•MCIDs are disease- and procedure-specific.•No MCIDs of major PROMs specific to LSS undergoing decompression were reported.•MCIDs of the NRS, RMDQ, and SF-8 specific to LSS after decompression were ...identified.•MCIDs of NRS was 2 points for back pain, 2–4 points for leg pain and numbness.•MCID was 3–5 points for RMDQ, 5–6 points for PCS, and 2–6 points for MCS.
A minimum clinically important difference (MCID) has been increasingly well known in the current era of patient-centered care because it reflects a smallest change that is meaningful for patients following a clinical intervention. Previous studies suggested MCID values are disease and/or procedure dependent. No MCID values have been reported on the lumbar spinal stenosis (LSS) following decompression surgery despite LSS is the most common spinal disease and the main treatment is decompression surgery. Therefore, this study aimed to determine the MCID values as major outcome measures including the Numeric Rating Scale (NRS) of back pain, leg pain and numbness, Roland-Morris Disability Questionnaire (RMDQ), and Physical Component Summary (PCS) and Mental Component Summary (MCS) of Short Form 8 (SF-8) for patients with LSS undergoing decompression surgery.
This is a retrospective cohort study using prospectively collected data from consecutive patients who underwent lumbar decompression without fusion for LSS at a single institution between May 2014 and March 2016. Inclusion criteria were 1) minimum 1-year follow-up 2) a complete set of preoperative and final follow-up questionnaires available, including the NRS, RMDQ, and SF-8. Revision surgery or non-degenerative etiology such as infection or tumor was excluded. MCIDs of each outcome measure were determined using two major approaches, distribution- and anchor-based methods. The distribution-based method uses the distributional characteristics of the sample. This method expresses the observed degree of variation to obtain a standardized metric such as the standard deviation or standard error of measurement. The anchor-based method uses an external criterion known as anchor to determine the factors that should be considered by patients for an important improvement. Anchor-based methods assess how much changes in the measurement instrument correspond with a minimal important change defined on the anchor. We used symptom severity, physical function, and satisfaction scores from Zurich Claudication Questionnaire as anchors for NRS and RMDQ, PCS, and MCS, respectively.
A total of 126 patients were included. From the anchor-based method, MCIDs were determined to be 2 points for back pain, 4 points for leg pain and numbness, 5 points for RMDQ, 5 points for PCS, and 2 points for MCS. From the distribution-based method, MCIDs were determined to be 2 points for back pain, leg pain and numbness, 3–4 points for RMDQ, 6 points for PCS, and 5 points for MCS.
We first identified the MCIDs of the NRS, RMDQ, and SF-8 specific to patients undergoing decompression surgery for LSS.
Composite nanoparticles (NPs) having a double-shell structure, Au core, spacer layer (inner shell), and J-aggregate (JA) layer (outer shell) (Au/spacer/JA) have been synthesized. The spacer layer ...composed of N,N,N-trimethyl(11-mercaptoundecyl)ammonium chloride played an important role in promoting the J-aggregation of anionic cyanine dyes on the surface, as evidenced by the successful formation of the JA layers with four kinds of anionic cyanine dyes. It was found that the presence of a spacer layer causes a significant change in the line shape of the absorption spectrum, particularly near the J-band; there is the appearance of a peak type absorption for the composite NPs with the double-shell structure, while there is a dip type absorption for the ones without the spacer layer. The change from the peak type absorption to the dip type absorption in the Au/spacer/JA NPs occurs when the size of the Au core is varied from 5 to 15 nm. These observations would indicate that the strength of exciton−plasmon coupling between the Au core and the JA layer is enhanced with the increase in the core size or the decrease in the separation between the Au core and the JA shell. The photoluminescence arising from the JA can be detected for the composite NPs with the double-shell structure, showing that the quenching by the Au core is effectively suppressed by the spacer layer.
•Impact of postoperative residual numbness on patient satisfaction has not been well studied.•Residual numbness had a greater impact than leg/back pain on patient satisfaction.•We suggest not only ...back and leg pain but also numbness should be evaluated pre- and postoperatively.
Decompression surgery is the most common surgical treatment for lumbar spinal stenosis (LSS). Relatively low satisfaction rate was reported. Patients often complaint of residual numbness despite significant pain relief. We hypothesized that numbness had a significant impact on patient satisfaction, but had not been evaluated, which is associated with low satisfaction rate. This study aimed to examine how much numbness is associated with patient satisfaction.
We retrospectively reviewed prospectively collected data from consecutive patients who underwent decompression without fusion for LSS. We evaluated the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness preoperatively and at the final follow-up visit. Improvement was evaluated using minimum clinically important differences (MCIDs). Patient satisfaction was evaluated using the question, “How satisfied are you with the overall result of your back operation?”. There are four possible answers consisting of “very satisfied (4-point)”, “somewhat satisfied (3-point)”, “somewhat dissatisfied (2-point)”, or “very dissatisfied (1-point)”. Spearman correlation was used to evaluate the association between patient satisfaction and reaching MCIDs.
A total of 116 patients were included. All three components had correlation with patient satisfaction with the correlation efficient of 0.30 in LBP, 0.22 in leg pain, and 0.33 in numbness. Numbness had greatest correlation efficient value.
We showed that numbness has a greater impact than leg/back pain on patient satisfaction in patients undergoing decompression for LSS. We suggest not only LBP and leg pain but also numbness should be evaluated pre- and postoperatively.
Retrospective chart audit.
This study aimed to investigate the gender difference in pre- and postoperative health-related quality of life (HRQOL) in patients who have had decompression surgery for ...lumbar spinal stenosis (LSS).
Gender differences may contribute to variations in disease presentations and health outcomes. The influence of gender on pre- and postoperative HRQOL in spinal disorders remains unclear.
We reviewed 125 patients (79 men and 46 women) who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed the following clinical information: Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain (LBP), leg pain, and leg numbness; Zurich Claudication Questionnaire; JOA Back Pain Evaluation Questionnaire; Roland- Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as HRQOL. We compared the HRQOLs of men and women pre- and postoperatively.
Although the preoperative NRS results for LBP were significantly higher in women (p <0.05), there were no significant differences in clinical outcomes between men and women postoperatively. For HRQOL, the RMDQ scores were significantly worse in women preoperatively (p <0.05), but no significant differences were found postoperatively between men and women. Similarly, the SF-8 mental health score was also significantly lower in women preoperatively (p <0.05), but no significant differences were noted between the two groups postoperatively.
LSPSL greatly reduced LBP, leg pain, and leg numbness in both genders. There were limited differences in pain and several HRQOL questionnaire responses between men and women after surgery. We found that women had greater sensitivity to and/or lower tolerance for pain than men, which led to lower HRQOL mental health scores preoperatively.
Study Design:
Retrospective cohort study.
Objectives:
Decompression without fusion is a standard surgical treatment for lumbar spinal stenosis (LSS) with reasonable surgical outcomes. Nevertheless, ...some studies have reported low patient satisfaction (PS) following decompression surgery. The cause of the discrepancy between reasonable clinical outcomes and PS is unknown; moreover, the factors associated with PS are expected to be complex, and little is known about them. This study aimed to identify satisfaction rate and to clarify the factors related to PS following decompression surgery in LSS patients.
Methods:
We retrospectively reviewed 126 patients who underwent lumbar decompression with a minimum follow-up of 1 year. Patients were divided into 2 groups based on the PS question. The Japanese Orthopaedic Association (JOA) scores, and the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness were compared between the 2 groups preoperatively and at the latest visit. To identify the prognostic factors for dissatisfaction, multiple logistic regression analysis was performed.
Results:
Overall satisfaction rate was 75%. The JOA recovery rate, NRS improvement, and Short Form–8 (SF-8) were significantly higher in the satisfied group. Postoperative NRS scores of LBP, leg pain, and leg numbness were significantly lower in the satisfied group. Multivariate logistic regression analysis showed that smoking and scoliosis were significant risk factors for dissatisfaction.
Conclusions:
Overall satisfaction rate was 75% in patients with LSS undergoing decompression surgery. This study found that smoking status and scoliosis were associated with patient dissatisfaction following decompression in LSS patients.
Study Design:
Retrospective observational study.
Objectives:
There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of ...this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP.
Methods:
We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R.
Results:
LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P < .001; JOABPEQ LBP score, 41.3 vs 79.6, P < .001; RMDQ, 10.3 vs 3.6, P < .001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R.
Conclusions:
Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.
Formation and aggregation of photolytic gold nanoparticles at the surface of chitosan (CTO) films have been investigated. When thin films of chloroauric acid salt of CTO were irradiated with UV light ...in wet air at room temperature for 10 min, gold nanoparticles of ∼10 nm size are formed at the film surface. Detailed X-ray photoelectron spectroscopy (XPS) study and field emission type scanning electron microscopy (FE-SEM) observation have been carried out to characterize gold nanoparticles at the film surface. The shift of Au(4f) peak to the higher energy side and broadening of full width at half-maximum in the XPS spectrum are the direct evidence of the existence of gold atoms and small clusters in the early stage of photolysis. According to FE-SEM observation, growth in the particle diameter and aggregation of nanoparticles were observed after prolonged irradiation, and, finally, the film surface was densely covered with gold particles of 20−100-nm size. Gold atoms and clusters could move in the film and precipitate to the irradiated surface. Chemical composition analysis further suggests that gold particles at the surface are covered with an ultrathin CTO layer, which is partly oxidized by oxygen and chlorinated by chlorine during photochemical reactions.
Au, Ag, and Au/Ag colloidal nanoparticles coated with the J-aggregate of an anionic cyanine dye, 3,3‘-disulfopropyl-5,5‘-dichlorothiacyanine sodium salt (TC), have been prepared for the first time. ...The absorption spectrum of TC-coated Au colloidal nanoparticles is not a simple sum of the contributions of colloidal gold and TC but is characterized by an evident absorption dip at the position corresponding to the J-band of TC. These spectral features are reproduced by the simulation based on the Maxwell−Garnett-type treatment of Gao et al. The alternate adsorption technique allowed us to deposit dye-coated Au/Ag composite nanoparticles at the surface of a cationic polymer, poly(diallyldimethylammonium chroride).
Although many surgical procedures are available for treating osteoporotic vertebral fractures, there have been no comprehensive multicenter surveys in Japan focusing on surgical treatments for these ...fractures. This study aimed at (1) conducting a retrospective multicenter study to survey surgical treatments performed at referral center hospitals in various regions in Japan and (2) analyzing situations and problems related to the surgical treatments of osteoporotic vertebral fractures in Japanese hospitals.
Among 738 patients who were hospitalized in 13 hospitals in various regions in Japan between 2005 and 2006 for osteoporotic vertebral fractures, 84 patients (11.4%) who underwent spinal surgery were enrolled. These patients were retrospectively analyzed regarding cause of injury, preoperative symptoms, preoperative neurological function, surgical procedures, periods of bed rest, length of hospital stay, and ambulatory status at discharge from hospital.
As to the cause of spinal fracture, 38 patients (45% of the surgical patients) could not identify a specific cause of their spinal fracture. Preoperative neurological motor weakness in legs was observed in 41 (49%). With regard to surgical treatment, posterior spinal reconstruction surgery was performed in 50 patients (60%), vertebroplasty in 26 (31%), anterior reconstruction surgery in 6 (7%), anterior and posterior combined reconstruction surgery in 1, and posterior decompression alone in 1 patient. In all, 70 patients (83.3%), whose periods of hospital stay averaged 52.8 days, could walk by themselves at the time of discharge; 14 (16.7%), whose periods of hospital stay averaged 44.7 days, could not walk by themselves at the time of discharge.
Even after a large variety of surgical procedures were tried to treat osteoporotic vertebral fractures and long hospital stays, about 17% of the patients were unable to walk by themselves at the time of discharge from hospital.
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