Comparison of Physical Therapy Follow-Up of Patients with Operated and Non-Operated Lumbar Spinal Stenosis According to the Nottingham Health Profile-Pain Scale

Background: Lumbar spinal stenosis (LSS) continues to be a major problem in societies, causing job loss and lowering quality of life. There are two types of treatment methods, physical therapy and surgery. If patients with LSS avoid treatment, they are likely to experience neurological deterioration in later years. Objective: The study aimed to evaluate the effect of physical therapy applied after decompression surgery or the effect of only applied physical therapy in patients with lumbar spinal stenosis. Materials and Methods: The results of the physical therapy follow-up of patients who had surgery and did not have surgery due to lumbar spinal stenosis between July 2014 and December 2019 were compared with each other. All patients received physical therapy for 6 months. Included were 42 patients who underwent decompression surgery due to LSS; 56 patients were not operated. Clinical outcomes were measured using the Nottingham Health Profile-Pain (NHP-Pain) scale at the initial, first, third and sixth months. The results were compared statistically. Results: The age of the operated patients was 54.69 ± 8.42 (39 - 71), while the non-operated patients were 59.16 ± 14.04 (34 - 83). There was no significant difference in the statistical comparison (p = 0.053). While the body mass index (BMI) of the operated patients was 29.43 ± 4.99 (21 - 40), the BMI of the non-operated patients was 28.84 ± 4.62 (22 - 42). There was no significant difference in the statistical comparison (p = 0.552). The scores of a 6-month physical therapy follow-up of patients were evaluated according to the NHP-pain scale. The values of patients who underwent surgery, initial - 1st month (p < 0.001), 1st month - 3rd month (p = 0.028), 3rd month - 6th month (p = 0.389) follow-up of the intervals were compared statistically. The values of non-operated patients, initial - 1st month (p = 0.008), 1st month -3rd month (p = 0.013), 3rd month - 6th month (p = 0.025) were compared statistically. Patients with and without surgery had significantly different initial pain scores (p < 0.001). Conclusions: The NHP-Pain scores of the patients undergoing physical therapy with the operation were shown to provide more significant improvement than the group receiving only the physical therapy. Patients with LSS should be treated with an operation to obtain the maximum benefit of physical therapy.

ADAMTS-8 Activity in Synovial Cells in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA), chronic, autoimmune causing joint stiffness, pain, fatigue and functional disorders is a disease. The aim of this study is to investigate the presence of ADAMTS-8 expression in cells in synovial fluid in rheumatoid arthritis patients. Patients with active RA were aspirated with arthro synthesis from the knee joint. Blood samples were taken from the patients at the same time, plasma samples were separated. Patients with sinovial fluid treated between 2019-2020 year in the Gazi Yaşargil Hospital Physical Therapy and Rehabilitation Clinic were involved in the study that was consulted with knee pain and difficulty in performing their daily activities. Informed consent form was obtained from all of the patients (10 RA and 10 patients). CRP, RF and ESH results were statistically evaluated in patients with Control and Rheumatoid arthritis. CRP, RF and ESH results were statistically evaluated in patients with Control and Rheumatoid arthritis. In patient samples with Rheumatoid arthritis, degeneration in synovial cells was observed in some nuclei in the form of pycnosis and apoptotic. ADAMTS-8 expression in the form of aggregates in synovial cells was found to be positive. It was observed that rheumatoid arthritis increased apoptotic change in synovial cells. ADAMTS8 in synovial cells in rheumatoid arthritis cases may cause a significant increase in apoptosis levels by suppressing some signal pathways, and predicts that apoptosis induction may play a role in the inhibition of ADAMTS8-mediated synovial cell proliferation.