STUDY DESIGN: Prospective cohort study along with questionnaire. PURPOSE: To measure the correlation of the visual analogue score (VAS), with (Oswestry disability Index [ODI], version 2.1a) in English, and modified ODI (English and Hindi version). To validate translated version of the modified ODI in English version to Hindi. OVERVIEW OF LITERATURE: Conflicting evidence in literature regarding the ability for existing ODI score to accurately measure the pain associated disability. METHODS: One hundred and three patients conservatively treated for low back pain were enrolled in the study. The Pearson correlation coefficient for VAS and ODI along with the Cronbach alpha and test-retest reliability for Hindi version using the intraclass correlation coefficient was recorded. The new proposed translated Hindi version of ODI was carried out with established guidelines. RESULTS: The mean age in English and Hindi version of ODI was 53.5 years and 58.5 years, respectively. The gender ration was 21:24 in the English version and 35:23 in the Hindi version. The mean follow-up in English and Hindi version of ODI was 3.4 months and 50.27 months, respectively. The Cronbach coefficient alpha=0.7541 for English ODI and 0.9913 for Hindi ODI was recorded for the both modified versions. CONCLUSIONS: The new modified ODI is time saving and accurate, and it avoids the need to measure other scores and has stronger correlation with VAS score compared to the previous scores. We recommend this version for both English and Hindi speaking population as an assessment tool to measure the disability related to pain.
Back Pain ; Cohort Studies ; Follow-Up Studies ; Humans ; Low Back Pain* ; Outcome Assessment (Health Care) ; Prospective Studies ; Surveys and Questionnaires

STUDY DESIGN: Prospective cohort study with questionnaire. PURPOSE: To compare the treatment outcome of nocturnal leg cramps in lumbar spinal canal stenosis (LSCS) patients on conservative treatment with historical surgical cohorts and to determine the sensitivity and specificity as well as positive predictive value and negative predictive value of knee flexion test suggested for LSCS patient. OVERVIEW OF LITERATURE: True prevalence of nocturnal leg cramps in LSCS patients as well as the clinical outcome of its surgical treatment have been reported. METHODS: A questionnaire suggested from previous study with minor modifications was used in this study. Clinical data was collected. Knee flexion test was performed in two groups. RESULTS: The prevalence of nocturnal leg cramp was higher in the LSCS group compared to the control group (second group). In LSCS patients, 38 (88%) had improved leg cramps after the conservative treatment, 3 (6.97%) remained unchanged, and 2 (4.6%) had worsened leg cramps. Of the 43 patients, 21 (48.8%) had no disturbance to their activities of daily living. In the LSCS group, the sensitivity and specificity of the knee flexion test was 53.5% and 33.3%, respectively. The knee flexion test in the LSCS group had a positive predictive value and a negative predictive value of 65.71% and 23.1%, respectively. CONCLUSIONS: Our study demonstrated that nocturnal leg cramps were significantly more frequent in LSCS patients than in the control group.
Activities of Daily Living ; Cohort Studies ; Constriction, Pathologic* ; Humans ; Knee ; Leg ; Muscle Cramp* ; Prevalence ; Prospective Studies* ; Sensitivity and Specificity ; Sleep-Wake Transition Disorders ; Spinal Canal* ; Treatment Outcome ; Surveys and Questionnaires

No abstract available.
Prolapse ; Tropism ; Zygapophyseal Joint

Methods: The clinical records of 953 patients who were operated between 1998 and 2008 were analyzed in 2018. Along with patient characteristics, information about return to daily activities, complication rates, and functional outcomes using Prolo score was assessed. Results: L4–L5 was the most common level for which surgery was performed. Two-level decompression was performed in 116 patients; 89.5% patients were able to return to their daily activities after 2 weeks. Functional outcomes as per the Prolo score were reported by patients as excellent, good, and poor in 89.85%, 1.59%, and 8.55%, respectively. Repeat surgery was required at same level in 16 patients and at a different level in 21 patients. Total 605 patients (63.49%) were symptom-free during the 70-month followup, while 344 complained of residual back pain, and four complained of persistent leg pain. Conclusions ULBD using the Endospine system achieves adequate decompression in most cases and is a good alternative to open laminectomy, with the advantage of avoiding damage to the structural integrity of the spine and preserving soft tissue attachments.

Methods: The clinical records of 953 patients who were operated between 1998 and 2008 were analyzed in 2018. Along with patient characteristics, information about return to daily activities, complication rates, and functional outcomes using Prolo score was assessed. Results: L4–L5 was the most common level for which surgery was performed. Two-level decompression was performed in 116 patients; 89.5% patients were able to return to their daily activities after 2 weeks. Functional outcomes as per the Prolo score were reported by patients as excellent, good, and poor in 89.85%, 1.59%, and 8.55%, respectively. Repeat surgery was required at same level in 16 patients and at a different level in 21 patients. Total 605 patients (63.49%) were symptom-free during the 70-month followup, while 344 complained of residual back pain, and four complained of persistent leg pain. Conclusions ULBD using the Endospine system achieves adequate decompression in most cases and is a good alternative to open laminectomy, with the advantage of avoiding damage to the structural integrity of the spine and preserving soft tissue attachments.

Methods: All cases of cauda equine syndrome secondary to lumbar disc herniation were recruited. Biographical and clinical data, history, examination findings, operative variables, recovery, and SD were noted. Water cystometry and uroflowmetry were done pre- and postoperatively. The International Index of Erectile Function questionnaire and Female Sexual Function Index were used to assess SD among the men and women, respectively. Results: A total of 43 patients with up to 2.94-year follow-up were included. Urodynamic studies were found to correlate significantly with age, days of bladder involvement, perianal numbness, and motor weakness (p<0.01). In step-wise regression analysis, perianal sensation and overall motor weakness were bladder function determinants. Bladder function recovery was directly related to the number of delay days (t=2.30, p<0.05) and with unilateral leg pain (t=2.15, p<0.05). Significant correlation between SD with age and days of bladder involvement before surgery was found (p<0.01). Conclusions Surgery timing is related to patient’s functional and sexual outcomes. Patients with unilateral leg pain and hypocontractile bladder have better outcomes. SD is a remarkable problem in CES.

Methods: In this single-center double-blind randomized controlled pilot study, 46 patients were recruited and randomized by the lottery method. The Visual Analog Scale (VAS) for leg pain, modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) were assessed at 1 week, 3 weeks, 6 weeks, 6 months, and 1 year. Results: Both groups were comparable in terms of demographics, preprocedure VAS scores, mODI, and SF-12 scores (p=0.52). At the 1-week follow-up, the steroid group had significantly better improvement than the PRP group (p=0.0001). At the 3-week follow-up, both groups showed comparable outcomes; however, the PRP group had better symptom improvement. At 6 weeks and 6 months, the PRP group had better outcomes (VAS, p<0.0001; ODI, p=0.02; SF-12, p=0.002). Moreover, 17 and 16 patients in the steroid and PRP groups underwent repeat LTI with steroids or surgery because of pain recurrence during follow-up. At 1 year, no difference in outcomes was observed. Conclusions PRP may be a useful alternative to steroids for LTI in lumbar radiculopathy. Although improvement was delayed and 1-year outcomes were comparable, the 6-week and 6-month outcomes were better with PRP than with LTI. Multiple PRP injections may be beneficial because of its autologous nature. However, further studies with a larger number of participants, longer follow-up, and repeat LTIs are warranted to draw definite conclusions.

STUDY DESIGN: A retrospective computed tomography (CT)-based morphometric study of 84 C1pedicles in an Indian population focusing on critical morphometric dimensions vis-a-vis C1 pedicle screw placement. PURPOSE: To determine the feasibility of C1 pedicle screw placement in an Indian population and propose a novel classification system for the same. OVERVIEW OF LITERATURE: At present, C1 pedicle screws are rarely used, and very few studies have focused on the feasibility of pedicle screw placement in terms of racial, gender, and ethnic variations in anatomical structures. There are no CT-based data on C1 pedicles that assess the feasibility of pedicle screw placement in the Indian population. METHODS: We measured C1 pedicle diameter on CT coronal scan images of 42 adult patients. Extramedullary height (EMH) and intramedullary height (IMH) were measured. We examined the differences between the right and left atlas pedicles and compared measures between males and females. These data were analyzed using significance tests. Based on the results, we propose a novel classification system, which we believe will help in determining the feasibility of C1 pedicle screw placement. RESULTS: Forty-two adult patients (84 pedicles) were examined. Average EMH and IMH were 4.48±0.91 and 0.86±0.77, respectively. Approximately, 32% of the C1 pedicles had bone thicknesses of <4 mm, 49% had IMH of <1 mm, and 38% had no pedicles. The average thickness in women was 4.21±0.93 mm, which was significantly thinner than that in men (4.73±0.81 mm, p=0.004). Right and left pedicles were not significantly different. CONCLUSIONS: Our data indicate that approximately one-third of the Indian population may not be suitable candidates for C1 pedicle screw placement. Caution should be exercised while placing type 1B and type 2 pedicles based on our proposed classification system.
Adult ; Classification* ; Female ; Humans ; Male ; Pedicle Screws* ; Retrospective Studies

INTRODUCTIONWe evaluated reduced back pain in a multiethnic population treated with teriparatide and/or antiresorptives in real-life clinical settings over 12 months.

METHODSThis prospective observational study comprised 562 men and postmenopausal women (mean age 68.8 years) receiving either teriparatide (n = 230), antiresorptives (raloxifene or bisphosphonates; n = 322), or both (n = 10) for severe osteoporosis. The primary endpoint was the relative risk of new/worsening back pain at six months.

RESULTSAt baseline, a higher proportion of teriparatide-treated than antiresorptive-treated patients had severe back pain (30.9% vs. 17.7%), extreme pain/discomfort (25.3% vs. 16.8%), extreme anxiety/depression (16.6% vs. 7.8%) and were confined to bed (10.0% vs. 5.3%). Teriparatide-treated patients had higher visual analog scale (VAS) scores for pain (5.8 ± 2.42 vs. 5.1 ± 2.58) and lower mean European Quality of Life-5 Dimensions (EQ-5D) scores (37.7 ± 29.15 vs. 45.5 ± 31.42) than antiresorptive-treated patients. The incidence of new/worsening back pain at six months for patients on teriparatide and antiresorptives was 9.8% and 10.3% (relative risk 0.99, 95% confidence interval 0.80-1.23), respectively. The incidence of severe back pain at 12 months was 1.3% and 1.6% in the teriparatide and antiresorptive treatment groups, respectively. Teriparatide-treated patients had lower mean VAS (2.71 ± 2.21 vs. 3.30 ± 2.37) and EQ‑5D (46.1 ± 33.18 vs. 55.4 ± 32.65) scores at 12 months. More teriparatide-treated patients felt better (82.7% vs. 71.0%) and were very satisfied with treatment (49.4% vs. 36.8%) compared to antiresorptive-treated patients.

CONCLUSIONPatients treated with either teriparatide or antiresorptives had similar risk of new/worsening back pain at six months.

Aged ; Back Pain ; complications ; diagnosis ; ethnology ; Bone Density Conservation Agents ; adverse effects ; Diphosphonates ; adverse effects ; Ethnic Groups ; Female ; Humans ; International Cooperation ; Male ; Middle Aged ; Osteoporosis ; complications ; drug therapy ; Prospective Studies ; Quality of Life ; Raloxifene Hydrochloride ; adverse effects ; Surveys and Questionnaires ; Teriparatide ; adverse effects ; Time Factors ; Treatment Outcome