Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oswestry Disability Index.

PURPOSE: The Oswestry Disability Index (ODI) is one of the most common patient-reported outcome measures used for low back pain (LBP). Since it was not available in Indonesian, this study aimed to perform a cross-cultural adaptation of ODI to Indonesian and evaluate its psychometric properties. METHODS: We performed a cross-cultural adaptation of ODI v2.1a into Indonesian language (ODI-ID) and determined its internal consistency, test-retest reliability, measurement error, confirmatory factor analysis, floor-ceiling effect, and construct validity by hypotheses testing of its correlation with Short Form-36 (SF-36) and visual analog scale (VAS). Adults (> 17 years of age) diagnosed with low back pain were included. RESULTS: A total of 96 subjects were included in this study. The original ODI questionnaire was translated into an Indonesian version and showed a good internal consistency (Cronbach's alpha = 0.90) and good reliability (intraclass correlation = 0.97). The standard error of measurement values of 3.35 resulted in a minimal detectable change score of 9. Nine out of nine (100%) a priori hypotheses were met, confirming the construct validity. A strong correlation was found with the physical component of SF-36 (0.77 and 0.76 for pain and physical function, respectively) and VAS (0.79). Confirmatory factor analysis resulted in a poor but significant fit to the original one-factor structure and the static-dynamic two-factor structure. Floor-ceiling effects were not found. CONCLUSIONS: The Indonesian version of ODI displayed similar reliability, validity, and psychometric characteristics to the original ODI. This questionnaire will be a suitable instrument for assessing LBP-related disability for Indonesian-speaking patients.

Unilateral biportal endoscopic surgical decompression for symptomatic ossification of the ligamentum flavum - Is it enough to improve the clinical outcome? A case-control study.

Purpose: Open decompression is currently the standard surgical procedure for symptomatic OLF. As the minimal invasive method gains popularity, UBE is considered a reliable technique with less complication. However, the outcome is still in question. This study aimed to evaluate and compare UBE versus open surgery in symptomatic OLF cases. Methods: We evaluated 35 patients with single- or two-level thoracic OLF, underwent decompression by open or UBE. Surgery duration, estimated blood loss, and LOS were recorded as intraoperative parameters. Minimum follow-up was 1 year to evaluate clinical parameters based on the mJOA score, Frankel grade, and recovery rate (RR). Results: The UBE procedure showed significant superiority with faster surgery (62.5 min vs. 180 min; p < 0.001), less blood loss (50 mL vs. 250 mL; p < 0.001), and shorter LOS (4 days vs. 6 days; p < 0,001). UBE patients showed notable clinical improvement on the mJOA score at 1 year (8.2 ± 0.18 vs. 6.8 ± 0.24; p = 0.015). Frankel grade improvements seen in both groups with 51.4% of subjects having at least a 1-point upgrade. RR in 1 year resulted in significant recovery in UBE group (RR-UBE 43.2 ± 17 vs. RR-open 26.3 ± 15.3; p < 0.05). No neurological deterioration or significant complication occurred after either procedure. Conclusion: The UBE technique allows faster decompression with less blood loss and shorter LOS compared to open surgery. It was found to be a reliable treatment option in treating OLF with favorable clinical outcomes and improved patient neurological status.

Etiopathogenesis of adolescent idiopathic scoliosis (AIS): Role of genetic and environmental factors.

Adolescent idiopathic scoliosis (AIS) has been known to be related closely to genetic factors. Higher prevalence of AIS among individuals with family history of scoliosis suggesting critical roles of genetic in the pathogenesis of AIS. However, evidence also suggested that environmental factors such as latitude and sun exposure also play a critical role in the pathogenesis of the disease. While genetic factors played an important role in the occurrence of AIS, environmental factors are more likely to affect the progression of the disease. Although the pathogenesis of AIS remains elusive, current knowledge suggests that genetic factors and its interaction with environmental factors are crucial in the development of the disease, explaining differences in clinical characteristics of AIS across the globe. The aim of this review is to summarize the current knowledge of genetic and environmental factors contributing to AIS and their interactions.

Full Endoscopic Lumbar Stenosis Decompression: A Future Gold Standard in Managing Degenerative Lumbar Canal Stenosis.

BACKGROUND: Until recently, open decompression was considered the gold standard for the management of spinal stenosis, but the evolution of minimally invasive spine instruments has brought a new dimension to the management of spinal stenosis. Full endoscopic surgery has a lot of advantages in terms of minimal soft tissue damage, less bleeding, shorter hospital length of stay, and earlier return to work. Our aim was to evaluate the efficacy of full endoscopic lumbar decompression for degenerative lumbar canal stenosis compared with classic open decompression surgery. METHODS: This is a retrospective cohort study of degenerative lumbar spinal stenosis without instability, consisting of 132 open decompression and 163 full endoscopic decompression patients. We evaluated the clinical result of the pre- and postoperative visual analog scale (VAS) of leg pain, back pain, and Oswestry Disability Index (ODI). We observed the patients until 1 year after the operation. RESULTS: The postoperative ODI scores and VAS scores for back pain and leg pain were better than the preoperative scores. The ODI scores and VAS scores for leg pain were significantly better in both groups (P = 0.033 and 0.04, respectively). The main difference between open and full endoscopic decompression was the VAS back pain and amount of bleeding. In the full endoscopic group, the mean VAS back pain was 1.6 and the amount of bleeding was minimal. In the open decompression surgery, the mean VAS back pain was 3.5 and the amount of bleeding was around 84 mL. The length of hospital stay was shorter in the full endoscopic group, which was 1.5 days compared with 3.4 days in open decompression (P = 0.034). CONCLUSION: Full endoscopic decompression showed better early results compared with the conventional group, but a long-term study is still needed for further evaluation of the clinical results. The use of the full endoscopic technique is very promising in the management of spinal stenosis. CLINICAL RELEVANCE: This study provides a comparison of the efficacy of open decompression and full endoscopic decompression in degenerative lumbar canal stenosis.

Full Endoscopic Posterior Cervical Foraminotomy in Management of Foraminal Disc Herniation and Foraminal Stenosis.

BACKGROUND: The development of full endoscopic procedures enables surgeons to visualize the operative field very clearly. Posterior foraminotomy using endoscopy was developed as a minimally invasive procedure to reduce the complication of the anterior cervical approach and to preserve the segmental motion without decreasing the effectiveness of nerve decompression. Our aim is to evaluate the result of full endoscopic posterior cervical foraminotomy in our center. METHODS: This is a prospective single-arm study of 65 foraminal disc herniation and foraminal stenosis patients that underwent full endoscopic posterior foraminotomy procedures. All patients were routinely observed for 12-months duration to evaluate Visual Analog Score (VAS) of the neck, arm, and modified Macnab criteria. RESULTS: Arm pain VAS decreased significantly compared with the pre-operation state (p < 0.001, 0.034, 0.001 on immediate post-operative, 6-months follow-up, and 12-months follow-up, respectively) even though 6.15% of patients had hypesthesia on follow-up. There was no neck pain observed during 1 year follow-up, and modified Macnab criteria showed a good outcome following full endoscopic posterior foraminotomy. CONCLUSION: Full endoscopic posterior foraminotomy provides good nerve decompression with all the benefits of endoscopic spine procedure.

A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess.

INTRODUCTION AND IMPORTANCE: Spondylitis tuberculosis is a spinal infection characterized by bone destruction, fracture, abscess, and resulting in deformity (kyphosis and gibbus formation). Therefore, early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications. Surgery is reserved for progressive deformity or where the neurological deficit is not improved by anti-tubercular treatment. The spine can be approached anteriorly or posteriorly in a minimally invasive way. We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess. CASE PRESENTATION: We collected data from two patients, a 24 years-old female and 27 years-old male, who was diagnosed with spondylitis tuberculosis with psoas abscess based on the history, physical, and supportive examination. Patients were given chemotherapy antituberculosis agents and performed percutaneous endoscopic debridement. The outcome was measured by clinical signs, laboratory findings, and radiology evaluation. DISCUSSION: Patients had pre-operative symptoms of unremitting lower back and thigh pain, febrile sensation, signs of paravertebral muscle tenderness, and limitation of spine motion. Post percutaneous endoscopic debridement, patients showed good response with clinical improvement seen from significant reduction of pain, paravertebral muscle tenderness, increasing spinal motion, laboratory improvement with a decline of ESR and CRP value, and radiology findings improvement with resorption of psoas abscess. No complications were found. CONCLUSION: Treatment of spondylitis tuberculosis remains controversial regarding optimal use of antituberculosis drugs and the approach used for surgical decompression. Patients had immediate pain relief and reduced disability in treating spinal tuberculosis after percutaneous endoscopic debridement.

Unilateral Biportal Endoscopic Lumbar Interbody Fusion: A Technical Note and an Outcome Comparison with the Conventional Minimally Invasive Fusion.

BACKGROUND: In the past few decades, the minimally invasive technique for spine surgery has developed extensively from the scope of decompression until fusion surgeries to reduce damages to the normal anatomical structure. Unilateral biportal endoscopic lumbar interbody fusion (ULIF) is one of the fusion options which is readily available without a sophisticated minimal invasive instrument. Our aim is to introduce ULIF experience in our center and comparing the result with conventional minimally invasive lumbar interbody fusion (MIS-TLIF). METHODS: This is a retrospective cohort study of 145 lumbar spondylolisthesis cases that underwent fusion surgery with either ULIF or the conventional MIS-TLIF. All of the patients were observed within a 12-month follow-up period to evaluate the back pain and leg pain Visual Analogue Score (VAS), the Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and fusion rate. RESULTS: The leg pain VAS was similarly improved in both groups. ULIF has a significant back pain improvement on direct post operation and at the 3-months follow-up (p value 0.032 and 0.046 respectively). ULIF group also had a significantly better improvement of ODI scores on the early post-operative period (p=0.045). However, both groups similarly showed improvement of ODI score and the SF-36 at the 3-, 6-, and 12- months follow up. CONCLUSION: Full endoscopic fusion surgery with ULIF offers a comparable long-term outcome and a significantly better back pain VAS reduction in short-term follow up compared to the conventional MIS-TLIF. ULIF, with further improvement, can be the next gold standard in managing degenerative lumbar spine conditions.

A rare case of intramedullary spinal dermoid cyst in adult: A case report.

INTRODUCTION: Intramedullary spine dermoid cysts are rare and benign tumors that occur mainly due to the defective closure of the neural tube during the development process. They are slow-growing tumor that manifest in the second and third decades of life. The prevalence of intramedullary dermoid cysts is only 1%. PRESENTATION OF CASE: We reported a 30 years old female with chief complain of weakness of the right leg in the last 6 months before admission. She complained about back pain and had history of scoliosis. In MRI we found intramedullary tumor at level T11-L1. We performed marginal excision and sent the sample for histopathological examination. The histopathological result was dermoid cyst tumor. DISCUSSION: During six months of post-operative period, no recurrence was detected, and a complete relief of symptoms is as expected. Early diagnosis is needed for proper handling and to achieve good outcomes. CONCLUSION: Dermoid cysts in adults without a history of trauma are a rare case. Surgical excision is the choice of treatment. However, long-term follow up is needed to monitor the sensory-motor function.

A posterior-only approach for treatment of severe adolescent idiopathic scoliosis with pedicle screw fixation: A case series.

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) can lead to severe deformity. However, early detection and treatment can prevent its progression. Surgical instrumentation for scoliosis treatment has evolved from Harrington instrumentation to pedicle screws. However, there are still some concerns about the efficacy and long-term effects of pedicle screw fixation, and the clinical and radiographic outcomes of surgical treatment for severe AIS (>90°) by posterior spinal fusion alone need to be established. PRESENTATION OF CASE: Eight patients with severe and rigid idiopathic scoliosis were recruited for this study. All surgeries were performed by one senior spine surgeon between 2015 and 2018. Free hand technique, intraoperative neurophysiologic monitoring (IONM), and intraoperative fluoroscopy to assess the screw position was performed. DISCUSSION: Severe scoliosis results in a complex three-dimensional spinal deformity that often requires correction in multiple planes. Mean major coronal correction rate was 67% (45-80%). No major complications occurred during the perioperative period and after one year follow up. CONCLUSION: Pedicle screws provide three-dimensional deformity correction. There were no complications other than the low-grade late implant-associated infections. Posterior spinal fusion with pedicle screw-only instrumentation obtains a good and stable correction for severe scoliosis.

The outcome of kyphosis tuberculosis treated with one stage reconstruction surgery. A case series.

INTRODUCTION: Commonly, two stage combined anterior - posterior approaches were performed to treat significant kyphotic deformity, but potentially increase morbidity level. Recently, single - stage posterior approach for anterior column reconstruction have shown sagittal alignment improvement. The objective of this study is to describe a series of kyphotic deformity patients whom were treated using modified lateral extracavitary approach for anterior column reconstruction and posterior instrumentation. METHODS: Data collected from all kyphotic deformity patients whom treated with modified lateral extracavitary approach between 2016 until 2017 and this research work has been reported in line with the PROCESS criteria. In addition this technique could address kyphotic correction. RESULTS: 7 patients were reported, 4 males and 3 females with local and regional kyphotic more than 40 degrees. Procedures performed mostly on the right side to avoid the aorta with approximately 2 cm of the rib distal to the transverse processes. The average estimated blood loss and length of surgery were 1280 ml and 3.9 h. None of the patient had neurological deficit, and all of them have shown kyphotic improvement. CONCLUSION: The modified lateral extracavitary approach for anterior column reconstruction and posterior instrumentation is a viable alternative to the standard combined approach. This approach continues to evolve as instrumentation development and possesses significant advantages.

Motoric Recovery After Transplantation of Bone Marrow Derived Mesenchymal Stem Cells in Chronic Spinal Cord Injury: A Case Report.

BACKGROUND For the past 20 years, numerous of clinical trials focusing on the use of mesenchymal stem cells (MSC) in spinal cord injury (SCI) treatment has been conducted. However, controversies over whether stem cells are the main factor in a patient's recovery still persisted in sub-acute SCI. This study aimed to evaluate the motoric recovery in a chronic SCI patient treated with bone marrow derived MSC (BM-MSC) transplantation. CASE REPORT We present a case report of patient with a 12-year-long-chronic SCI that was treated by BM-MSC) transplantation using a serial administration protocol. The protocol consisted of direct parenchymal injection to the affected lesion and multiple (5 times) intravenous stem cell injection as the adjuncts. There was no complication or serious adverse effects encountered during the procedure and follow up. At the final follow up of 5 years, the patient neurological status improved from American Spinal Injury Association (ASIA) A status to ASIA C status, which signifies improvement in his ambulatory status. Magnetic resonance imaging and electrophysiology examination also showed changes that indicated recovery of the neurologic function. CONCLUSIONS Based on the limited adverse reaction and outcome, our case report may serve as an additional alternative protocol in stem cell administration to improve the outcome of chronic spinal cord injury patients.

Comparison of Clinical and Radiological Outcomes of Lumbar Interbody Fusion Using a Combination of Hydroxyapatite and Demineralized Bone Matrix and Autografts for Lumbar Degenerative Spondylolisthesis.

STUDY DESIGN: Prospective, cohort, non-inferiority study. PURPOSE: This study evaluated the clinical and radiological outcomes of interbody fusion using a combination of demineralized bone matrix (DBM) and hydroxyapatite (HA). OVERVIEW OF LITERATURE: The use of autografts remains a gold standard in lumbar interbody fusion, but the limited availability and donor site morbidity encourages the use of bone substitutes. In addition to autografts, a combination of HA and DBM is being increasingly use for lumbar interbody fusion. However, there are no data on the clinical and radiological outcomes of this procedure. METHODS: We examined 35 patients with lumbar degenerative spondylolisthesis who underwent transforaminal interbody fusion. Autografts were used in 18 patients, and 17 patients received a combination of HA and DBM. Clinical outcomes were evaluated using the visual analog scale (VAS) for back and leg pain, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores at 3, 6, and 12 months postoperatively. Fusion was evaluated using computed tomography images obtained at 12 months postoperatively. RESULTS: The mean ODI, JOA, and back and leg pain VAS scores increased significantly in both groups. However, the VAS, JOA, and ODI scores did not differ significantly between the two groups (p=0.599, p=0.543, and p=0.780, respectively). The fusion rates at 1 year postoperatively were 77.8% and 76.5% in the autograft and HA+DBM groups, respectively (p=0.99). CONCLUSIONS: The clinical and radiological outcomes of using a combination of HA and DBM in lumbar interbody fusion were not inferior to those of using autografts. A combination of HA and DBM can be considered as an alternative in patients with lumbar degenerative spondylolisthesis requiring surgery.