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Hamdriansyah Siagian

Relationship between Oswerty Disability Index (ODI score) improvement and fusion of Degenerative Lumbal Spondylosis after PLIF . Hamdriansyah Siagian. BACKGROUND . DLS. Degenerative segmen lumbal process*

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Hamdriansyah Siagian

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  1. Relationship between Oswerty Disability Index (ODI score) improvement and fusion of Degenerative LumbalSpondylosis after PLIF HamdriansyahSiagian

  2. BACKGROUND • DLS • Degenerative segmenlumbal process* • Clinical symptom : Discogenic low back pain, facet lumbar osteoarthritis and segmental instability*. • PLIF • Arthrodesis** • Posterior Approach** • Insertion bone graft with retraction of spinal root** • ODI • Gold standart of Measurement clinical and functional outcome in low back pain*** *Modic M T, Ross J S. Lumbar Degenerative disc disease. Radiology 2007;1:43-61 **Dipaola CP, Moliniari RW. Posterior Lumbar Interbody Fusion . J Am AcadOrthopSurg 2008;16:130-139 ***Roland M, Fairbank J. The Roland –Morris Disability questionnaire and the Osswerty disability questionnaire. Spine,2000. Vol 25,No.24,pp 3115-31124

  3. BACKGROUND Incidence • 60% , adult had history of low back pain* • 75% looking for medical intervention* clinical • Spinal insrumentation will increase fusion rate but didnot have the same result in clinical outcome** • Rate of fusion in PLIF (89%) and clinical outcome (82%). *** *Peng B, Wu W, Hou S, Li P, Zhang C, Yang Y. The pathogenesis of discogenic low back pain. J Bone Joint Surg ( Br) 2008;87-B: 62-7. **Krismer M. Fusion of Lumbar Spine. J Bone Joint Surg (Br) 2012;84-B:783-94 ***Dipaola CP, Moliniari RW. Posterior Lumbar Interbody Fusion . J Am AcadOrthopSurg2008;16:130-139

  4. PROBLEM What is the relationship between improvement of Clinical outcomewith fusion in DLS post PLIF ?

  5. RESEARCH QUESTION • Improvement of ODI score 6 months after PLIF? • Lumbar Fusion after PLIF 6 months? • Relationship between improvement of ODI score with lumbar fusion after 6 months?

  6. HIPOTHESIS • Improvement of ODI score in DLS patient after 6 months post PLIF • Lumbar fusion after 6 months PLIF • There was Relationship between ODI score and lumbar fusion after 6 months PLIF.

  7. GOAL

  8. GOAL

  9. The Research’s Benefit Theoretical benefit This reaserch could give information about the relationship between improvement of ODI score with lumbar fusion after PLIF

  10. The Research’s Benefit Methodologicalbenefit This study is expected to be one of the baseline in assessing clinical outcomes post-fusion, considering the different resultspost-operative clinical outcomes comparing with fusion after PLIF. Clinical benefit This study is expected to be one of therefference to asses the optimalization of PLIF

  11. Teoritical framework Morfology Occupation psycology Individu Physical Occupation Degenerative LumbarSpondylosis General psyclogist • Non operative : • Medicamentosa • spinal injection • Non Medicamentosa • RFA • Fisiotherapy Daily activity Neurogenic pain Mechanical pain inflamation instrumentation Operative Without instrumetation ODI score Fusion

  12. Conceptual framework Chronic Low Back Pain Degenerative LumbarSpondylosis Operative Fusion (PLIF) ODI score

  13. ResearchMethode

  14. ResearchMethode Number of Subject Z2 (1-α/2) P(1-P) n = d2 n = 19

  15. ResearchMethode Inclusion Criteria DLS patient as out patient clinics at cipto mangunkusumo hospital after 6 months PLIF

  16. ResearchMethode Exclusion Criteria • Patients who performed posterior stabilization and lumbar fusion due to other diseases such as infections or/and trauma. • Patients with degenerative lumbar after decompression only without stabilization and fusion. • Patients with lumbar degenerative managed by conservatively. • Patients with incomplete ODI data, can not be contacted, or died.

  17. ResearchMethode • Dependent variable: • Oswerty Disability Index (ODI) were measured after 6 months PLIF • Fusion (bridging trabercula) that occurs at every level of lumbar after 6 months PLIF. Where it will be evaluated with CT-Scan 2. Independent variable: DLSPatients who have undergone the surgical fusion with PLIF

  18. Research Approval Patients who agreed to participate in this research, must complete the informed consent sheet.

  19. Operational Defenition DLS is expressed as the abnormalityprocess of degenerativelumbar segment with clinical symptoms may include lower back pain discogenic, facet osteoarthritis and lumbar segmental instability.* *Peng B, Wu W, Hou S, Li P, Zhang C, Yang Y. The pathogenesis of discogenic low back pain. J Bone Joint Surg ( Br) 2008;87-B: 62-7.

  20. Operational Defenition Posterolateralinterbody fusion (PLIF) is expressed as an arthrodesis procedure of 2 vertebrae with disc excision and bone graft insertion into the intervertebral space through the posterior approach.* *Dipaola CP, Moliniari RW. Posterior Lumbar Interbody Fusion . J Am AcadOrthopSurg 2008;16:130-139

  21. Operational Defenition Fusion expressed as bridging trabecula occurs in the lumbar segment stabilization which is normally not done supported by new bone. Which will be evaluated through CT-Scan. Will be scaled catagorically.* *Krismer M. Fusion of Lumbar Spine. J Bone Joint Surg (Br) 2012;84-B:783-94

  22. Operational Defenition Radiographic fusion criteria for PLIF* • * Kim KH, Park JY, Chin DK. Fusion Criteria for Posterior Lumbar Interbody Fusion with Intervertebral cages : The Significance of Traction Spur. J Korean Neurosurg 2009:46;328-32

  23. Radiologic fusion after PLIF

  24. Operational Defenition Oswerty Disability Index is a gold standard for the assessment of clinical outcomes of low back pain. Which will be assessed 6 months post-surgery, as measured by ordinal scale.* *Roland M, Fairbank J. The Roland –Morris Disability questionnaire and the Osswerty disability questionnaire. Spine,2000. Vol 25,No.24,pp 3115-31124.

  25. Research Protocol Preparation of research Does not meet the criteria Identification of subjects Meet the criteria Refused Inform consent Agree Consecutive Data analysis Controls 6 months (ODI score and CT scan)

  26. Data analysis • Grouping is done based on the fusion range follow-up period up to 6 months. • Population samples were then compared between the median difference score ODI pre surgery with a median score of 6 months postoperative ODI between groups fusion and non fusion. • Analyzed by Mann Whitney test 2 unpaired groups.

  27. Results 1. Patient Charateristic

  28. Results Fusion after 6 months PLIF

  29. Results Coronal view of fusion CT-scan Sagital view of fusion CT-scan

  30. Results 2. ODI Score measurement Pre and Post operation 6 months Friedman’s Test → p=0.005 → significant Wilcoxon’s Test → p=0,005 → significant

  31. Results 3.Difference (delta) ODI score measurement pre operation and 6 months post operation between Fused Group and Non-Fusion group

  32. Results • From the above table there was difference in the median delta in ODI pre surgical and post-surgical. • From the results of Mann Whitney statistical test obtained p value = 0.034. • So it can be said that the difference in median delta comparison ODI pre surgical and post-surgical meaningful.

  33. Discussion • In this study, researchers assess 17 patients after PLIF in ciptoMangunkusumo Hospital from 2008 untill 2013. • But the patients collected only 10 people, so researchers conducted a total sampling of all existing patients. • With the proportion of 6 men (60%) and 4 women (40%). • Age range 28-64 years with a mean of 54.1 years.

  34. Discussion ODI score 6 months after PLIF Clinical outcomes pre-surgery and 6 months post-surgery were measured for each patient. From the 10 patients had a significant decrease in odi score which is median pre surgical 65%, while the median odi score 6 after surgery 15%. Based on these findings obtained improved clinical outcomes in patients 6 months after surgery DLS with PLIF.* *Glassman S, Gornet MF, Branch C, Polly D. MOS Short form 36 and OswertyDiisability Index outcome in lumbar fusion: a multicenter experience. The Spine Journal 2006;6:21-26

  35. Discussion 6 months post-surgery fusion On the measurement of fusion with CT scan at 6 months postoperatively conclude : 8 fusion and 2not fused. From this data, it can be concluded that the technique of PLIF surgery will improve the fusion 6 months after surgery (80%)*. *Hu MW, Liu ZL, Zhou Y, Shu Y, Chen CL, Yuan X. Posterior Interbody Fusion using spinous process and laminae. J Bone Joint Surgery Br 2012;94-B:373-7

  36. Discussion The median delta value of the difference in ODI scores in each group. Measured median delta in the ODI score fusion group, minimum 15%, maximum 65%, so the median obtained 50%. While the median delta in ODI scores in non-fusion group, minimum 10%, maximum 20%, so the median obtained 10% *Yu CH, Wang CT, Chen PQ. Instrumented PostriorInterbody Fusion In Adult Spondylolisthesis. ClinOrthopRelat res 2008;466:3034-3043

  37. Discussion • From the analysis of the criterion-based interpretation, the author managedthe conclusion that there are differences in the median delta in ODI scores pre and 6 months after PLIF group occurring fusion compared with the group that is not fusion. • It can be concluded that the improvement of good clinical outcomes (ODI score) associated with the occurrence of fusion after 6 months of PLIF

  38. Conclusion PLIF surgical techniques proven in the improvement of clinical outcomes in patients with DLS. PLIF surgical techniques proven to increase fusion in patients with DLS. There is a difference between the median difference in ODI scores between the pre and post-surgery with fusion group compared with the non-fusion group.It can be concluded that the improvement of good clinical outcomes (ODI score) associated with the occurrence of fusion after 6 months of PLIF

  39. Sugesstion Further research is needed with long follow-up period to assess clinical and fusion of patients after PLIF. Further research is also necessary to consider the operation technique and the number of levels involved. Further research is also necessary to consider the number of lumbar levels was involved.

  40. THANK YOU

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