stenosisالملخص
Objective To investigate the therapeutic effect of short thrust needling on osteoporotic vertebral compression fractures.Method Seventy-two patients with osteoporotic vertebral compression fractures were randomly allocated to observation and controlgroups, 36 cases each.In the observation group,short thrust needlingwas used with lifting-thrusting and twirling manipulation; the bone was rubbed with the needle tip up anddownin the place near the bone; reinforcing manipulation was performed for nine times after arrival of qi.The control group received conventional acupuncture with uniform reinforcing-reducing manipulation.Both groups were treated four weeks as a course for two courses.The Visual Analogue Scale(VAS) score and the Oswestry Disability Index (ODI)score were recorded in the two groups before and after four and eight weeks of treatment.The clinical therapeutic effects were evaluated.Result The total efficacy rate was 94.4% in the observation group.Which was higher than 66.7% in the control group (P<0.05).Boththe VAS and ODI scores were lower after treatment compared with before (P<0.05) and decreased significantly more in the observation than in the control group(P<0.05).Conclusion Short thrust needling canmarkedly relieve the pain and dysfunction in patients with osteoporotic vertebral compression fractures.Its the rapeutic effect is significantly better than that of conventional acupuncture.
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Objective To investigate the clinical improving effect on the symptoms of acupuncture at point Weizhong(BL40) plus following lumbar vertebra-stabilizing core muscle group training in patients with lumbar intervertebral disc herniation. Method Sixty patients with lumbar intervertebral disc herniation were randomized to a treatment group (30 cases) and a control group (30 cases). The treatment group received acupuncture at point Weizhong plus following lumbar vertebra-stabilizing core muscle group training and the control group, oral administration of celecoxib capsules. After treatment, the clinical improving effect on the symptoms was evaluated in the patients using the NRS, JOA Lumbar Scoring and ODI. Result The total efficacy rate was 100% in the treatment group and 53.3%in the control group. Post-treatment NRS, JOA and ODI scores were better in the treatment group than in the control group; there were statistically significant differences (P<0.001). Conclusion Acupuncture at point Weizhong plus following lumbar vertebra-stabilizing core muscle group training can effectively treat lumbar intervertebral disc herniation.
الملخص
OBJETIVOS: Establecer la evolución funcional y condición neurológica con la escala de Oswestry en la biomecánica de la columna lumbar en pacientes que fueron intervenidos mediante descompresión neurológica y artrodesis posterolateral más estabilización con tornillos transpediculares por presentar diagnóstico de canal lumbar estrecho (CLE) en el Hospital Obrero N°1 de la ciudad de La Paz, Bolivia, durante las gestiones 2012 a 2014. Identificar los factores clínicos, socio-demográficos de pacientes en los cuales se realizó artrodesis en columna vertebral por canal lumbar estrechó. MÉTODOS: Se realizó un estudio retrospectivo, descriptivo, de corte transversal de pacientes en los cuales se realizó artrodesis postero-lateral por CLE en el servicio de ortopedia traumatología entre las gestiones 2012-2014, en el Hospital Obrero Nro1. Se evaluó 16 pacientes que cumplieron los criterios de inclusión. RESULTADOS: Según valoración de la escala de Oswestry: un 56% de pacientes tienen limitación funcional mínima y un 6% discapacidad a los 6 meses post operatorio. El género más afectado fue el femenino con un 57%, la edad promedio fue de 64 años, el tiempo previo al tratamiento quirúrgico fue mayor a 12 meses en el 63%, los niveles instrumentados más frecuentes fueron de L3-L5 y L5-S1 con un 25%. CONCLUSIONES: Se realizaron técnicas quirúrgicas descompresivas: laminectomia, foraminectomia con instrumentación. El índice de discapacidad de Oswestry permite valorar que la técnica fue efectiva debido a que los pacientes presentan una evolución funcional sin limitaciones en su vida cotidiana en la mayoría de los casos.
OBJECTIVES: To stablish the functional evolution and neurological condition through Oswestrydisability index (ODI)inthe biomechanics of the lumbar spine in patients who underwent neurological decompression and posterolateral arthrodesisand transpedicular screws stabilization by presenting lumbar spinalstenosis(LSS) in Obrero Hospital N° 1, La Paz city, Bolivia. To identify clinical, social and demographic factors of patients with degenerative lumbar spinal stenosis in which postero-lateral arthrodesis was performed. METHODS: A retrospective, descriptive and cross-sectional study between 2012 and 2014 was conducted. Patients who were treated with postero-lateral arthrodesis for lumbar spinal stenosis, in the traumatology service at Obrero Hospital in La Paz city were considered. We evaluated 16 patients who met the inclusion criteria. RESULTS: According to Oswestrydesability index, 56% of the patients have minimal functional limitation and 6% of disability at 6-month postoperative. The most affected gender were females with 57%, the average age was 64 years, prior time to surgical treatment was more than 12 months in 63%, and the most frequent instrumented levels were L3-L5 and L5-S1 with 25%. CONCLUSIONS: We performed decompressive surgical techniques: laminectomy, foraminotomy with instrumentation. Oswestry disability index helped to determine the applied techniqueswere effective. In most cases, patients displayed a functional evolution without limitations in their daily lives.
الموضوعات
Arthrodesis/rehabilitationالملخص
STUDY DESIGN: Cross-sectional. PURPOSE: To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction. OVERVIEW OF LITERATURE: The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial. METHODS: This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not. RESULTS: In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed. CONCLUSIONS: The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.