We validated the North American Spine Society (NASS) outcome-assessment instrument for the lumbar spine in a computerised touch-screen format and assessed patients’ acceptance, taking into account previous computer experience, age and gender. Fifty consecutive patients with symptomatic and radiologically-proven degenerative disease of the lumbar spine completed both the hard copy (paper) and the computerised versions of the NASS questionnaire. Statistical analysis showed high agreement between the paper and the touch-screen computer format for both subscales (intraclass correlation coefficient 0.94, 95% confidence interval (0.90 to 0.97)) independent of computer experience, age and gender. In total, 55% of patients stated that the computer format was easier to use and 66% preferred it to the paper version (p < 0.0001 among subjects expressing a preference). Our data indicate that the touch-screen format is comparable to the paper form. It may improve follow-up in clinical practice and research by meeting patients’ preferences and minimising administrative work

Purpose of the study and background. Healthcare practitioners' (HCPs) attitudes and beliefs about MSK pain influence their practice behaviour. The Pain Attitudes and Beliefs Scale (PABS), developed for use in the context of LBP, consists of two subscales (biomedical and biopsychosocial) is the most widely used measure. However, poor performance of the biopsychosocial orientation scale is attributed, in part, to inadequate conceptualisation of the orientation. Purpose. To develop a new biopsychosocial scale and adapt the PABS to assess HCPs' attitudes and beliefs about common MSK pain. Methods and results. A grounded conceptualisation process was conducted with 40 MSK HCPs and/or researchers using concept mapping methodology. The resultant conceptual framework consisted of six primary domains of biopsychosocial clinical orientation (bio-clinical, therapeutic relationship, individual patient aspects, emotions, social and work) and informed development of new scale items. These items were included with existing PABS items in a national survey of UK-based HCPs, and analysis was conducted on 587 responses. Exploratory and confirmatory factor analyses identified and confirmed a new 10-item biopsychosocial scale (Cronbach's alpha of 0.83). The new biopsychosocial and existing biomedical scales demonstrated good test-retest reliability (ICC(2,1) 0.77 and 0.74 respectively). Standard error of measurement and smallest detectable change were also established. Conclusion. The new generic MSK version of the PABS biopsychosocial scale shows promising structural validity and test-retest reliability. The existing PABS biomedical scale's structure and performance was upheld. The new conceptual framework provides a contemporary, comprehensive understanding of the biopsychosocial clinical approach to common MSK pain, with potential value for the development, delivery and evaluation of biopsychosocial clinical practice. No conflicts of interest. Sources of funding:. Kirsty Duncan was the holder of an ACORN PhD studentship from Keele University. Part of the conceptualisation component of this work was also supported by a Chartered Society of Physiotherapy Charitable Trust International Lecture Fund Award. Annette Bishop and Nadine Foster were supported through an NIHR Research Professorship for Nadine Foster (NIHR-RP-011-015). NEF is an NIHR Senior Investigator. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health

Background. Disability is an important multifaceted construct. The aim of this study was to develop and evaluate a brief, generic self-reported disability questionnaire: the Universal Disability Index (UDI). Methods. Convenience sampling was used to collect general population data via an online survey. Data were randomly divided into training and validation subsets. The dimensionality and structure of eight UDI questionnaire items were evaluated using exploratory factor analysis (EFA, training subset) followed by confirmatory factor analysis (CFA, validation subset). To assess concurrent validity, the UDI summed score from the full dataset was compared to the Groningen Activity Restriction Scale (GARS) and the Graded Chronic Pain Scale (GCPS) disability scores. Internal consistency was also assessed. Results. 403 participants enrolled; 364 completed at least one UDI item. Three single-factor versions of the UDI were assessed (8-item, 7-item, and 6-item). All versions performed well during EFA and CFA (182 cases assigned to each), but none met the RMSEA (Root Mean Square Error of Approximation) criterion (≤ 0.08). All versions of the UDI had high internal consistency (Cronbach's α > 0.90) and were strongly correlated (Pearson's r > 0.7) with both GARS and GCPS disability scores, indicating concurrent validity. Conclusions. A brief, generic self-reported disability questionnaire was found to be valid and to possess good psychometric properties. The UDI has a single factor structure and either a 6-item, 7-item or 8-item version can be used to measure disability. For brevity and parsimony, the 6-item UDI is recommended, but further testing of all versions is warranted. Conflicts of interest. No conflicts of interest. Sources of funding. No funding obtained

Background to the study. The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. When evaluating outcome it is important to identify a PROM with good measurement properties. Purpose of the study. To review the measurement properties of the low back and neck versions of the Bournemouth Questionnaire. Methods. Bibliographic databases (e.g. EMBASE, MEDLINE, CINAHL and PsycInfo) were searched for articles evaluating the measurement properties of the Bournemouth Questionnaire. Articles were excluded that did not evaluate measurement properties of this instrument. The methodological quality of the studies selected was evaluated using the COSMIN checklist with the four point rating scale. Studies were rated as “excellent”, “good”, “fair” or “poor” based on completion of the checklist. Results. The initial search produced 6265 hits. A total of 13 studies were included in the final evaluation. Seven studies used the Bournemouth Questionnaire neck version, and six studies involved the back version. Cross-cultural translation was reported in six studies, reliability data were reported in eight studies, and responsiveness in ten studies. Conclusion. The review's findings suggest that the Bournemouth Questionnaire has suitable measurement properties for benchmarking practice in musculoskeletal settings. Conflicts of interest. None. Sources of funding. This study was sponsored by the National Council for Osteopathic Research (. www.ncor.org.uk. )

Background to the study:. The use of Patient Reported Outcome Measures (PROMs) is being increasingly advocated but data are still being collected using paper systems. This is costly and environmentally challenging. New innovations are required to balance the challenges of capturing PROM data while considering budgets, and access to IT, and patient choice. Purpose of the study:. To develop and test a mobile phone and web app for collecting patient reported outcomes about musculoskeletal symptoms. Methods:. The content of the app was developed following qualitative work with patients and clinicians, and a review of measurement properties of different PROMs. Early versions of the app underwent α- and β-testing to identify issues with functionality. The PROM app was pilot-tested to assess feasibility, responsiveness, and test-retest reliability of the PROMs. The pilot version of the app contained demographic data, the Roland Morris Disability Questionnaire (RMDQ), the Bournemouth Questionnaire, and Visual Analogue Scale for pain. At follow-up additional questions exploring patient satisfaction and experience of care, plus a transition question were asked. Results:. A total of 517 patient codes were allocated. Completed datasets were gathered from patients (N=92) potentially indicating issues with acceptability and feasibility. Data analysis indicated good completion of questions. The RMDQ appeared to be largely redundant in this patient population and was removed in the final version of the app. Conclusion:. The app performed well when used by participants. Support is required for practitioners and patients to implement this electronic data capture system

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To report the development of the technique for minimally invasive lumbar decompression using robotic-assisted navigation.

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Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date.

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To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation.

Background. There is a paucity of prognosis research in patients with neuropathic low back-related leg pain (LBLP) in primary care. Purpose. To investigate the clinical course and prognostic factors in primary care LBLP patients consulting with neuropathic pain (NP). Methods. LBLP patients in a primary-care cohort study (n=606) completed the self-report version of Leeds Assessment for Neurological Symptoms and Signs (s-LANSS, score of ≥12 indicates possible NP) at baseline and 4-months. Mixed effects models compared pain-intensity (highest of mean leg or mean back pain - 0–10 NRS at baseline, 4-months, 12-months and 3-years) between those with persistent NP (s-LANSS ≥12 at baseline and 4-months) and those without (s-LANSS ≥12 at baseline and <12 at 4-months). Univariable and multivariable binary logistic regression examined association between potential prognostic factors (chosen from baseline self-report questionnaires, clinical examination, MRI scan findings) and persistent NP. Multiple imputation was used to account for missing data. Results. 44% (72/164) of patients with NP at baseline had persistent NP at 4-months. Mean pain intensity of patients with persistent NP was higher at 4-months, 12-months and 3-years compared to those without. In univariable analysis, only pain self-efficacy was significantly associated with persistent NP (OR 0.98, 95% CI 0.96 to 0.998). In multivariable analysis, none of the 7 investigated factors were significantly associated with persistent NP. Conclusion. Patients with persistent NP were consistently worse-off up to 3-years follow-up compared to those without. It was difficult to identify those patients with NP at baseline who would have persistent NP at 4-months. No conflicts of interest. Sources of funding: Sarah Harrisson is a Clinical Doctoral Fellow funded through a National Institute for Health Research (NIHR) Research Professorship for Nadine Foster (NIHR-RP-011-015). Nadine Foster is a NIHR Senior Investigator. Kika Konstantinou is supported by a Higher Education Funding Council for England/ National Institute for Health Research Senior Clinical Lectureship. The views expressed in this publication are those of the author(s), not necessarily those of the NHS, NIHR or the Department of Health and Social Care. This work relates to an Education and Continued Professional Development (level 2) award by the Musculoskeletal Association of Chartered Physiotherapists to Sarah Harrisson (June 2016)

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To investigate the correlations among cytokines and regulatory T cells (T-regs) in ankylosing spondylitis (AS) patients, and their changes after anti-tumour necrosis factor-α (TNF-α) treatment.

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To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so.

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Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS).

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The aim of this study was to investigate the incidence and characteristics of instrumentation failure (IF) after total en bloc spondylectomy (TES), and to analyze risk factors for IF.

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To determine the major risk factors for unplanned reoperations (UROs) following corrective surgery for adult spinal deformity (ASD) and their interactions, using machine learning-based prediction algorithms and game theory.

Background. Medication prescribing patterns for patients with neuropathic low back-related leg pain (LBLP) in primary care are unknown. Purpose. To estimate the proportion of patients prescribed pain medications, describe baseline characteristics of patients prescribed neuropathic pain (NP) medication and estimate the proportion of LBLP patients with refractory NP. Methods. General practice electronic medical and prescribing records of a large (n=609), prospective, primary-care cohort of LBLP patients were analysed. Cases of NP were identified using the self-report version of the NP scale, Leeds Assessment for Neurological Symptoms and Signs (score of ≥12 indicates possible NP) (n=293). Patients with leg pain intensity ≥ 5 (mean of three 0–10 NRSs) or <30% reduction in disability (RMDQ 0–23) at 4-months compared to baseline and who were prescribed ≥ 2 NP medications were considered to have refractory NP. Results. 82% (223/273) of patients with NP were prescribed at least one pain medication; 29% (80/273) of patients were prescribed one first-line NP medication (for example Amitriptyline). Patients who were prescribed NP medication(s) had higher leg pain intensity and disability. There was evidence that patients improved with (61%, 41/67) and without (75%, 76/102) having been prescribed NP medication. Few patients (4%, 7/169) met the criteria for refractory NP suggesting that the scale of the problem in primary care is limited. Conclusion. Patients with NP were commonly prescribed pain medication, under a third were prescribed NP medication and many patients improved without such medication. Future research is needed to determine the effectiveness of NP medication. No conflicts of interest. Sources of funding: Sarah Harrisson is a Clinical Doctoral Fellow funded through a National Institute for Health Research (NIHR) Research Professorship awarded to Nadine Foster (NIHR-RP-011-015). Nadine Foster is a NIHR Senior Investigator. Kika Konstantinou is supported by a Higher Education Funding Council for England/ National Institute for Health Research Senior Clinical Lectureship. The views expressed in this publication are those of the author(s), not necessarily those of the NHS, NIHR or the Department of Health and Social Care. This work relates to an Education and Continued Professional Development (level 2) award by the Musculoskeletal Association of Chartered Physiotherapists to Sarah Harrisson (June 2016)

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Frailty has been gathering attention as a factor to predict surgical outcomes. However, the association of frailty with postoperative complications remains controversial in spinal metastases surgery. We therefore designed a prospective study to elucidate risk factors for postoperative complications with a focus on frailty.

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CRP is an acute-phase protein that is used as a biomarker to follow severity and progression in infectious and inflammatory diseases. Its pathophysiological mechanisms of action are still poorly defined. CRP in its pentameric form exhibits weak anti-inflammatory activity. The monomeric isoform (mCRP) exerts potent proinflammatory properties in chondrocytes, endothelial cells, and leucocytes. No data exist regarding mCRP effects in human intervertebral disc (IVD) cells. This work aimed to verify the pathophysiological relevance of mCRP in the aetiology and/or progression of IVD degeneration.

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In this investigation, we administered oxidative stress to nucleus pulposus cells (NPCs), recognized DNA-damage-inducible transcript 4 (DDIT4) as a component in intervertebral disc degeneration (IVDD), and devised a hydrogel capable of conveying small interfering RNA (siRNA) to IVDD.

Background. Patients with low back-related leg pain (LBLP) can present with neuropathic pain; it is not known but is often assumed that neuropathic pain persists over time. This research aimed to identify cases with neuropathic pain that persisted at short, intermediate and longer-term time points, in LBLP patients consulting in primary care. Methods. LBLP patients in a primary care cohort study (n=606) completed the self-report version of Leeds Assessment for Neurological Symptoms and Signs (s-LANSS, score of ≥12 indicates possible neuropathic pain) at baseline, 4-months, 12-months and 3-years. S-LANSS scores and percentages of patients with score of ≥12 are described at each time-point. Multiple imputation was used to account for missing data. Results. At baseline, 48.3% (293/606) of patients presented with neuropathic pain, 25.0% (94/376) at 4-months, 22.6% (79/349) at 12-months and 21.6% (58/268) at 3-years. A small proportion (6.6%) scored ≥ 12 at all four time-points. Those who scored ≥ 12 at baseline and 4-months reported higher disability (RMDQ (0–23) 15.2) and depression scores (HADS (0–21) 8.6), and lower pain self-efficacy (PSEQ (0–60) 27.2), compared to those with neuropathic pain at one other time-point at most. Conclusion. Few LBLP patients in primary care present with long-term persistent neuropathic pain. Patients with neuropathic pain at baseline and short-term follow-up present with greater morbidity in terms of disability, depression and lower confidence to manage their pain. This is important because these patients may benefit the most from early intervention using neuropathic pain medication. These findings will inform research investigating potential prognostic indicators of persistent neuropathic pain. Conflicts of interest: None. Sources of funding: Support for SA Harrisson, a National Institute for Health Research (NIHR) Clinical Doctoral Fellow and NE Foster, an NIHR Senior Investigator, was provided by an NIHR Research Professorship awarded to NE Foster (NIHR-RP-011-015). K Konstantinou is supported by a Higher Education Funding Council for England/ NIHR Senior Clinical Lectureship. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health

Purpose of study and background. Neuropathic pain is a challenging pain syndrome to manage. Low back-related leg pain (LBLP) is clinically diagnosed as either sciatica or referred leg pain and sciatica is often assumed to be neuropathic. Our aim was to describe the prevalence and characteristics of neuropathic pain in LBLP patients. Methods. Analysis of cross-sectional data from a prospective, primary care cohort of 609 LBLP patients. Patients completed questionnaires, and received clinical assessment including MRI. Neuropathic characteristics (NC) were measured using the self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (SLANSS; score of ≥12 indicates pain with NC). Results. 52% of the patients diagnosed with sciatica and 39% of those diagnosed with referred leg pain presented with pain with NC. Irrespective of LBLP diagnosis, patients with NC reported significantly worse leg pain (mean 5.8 vs 4.7), back pain intensity (0.0 vs 0.0), disability (RMDQ 15.2 vs 12.4), high risk of persistent disabling pain (47.5% vs 31.5%), depression (HADS 7.3 vs 5.4) and anxiety (8.9 vs 6.7), compared to patients without NC. Sciatica patients with NC presented with higher leg pain (6.0 vs 4.8) and disability but less anxiety (8.6 vs 10.2) and depression compared to patients with referred pain with NC. Conclusion. LBLP patients with NC present with more severe pain, disability and psychological morbidity, but these characteristics differ according to clinical diagnosis, suggesting potential subgroups. The data will inform future research on the clinical course and prognosis of these patients. No conflicts of interest. Sources of funding: Support for SA Harrisson, a National Institute for Health Research (NIHR) Clinical Doctoral Fellow and NE Foster, an NIHR Senior Investigator, was provided by an NIHR Research Professorship awarded to NE Foster (NIHR-RP-011-015). K Konstantinou is supported by a Higher Education Funding Council for England/ NIHR Senior Clinical Lectureship. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health