Decision-Making Process in Patients with Thoracolumbar and Lumbar Burst Fractures with Thoracolumbar Injury Severity and Classification Score Less than Four

Study DesignCross-sectional.PurposeTo develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction.Overview of LiteratureThe ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial.MethodsThis 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.ResultsIn 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.ConclusionsThe findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making

Role of the Self-Administered, Self-Reported History Questionnaire to Identify Types of Lumbar Spinal Stenosis: A Sensitivity Analysis

Study DesignCase-control design.PurposeTo evaluate the role of the self-administered, self-reported history questionnaire (SSHQ) in identifying types of lumbar spinal stenosis (LSS).Overview of LiteratureDiagnosis of types of LSS is controversial.MethodsA total of 235 patients with LSS were asked to respond to the SSHQ. All of these patients recovered following surgical treatment. The classification of LSS patients was based on history, physical examinations, and imaging studies. It is considered to be the gold standard. Radicular and neurogenic claudication types of LSS were based on the SSHQ developed by Konno et al. Two categories of LSS were determined based on the SSHQ tool and gold standard. Finally, a sensitivity analysis was carried out to evaluate the diagnostic value of the SSHQ.ResultsThe mean age of patients was 59.4 years. According to the criteria for gold standard, patients were diagnosed with the radicular type (n=103), and neurogenic claudication type (n=132). The questionnaire had desirable sensitivity, specificity, and accuracy in categorizing the two types of LSS: 97.8%, 66.6%, and 96.8% for the radicular type, and 97.0%, 80.0%, and 95.7% for the neurogenic claudication type.ConclusionsOur findings indicate that the SSHQ is a reliable and a valid measure and it may be a clinical diagnosis support tool for identifying patients with two types of LSS

Lumbar Spinal Canal Stenosis Classification Criteria: A New Tool

Study DesignCase-control study.PurposeTo design a new tool for classifying lumbar spinal canal stenosis (CLSCS).Overview of LiteratureGrading of patients with lumbar spinal canal stenosis (LSCS) is controversial.MethodsThe Oswestry disability index (ODI) and the neurogenic claudication outcome score (NCOS) were recorded. Four parameters, which indicate the severity of LSCS disease, including Hufschmidt-grade, grading of magnetic resonance imaging, self-paced walking test, and stenosis ratio (SR) were employed. For the SR, quartile analysis was applied for classifying LSCS and the Hufschmidt-grade was modified into a 4-grade score. An initial score was assigned to each metric based on the severity of LSCS. Using the inverse-variance weighting method, the relative weights of these domains and their categories were determined. The score for all of the cases was obtained based on their weight by summing up the points of the four variables. Quartile analysis was used and a CLSCS score was proposed. Finally, intra- and interobserver reliability, and validity were assessed.ResultsA total of 357 patients were studied. The final CLSCS score for each case ranged from 4 to 16.5. Based on the quartile analysis, using the new criteria set, the CLSCS score was divided into four categories: CLSCS<7 (grade 0); 7≤CLSCS<10 (grade 1); 10≤CLSCS<13 (grade 2); and 13≤CLSCS≤16.5 (grade 3). The kappa values of for the CLSCS score indicated a perfect agreement. The CLSCS was correlated with the ODI and NCOS. All patients with grade 3 CLSCS were observed in the surgical group.ConclusionsThe CLSCS score can be helpful for classifying LSCS patients and in the decision-making process

Outcome Measure of Pain in Patients with Lumbar Disc Herniation: Validation Study of the Iranian version of Pain Sensitivity Questionnaire

Study DesignCross-sectional.PurposeTo translate and culturally adapt an Iranian version of the Pain Sensitivity Questionnaire (PSQ) in Iran.Overview of LiteratureInstruments measuring patient reported outcomes should satisfy certain psychometric properties.MethodsThe PSQ was translated following cross-cultural adaptation guidelines. A total of 101 patients with lumbar disc herniation (LDH), and 39 healthy cases were included in the study. All participants completed the PSQ and the Pain Catastrophizing Scale (PCS). The internal consistency, test-retest reliability, known group comparison, criterion validity and item-scale correlations were assessed.ResultsThe mean age of participants was 51.7 years. Reliability, validity and correlation of PSQ and PCS showed satisfactory results. Cronbach's alpha coefficients were 0.81 for PSQ-total, 0.82 for PSQ-minor, and 0.82 for PSQ-moderate. The intraclass correlation coefficients value was 0.84 (0.616–0.932) indicating an excellent test-retest reliability. The instrument discriminated well between sub-groups of patients who differed in a standard predictive measure of LDH surgery (the Finneson–Cooper score). Total PSQ were also significantly correlated with the total scores of the PCS, lending support to its good convergent validity. Additionally, the correlation of each item with its hypothesized domain on the PSQ indicated acceptable results, suggesting that the items had a substantial relationship with their own domains.ConclusionsThe adapted Iranian PSQ is a valid and reliable questionnaire for the assessment of pain in patients with LDH

Outcome Measures of Functionality, Social Interaction, and Pain in Patients with Cervical Spondylotic Myelopathy: A Validation Study for the Iranian Version of the Copenhagen Neck Functional Disability Scale

Study DesignCross-sectional.PurposeTo translate and validate the Iranian version of the Copenhagen Neck Functional Disability Scale (CNFDS).Overview of LiteratureInstruments measuring patient-reported outcomes should satisfy certain psychometric properties.MethodsNinety-three cases of cervical spondylotic myelopathy were entered into the study and completed the CNFDS pre and postoperatively at the 6 month follow-up. The modified Japanese Orthopedic Association Score was also completed. The internal consistency, test-retest, convergent validity, construct validity (item scale correlation), and responsiveness to change were assessed.ResultsMean age of the patients was 54.3 years (standard deviation, 8.9). The Cronbach α coefficient was satisfactory (α=0.84). Test-retest reliability as assessed by the intraclass correlation coefficient analysis was 0.95 (95% confidence interval, 0.92-0.98). The modified Japanese Orthopedic Association score correlated strongly with the CNFDS score, lending support to its good convergent validity (r=-0.80; p<0.001). Additionally, the correlation of each item with its hypothesized domain on the CNFDS was acceptable, suggesting that the items had a substantial relationship with their own domains. These results also indicate that the instrument was responsive to change (p<0.0001).ConclusionsThe findings suggest that the Iranian version of the CNFDS is a valid measure to assess functionality, social interaction, and pain among patients with cervical spondylotic myelopathy

Grading of MRI and STarT Back Screening Tool (SBST) in the diagnosis of severity of lumbar central canal stenosis: a sensitivity analysis

ABSTRACTPurpose: This study aimed to correlation between the grading stenosis and the STarT Back Screening Tool (SBST) inpatients diagnosed with lumbar central canal stenosis (LCCS). Methods: In a prospective clinical study, a total of269 patients with LCCS were asked to respond to the questionnaire at their first visits. Grading of LCCS on MRI was determined and also the severities of the disease were observed based on SBST as the gold standard. Finally grading on MRI and calcification of the SBST were determined, and sensitivity analysis carried out to evaluate severity of LCCS on grading of MRI using the SBST. Results: The mean age of patients was 58.6 (SD= 10.9) years; and 56.5% were female. According to patients’ imaging they have been diagnosed as grade 1 (n = 86), grade 2 (n =107) and grade 3 (n = 76). The sensitivity, specificity and accuracy of the estimated grading of LCCS on MRI for low, medium, and high risk groups were found to be desirable: 97.6%, 66.7%, 96.5% for low risk; 93.1%, 83.3%, 92.5% for medium risk, and 97.2%, 66.7%, 94.7% for high risk, respectively. Conclusion: Our findings indicate that grading of LCCS on MRI correlate with SBST and suggest that it is a reliable measure for screening LCCS patients

Filament wound pipes optimization platform development: a methodological approach

A multi-objective and multi-level optimization procedure is developed for obtaining optimal structural design of filament wound composite pipes in oil and gas industries. At the first stage, regulated design constraints are identified. Required computational tools for predicting structural properties of the composite pipes are developed and validated through experimental study. Then, the pipe design procedure is formulated as an engineering optimization problem where a hybrid design-optimization platform is developed to deal with that. The platform integrates multi-objective genetic algorithm on level 1 with a premutation-based direct search approach on level 2. It is aimed to minimize the cost of the pipe while maximum values for other structural properties are expected. Manufacturing limitations are also taken into account as the constraints in addition to design requirements

Surgery outcomes and functionality in patients with cervical spondylotic myelopathy

Purpose: This study investigated functionality statues and surgical outcome of patients with cervical spondylotic myelopathy (CSM) contains cervical herniated disc (CHD) and cervical spinal stenosis (CSS) based on the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).Methods: This was a prospective clinical study a sample of cases with CSM. Patient’s functionality statues and surgical outcome were evaluated based on JOACMEQ scores at two points in time: pre- and postoperative assessments.Results: In all 87 patients were completed the JOACMEQ measure. The mean age of patients was 50.3 (SD=10.2) years. The mean clinical follow-up was 12 months (range 7-37 months). Statistically difference between was observed pre- and postoperative indicating improvements on the outcomes and functionality in all subscales (P &lt; 0.001). However, there was no significant difference between patients with CSM and CHD.Conclusion: The findings suggest that surgery is an efficacious procedure for the treatment of CSM and the functionality statues as measured by the JOACMEQ are higher than prior to surgery

Surgical outcomes and correlation ODI and ASIA scores in patients with thoracolumbar and lumbar burst fractures

Background and Purpose: Decision-making process in Thoracolumbar and Lumbar Burst Fracture (TLBF) patients with Thoracolumbar Injury Severity and Classification Score (TLICS) &gt; 4 is remained controversial. On the other hand, the question is whether that the Oswestry Disability Index (ODI) can be use to assess to clinical outcomes in these patients. We aimed to study the correlation between the ODI and American Spinal Injury Association (ASIA) impairment scale in these patients and evaluation of surgical outcome.Methods: This was a prospective study. The TLICS were determined and TLICS &gt; 4 was included. The nerve injury was assessed according to sensory scores and motors scores of the using ASIA Scale at pre- and postoperative. It was also ODI calculated at last follow-up. In addition, correlation between ASIA and ODI was evaluated at last follow-up.Results: Fifty eight patients (20.7% female) who underwent spinal surgery for TLBF with a minimum follow up of 2 years were studied. The mean age was 30.7 ± 8.7 (24 to 65) years. Automobile accident was the predominant mode of injury. Patients were followed for 25 months on average (24 – 43 months). ASIA sensory scores and motor scores were improved significantly at last follow-up (P &lt; 0.001). No patient experienced neurological worsening during the follow-up period. The mean ODI were 29.7 (SD= 4.9) at last follow-up. Correlation test showed significant correlations among the ODI and the ASIA sensory scores (r = 0.74, P &lt; 0.02) and motor scores (r = 0.78, P &lt; 0.01) at last follow-up assessment.Conclusion: The findings confirm that for TLICS &gt; 4 surgical outcome is acceptable. It also shows that the ODI and the ASIA scores have a strong correlation in measuring disability in patients with TLBF after at least 2 year follow-up

The Effect of Thalamic Stimulation on Memory and Language Processing in Parkinsonian Patients

Objective: Thalamic Deep Brain Stimulation (DBS) is reported to be successful in Parkinson patients with motor symptoms resistant to medication as a treatment procedure. Despite evidence of cortico-subcortico-cortical circuit involvement in motor control, the role of this neural circuitry on higher cognitive functions such as language is still controversial. In particular, research evidence pertaining to the impact of ventrolateral thalamic stimulation on linguistic processing is scarce. This paper investigates the effect of right and left thalamus-DBS on memory and language processing in Parkinson patients. Materials & Methods: In this paper as a case series research we measured memory and language processing in six Parkinson patients (2 left, 2right, 2 bilateral) underwent implantation of deep brain stimulating electrode in ventrolateral thalamic nucleus. The data were collected in two “on” and “off” positions, with at least 40 days time interval in between. The patients were assessed using Wechsler memory test, verbal fluency and some sub-tests of Farsi version of Bilingual Aphasia Test (BAT). Results: The findings of this research are suggesting an improvement on grammar comprehension and a decline in sentence production and verbal fluency in “on” position versus “off” position, in both groups. The Wechsler memory scores in left thalamus group improved but declined in right thalamus group. Conclusion: The results indicate that thalamic DBS did not cause any deficit on grammar comprehension and even improved the level of comprehension. On the contrary a decrease in verbal fluency and sentence production, as two high level linguistic processing tasks, was observed. The results confirmed contemporary theories of thalamic participation on language processing and did not confirm a laterality effect on language skills. Although observed difference after thalamic DBS between right and left group on memory score can confirm laterality effect on memory