Fully Endoscopic Spine Separation Surgery in Metastatic Disease-Case Series, Technical Notes, and Preliminary Findings.

Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, thus, the possibility of faster application of radiotherapy. Materials and Methods: In this study, separation surgery for preparing patients for stereotactic body radiotherapy (SBRT) was performed with fully endoscopic spine surgery (FESS) followed by percutaneous screw fixation (PSF). Results: Three patients with metastatic spine disease in the thoracic spine were treated with fully endoscopic spine separation surgery. The first case resulted in the progression of paresis symptoms that resulted in disqualification from further oncological treatment. The remaining two patients achieved satisfactory clinical and radiological effects and were referred for additional radiotherapy. Conclusions: With advancements in medical technology, such as endoscopic visualization, and new tools for coagulation, we can treat more and more spine diseases. Until now, spine metastasis was not an indication for the use of endoscopy. This method is very technically challenging and risky, especially at such an early stage of application, due to variations in the patient's condition, morphological diversity, and the nature of metastatic lesions in the spine. Further trials are needed to determine whether this new approach to treating patients with spine metastases is a promising breakthrough or a dead end.

Prevalence of "red flags" among the internet user with low back pain seeking information on spinal health-a web survey.

BACKGROUND: In early management of low back pain (LBP) the identification of "red flags" (RFs) plays an important role, as this condition is highly prevalent, and advanced treatment would not be feasible in every case. These alarm signs are designed to detect serious causes requiring prompt interventions, such as malignancy, fracture, inflammation, or cauda equina syndrome. Although their predictive value has been questioned, they are commonly used in clinical practice. The use of RFs in Web applications has never been evaluated before. In theory, they should reduce risks related to online counseling on LBP, screening for possible potentially serious underlying conditions based on relatively simple questionnaires. This study was designed to assess the prevalence of RFs among Internet users with LBP seeking information about spinal disorders. MATERIALS AND METHODS: Of 2,471 respondents who completed the RF questionnaire, 2,349 entries were used for analysis. Of another 1,959 respondents who completed the additional questionnaire containing the Oswestry Disability Scale, data from 1,850 were included in the study. RESULTS: The majority of subjects (68.16%) reported at least one RF. The most prevalent RF was a foot weakness; the least prevalent was unexplained weight loss. Pain intensity was a significant risk factor for presence of at least one RF. CONCLUSIONS: The results show that RFs are highly prevalent and that most likely the negative predictive value of RFs will be low. Unfortunately, considering the nature of this study it was impossible to evaluate their sensitivity and specificity. In conclusion, although RFs are highly prevalent in the population studied, simple screening should be mandatory in all Web sites providing information on spinal health. Further research should be undertaken to optimize RFs.

Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index.

STUDY DESIGN: Validation of a translated, culturally adapted questionnaire. OBJECTIVE: To translate and culturally adapt a Polish version of the Oswestry Disability Index (ODI) and to validate its use in Polish patients. SUMMARY OF BACKGROUND DATA: The ODI is among the most popular questionnaires used to evaluate back pain-related disability. To our knowledge no validated Polish version of the index was available at the time our study was initiated. METHODS: The questionnaire was translated and culturally adapted by 2 independent translators and approved by expert committee. Final version was included in the booklet consisting in addition of a previously validated Roland-Morris disability questionnaire, VAS for low back and leg and 3 Likert scale questions (pain medications, pain frequency, disability). It was tested on 169 patients with chronic low back pain, 164 (97%) of them were enrolled, and 84 of 164 (53%) returned the completed retest booklet within 2 to 14 days after the baseline test. There were no differences between the 2 groups in demographic and clinical parameters. Test-retest reliability, internal consistency, and construct validity were investigated. RESULTS: The mean ODI (standard deviation [SD]) was 48.45 (18.94); minimum 2, maximum 94. The Cronbach α for baseline questionnaires (n = 164) was 0.90. Concurrent validity, measured by comparing ODI responses with the results of the Roland-Morris disability questionnaire score was very good (r = 0.607, P < 0.001). The correlation with VAS back was fair (r = 0.37, P < 0.001) and with VAS leg was good (r = 0.56, P < 0.001). The tested ODI had excellent test-retest reliability, the intraclass correlation coefficient was 0.97 and standard error of measurements was 3.54, the resulting minimal detectable changes at the 95% confidence level was 10. CONCLUSION: The results of this study indicate that the Polish version of the ODI is a reliable and valid instrument for the measurement of disability in Polish-speaking patients with lower back pain.

Cross-cultural adaptation and validation of the Polish version of the core outcome measures index for low back pain.

PURPOSE: The core outcome measures index (COMI) is a short, multidimensional outcome scale validated for the use by patients with spinal disorders. It is a recommended instrument in the Spine Society of Europe Spine Tango Registry. The purpose of this study was to produce a cross-culturally adapted and validated Polish COMI. METHODS: The cross-cultural adaptation was carried out using the established guidelines. One-hundred and sixty-nine patients with chronic low back pain were enrolled, 89 took part in the reproducibility part of the study. Data quality, construct validity and reproducibility were assessed. RESULTS: The quality of data was very good with very few missing answers and modest floor effect. Reliability expressed as intraclass correlation coefficient (ICC) was 0.90 (95 % CI 0.85-0.93) for the overall COMI score and for most of the individual core items. The minimum detectable change (MDC95%) was 1.79. CONCLUSIONS: The Polish version of COMI showed a favorable reproducibility similar to that of previously tested language versions. The COMI scores correlated sufficiently with existing measures. This version of the COMI is a valuable instrument for the use by Polish-speaking patients with spinal disorders.