Arun Kumar Somasundaram

Abstract

Introduction: Lumbar spondylolisthesis is a common condition in the middle-aged population that causes significant morbidity. In the management of spondylolisthesis, spinal fusion with instrumentation has been the standard of care. This study aimed to analyze whether fusion is a necessary component for achieving an optimal functional outcome in the management of spondylolisthesis. Materials and Methods: This is a retrospective study involving 76 patients who underwent a transforaminal lumbar interbody fusion with a minimum follow-up of one year. Parameters assessed were preoperative pain score with VAS, functional ability with ODI, radiological outcome with reduction of slip grade, slip angle, and lumbar lordosis improvement. MacNab’s criteria for functional outcome and Lee’s criteria for fusion were utilized. Statistical analysis was performed with students’ paired t-test and Pearsons’ correlation analysis. Results: Improvement in VAS and ODI was noted as 8.2 to 2.1 and 72 to 14 respectively. Slip angle improved from 240 to 6o and 78% of the patients showed radiological fusion and 89% showed good clinical outcomes at 1-year follow-up. Correlation analysis showed no significant correlation between the pain scores and radiological fusion parameters analyzed (r=0.142, p=0.361). However, a significant correlation was noted between the fusion group and functional outcome parameters like the ODI score (r=0.34, p Conclusion: TLIF ensures successful fusion in spondylolisthesis patients. Spina fusion is a necessary prerequisite for a successful functional outcome in spondylolisthesis patients undergoing TLIF. Slip angle reduction is not mandatory in all patients of lumbar spondylolisthesis. Keywords: Fusion, Spondylolisthesis, TLIF, PLIF, Interbody Fusion, Spine.

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Abstract

Introduction: Plantar Fasciitis is one of the commonest causes of heel pain and can be very challenging for clinicians to treat it successfully in the long run. The results of using autologous platelet-rich plasma(PRP) to treat chronic plantar fasciitis have been very encouraging but there is a dearth of literature comparing its effectiveness with steroid injection in long term for the treatment of chronic plantar fasciitis. This prospective comparative study is conducted to compare the efficacy of PRP over corticosteroids. Materials and Methods: We conducted this prospective comparative study between PRP and steroid injection by enrolling patients who failed the conservative line of management for 6 weeks period. We sequentially followed up the patient at discharge from the hospital, 6 weeks, 3 months, 6 months, and one year. The preoperative and postoperative function was assessed with The American Orthopaedic Foot and Ankle SocietyAOFAS) Score including pain, function, alignment components along with the Visual Analog Scale(VAS) score for pain. Inter and Intragroup comparisons were made with student t-test and paired t-test respectively. Results: 50 patients with a mean age of 37.2 years were enrolled in the study. In comparison, the PRP group showed a significant improvement in the AOFAS score at 6 months (p=0.021) and 1 year(p=0.001) compared to the corticosteroid injection. However, the reduction in pain by the VAS score was comparable between the two groups at 6 months (p=0.542) and one year (p=0.224) respectively. Conclusion: While both PRP and corticosteroid injection significantly reduces the pain at 1-year followup, functional improvement is significantly better in the PRP group compared to the steroids. PRP injection therapy remains more effective compared to steroid injection in the management of recalcitrant plantar fasciitis considering the degenerative component of the disease entity. Keywords: Platelet Rich Plasma, Corticosteroid, Plantar Fasciitis.

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