•Persistent numbness can be related to dissatisfaction after surgery for LSS.•Few studies have evaluated numbness after decompression for LSS.•We examined the rate and risk factors of persistent ...numbness.•16% had persistent numbness postoperatively.•Durotomy and diabetes were identified as modifiable risk factors.
Decompression surgery is a mainstay of surgical treatment for lumbar spinal stenosis (LSS). However, up to 30% of patients have low satisfaction due to residual symptoms. In the clinical setting, improvements in leg pain are more significant than those in leg numbness. Residual numbness could be related to the relatively low satisfaction rate. However, few studies have focused on numbness; thus, elucidating the risk factors and rate of residual numbness would benefit surgeons and patients. This study aimed to clarify the risk factors for and rate of residual numbness after decompression surgery.
We retrospectively reviewed prospectively collected data from consecutive patients who underwent lumbar decompression without fusion for LSS at a single institution between January 2014 and March 2016. Patients were included if preoperative and final follow-up questionnaires and radiographs were available. A minimum one-year follow-up was required. We evaluated the Numeric Rating Scale (NRS) scores of low back pain, leg pain, and leg numbness preoperatively and at the final follow-up visit. Residual numbness was defined as a postoperative NRS ≥ 1, whereas persistent numbness was defined as a postoperative NRS ≥ 5. We compared the clinical data of patients with or without residual numbness to those of patients with or without persistent numbness. Multivariate logistic regression analysis was performed to identify risk factors for residual and persistent numbness.
A total of 116 patients (73 men, 43 women) were included. Of them, 60% had residual numbness with a mean follow-up period of 25 months. Only durotomy differed significantly between patients with and those without residual numbness. However, the significance did not persist after logistic regression analysis. A total of 16% had persistent numbness. Diabetes mellitus, intraoperative durotomy, and preoperative NRS of numbness were identified as risk factors. There were no differences in smoking status, presence of spondylolisthesis or scoliosis, or severity of stenosis.
We found three risk factors for persistent numbness following decompression surgery for LSS; diabetes mellitus and durotomy were modifiable, whereas preoperative numbness was not. Our findings would help surgeons minimize the incidence of persistent numbness by adequately controlling diabetes and avoiding durotomy during surgery. Providing information about the potential for residual numbness during the informed consent process is important to ensuring realistic patient expectations.
•JOABPEQ has not been studied well.•MCIDs of JOABPEQ in LSS undergoing decompression were identified for the first time.•MCIDs identified were slightly different from JOABPEQ user’s manual.•Our ...findings should be considered when evaluating LSS as the JOABPEQ was not specific to LSS.
Decompression surgery is the standard treatment in lumbar spinal stenosis (LSS). Recent studies have shown that patient satisfaction following decompression surgery does not correspond well with outcomes measured by conventional patient-reported outcome measurements. Recent study reported that the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is the most accurate outcome measurement to reflect patient satisfaction. Nevertheless, the JOABPEQ was not studied enough, especially along with the minimally clinically important differences (MCIDs), as JOABPEQ is relatively new questionnaire. The MCID is the minimum score change which patients perceive as beneficial. Thus, knowing the MCID is critical evaluating the efficacy of intervention. The aim of this study was to determine the MCIDs of the JOABPEQ for patients with LSS undergoing decompression surgery.
Patients who underwent decompression surgery for LSS were consecutively enrolled if they had a complete set of questionnaires. We determined the MCIDs of each domain in the JOABPEQ using distribution-based and anchor-based methods. The MCIDs were determined to be 20.4 in low back pain, 15.6 in lumbar function, 16.8 in walking ability, 13.4 in social life function, and 9.4 in mental health by the distribution-based method. Using the anchor-based method, the MCIDs were determined to be 28.5, 16.5, 25.0, 21.5, and 14.5, respectively.
The MCIDs of the JOABPEQ in LSS were slightly different from 20-point, which was proposed in the JOABPEQ user’s manual. Our findings should be considered when evaluating LSS patients undergoing decompression surgery as JOABPEQ is not LSS specific.
Highlights•LSPSL greatly reduced low back pain, leg pain, and leg numbness. •LSPSL resulted in a significant improvement based on HRQOL questionnaires even in patients with preoperative depressive ...mood. •Preoperative mental health may not affect the HRQOL outcomes in patients with LSS.
•Outcome measures used for LSS may not accurately reflect patient satisfaction.•Identifying the best outcome measure to reflect patient satisfaction is necessary.•We examined the correlation of ...patient satisfaction with major outcome measures.•A strong correlation was found between patient satisfaction and JOABPEQ.•JOABPEQ may be used as a main questionnaire for LSS after decompression surgery.
Decompression surgery is the standard treatment for lumbar spinal stenosis (LSS); however, despite the good clinical outcomes reported for this procedure, a relatively high dissatisfaction rate has been reported. We hypothesized that the previously used outcome measures do not accurately reflect patient satisfaction (PS). This study aimed to examine which outcome measures reflect PS accurately in patients undergoing decompression for LSS.
Patients with LSS treated with lumbar decompression surgery between January 2014 and March 2016 were enrolled if they had the preoperative and final follow-up questionnaires including the Numeric Rating Scale (NRS), Roland-Morris Disability Questionnaire (RMDQ), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and Short Form-8 (SF-8). PS 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)”. The Spearman correlation coefficient between PS and each questionnaire was calculated.
Postoperative JOABPEQ had strong correlation with PS (r > 0.6) whereas NRS, RMDQ and SF-8 had moderate correlation (0.4 <r < 0.6). JOABPEQ reflected PS much better than other questionnaires.
JOABPEQ reflected PS and therefore may be used as a main outcome measure in evaluating patients who underwent decompression surgery for LSS.
Rotational Dynamics of Coumarin 153 in Supercritical Fluoroform Kometani, Noritsugu; Hoshihara, Yuji; Yonezawa, Yoshiro ...
The journal of physical chemistry. A, Molecules, spectroscopy, kinetics, environment, & general theory,
11/2004, Letnik:
108, Številka:
44
Journal Article
Recenzirano
Subpicosecond fluorescence anisotropy decay curves have been measured using the fluorescence up-conversion technique to examine the rotational dynamics of coumarin 153 (C153) in supercritical ...fluoroform (T = 302 and 310 K). For reduced densities (ρr = ρ/ρc) above 0.9, the rotation times of C153 increase with density. For reduced densities lower than 0.9, the rotation times increase with decreasing density and has a maximum at a density near ρr = 0.5. The comparison with the extrapolation of the data in polar aprotic solvents indicates that the local solvent density around the solute exceeds about 4 times the bulk density at a density near ρr = 0.5, which is consistent with those obtained from the steady-state electronic spectral shifts.
Sensitized photoreduction of Ag+ ions and subsequent formation of colloidal Ag nanoparticles occur when near-UV light is irradiated onto the ethanol solution of a mixture of benzoin (BN), AgClO4 and ...poly(vinylpyrrolidone). Transient species generated by α-cleavage of BN; α-hydroxybenzyl radical (α-HBR) and benzoyl radical (BR), are detected by means of nanosecond laser flash photolysis. It has been found that an apparent decay time of the absorption band of α-HBR is decreased with increasing AgClO4 concentration. In combination with comparative laser flash photolysis studies on benzaldehyde and benzyl in solutions, it has been suggested that α-HBR is capable of reducing Ag+ ions but BR is not.
A novel hybrid process of hydrothermal or supercritical water oxidation and TiO
2
photocatalysis was developed to examine the degradation of chlorobenzene as a model of the oxidative decomposition of ...organic pollutants. Aqueous solutions of chlorobenzene containing H
2
O
2
as the oxidizing agent and/or colloidal TiO
2
nanoparticles as catalyst, were fed into the reactor with the temperature and the pressure controlled to be T = 25-400°C and P = 30 MPa, respectively. Chlorobenzene was considerably decomposed in the presence of H
2
O
2
under hydrothermal conditions for T ≧ 300°C. It appeared that photocatalytic decomposition of chlorobenzene takes place at all temperatures by colloidal TiO
2
nanoparticles under irradiation with near-UV light. We have realized the synergic decomposition of chlorobenzene by the coexistence of H
2
O
2
and TiO
2
in which maximum conversion is more than 80% under irradiation at T = 200°C.
We have examined optical absorption properties of the composite nanoparticles consisting of Ag core coated with the J-aggregate of 3,3′-disulfopropyl-5,5′-dichlorothiacyanine sodium salt (TC) in ...aqueous suspensions and in self-assembled (SA) films on the quartz plates. Four kinds of SA films were fabricated by the alternate adsorption technique; the monolayer SA films in which Ag:TC composite nanoparticles were sparsely (S film) or densely (D film) packed on the surface, and the multilayer SA films composed of D films and thin (SAS film) or thick (SAL film) spacer layers. Based on the absorption spectra and the atomic force microscopic images of those films, the existence of electromagnetic interaction between densely packed Ag:TC nanoparticles in the single layers, as well as between adjacent layers incorporating those nanoparticles has been suggested.
