Comparison of the Oswestry Disability Index and Magnetic Resonance Imaging Findings in Lumbar Canal Stenosis: An Observational Study

Vijay G Goni,Aravind Hampannavar,Nirmal Raj Gopinathan,Paramjeet Singh,Pebam Sudesh,Rajesh Kumar Logithasan,Anurag Sharma,Shashidhar BK,Radheshyam Sament 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.1

Study Design: Cross-sectional study. Purpose: The aim of the study was to determine relationship between the degrees of radiologically demonstrated anatomical lumbar canal stenosis using magnetic resonance imaging (MRI) and its correlation with the patient’s disability level, using the Oswestry Disability Index (ODI). Overview of Literature: The relationship between the imaging studies and clinical symptoms has been uncertain in patients suffering from symptomatic lumbar canal stenosis. There is a limited number of studies which correlates the degree of stenosis with simple reproducible scoring methods. Methods: Fifty patients were selected from 350 patients who fulfilled the inclusion criteria. The patients answered the nationallanguage translated form of ODI. The ratio of disability was interpreted, and the patients were grouped accordingly. They were subjected to MRI; and the anteroposterior diameters of the lumbar intervertebral disc spaces and the thecal sac cross sectional area were measured. Comparison was performed between the subdivisions of the degree of lumbar canal stenosis, based on the following: anteroposterior diameter (three groups: normal, relative stenosis and absolute stenosis); subdivisions of the degree of central canal stenosis, based on the thecal sac cross-sectional area, measured on axial views (three groups: normal, moderately stenotic and severely stenotic); and the ODI outcome, which was also presented in 20 percentiles. Results: No significant correlation was established between the radiologically depicted anatomical lumbar stenosis and the Oswestry Disability scores. Conclusions: Magnetic resonance imaging alone should not be considered in isolation when assessing and treating patients diagnosed with lumbar canal stenosis.

Safety Profile, Feasibility and Early Clinical Outcome of Cotransplantation of Olfactory Mucosa and Bone Marrow Stem Cells in Chronic Spinal Cord Injury Patients

Vijay G Goni,Rajesh Chhabra,Ashok Gupta,Neelam Marwaha,Mandeep S Dhillon,Sudesh Pebam,Nirmal Raj Gopinathan,Shashidhar Bangalore Kantharajanna 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.4

Study Design: Prospective case series. Purpose: To study the safety and feasibility of cotransplantation of bone marrow stem cells and autologous olfactory mucosa in chronic spinal cord injury. Overview of Literature: Stem cell therapies are a novel method in the attempt to restitute heavily damaged tissues. We discuss our experience with this modality in postspinal cord injury paraplegics. Methods: The study includes 9 dorsal spine injury patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A neurological impairment who underwent de-tethering of the spinal cord followed by cotransplantation with bone marrow stem cells and an olfactory mucosal graft. Participants were evaluated at the baseline and at 6 monthly intervals. Safety and tolerability were evaluated through the monitoring for adverse events and magnetic resonance imaging evaluation. Efficacy assessment was done through neurological and functional outcome measures. Results: Surgery was tolerated well by all participants. No significant difference in the ASIA score was observed, although differences in the Functional Independence Measure and Modified Ashworth Scale were statistically significant. No significant complication was observed in any of our patients, except for neurogenic pain in one participant. The follow-up magnetic resonance imaging evaluation revealed an increase in the length of myelomalacia in seven participants. Conclusions: The cotransplantation of bone marrow stem cells and olfactory mucosa is a safe, feasible and viable procedure in AIS A participants with thoracic level injuries, as assessed at the 24-month follow-up. No efficacy could be demonstrated. For application, further large-scale multicenter studies are needed.

Can High-Sensitivity C-Reactive Protein Levels Predict Functional Outcome Following Epidural Steroid Injection in Patients with Lumbar Disc Disease?

Gopireddy Rajesh,Rangasamy Karthick,Goni Vijay G.,Vatsya Pulak,Behera Prateek,Batra Yatindra K.,Vaishnavi Chetana 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

Study Design: Prospective cohort study. Purpose: Inflammatory cytokines produced at the site of disc herniation are considered as pain generators in patients with lumbar disc disease. Whether a high-sensitivity C-reactive protein (hs-CRP) assay can be used in order to predict the quantum of inflammation surrounding nerve roots is a matter of investigation. This study aimed to evaluate the association of hs-CRP level and functional outcomes measured by the Modified Oswestry Low Back Pain Disability Questionnaire (MODY) before and after epidural steroid injection (ESI) in patients with lumbar disc disease. Overview of Literature: Although many studies examining the role of hs-CRP levels and lumbar pain have been published previously, the results are equivocal, and there is no clear consensus regarding which patients will benefit from an ESI. Methods: This was a prospective study, with 77 patients in the study group and 23 participants in the control group. Baseline hsCRP levels were obtained for both groups. Study group patients received a single ESI and were subjected to detailed pre- and postprocedure evaluation using MODY scores. For this group, hs-CRP levels were measured at 1 and 2 months after injection. Results: Out of 77 patients, 52 had acute and 25 had chronic low back pain. Thirty-six patients with acute pain obtained significant improvement, while 16 had an insignificant response to the ESI. None of the chronic cases had a significant response. The mean baseline hs-CRP (mg/L) among the study group (29.83±10.43) was significantly higher than for the controls (10.26±2.783). The baseline hs-CRP among acute cases, where post ESI MODY score at 2 months had significant reduction, was 32.19±5.126, and those with insignificant reduction was 18.13±7.949 (p<0.001). Conclusions: Baseline hs-CRP levels can be used to prognosticate the outcome following ESI in patients with acute lumbar disc disease, with radicular pain refractory to physiotherapy and analgesics.

Autologous Conditioned Serum as a Novel Alternative Option in the Treatment of Unilateral Lumbar Radiculopathy: A Prospective Study

Ravi Kumar H. S.,Vijay G Goni,Batra Y. K. 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6

Study Design: The study was conducted on patients who received autologous conditioned serum (ACS) as a line of treatment at the Orthopedics outpatient department of Post Graduate Institute of Medical Education and Research (PGIMER, Chandigarh) from January 2011 to June 2012. Of the 1,224 patients, 20 males or females were included in the study based on the inclusion and exclusion criteria. The institutional board of PGIMER approved the study before it was initiated. Purpose: To study the efficacy of ACS in the treatment of unilateral lumbar radiculopathy. Overview of Literature: Interleukin (IL)-1 appears to be of special importance among the cytokines identified in orthopedic diseases. ACS contains high concentrations of IL-1 receptor antagonist, antagonist to IL-1 in that is a biochemical ‘sensitizer’ of nerve roots in radiculopathy. Methods: We included 20 patients with unilateral lumbar radiculopathy after obtaining informed consent. We prepared ACS as described by Meijer et al. Under bi-planar fluoroscopic imaging in anterior-posterior and lateral views, ACS was administered via epidural perineural technique. Patients in both groups were evaluated by quadruple visual analogue scale, straight leg raising test, revised Oswestry disability index, and 12-Item Short Form of Health Survey before and after epidural injections at 3 weeks, 3 months, and 6 months. Results: There was a statistically significant change in all parameters from pre-injection to first, second, and third follow-up (p <0.001). Conclusions: ACS can modify the disease course in addition to reducing pain, disability and improving general health.

Minimally Invasive Surgery versus Open Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

Neradi Deepak,Kumar Vishal,Kumar Sunil,Sodavarapu Praveen,Goni Vijay G.,Dhatt Sarvdeep Singh 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.2

Minimally invasive surgery (MIS) is being recommended over more invasive methods. MIS advantages are less time in the operating room, less blood loss, a shorter recovery time, and shorter length of stay. A systematic review and meta-analysis were performed using the literature from minimally invasive and open surgery for adolescent idiopathic scoliosis (AIS). We conducted this analysis to see whether MIS has advantages over traditional surgery. A systematic review was conducted using PubMed, Embase, and Scopus to find articles comparing minimally invasive and open surgery techniques for AIS patients. Data extraction and meta-analysis were completed. The primary data points collected were correction rate and functional outcomes, including perioperative and postoperative parameters. A total of six studies were included in the final analysis. The MIS group had 123 patients, and the open surgery group had 150 patients. The correction rate and functional outcomes favored the open surgery group with a mean difference of 4.60 (95% confidence interval [CI], 0.08 to 9.12) and 0.11 (95% CI, 0.04 to 0.17), respectively. The duration of surgery, blood loss, number of patients requiring transfusion, and analgesic requirements favored the MIS group with a significant difference. Open surgery is better than MIS in achieving a better correction rate and good functional outcomes. MIS is better over open surgery when perioperative parameters are considered.