Introduction: Osteoarthritis (OA) knee is the most common debilitating degenerative disorder beyond age 60 seeking medical attention for disabling pain and progressive reduction of joint movements and functional limitation. Conservative and rehabilitative measures remain the mainstay for early stages. In the recent years, intra articular injections particularly steroids and viscosupplementation are increasingly used for early stage management and have raised concerns about their efficacy. Various studies have claimed that intra-articular viscosupplementation with Hyaluronic acid (HA), specially hylan G-F 20 appeared to be safe, effective in pain relief and improved functional outcomes. Having this hypothesis, we wanted to analyze in detail by using various outcome scores (VAS, WOMAC, SF-36) and compare it with the steroids (methyl prednisolone acetate). Materials and methods: After the institutional review board clearance, this study was conducted as a randomized, prospective study between July 2012 and April 2015. Patients of both sexes beyond age 40 with symptomatic knee OA demonstrating radiological evidence of arthritis [Kellgren-Lawrence (K-L) grade of less than III were randomized into two groups. Patients in the steroid group (group 1, MPG) were subjected to two sittings of intra-articular 6-Methylprednisolone acetate 40mg each (day 0 and day 7). Patients in viscosupplementation group (group 2, HG) were given a single intra-articular injection of hylan G-F 20. Both groups were given standard physiotherapy regimen post-injection. We used the following parameters to measure outcome, 1) 100 mm visual analog pain scale (VAS), 2) Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), 3) SF-36 health survey and 4) Range of motion (ROM) to document the baseline characteristics and subsequent follow ups at 2 nd , 4 th , 12 th , 24 th and 52 nd week. Results: Among the 68 enrolled patients, no statistically significant differences were found regarding demographic patterns and the baseline outcome scores of patients between two groups. The mean age, grade and duration at presentation among the two groups were 56.57 /59.83 years, grade 2 and 3.4 / 3.8 years respectively. At 54 weeks, HG group had a mean ROM of 126.93 o compared to 120.83 o in the MPG group (p=0.001). Regarding VAS, better pain relief (24.80) was noted in the MPG during early period (<3 weeks) as against the HG (67.10). However, reversal of results was noted in the later period (>3 months) with the VAS scores doing significantly better in the HG group (18.67) as against MPG (61.18). In the HG group, WOMAC scores revealed a delayed (>4 weeks) onset of improvement, with plateau formation at 6 th month (28.43). Early improved WOMAC scores in the MPG showed a decreasing trend reaching pre-injection baseline level (55.93) within 3 months. Post-treatment SF-36 health survey at final follow-up revealed that, patients in hylan group showed greater improvement of mean score from baseline in all 8 functional categories compared to cort...
Introduction: Among various spine disorders, degenerative conditions like lumbar disc disease and spondylolisthesis are commonly encountered. Surgery is the option if conservative management fails. Fusion is the only option to alleviate instability. Transforaminal Lumbar Interbody Fusion (TLIF) is a promising procedure to achieve this goal. The aim of our study was to evaluate whether unilateral TLIF with one cage is comparable with other established techniques. Materials and Methods: This is a prospective study with 11 males & 11 females who have undergone TLIF for disc disease and low grade listhesis. A single TLIF cage was used for single level pathologies. In one patient with contiguous two level disc disease, two level TLIF was performed. Results: Results were analysed with respect to intra-op parameters (like surgery duration, blood loss, etc.) and post-op parameters (like fusion, pain relief, etc.). Oswestry Disability Index was used to measure functional outcome. There was a statistically significant improvement in post-op scores (p<0.0001). One complication in the form of Ischemic Optic Neuropathy was encountered. Conclusion: Proper patient selection and surgeon's expertise are important for a successful outcome. TLIF has many advantages when compared to other fusion techniques. It is an ideal management for treating degenerative disc disease and listhesis of low grades.
Background: Osteoporosis is a global problem involving majority of elderly population. Vertebral compression fracture in this population leads to severe pain and decreased quality of life. Percutaneous vertebroplasty alleviates the pain, with a minimal invasive approach. The aim of our study was to analyze the technical considerations and complications of this surgery. Materials and methods: Vertebroplasty was performed in 35 patients with male: female ratio 13:22 in the age group of 52-80 years. We used unipedicular needle insertion and injected 2-3 mL of high-viscosity polymethylmethacrylate in the fractured vertebral body. Visual analog score, Oswestry disability score, and Oswestry disability index were used to analyze functional outcome. Results: Pain relief had a significant p value (<0.0001). Oswestry disability score and index showed a good improvement in the quality of life with a p value < 0.0001. The Beck index did not show a significant change postoperatively. Complications encountered were cement extravasation into venous pathway, cement extravasation into the soft tissue, cement extravasation into the needle tract, and adjacent vertebral fractures. No major complication was encountered. Conclusion: Vertebroplasty provides better pain relief, improved function, and quality of life than conservative management. Use of an appropriate technique will improve the overall success rate of the procedure and minimize the complications. Clinical significance: For patients with osteoporotic fractures who do not respond to conservative measures, vertebroplasty is a simple, effective, and minimally invasive procedure providing adequate pain relief and improving the quality of life.
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