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Wottrich S, Kha S, Thompson N, Bakar D, Yee P, Melillo A, Nash C, Healy AT, Steinmetz M, Mroz T. The Effect of Cervical and Lumbar Decompression Surgery for Spinal Stenosis on Erectile Dysfunction. Global Spine J 2024; 14:1193-1200. [PMID: 36281560 DOI: 10.1177/21925682221136493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVES To evaluate the prevalence of erectile dysfunction and evaluate the effects of decompressive surgery on erectile dysfunction in cervical spinal stenosis and lumbar canal stenosis patients. METHODS This observational, prospective analysis enrolled patients aged 18-80 with cervical spinal stenosis and/or lumbar canal stenosis that underwent respective decompressive surgery. The IIEF-5 questionnaire was administered preoperatively, and at 6- and 12-months postoperatively to assess erectile dysfunction severity. The EPIC database was queried to determine any postoperative complications and document prominent erectile dysfunction risk factors. RESULTS Of 79 patients included in the analysis, 42 (53.2%) completed the IIEF-5 at 6 months, and 62 (78.5%) completed it at 12 months. Eighteen had cervical stenosis only, 54 had lumbar stenosis only, and 7 had both. 72% (18/25) of cervical stenosis patients and 83.6% (51/61) of lumbar stenosis patients had erectile dysfunction preoperatively according to IIEF-5 responses. The average preoperative IIEF-5 score indicated significant presence of erectile dysfunction for both the cervical and lumbar stenosis groups. No significant differences were identified in IIEF-5 score deltas from pre- to both postoperative periods. The presence of erectile dysfunction in both the cervical and lumbar stenosis groups was not significantly associated with the presence of any documented risk factors. CONCLUSIONS Our results suggest no significant improvement in overall erectile function postoperatively for patients with preoperative erectile dysfunction. This is important to address during patient counseling for decompression surgery candidates with cervical spinal stenosis and/or lumbar canal stenosis to manage expectations.
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Affiliation(s)
- Stephanie Wottrich
- Dell Seton Medical Center at the University of Texas at Austin, Austin, TX, USA
| | - Stephanie Kha
- The Cleveland Clinic Foundation, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Dara Bakar
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philina Yee
- The Cleveland Clinic Foundation, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Andrew T Healy
- Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | | | - Thomas Mroz
- The Cleveland Clinic Foundation, Cleveland, OH, USA
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Akeda K, Takegami N, Yamada J, Fujiwara T, Murata K, Kono T, Sudo T, Imanishi T, Kurata T, Kawakita E, Sakakibara T, Kondo T, Takegami K, Sato M, Sudo A. Influence of Central Sensitization on Surgical Outcomes of Patients With Degenerative Cervical Myelopathy After Posterior Decompression Surgery: A Multicenter Prospective Study. Global Spine J 2024; 14:1277-1286. [PMID: 36350595 DOI: 10.1177/21925682221139813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
STUDY DESIGN Multicenter prospective study. OBJECTIVE The influence of central sensitization (CS) on neurological symptoms and surgical outcomes in patients with degenerative cervical myelopathy (DCM) remains unknown. This study aimed to investigate the effects of preoperative CS on surgical outcomes of patients with DCM following posterior decompression surgery. METHODS 77 consecutive patients with DCM (mean age 67.1) who received posterior decompression surgery were included in this study. The participants completed CS inventory (CSI) scores and the following patient-reported outcome measures (PROMs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for cervical myelopathy and JOA cervical myelopathy evaluation questionnaire (JOACMEQ) for cervical spinal diseases. The association of preoperative CSI scores with preoperative and postoperative PROMs was analyzed, and their changes were statistically evaluated. RESULTS The preoperative CSI score was significantly decreased at 12 months postoperatively, and it was significantly associated with the JOA score and JOACMEQ preoperatively and at 12 months postoperatively. However, no significant association was observed between preoperative CSI and the postoperative change of any PROMs at 12 months. The posterior decompression surgery significantly improved the JOA scores and 'lower extremity function' and 'quality of life (QOL)' domains of the JOACMEQ, independent of the severity of preoperative CSI score. Multiple regression analysis demonstrated that preoperative CSI was significantly associated with the 'QOL' domain of JOACMEQ and original JOA score at 12 months postoperatively. CONCLUSION The CSI score can be an auxiliary indicator of surgical outcomes of patients with DCM following posterior decompression surgery.
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Affiliation(s)
- Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Orthopedic Surgery, Iwasaki Hospital, Tsu, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Orthopedic Surgery, Iwasaki Hospital, Tsu, Japan
| | - Tatsuhiko Fujiwara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koichiro Murata
- Department of Orthopedic Surgery, Tomidahama Hospital, Yokkaichi, Japan
| | - Toshifumi Kono
- Department of Orthopedic Surgery, Tomidahama Hospital, Yokkaichi, Japan
| | - Takao Sudo
- Department of Orthopedic Surgery, Murase Hospital, Suzuka, Japan
| | - Takao Imanishi
- Department of Orthopedic Surgery, Murase Hospital, Suzuka, Japan
| | - Tatsuya Kurata
- Department of Orthopedic Surgery, Sakakibara Onsen Hospital, Tsu, Japan
| | - Eiji Kawakita
- Department of Orthopedic Surgery, Saiseikai Matsusaka General Hospital, Matsusaka, Japan
| | | | - Tetsushi Kondo
- Department of Orthopedic Surgery, Murase Hospital, Suzuka, Japan
| | - Kenji Takegami
- Department of Orthopedic Surgery, Saiseikai Matsusaka General Hospital, Matsusaka, Japan
| | - Masayoshi Sato
- Department of Orthopedic Surgery, Iga City General Hospital, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Hasan S, Al-Jamal M, Miller A, Higginbotham DO, Cavazos DR, Waheed M, Saleh E, McCarty SA. Efficacy and Outcome Measurement of iFactor/ABM/P-15 in Lumbar Spine Surgery: A Systematic Review. Global Spine J 2024; 14:1422-1433. [PMID: 37994908 DOI: 10.1177/21925682231217253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To determine the efficacy and overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. METHODS We performed a search of the Cochrane Library, Medline Ovid, PubMed, and SCOPUS databases from inception until August 2023. Eligible studies included outcomes of patients receiving iFactor following lumbar spine surgery. The primary outcomes of interest were fusion rates and iFactor efficacy after lumbar surgery in patients who received iFactor. Secondary outcomes included patient-reported outcomes and complication rates. RESULTS A total of 766 titles were initially screened. After inclusion criteria were applied, 5 studies (388 patients) were included, which measured overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. These studies showed acceptable reliability for inclusion based on the Methodical Index for Non-Randomized studies and Critical Appraisal Skills Programme assessment tools. iFactor/ABM/P-15 facilitated significantly faster bone development in various procedures while maintaining favorable clinical outcomes compared to traditional grafts. CONCLUSIONS This systematic review found that iFactor/ABM/P-15 use for lumbar spine surgery maintains similar managing patient-reported outcomes relative to other grafting methods. In regard to rates of fusion, iFactor/ABM/P-15 showed a significantly faster rate of fusion when compared to traditional grafts including allograft, autograft, demineralized bone matrix (DBM), and recombinant human bone morphogenetic protein-2 (rhBMP-2). Future multicenter randomized control trials with larger sample sizes are recommended to further assess iFactor/ABM/P-15 efficacy in lumbar spine surgery.
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Affiliation(s)
- Sazid Hasan
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Malik Al-Jamal
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Alex Miller
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | | | - Daniel R Cavazos
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Muhammad Waheed
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Ehab Saleh
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Scott A McCarty
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
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Munk Bang M, Schou Andersen MC, Poulsen FR, Bonde Pedersen C, Darling P, Jakobsen J, Bechtold D, Dehghani Molander L, Hedegaard Dahlrot R, Nguyen N, Halle B. Treatment of meningiomas involving the optic canal with endoscopic transnasal decompression of the optic nerve. World Neurosurg 2024:S1878-8750(24)00710-1. [PMID: 38692572 DOI: 10.1016/j.wneu.2024.04.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Management of patients with optic nerve sheath meningiomas (ONSM) is controversial and the treatment strategy in this patient group is still up for discussion. Transnasal endoscopic orbital and optic nerve decompression aims to reduce the pressure in the orbit and on the optic nerve and thereby prevent vision loss. This article presents material from seven cases of transnasal endoscopic orbital decompressions. METHODS The study design is a retrospective cohort study. The aim was to include all patients with a meningioma residing along the nerve sheath and who were operated using endoscopic transnasal decompression of the orbit and if needed the optic canal at Odense University Hospital. Data from the medical records were collected and pre- and postoperative eye examinations were compared. In addition, it was recorded whether there were complications to the procedure and whether additional treatments were given. RESULTS In total, four women and three men were included in the study. Four out of seven patients experienced improvement in vision after the operation. One patient experienced unchanged vision and two patients experienced deterioration of vision after surgery. CONCLUSIONS The current report of seven patients with ONSM shows promising results for this surgical procedure as four out of seven patients experienced improvement in their vision at follow-up examinations. The two patients, who experienced deterioration of vision, already had severely reduced vision pre-operatively, which indicates that surgery should be considered before the vision becomes significantly reduced.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nina Nguyen
- Radiology at Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
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Meter J, Anthony T, Walsh JP, Amesur A, Williams CN. Decompression and collagen wrapping of a fibrolipomatous hamartoma of the median nerve: a new approach for a rare and difficult problem. Case Reports Plast Surg Hand Surg 2024; 11:2344262. [PMID: 38665769 PMCID: PMC11044751 DOI: 10.1080/23320885.2024.2344262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 12/12/2023] [Indexed: 04/28/2024]
Abstract
Fibrolipomatous hamartoma is a rare benign slow growing fibrofatty tumor of peripheral nerves of unknown etiology. Clinical presentation may mimic carpal tunnel syndrome when involving the median nerve. We present a case of FLH of the median nerve in a 59-year-old female treated with decompression and collagen nerve wrapping.
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Affiliation(s)
- Joseph Meter
- Valley Hospital Medical Center, Las Vegas, Nevada, USA
| | | | - John P. Walsh
- Valley Hospital Medical Center, Las Vegas, Nevada, USA
| | - Ajit Amesur
- Valley Hospital Medical Center, Las Vegas, Nevada, USA
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Watanabe K, Otani K, Nikaido T, Kato K, Kobayashi H, Yabuki S, Konno SI, Matsumoto Y. Time Course of Asymptomatic Stenosis in Multiple Lumbar Spinal Stenosis-Five-Year Results of Selective Decompression of Symptomatic Levels. Medicina (Kaunas) 2024; 60:636. [PMID: 38674282 PMCID: PMC11052377 DOI: 10.3390/medicina60040636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Background: In the diagnosis of lumbar spinal stenosis (LSS), finding stenosis with magnetic resonance imaging (MRI) does not always correlate with symptoms such as sciatica or intermittent claudication. We perform decompression surgery only for cases where the levels diagnosed from neurological findings are symptomatic, even if multiple stenoses are observed on MRI. The objective of this study was to examine the time course of asymptomatic stenosis in patients with LSS after they underwent decompression surgery for symptomatic stenosis. Materials and Methods: The participants in this study comprised 137 LSS patients who underwent single-level L4-5 decompression surgery from 2003 to 2013. The dural sac cross-sectional area at the L3-4 disc level was calculated based on preoperative MRI. A cross-sectional area less than 50 mm2 was defined as stenosis. The patients were grouped, according to additional spinal stenosis at the L3-4 level, into a double group (16 cases) with L3-4 stenosis, and a single group (121 cases) without L3-4 stenosis. Incidences of new-onset symptoms originating from L3-4 and additional L3-4-level surgery were examined. Results: Five years after surgery, 98 cases (72%) completed follow-up. During follow-up, 2 of 12 patients in the double group (16.7%) and 9 of 86 patients in the single group (10.5%) presented with new-onset symptoms originating from L3-4, showing no significant difference between groups. Additional L3-4 surgery was performed for one patient (8.3%) in the double group and three patients (3.5%) in the single group; again, no significant difference was shown. Conclusion: Patients with asymptomatic L3-4 stenosis on preoperative MRI were not prone to develop new symptoms or need additional L3-4-level surgery within 5 years after surgery when compared to patients without preoperative L3-4 stenosis. These results indicate that prophylactic decompression for asymptomatic levels is unnecessary.
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Affiliation(s)
- Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan; (K.O.); (T.N.); (K.K.); (H.K.); (S.Y.); (Y.M.)
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Huang CC, Fitts J, Huie D, Bhowmick DA, Abd-El-Barr MM. Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions-A Narrative Review. J Clin Med 2024; 13:2122. [PMID: 38610887 PMCID: PMC11012719 DOI: 10.3390/jcm13072122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery.
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Affiliation(s)
- Chuan-Ching Huang
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jamal Fitts
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - David Huie
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Deb A. Bhowmick
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
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Wan Y, Wang Z, Bai JJ, Cai YM, Ming Y, Qin W. Efficacy of Biomechanics-based Decompression Therapy in Managing Recurrent Diabetic Plantar Ulcers. INT J LOW EXTR WOUND 2024:15347346241245087. [PMID: 38572515 DOI: 10.1177/15347346241245087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The objective of this study is to assess the efficacy of decompression nursing based on biomechanical principles in managing recurrent diabetic plantar ulcers. METHODS Sixty-seven patients experiencing recurrent diabetic plantar ulcers who sought medical attention at Huadong Hospital Affiliated to Fudan University between January 2021 and December 2022 were selected as participants for this study. The participants underwent biomechanics-based decompression nursing. We compared pre-intervention and post-intervention data to assess the differences in relevant observational indexes. RESULTS Post-intervention, patients showed significant improvements in foot comfort scores and adherence to pressure reduction behavior compared with their pre-intervention status, with statistical significance (P < 0.05). The intervention was effective in 41 cases (61.19%), with 18 cases (26.87%) showing improvement and 8 cases (11.94%) deemed ineffective, culminating in an overall efficacy rate of 88.06%. All 67 patients achieved complete ulcer healing within an average duration of 58.63 ± 18.13 days, without any recorded recurrences. CONCLUSION Biomechanics-based decompression nursing demonstrates effective facilitation of wound healing, yielding expeditious recovery, enhanced comfort, and a reduced incidence of recurrence.
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Affiliation(s)
- Yan Wan
- Diabetic Foot Integration Clinic, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Zheng Wang
- Diabetic Foot Integration Clinic, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiao-Jiao Bai
- Diabetic Foot Integration Clinic, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yun-Min Cai
- Wound Diagnosis and Treatment Centre, Jinshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yue Ming
- Diabetic Foot Integration Clinic, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wen Qin
- Diabetic Foot Integration Clinic, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Nakamatsu D, Nishida T, Sugimoto A, Matsumoto K, Yamamoto M. Clinical outcome of patients treated with endoscopic decompression after failure of detorsion for uncomplicated sigmoid volvulus. DEN Open 2024; 4:e299. [PMID: 37818097 PMCID: PMC10560703 DOI: 10.1002/deo2.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/17/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023]
Abstract
Background Endoscopic treatment is the first-line therapy for uncomplicated sigmoid volvulus (SV). However, there are few reports on the clinical course of SV. We investigated the clinical courses of successful and unsuccessful endoscopic detorsions for bowel decompression in patients with uncomplicated SV. Methods Between May 2009 and February 2022, patients with uncomplicated SV who underwent endoscopic detorsion or decompression only if detorsion failed were enrolled. A case analysis (all cases) and a patient analysis (first episode cases) were performed. Outcomes were compared between the detorsion and decompression groups, including length of hospital stay, recurrence rate, and days to readmission due to SV. Results Seventy patients were included in this study. The success rate of endoscopic detorsion of the SV was 28.6%. There were no differences in age, sex, or other characteristics between the two groups. The hospital stay tended to be longer in the decompression group than in the detorsion group. However, there was no difference in the 30-day, 6-month, or 12-month recurrence rate or the number of days to readmission for SV between the two groups in the case and patient analyses. Conclusions This study suggests that endoscopic decompression is a feasible alternative to endoscopic detorsion in patients with uncomplicated SV.
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Affiliation(s)
- Dai Nakamatsu
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Aya Sugimoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Kengo Matsumoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
| | - Masashi Yamamoto
- Department of GastroenterologyToyonaka Municipal HospitalOsakaJapan
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Setiawan DR, Giordan E, Lee C, Park CW, Pholprajug P, Kim JS. Navigation-guided endoscopic lumbar decompression on foramen and lateral recess in advanced scoliosis. Neurosurg Focus Video 2024; 10:V4. [PMID: 38616902 PMCID: PMC11013331 DOI: 10.3171/2024.1.focvid23195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
An 84-year-old woman presented with left leg radiating pain for 18 months and a numeric rating scale score of 8. From examination, motoric on left knee extension was grade 4, with dysesthesia and numbness along the left anterolateral thigh. Imaging showed left L3-4 foraminal and lateral recess stenosis with severe-degree scoliosis. The patient underwent navigation-guided endoscopic transforaminal foraminotomy and lateral recess decompression on the left L3-4 level with a good outcome. Three-years' follow-up showed a well-maintained clinical outcome and coronal sagittal balance. This video explores navigation-guided endoscopic lumbar decompression for neural compression in advanced scoliosis. Further research is encouraged to establish long-term efficacy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23195.
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Affiliation(s)
- Dimas Rahman Setiawan
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Neurosurgery Department, Medistra Hospital, Jakarta, Indonesia
| | - Enrico Giordan
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Neurosurgical Department, AULSS2 Marca Trevigiana, Treviso, Italy; and
| | - Changik Lee
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chan Woong Park
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Phattareeya Pholprajug
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Orthopedics Department, Rayong Hospital, Rayong, Thailand
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Kaen A, Quillo-Olvera J, Park MK, Rocha S, Durand F, Martin I, Son SK. Five-step unilateral biportal endoscopic surgery for central lumbar canal stenosis: "Z" technique nuance. Neurosurg Focus Video 2024; 10:V3. [PMID: 38616911 PMCID: PMC11013373 DOI: 10.3171/2024.1.focvid23182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
The treatment for lumbar spinal stenosis has advanced through the use of minimally invasive surgery techniques. Endoscopic methods go even further, with studies showing that both uniportal and biportal endoscopic techniques have outcomes comparable to traditional approaches. However, there is limited knowledge of the step-by-step decompression process when using the unilateral biportal endoscopic (UBE). To address this, the authors introduce the five steps in the "Z" sequence, which aims to reduce surgical time and complications. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23182.
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Affiliation(s)
- Ariel Kaen
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Javier Quillo-Olvera
- Neurosurgery Unit, Spine Center, Hospital Angeles Centro Sur, Querétaro City, Mexico
| | - Man Kyu Park
- Department of Neurosurgery, Good Gangan Hospital, Busan, Korea; and
| | - Santiago Rocha
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Fernando Durand
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Ignacio Martin
- Department of Neurosurgery, Hospital Virgen del Rocío, Seville, Spain
| | - Sang-Kyu Son
- Department of Neurosurgery, Good Moonhwa Hospital, Busan, Korea
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Jin C, Wang K, Ren Y, Li Y, Wang Z, Cheng L, Xie N. Role of durotomy on function outcome, tissue sparing, inflammation, and tissue stiffness after spinal cord injury in rats. MedComm (Beijing) 2024; 5:e530. [PMID: 38576458 PMCID: PMC10993870 DOI: 10.1002/mco2.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 04/06/2024] Open
Abstract
Currently, there is a lack of effective treatments for spinal cord injury (SCI), a debilitating medical condition associated with enduring paralysis and irreversible neuronal damage. Extradural decompression of osseous as well as soft tissue components has historically been the principal objective of surgical procedures. Nevertheless, this particular surgical procedure fails to tackle the intradural compressive alterations that contribute to secondary SCI. Here, we propose an early intrathecal decompression strategy and evaluate its role on function outcome, tissue sparing, inflammation, and tissue stiffness after SCI. Durotomy surgery significantly promoted recovery of hindlimb locomotor function in an open-field test. Radiological analysis suggested that lesion size and tissue edema were significantly reduced in animals that received durotomy. Relative to the group with laminectomy alone, the animals treated with a durotomy had decreased cavitation, scar formation, and inflammatory responses at 4 weeks after SCI. An examination of the mechanical properties revealed that durotomy facilitated an expeditious restoration of the injured tissue's elastic rigidity. In general, early decompressive durotomy could serve as a significant strategy to mitigate the impairments caused by secondary injury and establish a more conducive microenvironment for prospective cellular or biomaterial transplantation.
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Affiliation(s)
- Chen Jin
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
- Department of OrthopedicsTongren HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Kaiwei Wang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Yilong Ren
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
- Department of OrthopedicsShanghai General HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yi Li
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Zhanwei Wang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Liming Cheng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Ning Xie
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of EducationOrthopaedic Department of Tongji HospitalSchool of MedicineTongji UniversityShanghaiChina
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13
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Silva VT, de Campos WG, Leone C, de Abreu Alves F, Lemos CA. Which devices can be used to decompress odontogenic cystic lesions in the oral cavity? A systematic review. Br J Oral Maxillofac Surg 2024; 62:252-258. [PMID: 38458909 DOI: 10.1016/j.bjoms.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 03/10/2024]
Abstract
Odontogenic cysts are bony lesions in the jaws that can reach large sizes. Decompression, a technique that helps in their surgical treatment, aims to reduce their size. We aimed to conduct a systematic review of the main types of device used for the decompression of odontogenic cysts and to analyse the indications, types, advantages, and disadvantages of the devices used. We searched PubMed, Science Direct, LILACS, EMBASE, and Web of Science until February 2023, with no time restriction. We considered studies with a minimum of 10 patients published only in English, those that reported cases and case series, randomised clinical trials of the decompression of odontogenic cysts, and the types of devices used during the decompression period. All reported odontogenic cysts had to have been confirmed by biopsy in their respective publications. We found 713 articles in the selected databases. After removing duplicates, 499 remained. After reading the titles and abstracts, we excluded 461 articles so 38 remained. Nine studies were selected for the review, totalling 244 patients. A total of 206 lesions were identified and confirmed by anatomopathological examination: 123 keratocysts, 40 dentigerous cysts, 34 radicular cysts, one cyst of epithelial origin but without specification, and eight unicystic ameloblastomas. Although we did not find out which device is best for the decompression of odontogenic cysts, our findings show that those that are most effective should be as comfortable as possible and should remain in place. They should have stability in the oral cavity and be easy for the patient to clean.
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Affiliation(s)
- Vinícius Teixeira Silva
- Department of Oral Medicine, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Caroline Leone
- Department of Oral Medicine, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil
| | - Fábio de Abreu Alves
- Department of Oral Medicine, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil
| | - Celso Augusto Lemos
- Department of Oral Medicine, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil.
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14
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Yee AHF, Zhang C, Koljonen PA, Shea GKH. Paired and matched analysis of neurological outcomes in revision surgery for cervical myelopathy following delayed neurological decline. J Spine Surg 2024; 10:89-97. [PMID: 38567002 PMCID: PMC10982917 DOI: 10.21037/jss-23-116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/18/2023] [Indexed: 04/04/2024]
Abstract
Background Delayed neurological decline may be experienced following successful decompression surgery for cervical myelopathy. Our objective was to analyze neurological recovery upon revision surgery with relation to the index procedure and a matched control. Methods Fourteen patients underwent both primary and revision decompression at a single academic center. Peri-operative clinical, radiological, and surgical details were retrieved. Neurological outcomes [change in modified Japanese Orthopedic Association (mJOA), recovery ratio] following the second surgery were compared to (I) the primary operation and (II) a control subject receiving primary decompression matched for gender, age, mJOA score, and surgical approach. The minimum clinically important difference (MCID) in mJOA score was set at 2.5. Results Revision decompressions were performed 6.8±4.2 years following the index surgery, when patients were 61.4±11.0 years of age. An increase in mJOA score of 2.7±2.0 following revision surgery was similar to that achieved after the primary operation (2.2±2.1, P=0.616). A recovery ratio of 38.1%±25.4% upon revision compared favorably to that following the primary operation (35.0%±37.4%, P=0.867). Non-inferiority testing between revision surgery and the first operation (P=0.02) demonstrated a similar capacity to achieve the MCID as did comparison with matched subjects (P<0.01). Conclusions Patients were able to make up for lost neurological gains following revision surgery. Careful selection of cases for revision likely facilitated recovery. Recovery trajectories should be consolidated upon larger sample sizes allowing for identification of prognostic factors.
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Affiliation(s)
- Andy Hon Fai Yee
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Changmeng Zhang
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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15
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Bellini P, Ricci A, Setti G, Veneri F, Losi L, Chester J, Consolo U. Optimal time to definitive enucleation of large cysts following marsupialization: a single center, retrospective study. J Stomatol Oral Maxillofac Surg 2024:101837. [PMID: 38508396 DOI: 10.1016/j.jormas.2024.101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/16/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Optimal time to enucleation following marsupialization of large odontogenic mandibular cysts is undefined. We aim to assess volume reduction throughout follow-up, to indicate optimal time to enucleation. Secondary objectives include the identification of factors influencing cyst reduction. STUDY DESIGN We retrospectively enrolled 15 patients with mandibular cysts of different histological types treated with marsupialization at our center between 2018-2022. Cyst volume was assessed with cone-beam computed tomography (CBCT) and a semi-automatic segmentation algorithm, at baseline and between 6-8 months post marsupialization. RESULTS The overall mean cyst volume reduction percent (VR%) was 57.7% or 0.2% per day. VR% at 8 months was significantly higher than those assessed at 6-7 months (67.1% vs 47.1%, p=0.003). Time to CBCT was the only independent variable influencing cyst VR%. CONCLUSION Our study proves that the optimal time to enucleation for mandibular cyst is 8 months, independent of histological cyst type, patient age, baseline cyst volume and the number of pre-operative residual bone walls.
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Affiliation(s)
- Pierantonio Bellini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, Unit of Dentistry and Oral-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Angelo Ricci
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, Unit of Dentistry and Oral-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giacomo Setti
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, Unit of Dentistry and Oral-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Federica Veneri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Luca Losi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, Unit of Dentistry and Oral-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology, and Regenerative Medicine Relevance, Unit of Dentistry and Oral-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125, Modena, Italy
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16
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闫 挺, 曾 俊, 林 旭, 胡 海, 吴 超. [Effectiveness of unilateral biportal endoscopy combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures with neurological symptoms]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:331-336. [PMID: 38500427 PMCID: PMC10982045 DOI: 10.7507/1002-1892.202401043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/04/2024] [Accepted: 02/04/2024] [Indexed: 03/20/2024]
Abstract
Objective To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms. Methods Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L 1 in 2 cases, L 2 in 4 cases, L 3 in 3 cases, and L 4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture. Results All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation ( P<0.05), and further improved at last follow-up ( P<0.05). The ASIA scale after operation significantly improved when compared with that before operation ( P<0.05), and there was no significant difference ( P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation ( P<0.05), and without significant loss of correction during the follow-up ( P>0.05). Conclusion Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.
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Affiliation(s)
- 挺 闫
- 自贡市第四人民医院骨科中心(四川自贡 643000)Department of Orthopedic Center, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P. R. China
| | - 俊 曾
- 自贡市第四人民医院骨科中心(四川自贡 643000)Department of Orthopedic Center, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P. R. China
| | - 旭 林
- 自贡市第四人民医院骨科中心(四川自贡 643000)Department of Orthopedic Center, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P. R. China
| | - 海刚 胡
- 自贡市第四人民医院骨科中心(四川自贡 643000)Department of Orthopedic Center, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P. R. China
| | - 超 吴
- 自贡市第四人民医院骨科中心(四川自贡 643000)Department of Orthopedic Center, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P. R. China
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17
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Sherlock D, Brown NJ, Chan AY, Campos JK, Olaya J. Successful treatment of unilateral facial nerve palsy in a pediatric patient with syringobulbia and Chiari malformation type I: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23282. [PMID: 38437673 PMCID: PMC10916844 DOI: 10.3171/case23282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/18/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Unlike syringomyelia, syringobulbia is not commonly observed in pediatric patients with Chiari malformation type I (CMI). Previous series have reported the incidence of syringobulbia as between 3% and 4% in these patients. Presentation is typically chronic, with the slow onset of neurological symptoms and cranial nerve (CN) palsies resulting from lower brainstem involvement. The authors report the first case of a pediatric patient with simultaneous CMI, syringobulbia, and unilateral CN VII palsy. OBSERVATIONS A 7-year-old male presented with right facial weakness in addition to headaches, ataxia, urinary incontinence, and falls. Magnetic resonance imaging revealed CMI with a syrinx of the cervicothoracic spine and syringobulbia. Posterior fossa decompression with duraplasty was performed without complications, and the patient was discharged home on postoperation day 5. At the 3-week follow-up, the patient's neurological deficits had largely subsided. At the 3-month follow-up, his CN VII palsy and syringobulbia had completely resolved. LESSONS Pediatric CMI patients with syringomyelia are at risk for developing syringobulbia and brainstem deficits, including unilateral facial palsy. However, craniocervical decompression can prove successful in treating such deficits.
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Affiliation(s)
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, California; and
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California; and
| | - Jessica K Campos
- Department of Neurological Surgery, University of California, Irvine, California; and
| | - Joffre Olaya
- Department of Neurological Surgery, University of California, Irvine, California; and
- Division of Pediatric Neurosurgery, Children’s Hospital of Orange County, Orange, California
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18
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Tetreault LA, Kwon BK, Evaniew N, Alvi MA, Skelly AC, Fehlings MG. A Clinical Practice Guideline on the Timing of Surgical Decompression and Hemodynamic Management of Acute Spinal Cord Injury and the Prevention, Diagnosis, and Management of Intraoperative Spinal Cord Injury: Introduction, Rationale, and Scope. Global Spine J 2024; 14:10S-24S. [PMID: 38632715 PMCID: PMC10964894 DOI: 10.1177/21925682231183969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
STUDY DESIGN Protocol for the development of clinical practice guidelines following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. OBJECTIVES Acute SCI or intraoperative SCI (ISCI) can have devastating physical and psychological consequences for patients and their families. The treatment of SCI has dramatically evolved over the last century as a result of preclinical and clinical research that has addressed important knowledge gaps, including injury mechanisms, disease pathophysiology, medical management, and the role of surgery. In an acute setting, clinicians are faced with critical decisions on how to optimize neurological recovery in patients with SCI that include the role and timing of surgical decompression and the best strategies for hemodynamic management. The lack of consensus surrounding these treatments has prevented standardization of care across centers and has created uncertainty with respect to how to best manage patients with SCI. ISCI is a feared complication that can occur in the best of hands. Unfortunately, there are no systematic reviews or clinical practice guidelines to assist spine surgeons in the assessment and management of ISCI in adult patients undergoing spinal surgery. Given these limitations, it is the objective of this initiative to develop evidence-based recommendations that will inform the management of both SCI and ISCI. This protocol describes the rationale for developing clinical practice guidelines on (i) the timing of surgical decompression in acute SCI; (ii) the hemodynamic management of acute SCI; and (iii) the prevention, identification, and management of ISCI in patients undergoing surgery for spine-related pathology. METHODS Systematic reviews were conducted according to PRISMA standards in order to summarize the current body of evidence and inform the guideline development process. The guideline development process followed the approach proposed by the GRADE working group. Separate multidisciplinary, international groups were created to perform the systematic reviews and formulate the guidelines. All potential conflicts of interest were vetted in advance. The sponsors exerted no influence over the editorial process or the development of the guidelines. RESULTS This process resulted in both systematic reviews and clinical practice guidelines/care pathways related to the role and timing of surgery in acute SCI; the optimal hemodynamic management of acute SCI; and the prevention, diagnosis and management of ISCI. CONCLUSIONS The ultimate goal of this clinical practice guideline initiative was to develop evidence-based recommendations for important areas of controversy in SCI and ISCI in hopes of improving neurological outcomes, reducing morbidity, and standardizing care across settings. Throughout this process, critical knowledge gaps and future directions were also defined.
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Affiliation(s)
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Nathan Evaniew
- McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Michael G Fehlings
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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19
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Shankar DS, Kim J, Bienstock DM, Gao M, Lee Y, Zubizarreta NJ, Poeran J, Lin JD, Chaudhary SB, Hecht AC. Postoperative Opioid Use and Prescribing Patterns among Patients Undergoing Cervical Laminectomy with Instrumented Fusion versus Cervical Laminoplasty with Reconstruction. Global Spine J 2024; 14:561-567. [PMID: 35861211 PMCID: PMC10802526 DOI: 10.1177/21925682221116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare patterns in opioid usage and prescriptions between patients who undergo cervical laminectomy with instrumented fusion (LF) vs cervical laminoplasty with reconstruction (LP) within single surgeon and national database cohorts. METHODS We identified patients with cervical myelopathy undergoing primary LF or LP in both a single-surgeon series cohort (2004-2018) and a nationally representative cohort drawn from the IBM® Marketscan® database (2014-2016). We recorded opioid usage within 6 months of surgery and identified differences in unadjusted opioid use rates between LF and LP patients. Multivariable logistic regression was used to evaluate the association between procedure type and postoperative opioid use. RESULTS Without adjusting for covariates, LF patients had a higher rate of 6-month opioid use in the single-surgeon cohort (15.7% vs 5.1%, P = .02). After adjusting for covariates, LF patients had higher odds of 6-month postoperative opioid use (OR 2.8 [95% CI 1.0-7.7], P = .04). In the national cohort, without adjusting for covariates, there was no significant difference in 6-month opioid use between LF and LP patients. Even after adjusting for covariates, we found no significant difference in odds. CONCLUSIONS Findings from a single-surgeon cohort reveal that LF is associated with a higher rate of 6-month opioid use than LP. This is at odds with findings from a national database cohort, which suggested that LP and LF patients have similar rates of opioid usage at 6-months postoperatively. To prevent overuse of narcotics, surgeons must consider the distinct pain requirements associated with different procedures even in treatment of the same condition.
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Affiliation(s)
- Dhruv S. Shankar
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseong Kim
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis M. Bienstock
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Gao
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yunsoo Lee
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole J. Zubizarreta
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James D. Lin
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saad B. Chaudhary
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C. Hecht
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Fehlings MG, Tetreault LA, Hachem L, Evaniew N, Ganau M, McKenna SL, Neal CJ, Nagoshi N, Rahimi-Movaghar V, Aarabi B, Hofstetter CP, Wengel VT, Nakashima H, Martin AR, Kirshblum S, Rodrigues Pinto R, Marco RAW, Wilson JR, Kahn DE, Newcombe VFJ, Zipser CM, Douglas S, Kurpad SN, Lu Y, Saigal R, Samadani U, Arnold PM, Hawryluk GWJ, Skelly AC, Kwon BK. An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery. Global Spine J 2024; 14:174S-186S. [PMID: 38526922 DOI: 10.1177/21925682231181883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
STUDY DESIGN Clinical practice guideline development. OBJECTIVES Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes. Emerging evidence indicates that "early" surgical decompression completed within 24 hours of injury also improves neurological recovery in patients with acute SCI. The objective of this clinical practice guideline (CPG) is to update the 2017 recommendations on the timing of surgical decompression and to evaluate the evidence with respect to ultra-early surgery (in particular, but not limited to, <12 hours after acute SCI). METHODS A multidisciplinary, international, guideline development group (GDG) was formed that consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. A systematic review was conducted based on accepted methodological standards to evaluate the impact of early (within 24 hours of acute SCI) or ultra-early (in particular, but not limited to, within 12 hours of acute SCI) surgery on neurological recovery, functional outcomes, administrative outcomes, safety, and cost-effectiveness. The GRADE approach was used to rate the overall strength of evidence across studies for each primary outcome. Using the "evidence-to-recommendation" framework, recommendations were then developed that considered the balance of benefits and harms, financial impact, patient values, acceptability, and feasibility. The guideline was internally appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS The GDG recommended that early surgery (≤24 hours after injury) be offered as the preferred option for adult patients with acute SCI regardless of level. This recommendation was based on moderate evidence suggesting that patients were 2 times more likely to recover by ≥ 2 ASIA Impairment Score (AIS) grades at 6 months (RR: 2.76, 95% CI 1.60 to 4.98) and 12 months (RR: 1.95, 95% CI 1.26 to 3.18) if they were decompressed within 24 hours compared to after 24 hours. Furthermore, patients undergoing early surgery improved by an additional 4.50 (95% 1.70 to 7.29) points on the ASIA Motor Score compared to patients undergoing surgery after 24 hours post-injury. The GDG also agreed that a recommendation for ultra-early surgery could not be made on the basis of the current evidence because of the small sample sizes, variable definitions of what constituted ultra-early in the literature, and the inconsistency of the evidence. CONCLUSIONS It is recommended that patients with an acute SCI, regardless of level, undergo surgery within 24 hours after injury when medically feasible. Future research is required to determine the differential effectiveness of early surgery in different subpopulations and the impact of ultra-early surgery on neurological recovery. Moreover, further work is required to define what constitutes effective spinal cord decompression and to individualize care. It is also recognized that a concerted international effort will be required to translate these recommendations into policy.
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Affiliation(s)
- Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Laureen Hachem
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan Evaniew
- Department of Surgery, Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Chris J Neal
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Valerie Ter Wengel
- Department of Neurosurgery, Amsterdam UMC VUMC Site, Amsterdam, Netherlands
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Allan R Martin
- Department of Neurological Surgery, University of California-Davis, Sacramento, CA, USA
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ricardo Rodrigues Pinto
- Spinal Unit (UVM), Centro Hospitalar Universitário de Santo António, Hospital CUF Trindade, Porto, Portugal
| | - Rex A W Marco
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Jefferson R Wilson
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
| | - David E Kahn
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Virginia F J Newcombe
- Department of Medicine, University Division of Anaesthesia and PACE, University of Cambridge, Cambridge, UK
| | - Carl M Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Sam Douglas
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yi Lu
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Uzma Samadani
- Department of Surgery, Minneapolis Veterans Affairs, Minneapolis, MN, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Illinois Champaign-Urbana, Urbana, IL, USA
| | | | | | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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Fehlings MG, Moghaddamjou A, Evaniew N, Tetreault LA, Alvi MA, Skelly AC, Kwon BK. The 2023 AO Spine-Praxis Guidelines in Acute Spinal Cord Injury: What Have We Learned? What Are the Critical Knowledge Gaps and Barriers to Implementation? Global Spine J 2024; 14:223S-230S. [PMID: 38526926 DOI: 10.1177/21925682231196825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
STUDY DESIGN Narrative summary of the 2023 AO Spine-Praxis clinical practice guidelines for management in acute spinal cord injury (SCI). OBJECTIVES The objective of this article is to summarize the key findings of the clinical practice guidelines for the optimal management of traumatic and intraoperative SCI (ISCI). This article will also highlight potential knowledge translation opportunities for each recommendation and discuss important knowledge gaps and areas of future research. METHODS Systematic reviews were conducted according to accepted methodological standards to evaluate the current body of evidence and inform the guideline development process. The summarized evidence was reviewed by a multidisciplinary guidelines development group that consisted of international multidisciplinary stakeholders. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of the evidence for each critical outcome and the "evidence to recommendation" framework was used to formulate the final recommendations. RESULTS The key recommendations regarding the timing of surgical decompression, hemodynamic management, and the prevention, diagnosis, and management of ISCI are summarized. While a strong recommendation was made for early surgery, further prospective research is required to define what constitutes sufficient surgical decompression, examine the role of ultra-early surgery, and assess the impact of early surgery in different SCI phenotypes, including central cord syndrome. Furthermore, additional investigation is required to evaluate the impact of mean arterial blood pressure targets on neurological recovery and to determine the utility of spinal cord perfusion pressure measurements. Finally, there is a need to examine the role of neuroprotective agents for the treatment of ISCI and to prospectively validate the new AO Spine-Praxis care pathway for the prevention, diagnosis, and management of ISCI. To optimize the translation of these guidelines into practice, important barriers to their implementation, particularly in underserved areas, need to be explored. Ultimately, these recommendations will help to establish more personalized approaches to care for SCI patients. CONCLUSIONS The recommendations from the 2023 AO Spine-Praxis guidelines not only highlight the current best practice in the management of SCI, but reveal critical knowledge gaps and barriers to implementation that will help to guide further research efforts in SCI.
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Affiliation(s)
- Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ali Moghaddamjou
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan Evaniew
- McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, AB, Canada
| | | | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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22
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Al F, Köroglu M, Özdeş HU, Aslantürk O. Iliacus hematoma causing late femoral nerve palsy. Clin Case Rep 2024; 12:e8654. [PMID: 38464580 PMCID: PMC10920301 DOI: 10.1002/ccr3.8654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Femoral nerve palsy is rare and may progress insidiously, leading to late clinical presentation. Identifying the underlying cause is very important for treatment. An iliacus hematoma causing nerve palsy is perhaps the most innocent etiology. However, this hematoma sometimes causes only abdominal pain and may even be misdiagnosed as a late intra-abdominal pathology.
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Affiliation(s)
- Fırat Al
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Muhammed Köroglu
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Hüseyin Utku Özdeş
- Yesilyurt Hasan Çalık State Hospital Orthopedics and TraumatologyMalatyaTurkey
| | - Okan Aslantürk
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
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23
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Fu H, Hu Y, Yang D, Wang X, Xu W. [Comparison of effectiveness between unilateral biportal endoscopic decompression and unilateral biportal endoscopic lumbar interbody fusion for degree Ⅰdegenerative lumbar spondylolisthesis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:169-175. [PMID: 38385229 PMCID: PMC10882227 DOI: 10.7507/1002-1892.202311025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective To compare the effectiveness of unilateral biportal endoscopic decompression and unilateral biportal endoscopic lumbar interbody fusion (ULIF) in the treatment of degreeⅠdegenerative lumbar spondylolisthesis (DLS). Methods A clinical data of 58 patients with degreeⅠDLS who met the selection criteria between October 2021 and October 2022 was retrospectively analyzed. Among them, 28 cases were treated with unilateral biportal endoscopic decompression (decompression group) and 30 cases with ULIF (ULIF group). There was no significant difference between the two groups ( P>0.05) in the gender, age, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of leg pain, Oswestry disability index (ODI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), disk height (DH), segmental lordosis (SL), and other baseline data. The operation time, postoperative drainage volume, postoperative ambulation time, VAS score of low back pain, VAS score of leg pain, ODI, laboratory examination indexes (CRP, ESR), and imaging parameters (DH, SL) were compared between the two groups. Results Compared with the ULIF group, the decompression group had shorter operation time, less postoperative drainage, and earlier ambulation ( P<0.05). All incisions healed by first intention, and no complication such as nerve root injury, epidural hematoma, or infection occurred. All patients were followed up 12 months. Laboratory tests showed that ESR and CRP at 3 days after operation in decompression group were not significantly different from those before operation ( P>0.05), while the above indexes in ULIF group significantly increased at 3 days after operation compared to preoperative values ( P<0.05). There were significant differences in the changes of ESR and CRP before and after operation between the two groups ( P<0.05). Except that the VAS score of low back pain at 3 days after operation was not significantly different from that before operation in decompression group ( P>0.05), there were significant differences in VAS score of low back pain and VAS score of leg pain between the two groups at other time points ( P<0.05). The VAS score of low back pain in ULIF group was significantly higher than that in decompression group at 3 days after operation ( P<0.05), and there was no significant difference in VAS score of low back pain and VAS score of leg pain between the two groups at other time points ( P>0.05). The ODI of the two groups significantly improved after operation ( P<0.05), but there was no significant difference between 3 days and 6 months after operation ( P>0.05). There was no significant difference between the two groups at the two time points after operation ( P<0.05). Imaging examination showed that there was no significant difference in DH and SL between pre-operation and 12 months after operation in decompression group ( P>0.05). However, the above two indexes in ULIF group were significantly higher than those before operation ( P<0.05). There were significant differences in the changes of DH and SL before and after operation between the two groups ( P<0.05). Conclusion Unilateral biportal endoscopic decompression can achieve good effectiveness in the treatment of degree Ⅰ DLS. Compared with ULIF, it can shorten operation time, reduce postoperative drainage volume, promote early ambulation, reduce inflammatory reaction, and accelerate postoperative recovery. ULIF has more advantages in restoring intervertebral DH and SL.
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Affiliation(s)
- Hao Fu
- Graduate School of Dalian Medical University, Dalian Liaoning, 116044, P. R. China
- Department of Orthopedics, Dalian Central Hospital, Dalian Liaoning, 116033, P. R. China
| | - Yutong Hu
- Department of Orthopedics, Osteoporosis Clinical Center, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P. R. China
- Graduate School of Soochow University, Suzhou Jiangsu, 215006, P. R. China
| | - Dongfang Yang
- Department of Orthopedics, Dalian Central Hospital, Dalian Liaoning, 116033, P. R. China
| | - Xin Wang
- Department of Orthopedics, Dalian Central Hospital, Dalian Liaoning, 116033, P. R. China
| | - Weibing Xu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, 200003, P. R. China
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Kakamad FH, Asaad SK, Tahir SH, Sabr NS, Ghafour AK, Omer CS, Rashid RJ, Hama Amin BJ, Kareem PM, Mohammed MS. Thoracic outlet syndrome caused by superior mediastinal mass: A case report. Asian Cardiovasc Thorac Ann 2024:2184923241230706. [PMID: 38327076 DOI: 10.1177/02184923241230706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Thoracic outlet syndrome (TOS) caused by superior mediastinal soft tissue mass has never been reported in the literature, the aim of this study is to discuss a case of TOS caused by a superior mediastinal mass in which the histopathological examinations of the mass showed vascular malformation. CASE REPORT A 45-year-old female presented with left upper limb pain and numbness for three months, associated with swelling and attacks of shortness of breath. Imaging studies showed soft tissue mass involving the superior mediastinum. The condition of the patient deteriorated and the signs and symptoms of TOS became clearer, all provocative tests and nerve conduction studies were positive. The patient underwent thoracic outlet decompression. The patient did not respond and the symptoms deteriorated further. After a multidisciplinary board discussion, the patient was prepared for median sternotomy under general anesthesia. A total resection of the mass was done. The patient was totally relieved a few hours after the operation. DISCUSSION The etiology of TOS can be multifaceted. Several factors contribute to its onset, and these can be categorized as congenital or acquired. Congenital causes include anatomical anomalies such as a cervical rib, or an elongated transverse process of the cervical vertebrae. These anatomical deviations can reduce the size of the thoracic outlet and make it prone to compression. CONCLUSION Although it is rare, TOS could be due to superior mediastinal mass and the treatment of choice is total resection either through median sternotomy or thoracoscopic procedure.
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Affiliation(s)
- Fahmi H Kakamad
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Kscien Organization for Scientific Research (Middle East office), Kurdstan, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan, Iraq
| | - Saywan Kakarash Asaad
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan, Iraq
| | - Soran H Tahir
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan, Iraq
| | - Nasren Sharef Sabr
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
| | - Adullah K Ghafour
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Orthopaedics, Shahid Peshraw Hospital, Kurdistan, Iraq
| | - Choman Sabah Omer
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
| | - Rezheen J Rashid
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
- Department of Radiology, Hiwa Cancer Hospital, Kurdistan, Iraq
| | | | - Pavel Mustafa Kareem
- Scientific Affairs Department, Smart Health Tower, Madam Mittrand, Sulaimani, Kurdistan, Iraq
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25
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Walia A, Ani F, Maglaras C, Raman T, Fischer C. Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion. Global Spine J 2024:21925682241230926. [PMID: 38315111 DOI: 10.1177/21925682241230926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. METHODS Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05. RESULTS 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. CONCLUSIONS Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.
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Affiliation(s)
- Arnaav Walia
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Fares Ani
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Tina Raman
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Charla Fischer
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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26
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Faizo E, Fallata A, Mirza I, Koshak AK, Bucklain YT, Alharbi R, Tasji A, Tasji T, Kabbarah A. The Efficacy of Trigger Site Surgery in the Elimination of Chronic Migraine Headache: An Update in the Rate of Success and Failure. Cureus 2024; 16:e54504. [PMID: 38516471 PMCID: PMC10955441 DOI: 10.7759/cureus.54504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Migraine headache (MH) is a prevalent neurovascular disorder that affects approximately 15% of the global population. They are more common in women and typically affect young and middle-aged individuals. Chronic MH is characterized by headaches occurring on ≥15 days per month for over three months. While only 5% of MHs are refractory, about 20%-50% do not respond to pharmacologic treatments. As a result, surgical interventions have emerged as an alternative method to eliminate MH since 2000 AD. These surgical treatments primarily target the peripheral mechanisms of MH, focusing on common trigger sites. Migraine surgery involves neurolysis of sensory branches of trigeminal and occipital nerves that supply the face and back of the head. Numerous clinical studies conducted between 2000 and 2021 have extensively described surgical interventions and their prognostic outcomes. After surgery, up to 80% of patients reported complete elimination of headaches, while 20%-35% experienced no relief. The failure to achieve complete elimination of MH can be attributed to various factors. The most common reason for a partial clinical response is the failure to identify all trigger sites or inadequate surgery on the trigger sites. In this review, we aim to provide an overview of current surgical interventions for MH at different trigger sites, including recent updates, success and failure rates, and potential causes of failure.
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Affiliation(s)
- Eyad Faizo
- Department of Surgery, University of Tabuk, Tabuk, SAU
| | - Ahmad Fallata
- Department of Internal Medicine, University of Tabuk, Tabuk, SAU
| | - Iman Mirza
- Department of Family and Community Medicine, University of Tabuk, Tabuk, SAU
| | - Ahmed K Koshak
- Department of Internal Medicine, University of Tabuk, Tabuk, SAU
| | | | - Reema Alharbi
- Faculty of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Abdulrahman Tasji
- Department of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Taha Tasji
- Department of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Ahmed Kabbarah
- Faculty of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
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27
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Lin H, Su H, Li C, Zhang P, Xiu B, Bai Y, Xu R. Classification of and individual treatment strategies for complex tethered cord syndrome. Front Surg 2024; 11:1277322. [PMID: 38322409 PMCID: PMC10844385 DOI: 10.3389/fsurg.2024.1277322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Objective To study the classification, diagnosis, and treatment strategies of complex tethered cord syndrome (C-TCS) on the basis of the patients' clinical symptoms, imaging findings, and therapeutic schedule. Methods The clinical data of 126 patients with C-TCS admitted to our department from January 2015 to December 2020 were retrospectively analyzed. Classification criteria for C-TCS were established by analyzing the causes of C-TCS. Different surgical strategies were adopted for different types of C-TCS. The Kirollos grading, visual analogue scale (VAS), critical muscle strength, and Japanese Orthopaedic Association (JOA) scores were used to evaluate the surgical outcomes and explore individualized diagnosis and treatment strategies for C-TCS. Results C-TCS was usually attributable to three or more types of tether-causing factors. The disease mechanisms could be categorized as pathological thickening and lipomatosis of the filum terminal (filum terminal type), arachnoid adhesion (arachnoid type), spina bifida with lipomyelomeningocele/meningocele (cele type), spinal lipoma (lipoma type), spinal deformity (bone type), and diastomyelia malformation (diastomyelia type). Patients with different subtypes showed complex and varied symptoms and required individualized treatment strategies. Conclusion Since C-TCS is attributable to different tether-related factors, C-TCS classification can guide individualized surgical treatment strategies to ensure complete release of the tethered cord and reduce surgical complications.
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Affiliation(s)
- Hepu Lin
- Department of Neurosurgery, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Hui Su
- Department of Neurosurgery, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Cuicui Li
- Department of Neurosurgery, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Pengfei Zhang
- Department of Neurosurgery, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Bo Xiu
- Department of Neurosurgery, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Yunjing Bai
- Department of Neurosurgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Ruxiang Xu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, Chengdu, China
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Açan AE, Hapa O, Gursan O, Türemiş C, Kürşat Şimşek M, Dilek B, Balci A. The effect of arthroscopic coracoplasty on subscapularis strength in cases of subcoracoid impingement in the absence of subscapularis tear. Medicine (Baltimore) 2024; 103:e36947. [PMID: 38241576 PMCID: PMC10798749 DOI: 10.1097/md.0000000000036947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/07/2023] [Indexed: 01/21/2024] Open
Abstract
Subcoracoid impingement leads to anterior shoulder pain, and arthroscopic subcoracoid decompression (coracoplasty) is the preferred treatment in recalcitrant cases. The purpose of the present study was to evaluate the effect of coracoplasty on the severity of anterior shoulder pain and the strength of the subscapularis muscle and to correlate it with the preoperative and postoperative coracohumeral distance (CHD) (t:transverse, s:sagittal). Sixteen patients without any subscapularis tendon tears who underwent arthroscopic subcoracoid decompression and rotator cuff repair with 2 years follow-up were included. Preoperative and postoperative 2-year assessments of function and pain were performed using the modified Kennedy-Hawkins test, power grading of various subscapularis muscle tests, and ASES scores. Preoperative and postoperative coracohumeral distance (tCHD, sCHD) and coracoid overlap (CO) were measured using MRIs before and after surgery. The Mean Hawkins pain score and coracoid overlap were decreased. The strength scores for subscapularis strength testing, ASES score, maximum degree of internal rotation, and coracohumeral distance increased (P < .05). Changes in belly press strength were negatively correlated with postoperative tCHD (r = -0.6, P = .04) and postoperative sCHD (r = -0.7, P = .008). A significant increase in the internal rotation range of the shoulder, subscapularis strength, and relief of anterior shoulder pain was observed. However, this increase was inversely proportional to the postoperative CHD, indicating the mechanical effect of the coracoid on subscapularis strength.
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Affiliation(s)
- Ahmet Emrah Açan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Onur Hapa
- Department of Orthopedics and Traumatology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Onur Gursan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Cihangir Türemiş
- Department of Orthopedics and Traumatology, Çeşme State Hospital, İzmir, Turkey
| | | | - Banu Dilek
- Department of Physical Treatment and Rehabilitation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ali Balci
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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29
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Atiç R, Alemdar C, Ulus SA, Yazar C, Durgut F, Sayar Ş, Aydın A. Outcomes of Lumbosacral Fixation in Patients with Suicidal Jumper's Fractures: A Retrospective Study from a Single Center in Turkey. Med Sci Monit 2024; 30:e942831. [PMID: 38225811 PMCID: PMC10802078 DOI: 10.12659/msm.942831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Suicide attempts that involve jumping from a great height may not be fatal but can result in lumbosacral facture-dislocations. This retrospective study aimed to present the experience from a single center in Turkey of 21 patients with lumbosacral facture-dislocations, or suicidal jumper fractures, treated with lumbosacral fixation between 2015 and 2022. MATERIAL AND METHODS The study included 21 patients. The diagnosis was established through X-ray and computed tomography (CT) examinations. Neurological damage was assessed using the Gibbons score. Among the patients, 2 were classified as Roy-Camille type 1, 12 as Roy-Camille type 2, and 7 as Roy-Camille type 3. Morphologically, 8 patients had H-type fractures, 7 had T-type fractures, and 6 had U-type fractures. Bilateral spinopelvic fixation was performed. Functional outcomes were evaluated using the Majeed score. RESULTS The average Injury Severity Score (ISS) was 31.6±12.2. The mean duration of surgery was 123.6±44.9 minutes. According to the Majeed score, excellent results were observed in 8 individuals (40%), good results in 5 individuals (25%), fair results in 5 individuals (25%), and poor results in 2 individuals (10%). Out of 18 patients with neurological deficits, 14 showed improvement after surgery, while 4 continued to experience deficits. CONCLUSIONS The findings from this study highlight the importance of obtaining a clear history of the cause of lumbosacral facture-dislocation, as attempted suicide by jumping from a height can cause specific types of injury to the lumbar spine and sacrum that require rapid diagnosis and management to reduce the incidence of permanent paraplegia.
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Affiliation(s)
- Ramazan Atiç
- Department of Orthopedics and Traumatology, Dicle University Medical School, Diyarbakır, Turkey
| | - Celil Alemdar
- Department of Orthopedics and Traumatology, Medicana International Hospital, Istanbul, Turkey
| | - Sait Anıl Ulus
- Department of Orthopedics and Traumatology, Mardin Training and Research Hospital, Mardin, Turkey
| | - Cihan Yazar
- Department of Orthopedics and Traumatology, Dicle University Medical School, Diyarbakır, Turkey
| | - Fatih Durgut
- Department of Orthopedics and Traumatology, Selçuk University Medical School, Konya, Turkey
| | - Şafak Sayar
- Department of Orthopedics and Traumatology, Biruni University Hospital, Istanbul, Turkey
| | - Abdulkadir Aydın
- Ataturk Vocational School of Health Services, Dicle University, Diyarbakir, Turkey
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30
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Qing L, Wang Y, Zhang M, Pu Q, Cai W, Pan Y, Xia D. Case report: tracheobronchial diverticulum, a potential risk for diving? Front Med (Lausanne) 2024; 10:1340974. [PMID: 38274443 PMCID: PMC10808740 DOI: 10.3389/fmed.2023.1340974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Tracheobronchial diverticulum (TBD) is an asymptomatic, benign cystic lesion outside the lumen of the trachea and bronchus. This is the first report case of a SCUBA (self contained underwater breathing apparatus) diver diagnosed with TBD, which is a potential risk to diving. No literature or guideline is available so far on the diving fitness for patients with congenital or acquired TBD condition. A healthy 26-year-old male professional diver has records of SCUBA diving up to a depth of 40 meters sea water. He did not have any diving-related injuries or symptoms during his career and had no history of smoking, drinking, or other special illnesses except for a COVID-19 infection. A tracheal diverticulum was found accidentally by computed tomography (CT), but its communication with the trachea was not clear initially. Therefore, high-resolution CT and electronic bronchoscopy were done to clarify the situation of the diverticulum and identify the diving risk. High-resolution CT showed a possible opening in the diverticulum, but this was not seen under electronic bronchoscopy. Although a potential opening was shown in high-resolution CT, the lack of visual bronchoscopic evidence made it likely to be a dead cavity. As there is a higher theoretical risk of barotrauma during decompression, leading to pneumomediastinum, hemorrhage, or arterial gas embolism, the current clinical consensus is that air-containing tissue should be regarded as a relative contraindication for diving. Overall, it is recommended that the diver should dive carefully and avoid ascending too rapidly.
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Affiliation(s)
- Long Qing
- Department of Naval Diving Medicine, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yan Wang
- Department of Naval Diving Medicine, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Meng Zhang
- Department of Naval Diving Medicine, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Qinqin Pu
- Department of Naval Diving Medicine, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Wanwan Cai
- Department of Naval Diving Medicine, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yaping Pan
- Department of Naval Diving Medicine, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Delin Xia
- Department of Respiratory Critical Care Medicine, Naval Medical Center, Naval Medical University, Shanghai, China
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Findlay MC, Twitchell S, Mahan MA. Exoscope for revision of right lateral femoral cutaneous nerve decompression. Neurosurg Focus Video 2024; 10:V18. [PMID: 38283809 PMCID: PMC10821651 DOI: 10.3171/2023.10.focvid23162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/20/2023] [Indexed: 01/30/2024]
Abstract
The exoscope serves as a valuable addition or alternative to traditional microscope systems in surgery, offering 3D visualization and magnification with enhanced maneuverability. In lateral femoral cutaneous nerve decompression for meralgia paresthetica, the exoscope is effective in identifying strictures of neural compression and minimizing iatrogenic nerve damage that may lead to improved pain management outcomes for patients. In this report, the specific case presented showcases how the exoscope aided in surgical decompression of the lateral femoral cutaneous nerve of a patient with refractory meralgia paresthetica with remote previous decompression and resultant scarring. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23162.
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Affiliation(s)
- Matthew C Findlay
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Spencer Twitchell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Andresen AK, Carreon LY, Overgaard S, Jacobsen MK, Andersen MØ. Safety and Reoperation Rates in Non-instrumented Lumbar Fusion Surgery: Secondary Report From a Randomized Controlled Trial of ABM/P-15 vs Allograft With Minimum 5 years Follow-Up. Global Spine J 2024; 14:33-40. [PMID: 35481422 PMCID: PMC10676187 DOI: 10.1177/21925682221090924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Randomized controlled trial with minimum of 5-years follow-up. OBJECTIVE The purpose of this study is to evaluate the peri- and postoperative complications rates, ectopic bone migration, and reoperation rates, and secondly evaluate the 5-year patient reported outcomes (PROs), in patients treated with decompression and non-instrumented posterolateral fusion with ABM/P-15 or allograft. METHODS Patients with degenerative spondylolisthesis were enrolled in a Randomized Clinical Trial and randomized 1:1 to either ABM/P-15 or allograft bone. Patient Reported Outcomes were collected at 5-year follow-up, and patients were invited to a clinical follow-up including a computed tomography scan (CT) to evaluate signs of osteolysis, ectopic bone formation, and bone migration. RESULTS Of 101 subjects enrolled in the primary study, 83 patients were available for the 5-year follow-up. We found a statistically significant difference in back pain and Oswestry Disability Index between groups. Fifty-eight patients agreed to participate in the CT study. Sixty percentage in the ABM/P-15 group vs 30% in the allograft group was classified as fused (P = .037). There were no differences in complications, reoperation-, or infection rates between the 2 groups. We found 2 patients with migration of graft material. Both patients were asymptomatic at minimum 5-year follow-up. CONCLUSION Our study indicated that complication rates are no higher in patients treated with ABM/P-15 than allograft. We found significantly higher fusion rates in the AMB/P-15 group than in the allograft group, and patients in the ABM/P-15 group reported less back pain and lower disability score at 5-year follow-up.
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Affiliation(s)
- Andreas K. Andresen
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Leah Y. Carreon
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Søren Overgaard
- Bispebjerg, Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Kobenhavn, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Michael K. Jacobsen
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Mikkel Ø. Andersen
- Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense C, Denmark
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Findlay MC, Hamrick FA, Kim RB, Twitchell S, Mahan MA. Hospital cost differences between open and endoscopic lumbar spine decompression surgery. J Neurosurg Spine 2024; 40:77-83. [PMID: 37856388 DOI: 10.3171/2023.8.spine23439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/17/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE In recent years, fully endoscopic decompression surgery for degenerative spine disease has become increasingly popular in the US. Although an endoscopic approach has demonstrated some benefits compared with open procedures in randomized controlled trials, the cost of advanced technologies remains contested. The authors evaluated the differences in costs and cost drivers between open and endoscopic decompression surgical procedures performed at a single institution. METHODS Using associated Current Procedural Terminology codes, the authors identified all open and endoscopic decompression lumbar surgical procedures performed from January 1, 2016, through December 31, 2022. Preoperative comorbidities, surgical characteristics, and postoperative outcomes were captured. The costs of index surgery-related readmission for revision, washout, or other complications were included in the index surgery expenses. Associated in-hospital costs were collected; these were reported in comparative percentages with open surgical procedures as the baseline because of an institutional agreement. Univariate and multivariate analyses were performed. RESULTS The retrospective search identified 633 open surgical procedures and 195 endoscopic surgical procedures for inclusion. The two patient cohorts were similar, with clinically nonrelevant but statistically significant differences in mean age (open 55.7 years vs endoscopic 59.4 years, p = 0.01) and mean American Society of Anesthesiologists physical status class (open 2.3 vs endoscopic 2.4, p = 0.03). Postoperatively, patients who underwent open surgical procedures had significantly longer mean hospital stays (open 1.4 days vs endoscopic 0.7, p < 0.01) and more perioperative complications (open 7.9% of patients vs endoscopic 3.1%, p = 0.02), and they required washout surgical procedures in some cases (open 1.3% vs endoscopic 0%, p = 0.12). The largest cost difference between open and endoscopic surgical procedures was the significantly greater cost of disposable supplies for endoscopic cases (10.1% vs 31.7% of the total cost of open procedures, p < 0.01), and open surgical procedures were generally less costly in total (100.0% vs 115.1%, p < 0.01). In multivariate linear regression, endoscopic surgery was independently associated with greater total costs (standardized beta 15.9%, p < 0.01), although length of hospital stay (standardized beta 34.0%) and readmissions (standardized beta 30.0%, p < 0.01) had larger effects on cost. CONCLUSIONS The endoscopic approach was associated with greater total in-hospital costs compared with open procedures. The findings of further cost evaluations, including those of patient-reported outcomes, social cost, and capital costs per procedure type, need to be included in operational and clinical decisions.
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Affiliation(s)
| | - Forrest A Hamrick
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Robert B Kim
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Spencer Twitchell
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Mark A Mahan
- 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Greenberg J, Magro M, Tubbs RS, Spiessberger A. Anterior Cervical Osteotomy and Corpectomy for Rigid Kyphosis: A Surgical Video. Int J Spine Surg 2023; 17:856-857. [PMID: 38123980 PMCID: PMC10753331 DOI: 10.14444/8555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Jacob Greenberg
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Matt Magro
- Ohio University Heritage College of Osteopathic Medicine Cleveland, Warrensville Heights, OH, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
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Dower A, Mulcahy M, Maharaj M, Chen H, Lim CED, Li Y, Sheridan M. Surgical Decompression for Malignant Cerebral Edema After Ischemic Stroke: Cochrane Review. Stroke 2023; 54:e500-e502. [PMID: 38011238 DOI: 10.1161/strokeaha.122.042260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Ashraf Dower
- Department of Neurosurgery, Liverpool Hospital, Sydney, Australia (A.D., M.S.)
- Department of Neurosurgery, Westmead Hospital, Sydney, Australia (A.D., M. Mulcahy)
| | - Michael Mulcahy
- Department of Neurosurgery, Westmead Hospital, Sydney, Australia (A.D., M. Mulcahy)
- Department of Neurosurgery, John Hunter Hospital, Newcastle, Australia (M. Mulcahy)
| | - Monish Maharaj
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand (M. Maharaj)
| | - Hui Chen
- School of Life Sciences (H.C.), University of Technology Sydney, Earlwood, Australia
| | - Chi Eung Danforn Lim
- School of Life Sciences (H.C.), University of Technology Sydney, Earlwood, Australia
| | - Yingda Li
- Department of Neurosurgery, Liverpool Hospital, Sydney, Australia (A.D., M.S.)
| | - Mark Sheridan
- Department of Neurosurgery, Liverpool Hospital, Sydney, Australia (A.D., M.S.)
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Firempong GK, Sheppard WL, Gelfand Y, Ellingson BM, Holly LT. Spinal Cord Signal Intensity Predicts Functional Outcomes in the Operative Management of Degenerative Cervical Myelopathy. Clin Spine Surg 2023; 36:438-443. [PMID: 38031316 PMCID: PMC10691530 DOI: 10.1097/bsd.0000000000001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/17/2023] [Indexed: 12/01/2023]
Abstract
STUDY DESIGN Prospective single institutional cohort study on degenerative cervical myelopathy (DCM) from 2009 to 2022. OBJECTIVE This study aims to assess the relationship among preoperative spinal cord signal change, postoperative signal change evolution, and functional outcome in patients undergoing surgery for DCM. SUMMARY OF BACKGROUND DATA There is conflicting evidence on whether spinal cord signal intensity influences functional outcomes in patients with DCM. PATIENTS AND METHODS This prospective study investigated 104 patients with DCM that underwent both preoperative and routine postoperative cervical spine magnetic resonance imaging (MRI) as part of a research protocol. Signal intensity/grade, modified Japanese Orthopedic Association (mJOA) scores, signal resolution, and patient demographics were assessed. RESULTS Sixty-eight of the subjects were found to have abnormal T2 spinal cord signal intensity changes on their preoperative MRI. The total mean preoperative mJOA score was 13.6, increasing postoperatively to 16 (P < 0.001). The presence or absence of preoperative spinal cord signal change was not associated with the change in mJOA score or neurological recovery rate after surgery. Of the 68 patients with preoperative T2 signal change, 36 were found to have an improvement in the T2-weighted signal grade after surgery and 32 had no change in postoperative signal grade. The mean improvement in mJOA score (3.7) and neurological recovery rate (70.3%) was significantly higher in the patients with preoperative signal change whose postoperative MRI signal change grade improved by at least one point compared with those that did not (2.0, 50.5%), (P < 0.001, P < 0.003). CONCLUSIONS The presence of preoperative T2-weighted signal change was associated with lower preoperative mJOA scores, but no change in mJOA after surgery or postoperative neurological recovery rate. However, improvement in T2-weighted spinal cord signal grade on postoperative MRI was significantly associated with a degree of neurological improvement after surgery.
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Affiliation(s)
- Gaylinn Kwame Firempong
- Department of Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William L Sheppard
- Department of Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Yaroslav Gelfand
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Langston T Holly
- Department of Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Zhu Q, Wang D. Decoding unusual MR findings: Spinal cord edema in atypical cervical spondylotic myelopathy-A case report and literature review. Clin Case Rep 2023; 11:e8261. [PMID: 38125624 PMCID: PMC10731126 DOI: 10.1002/ccr3.8261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 12/23/2023] Open
Abstract
We report a case of a young man with a slow progression of cervical spondylotic myelopathy (CSM). Cervical magnetic resonance imaging (MRI) revealed a mild cervical discbulging at C5-C6 and an area of atypically enlarged intramedullary high signal intensity extending from C4-C7 (T2-weighted) with contrast enhancement at C5-C6 (T1-weighted). Neurological and radiological diagnoses tend to favor demyelinating diseases, which interfere with the diagnosis of CSM. Patients were followed up and examined by MRI at 3 months, 1 year, and 2 years after surgery. The patient's symptoms improved immediately postoperatively. The functional result according to the modified Japanese Orthopedic Association (JOA) score improved from 10 to 13 within 3 months. He continued to improve neurologically over the first postoperative year. Two years postoperatively, a T2-weighted MRI showed that the edema signal had disappeared completely, and a fat-saturated T2-weighted MRI showed only slight abnormal signal. The numbness and weakness of the extremities had improved, and his JOA score was 16. Spinal cord edema is occasionally seen with CSM. In the case presented, the contrast enhancement was localized at the site of the greatest narrowing of the spinal canal and compression of the spinal cord. This coincidence was the best indicator of a mechanical cause of the spinal cord changes. This feature should increase physician's confidence in distinguishing CSM from intramedullary tumors and myelitis. Surgical decompression may be beneficial in improving neurologic outcomes.
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Affiliation(s)
- Qingrun Zhu
- The Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
| | - Dachuan Wang
- The Second Hospital, Cheeloo College of MedicineShandong UniversityJinanPeople's Republic of China
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Keorochana G, Tantrakansakun C, Suriyonplengsaeng C, Jaipanya P, Lertudomphonwanit T, Leelapattana P, Chanplakorn P, Kraiwattanapong C. The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study. Global Spine J 2023:21925682231217251. [PMID: 37983557 DOI: 10.1177/21925682231217251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
STUDY DESIGN Cadaveric anatomical studies. OBJECTIVE This study aims to investigate the anatomical relationship between bony landmark "V point", dural sac, nerve roots, and intervertebral disc for improving operative outcomes and decreasing post-operative complications in posterior endoscopic cervical foraminotomy or discectomy (PECF or PECD). METHOD 10 soft adult cadavers were studied. We measured the distance of the V point to the lateral margin of dural sac, V point to the inferior border of intervertebral disc, and the inferior border of cervical nerve root to the inferior border of intervertebral disc. Then we calculated the mean of distance from V point to the inferior border of cervical nerve root. RESULT The mean distance from the V point to the lateral margin of dural sac from C3/4 to C7/T1 ranged from 3.1 ± 1.38 mm to 3.37 ± 1.46 mm. The mean distances from V point to the inferior border of intervertebral disc from C3/4 to C7/T1 were .19 ± 1.16 mm at C3/4, .45 ± 1.23 mm at C4/5, .43 ± 1.01 at C5/6, -.43 ± 1.86 mm at C6/7 and -1.5 ± 1.2 mm at C7/T1. The mean distance between V point and the inferior border of cervical nerve root from C3/4 to C7/T1 showed all positive value, ranging from .06 ± 1.18 mm to 4.45 ± 2.57 mm, increasing caudally. CONCLUSION In performing PECF or PECD, a 3-4 mm radius of bone removal should be enough for exposure and neural decompression at C3/4 to C5/6. At C6/7 and C7/T1 a more extensive bone cut of more than 4 mm is recommended, especially in cranial direction.
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Affiliation(s)
- Gun Keorochana
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chakkraphan Tantrakansakun
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pilan Jaipanya
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Thamrong Lertudomphonwanit
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pittavat Leelapattana
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiwat Kraiwattanapong
- Department of Orthopedics, The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kasir R, Zakko P, Hasan S, Aleem I, Park D, Nerenz D, Abdulhak M, Perez-Cruz M, Schwalb J, Saleh ES, Easton R, Khalil JG. The Duration of Symptoms Influences Outcomes After Lumbar Microdiscectomies: A Michigan Spine Surgery Improvement Collaborative. Global Spine J 2023:21925682231210469. [PMID: 37918421 DOI: 10.1177/21925682231210469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE We investigate whether duration of symptoms a patient experiences prior to lumbar microdiscectomy affects pain, lifestyle, and return to work metrics after surgery. METHODS A retrospective review of patients with a diagnosis of lumbar radiculopathy undergoing microdiscectomy was conducted using a statewide registry. Patients were grouped based on self-reported duration of symptoms prior to surgical intervention (Group 1: symptoms less than 3 months; Group 2: symptoms between 3 months and 1 year; and Group 3: symptoms greater than 1 year). Radicular pain scores, PROMIS PF Physical Function measure (PROMIS PF), EQ-5D scores, and return to work rates at 90 days, 1 year, and 2 years after surgery were compared using univariate and multivariate analysis. RESULTS There were 2408 patients who underwent microdiscectomy for lumbar disc herniation for radiculopathy with 532, 910, and 955 in Groups 1, 2, and 3, respectively. Postoperative leg pain was lower for Group 1 at 90 days, 1 year, and 2 years compared to Groups 2 and 3 (P < .05). Postoperative PROMIS PF and EQ-5D scores were higher for Group 1 at 90 days, 1 year, and 2 years compared to Groups 2 and 3 (P < .05). CONCLUSION Patients with prolonged symptoms prior to surgical intervention experience smaller improvements in postoperative leg pain, PROMIS PF, and EQ-5D than those who undergo surgery earlier. Patients undergoing surgery within 3 months of symptom onset have the highest rates of return to work at 1 year after surgery.
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Affiliation(s)
- Rafid Kasir
- Department of Orthopedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Philip Zakko
- Department of Orthopedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Sazid Hasan
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ilyas Aleem
- Department of Orthopedic Surgery, University of Michigan Ann Arbor, MI, USA
| | - Daniel Park
- Department of Orthopedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - David Nerenz
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Muwaffak Abdulhak
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Mick Perez-Cruz
- Department of Neurosurgery, Beaumont Health, Royal Oak, MI, USA
| | - Jason Schwalb
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Ehab S Saleh
- Department of Orthopedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Richard Easton
- Department of Orthopedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
| | - Jad G Khalil
- Department of Orthopedic Surgery, Beaumont Hospital, Royal Oak, MI, USA
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Sherrod BA, Dailey AT, Mazur MD. Closed cervical traction techniques: moving into the 21st century. J Neurosurg Spine 2023; 39:618-627. [PMID: 37548544 DOI: 10.3171/2023.5.spine23344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/24/2023] [Indexed: 08/08/2023]
Abstract
Closed cervical traction for reducing dislocating cervical injuries, deformity correction, or discectomy distraction has been implemented in its modern form since the 1930s. Cervical traction state of the art has not changed significantly since the 1960s, with most reductions performed by using Gardner-Wells tongs or halo traction; however, there are many limitations of traditional weight-pulley traction, including limited reduction efficacy and patient safety shortcomings. In this paper, the authors review the history of cervical traction in the 20th century and the limitations of current traction techniques and describe a novel traction device developed at the University of Utah with robotic actuator load or position control and real-time force-sensing capabilities. Preliminary biomechanical testing results using the novel device in an extension spring loading model, with intact cadavers, and in iatrogenic facet injury cadaveric models demonstrated preliminary safety and efficacy of the device. The authors believe this and future research efforts aimed toward improving the efficacy and safety of cervical traction will help advance the field into the 21st century.
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Massie AM, Skorupski K, Vernau W, McLarty E, Brady RV, Vernau KM. Large T-cell extradural lymphoma with concurrent marked cerebrospinal fluid eosinophilia in a dog. J Vet Intern Med 2023; 37:2492-2497. [PMID: 37849352 PMCID: PMC10658537 DOI: 10.1111/jvim.16854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/23/2023] [Indexed: 10/19/2023] Open
Abstract
A 3-year-old male pit bull terrier was presented for a 4-day history of progressive tetraparesis and cervical pain. Magnetic resonance imaging confirmed an extradural mass within the left lateral vertebral canal extending from caudal C5 to mid-T2. Lumbar cerebrospinal fluid (CSF) demonstrated marked (90%) eosinophilic inflammation. A C6-7 dorsal laminectomy and C7-T2 left hemilaminectomy were done, with gross disease remaining. Histopathology revealed a large T cell lymphoma with marked eosinophilic infiltration. The dog underwent CHOP-based chemotherapy with resolution of clinical signs, with a similar course of therapy performed at recurrence 37 months after initial presentation. The dog was euthanized 39 months after presentation for multiorgan failure secondary to neutropenic sepsis and aspiration pneumonia. This represents a positive long-term response to multimodal treatment of extradural T-cell lymphoma within the vertebral canal associated with a marked CSF eosinophilia.
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Affiliation(s)
- Anna M. Massie
- Department of Clinical Sciences and Advanced MedicineUniversity of Pennsylvania School of Veterinary MedicinePhiladelphiaPennsylvaniaUSA
| | - Katherine Skorupski
- Department of Surgical and Radiological SciencesUniversity of California School of Veterinary MedicineDavisCaliforniaUSA
| | - William Vernau
- Department of Pathology, Microbiology and ImmunologyUniversity of California School of Veterinary MedicineDavisCaliforniaUSA
| | - Ehren McLarty
- Department of Surgical and Radiological SciencesUniversity of California School of Veterinary MedicineDavisCaliforniaUSA
| | - Rachel V. Brady
- Cell and Molecular Biology Graduate ProgramColorado State UniversityFort CollinsColoradoUSA
| | - Karen M. Vernau
- Department of Surgical and Radiological SciencesUniversity of California School of Veterinary MedicineDavisCaliforniaUSA
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Zaki P, Barbour A, Zaki MM, Tseng YD, Amin AG, Venur V, McGranahan T, Vellayappan B, Palmer JD, Chao ST, Yang JT, Foote M, Redmond KJ, Chang EL, Sahgal A, Lo SS, Schaub SK. Emergent radiotherapy for spinal cord compression/impingement-a narrative review. Ann Palliat Med 2023; 12:1447-1462. [PMID: 37817502 DOI: 10.21037/apm-23-342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Malignant epidural spinal cord compression (MESCC), often presenting with back pain and motor/sensory deficits, is associated with poor survival, particularly when there is loss of ambulation. The purpose of this review is to evaluate the literature and discuss appropriate workup and management of MESCC, specifically in the emergent setting. METHODS A PubMed search was conducted on "spinal cord compression" and "radiation therapy." Articles were analyzed for the purpose of this narrative review. KEY CONTENT AND FINDINGS If MESCC is suspected, neurologic examination and complete spine imaging are recommended. Emergent treatment is indicated if there is radiographic evidence of high-grade compression and/or clinically significant motor deficits. Treatment involves a combination of medical management, surgical decompression, radiation therapy (RT), and rehabilitation. For motor deficits, emergent initiation of high dose steroids is recommended. Circumferential surgical decompression ± stabilization followed by RT provides superior clinical outcomes than RT alone. For patients whom surgery is not reasonable, RT alone may provide significant treatment response which depends on radioresponsiveness of the pathology. Systemic therapy, if indicated, is typically reserved till after primary treatment of MESCC, but patients with chemoresponsive tumors may receive primary chemotherapy. The selected RT schedule should be personalized to each patient and commonly is 30 Gy in 10 fractions (fx), 20 Gy in 5 fx, or 8 Gy in 1 fx. MESCC recurrence may be treated with additional RT, if within the spinal cord tolerance, or surgery. Stereotactic body radiation therapy (SBRT) has been used for high grade MESCC in patients with relatively intact neurologic function at a few centers with a very robust infrastructure to support rapid initiation of treatment within a short period of time, but is generally not feasible for most clinical practices. SBRT may be advantageous for low grade MESCC, recurrence, or in the post-operative setting. Detection of MESCC prior to development of high-grade compression or deterioration of neurologic function may allow patients to benefit more from advanced therapies and improve prognosis. CONCLUSIONS MESCC is a devastating condition; optimal treatment should be personalized to each patient and approached collaboratively by a multidisciplinary team.
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Affiliation(s)
- Peter Zaki
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Andrew Barbour
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Mark M Zaki
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Anubhav G Amin
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Vyshak Venur
- Division of Medical Oncology, Fred Hutchinson Cancer Center/University of Washington, Seattle, WA, USA
| | - Tresa McGranahan
- Department of Neurology, Alvord Brain Tumor Center/University of Washington, Seattle, WA, USA
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute of Singapore, Singapore, Singapore
| | - Joshua D Palmer
- Department of Radiation Oncology, Arthur G. James Cancer Hospital/The Ohio State University, Columbus, OH, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jonathan T Yang
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, and ICON Cancer Centre, Brisbane, Queensland, Australia
| | - Kristin J Redmond
- Department of Radiation and Molecular Oncology, John Hopkins University, Baltimore, MD, USA
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine and Norris Cancer Center at University of Southern California, CA, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Stephanie K Schaub
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
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Burile G, Jawade S, Seth N. The Scope of Physiotherapy Rehabilitation in Compressive Myelopathy Managed by Spinal Fusion: A Case Report. Cureus 2023; 15:e48290. [PMID: 38058338 PMCID: PMC10696622 DOI: 10.7759/cureus.48290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Cervical myelopathy is a sequence of alterations that cause etiological ailments such as spondylosis, ossification of the posterior longitudinal ligament, and compression of nerve roots at various levels. The reduced diameter of the vertebral canal is because of degenerative changes in the structure of the disc, along with the formation of osteophytic spurs that compress the surrounding structures, such as nerve roots, at one or more levels. Radiography, CT, MRI, and dynamic study help identify cervical spondylotic myelopathy. Surgical methods such as anterior, posterior, or combined approaches are used to stabilize and potentially improve the subject's neurologic status. The spine's alignment, the number of mobility segments implicated, the morphology, and the location of the spondylotic compression guide surgical decision-making. Cervical spondylotic myelopathy is a condition of the cervical spine that causes narrowing of the spinal canal with symptoms such as neck pain, numbness in the hands, gait problems, and sphincter dysfunction. We present the case of a 52-year-old male diagnosed with compressive myelopathy from C3 to C7 with a history of falling from the bed. On MRI, there were degenerative changes, spondylosis, and compressive myelopathy, and a disc bulge at multiple levels was seen. The patient underwent a spinal fusion at C3 to C7 level followed by structured physical therapy rehabilitation to gain a good recovery and functional independence to improve quality of life.
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Affiliation(s)
- Ghanishtha Burile
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita Seth
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sowa D, Guzik G, Daniel P, Bronisz M, Merkiel D. Outcomes of Odontoid Process Fracture Surgery. Ortop Traumatol Rehabil 2023; 25:249-257. [PMID: 38088099 DOI: 10.5604/01.3001.0053.9673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Odontoid fractures are found in two age groups. In younger patients, they occur following traffic accidents, falls from a height and during sports. In older patients with poor bone quality, they are usually caused by falls from one's own height. Most fractures are stable and do not require surgical treatment. Unstable, severely displaced fractures with neurological deficits require surgical treatment. The aim of the study was to evaluate the surgical and functional outcomes of treatment of odontoid fractures with a cannulated screw. MATERIALS AND METHODS The study enrolled 20 patients that underwent surgery in the years 2020-2022. The patients were divided into two groups: below 60 (group A) and over 60 years of age (group B). Patients were assessed at one day pre-op, one day post-op, 6 weeks following surgery and 3 months following surgery. Imaging studies were performed to assess the angulation and degree of displacement of bone fragments. After the fracture was surgically fixed with a cannulated screw, bone union and the stability of fracture fixation were assessed. Preoperative and postoperative pain intensity as per a VAS, functional status assessed with the NDI questionnaire, quality of life (EQ-VAS) and neurological status (ASIA scale) were compared. RESULTS Good functional and surgical results were obtained in both groups of patients. Performance and quality of life improved, while pain intensity decreased in all patients. In 3 patients with post-traumatic paresis, the dysfunctions gradually subsided. No general medical or perioperative complications were observed. Bone union of the fracture was achieved in 40% of patients in group B and in 80% in group A. Achieving union did not determine the functional status of patients. On functional radiographs, all places of fixation were stable. CONCLUSIONS 1. Odontoid fracture fixation with a single cannulated screw is a safe method of treatment. It provided a high union rate and good stability of the fracture. 2. Fracture non-union was noted more often in the group of older patients, but it did not negatively impact quality of life and performance.
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Affiliation(s)
- Dariusz Sowa
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
| | - Grzegorz Guzik
- Odział Ortopedii Onkologicznej Szpitala Specjalistycznego w Brzozowie - Podkarpacki Ośrodek Onkologiczny, Rzeszów, Polska / Orthopaedic Oncology Department, Subcarpathian Oncology Centre in Brzozów, Rzeszów University of Technology, Rzeszów, Poland
| | - Pyrka Daniel
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
| | - Michał Bronisz
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
| | - Dawid Merkiel
- Oddział Urazowo Ortopedyczny Szpital Powiatowy w Stalowej Woli, Polska / Department of Orthopaedics and Traumatology, District Hospital in Stalowa Wola, Poland
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Bergamaschi JPM, de Brito MBS, de Araújo FF, Graciano RS, Utino ET, Lewandrowski KU, Wirth F. Surgical Technique of Central and Over-the-Top Full-Endoscopic Decompression of the Cervical Spine: A Technical Note. J Pers Med 2023; 13:1508. [PMID: 37888119 PMCID: PMC10608411 DOI: 10.3390/jpm13101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Endoscopic surgery of the cervical spine is constantly evolving and the spectrum of its indications has expanded in recent decades. Full-endoscopic techniques have standardized the procedures for posterior and anterior access. The full-endoscopic approach was developed to treat degenerative diseases with the least possible invasion and without causing instability of the cervical spine. The posterior full-endoscopic approach is indicated for the treatment of diseases of the lateral part of the vertebral segment, such as herniations and stenoses of the lateral recess and vertebral foramen. There has been little discussion of this approach to the treatment of central stenosis of the cervical spine. This technical note describes a step-by-step surgical technique for central and over-the-top full-endoscopic decompression in the cervical spine, using a 3.7 mm working channel endoscope. This technique has already been shown to be effective in a recent case series with a 4.7 mm working channel endoscope, and may represent a new treatment option for central or bilateral lateral recess stenosis. There is also the possibility of a bilateral full-endoscopic approach, but this may be associated with greater muscle damage and a longer operative time. Case series and comparative studies should be encouraged to confirm the safety and utility of this technique.
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Affiliation(s)
- João Paulo Machado Bergamaschi
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
| | | | - Fernando Flores de Araújo
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
| | - Ricardo Squiapati Graciano
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
| | - Edgar Takao Utino
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
| | | | - Fernanda Wirth
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES (1) To compare the risk of Spinal Epidural Hematoma (SEH) associated with specific pre-operative and post-operative anticoagulation (AC) and antiplatelet medications (APM). (2) To define the incidence of SEH and identify risk factors for SEH in our population. METHODS Thoracolumbar surgeries between October 2009 and March 2020 were collected. Patients who underwent incision and drainage of a symptomatic SEH were identified. AC and APM was recorded 14 days pre-operatively and post-operatively. Demographics and intra-operative factors were recorded. Relative risk with 95% confidence interval was used, with Bonferroni-corrected P-values <.05 used for significance. RESULTS 9307 surgeries were identified. 177 (1.9%) patients returned to the OR within 30 days, 37 of whom (.39%) returned due to SEH. Seven patients were on either AC or APM pre-op, and sixteen post-op. Five were on aspirin pre-operatively (RR 3.2, 95% CI 1.25-8.22, P = .015). Risk was not increased in patients on multiple agents. No AC or APM demonstrated increased risk of hematoma post-operatively, despite trends toward significance with multiple agents. The use of a drain and complicated hypertension were associated with increased risk of SEH. CONCLUSIONS Pre-operative aspirin is associated with increased risk of SEH, even when appropriately discontinued. Appropriately dosed post-operative anticoagulation does not increase the risk of SEH, though being on multiple agents trends toward statistical significance and should be better studied. Surgeons should be vigilant and carefully monitor patients on pre-operative antiplatelet medications for spinal epidural hematoma.
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Affiliation(s)
| | | | - Kathryn Hanson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark M Mikhael
- Illinois Bone and Joint Institute Glenview, Glenview, IL, USA
- NorthShore University Health System, Evanston, IL, USA
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Musali SR, Karla R, Gollapudi PR, Mohammed I, Nandigama PK. Anterolateral versus posterolateral decompression and spinal stabilization in thoracolumbar Potts spine: a comparative study. Br J Neurosurg 2023; 37:1028-1030. [PMID: 33241951 DOI: 10.1080/02688697.2020.1849540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
AIM To assess and compare the clinical, radiological, and functional outcomes of anterolateral and posterolateral decompression and spinal stabilization in the thoracolumbar tuberculous spine. MATERIAL AND METHODS 30 patients with thoracolumbar spinal tuberculosis were treated surgically between September 2014 and 2018. Fifteen patients underwent anterolateral decompression and spinal stabilization from September 2014 to September 2016. These patients were studied retrospectively (group A). Fifteen patients underwent posterolateral decompression by costotransversectomy and spinal stabilization from September 2016 to September 2017 were studied prospectively. Neurological recovery, correction of kyphotic deformity, pain (visual analog score) and ESR, and duration of stay were assessed. Neurological outcome was assessed using Frankel grading, and pain was assessed using visual analog scale. RESULTS The average follow-up period in both the groups is 12 months. There was a statistically significant difference in the kyphotic angle correction between anterolateral and posterolateral groups at the end of 12 months (follow up). No statistically significant difference was found between the two groups for ESR, visual analog scale for pain, and neurological recovery (Frankel's grading) at the end of 12 months. CONCLUSION Both anterolateral and posterolateral approaches are sufficient thoracic and thoracolumbar tuberculous spine but, the posterolateral approach allows a significant correction of kyphotic angle, better improvement of pain and lesser duration of stay.
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Affiliation(s)
- Siddartha Reddy Musali
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
| | - Ravi Karla
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
| | - Prakash Rao Gollapudi
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
| | - Imran Mohammed
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
| | - Prathap Kumar Nandigama
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
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Onafowokan OO, Das A, Mir JM, Alas H, Williamson TK, Mcfarland K, Varghese J, Naessig S, Imbo B, Passfall L, Krol O, Tretiakov P, Joujon-Roche R, Dave P, Moattari K, Owusu-Sarpong S, Lebovic J, Vira S, Diebo B, Lafage V, Passias PG. Predictors of reoperation for spinal disorders in Chiari malformation patients with prior surgical decompression. J Craniovertebr Junction Spine 2023; 14:336-340. [PMID: 38268684 PMCID: PMC10805163 DOI: 10.4103/jcvjs.jcvjs_140_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Background Chiari malformation (CM) is a cluster of related developmental anomalies of the posterior fossa ranging from asymptomatic to fatal. Cranial and spinal decompression can help alleviate symptoms of increased cerebrospinal fluid pressure and correct spinal deformity. As surgical intervention for CM increases in frequency, understanding predictors of reoperation may help optimize neurosurgical planning. Materials and Methods This was a retrospective analysis of the prospectively collected Healthcare Cost and Utilization Project's California State Inpatient Database years 2004-2011. Chiari malformation Types 1-4 (queried with ICD-9 CM codes) with associated spinal pathologies undergoing stand-alone spinal decompression (queried with ICD-9 CM procedure codes) were included. Cranial decompressions were excluded. Results One thousand four hundred and forty-six patients (29.28 years, 55.6% of females) were included. Fifty-eight patients (4.01%) required reoperation (67 reoperations). Patients aged 40-50 years had the most reoperations (11); however, patients aged 15-20 years had a significantly higher reoperation rate than all other groups (15.5% vs. 8.2%, P = 0.048). Female gender was significantly associated with reoperation (67.2% vs. 55.6%, P = 0.006). Medical comorbidities associated with reoperation included chronic lung disease (19% vs. 6.9%, P < 0.001), iron deficiency anemia (10.3% vs. 4.1%, P = 0.024), and renal failure (3.4% vs. 0.9%, P = 0.05). Associated significant cluster anomalies included spina bifida (48.3% vs. 34.8%, P = 0.035), tethered cord syndrome (6.9% vs. 2.1%, P = 0.015), syringomyelia (12.1% vs. 5.9%, P = 0.054), hydrocephalus (37.9% vs. 17.7%, P < 0.001), scoliosis (13.8% vs. 6.4%, P = 0.028), and ventricular septal defect (6.9% vs. 2.3%, P = 0.026). Conclusions Multiple medical and CM-specific comorbidities were associated with reoperation. Addressing them, where possible, may aid in improving CM surgery outcomes.
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Affiliation(s)
- Oluwatobi O. Onafowokan
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Ankita Das
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Jamshaid M. Mir
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Haddy Alas
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Tyler K. Williamson
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Kimberly Mcfarland
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | | | - Sara Naessig
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Bailey Imbo
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Lara Passfall
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Oscar Krol
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Peter Tretiakov
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Rachel Joujon-Roche
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Pooja Dave
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Kevin Moattari
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Stephane Owusu-Sarpong
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Jordan Lebovic
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
| | - Shaleen Vira
- Department of Orthopedic Surgery, Banner Health, Phoenix, AZ, USA
| | - Bassel Diebo
- Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, RI, USA
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, USA
| | - Peter Gust Passias
- Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA
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Dong W, Ren Z, Li S. Modified facet joint fusion for multilevel lumbar spinal stenosis: a retrospective study of 135 consecutive patients. Br J Neurosurg 2023; 37:1046-1051. [PMID: 33245247 DOI: 10.1080/02688697.2020.1850642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of modified facet joint fusion (MFF) for the treatment of multilevel (three-level or more) lumbar spinal stenosis (LSS). PATIENTS AND METHODS In this retrospective study, 135 consecutive patients who underwent initial MFF for multilevel LSS were included. Clinical outcomes included fusion rate, change of visual analogue scale pain scores for low back pain (VAS-LBP) and leg pain (VAS-LP), Japanese Orthopedic Association scores (JOA), Oswestry Disability Index (ODI) and MacNab classification before and after MFF. The complications were also analyzed. RESULTS The fusion rates were 46.7% (63/135) at 6-month and 89.6% (121/135) at 1-year. The mean VAS-LBP, VAS-LP, and ODI significantly decreased from 5.2 ± 0.6, 5.7 ± 0.8 and 65 ± 7.9 to 1.58 ± 0.4, 0.58 ± 0.3 and 20.8 ± 5.8, respectively (all p < 0.001). The mean JOA markedly improved from 10.0 ± 1.3 to 26.1 ± 1.5 (p < 0.001). Excellent/good results of MacNab classification were achieved in 88.9% (120/135) of the patients. The overall rate of complications after MFF was 5.9%, including poor wound healing (2.2%), calf muscular venous thrombosis (0.74%), deep venous thrombosis (0.74%), superficial wound infection (1.48%), transient foot drop (0.74%). All the complications were transient and improved without prolonged hospital stay and sequelae. CONCLUSION MFF may be safe and efficient for multilevel LSS with high fusion rate and significant symptom relief, which is worthy of further study.
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Affiliation(s)
- Wenfang Dong
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
- The Twelfth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Zhinan Ren
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
| | - Shugang Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing China
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Yordanov S, Yang X, Mowforth O, K Demetriades A, Ivanov M, Vergara P, Gardner A, Pereira E, Bateman A, Alamri A, Francis J, Trivedi R, Kotter M, Davies B, Budu A. Factors Influencing Surgical Decision-Making in the Posterior Laminectomy With Fixation for Degenerative Cervical Myelopathy (POLYFIX-DCM) Trial: Survey Study. JMIR Form Res 2023; 7:e48321. [PMID: 37698903 PMCID: PMC10523224 DOI: 10.2196/48321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/12/2023] [Accepted: 06/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM occurs when degenerative processes cause compression and injure the spinal cord. Surgery to remove the stress caused by the compression of the spinal cord is the mainstay of treatment, with a range of techniques in use. Although various factors are described to inform the selection of these techniques, there needs to be more consensus and limited comparative evidence. OBJECTIVE The main objective of this survey was to explore the variation of practice and decision-making, with a focus on laminectomy versus laminectomy and fusion in posterior surgery of the cervical spine. We present the results of a survey conducted among the principal investigators (PIs) of the National Institute for Health and Care Research (NIHR) randomized controlled trial on posterior laminectomy with fixation for degenerative cervical myelopathy (POLYFIX-DCM). METHODS A series of 7 cases were shared with 24 PIs using SurveyMonkey. Each case consisted of a midsagittal T2-weighted magnetic resonance imaging and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had the equipoise to randomize in the NIHR POLYFIX-DCM trial. Variability in decision-making was then explored using factors reported to inform decision-making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis, and patient age. RESULTS The majority of PIs (16/30, 53%) completed the survey. Overall, PIs favored a posterior approach (12/16, 75%) with instrumentation (75/112, average 66%) and would randomize (67/112, average 62%) most cases. Factors reported to inform decision-making poorly explained variability in responses in both univariate testing and with a multivariate model (R2=0.1). Only surgeon experience of more than 5 years and orthopedic specialty training background were significant predictors, both associated with an anterior approach (odds ratio [OR] 1.255; P=.02 and OR 1.344; P=.007, respectively) and fusion for posterior procedures (OR 0.628; P<.001 and OR 1.344; P<.001, respectively). Surgeon experience also significantly affected the openness to randomize, with those with more than 5 years of experience less likely to randomize (OR -0.68; P<.001). CONCLUSIONS In this representative sample of spine surgeons participating in the POLYFIX-DCM trial as investigators, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, this study supports the view that there appears to be a clinical equipoise, and conceptually, a randomized controlled trial appears feasible, which sets the scene for the NIHR POLYFIX-DCM trial.
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Affiliation(s)
- Stefan Yordanov
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Xiaoyu Yang
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Oliver Mowforth
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | | | - Marcel Ivanov
- Neurosurgery Department, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Pierluigi Vergara
- Department of Spinal Surgery, East Suffolk and North Essex NHS Foundation Trust, Ipswich, United Kingdom
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Erlick Pereira
- Department of Neurosurgery, St Georges University Hospital NHS Foundation Trust, London, United Kingdom
| | - Antony Bateman
- Royal Derby Spinal Centre, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Alexander Alamri
- Department of Neurosurgery, St Georges University Hospital NHS Foundation Trust, London, United Kingdom
| | - Jibin Francis
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Rikin Trivedi
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Mark Kotter
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Benjamin Davies
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Cambridge, United Kingdom
| | - Alexandru Budu
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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