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Kapetanakis S, Gkantsinikoudis N, Tsioulas P, Bladowska J, Apostolakis S. Assessment of Health-Related Quality of Life in Patients With Traumatic Fractures Following Thoracolumbar Fusion: Short-Term Results. Cureus 2024; 16:e53861. [PMID: 38465058 PMCID: PMC10924666 DOI: 10.7759/cureus.53861] [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] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION Thoracolumbar vertebral fractures (TVFs) constitute frequent injuries with specific therapeutic challenges and remarkable implications for affected individuals. The aim of this study is to investigate the alteration of overall health-related quality of life (HRQoL) in patients with traumatic TVFs undergoing thoracolumbar fusion surgery. MATERIALS AND METHODS A total of 72 patients with single-level traumatic thoracic or lumbar vertebral fractures (AO type A3 or A4) were enrolled in this prospective cohort study. All patients were subjected to thoracolumbar spinal fusion surgery with or without posterior decompression, being followed up for a two-year period. Clinical assessment was conducted via the implementation of the Visual Analog Scale (VAS) and 36-item Short-Form Survey Questionnaire (SF-36) for the evaluation of pain and HRQoL, respectively. Patient assessment was performed in determined postoperative follow-up intervals. RESULTS Recorded values of assessed outcome measures demonstrated a statistically significant improvement during the entire two-year follow-up period. This improvement was more pronounced throughout the first three to six postoperative months, subsequently demonstrating a plateau. No statistically significant correlation between age, SF-36, and VAS was found, with the exception of the bodily pain index, the improvement of which was observed to be positively correlated with age. Transient causalgia and cerebrospinal fluid leak were recorded in 5% of evaluated individuals. CONCLUSIONS Thoracolumbar fusion constitutes a safe and efficient option for the surgical management of single-level traumatic vertebral fractures. Nevertheless, rehabilitation is a lasting procedure that may last over six months until final amelioration is observed. Clinical improvement may be more pronounced in older patients, potentially due to different expectations.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Spine and Deformities, European Interbalkan Medical Center, Thessaloniki, GRC
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, GRC
| | | | - Paschalis Tsioulas
- 2nd Orthopaedic Department, General Hospital of Thessaloniki "Papageorgiou", Thessaloniki, GRC
| | - Joanna Bladowska
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, POL
- Department of Radiology, Wroclaw 4th Military Clinical Hospital, Wroclaw, POL
| | - Sotirios Apostolakis
- Department of Spine and Deformities, European Interbalkan Medical Center, Thessaloniki, GRC
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Kapetanakis S, Floros E, Gkantsinikoudis N. Extreme cases in percutaneous transforaminal endoscopic surgery: case series and brief review of the literature. Br J Neurosurg 2024; 38:94-98. [PMID: 34187254 DOI: 10.1080/02688697.2021.1944981] [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: 02/08/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Percutaneous transforaminal endoscopic decompression (PTED) is a minimally invasive method of surgical treatment of miscellaneous spinal conditions. We describe our experience with PTED in extreme cases of foraminal stenosis (FS) in adult degenerative scoliosis (ADS), recurrent foraminal stenosis (RFS) after previous open decompression surgery and adjacent segment disease (ASD) after previous lumbar fusion. METHODS Twenty-one (21) patients with FS encountered in the clinical framework of ADS (n = 6), previous open decompression surgery (n = 8) and ASD (n = 7) were prospectively reviewed. Patients were preoperatively assessed via clinical and radiologic evaluation. All patients underwent PTED in 2018-2019. Postoperative evaluation was conducted with clinical examination and evaluation of Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria in predetermined chronic intervals in a 1-2 years follow-up. RESULTS All patients were successfully managed with PTED. Operated levels were L3-L4 (19.0%), L4-L5 (52.4%) and L5-S1 (28.6%). No major perioperative complications were recorded. VAS and ODI scores were demonstrated to exhibit a clinically and statistically significant (p < 0.05) amelioration in all patients' categories directly postoperatively, which was preserved until the end of follow-up. Overall outcomes according to modified MacNab criteria were excellent in 12 patients (57.1%), good in 6 (28.6%) and fair in 3 (14.3%) patients. CONCLUSIONS PTED is safe and effective in extreme cases of FS encountered in patients with ADS, previous posterior open decompression surgery and ASD after previous spinal fusion.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | - Evangelos Floros
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Kapetanakis S, Gkantsinikoudis N, Apostolakis S, Tsioulas P, Chaniotakis C. Posterolateral Instrumented Fusion in Elderly Patients With a Single Osteoporotic Vertebral Fracture: Evaluation of Health-Related Quality of Life. Cureus 2024; 16:e53498. [PMID: 38440031 PMCID: PMC10910638 DOI: 10.7759/cureus.53498] [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] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Treatment of osteoporotic vertebral fractures (OVFs) is a factor that affects the quality of life and should be considered during management. In patients with a single OVF and neurologic deficit, surgical procedures aiming at neural decompression with instrumented fusion should be considered in elderly individuals. Posterolateral instrumented fusion (PLF) constitutes a largely performed fusion surgery for patients featuring indications for fusion surgery. The aim of this study was to determine the safety, effectiveness, and impact on health-related quality of life (HRQoL) of PLF surgery in elderly patients diagnosed with a single OVF. Methods This study was conducted at Interbalkan European Medical Center, Thessaloniki, Greece. Eighty (80) consecutive individuals with OVFs were subjected to PLF and recruited in this prospectively designed non-randomized study. Clinical evaluation was performed preoperatively and postoperatively at particular chronic intervals at one, three, six, and 12 months and two years. The assessment was conducted via the standardized Visual Analogue Scale (VAS) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire for pain and HRQoL, respectively. Results No major perioperative complications were observed. All parameters of SF-36 presented significant improvement over the entire follow-up period with VAS scores reaching a plateau at six months. Depicted improvement of these parameters proves the beneficial role of PLF in elderly patients who suffered from a single OVF with or without referable neurological deficit. Conclusion OVFs have a significant impact on the quality of life of elderly patients, and surgical treatment with PLF with or without decompression can lead to functional recovery, pain relief, and HRQoL amelioration. Our results demonstrated that the outcomes of PLF in the surgical treatment of these patients are remarkably favorable, demonstrating the safety and efficacy of the technique.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, GRC
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, GRC
| | | | - Sotirios Apostolakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, GRC
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Kapetanakis S, Gkantsinikoudis N, Apostolakis S. Technical challenges and surgical outcomes of percutaneous transforaminal endoscopic discectomy in patients with upper lumbar disc herniation: a prospective clinical study. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04725-6. [PMID: 36543922 DOI: 10.1007/s00402-022-04725-6] [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] [Received: 03/05/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Upper lumbar disc herniation (ULDH) constitutes a considerably complex and rare anatomic entity. As such, there are only a handful of studies investigating the application of percutaneous transforaminal endoscopic discectomy (PTED) in the management of this cause of low back pain. RESEARCH QUESTION To elucidate the safety and effectiveness of PTED in patients with ULDH. MATERIALS AND METHODS Twenty-six (26) individuals with diagnosed ULDH (L1-L2, L2-L3) according to clinical and radiologic criteria were prospectively evaluated in a 2-year follow-up period. All patients were assessed preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively. Clinical evaluation was conducted with visual analogue scale for lower limb (VAS-LP) and low back (VAS-BP) pain in conjunction with Short-Form 36 (SF-36) Medical Health Survey Questionnaire. Potential complications were recorded in each follow-up interval. RESULTS One patient (3.8%) featured temporary postoperative dysesthesia that was completely resolved at 6 weeks. No other major perioperative complications were observed. Values of all studied indices were found to be statistically significantly ameliorated at the end of follow-up. Improvement was depicted to be quantitatively maximal at 6 weeks postoperatively. CONCLUSIONS PTED constitutes a safe and effective technique for surgical management of ULDH that merits further assessment in current clinical practice in the framework of multicenter randomized controlled trials. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece. .,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, 15125, Athens, Greece.
| | - Nikolaos Gkantsinikoudis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece
| | - Sotirios Apostolakis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. Full-Endoscopic Ventral Facetectomy vs Open Laminectomy for Lumbar Lateral Recess Stenosis: A Comparative Study and Brief Literature Review. Int J Spine Surg 2022; 16:361-372. [PMID: 35444044 PMCID: PMC9930662 DOI: 10.14444/8218] [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: 11/20/2022] Open
Abstract
BACKGROUND Lateral recess stenosis (LRS) represents a major etiology of pain and disability in recent years. The aim of the present study was to compare the clinical outcomes of full-endoscopic ventral facetectomy (FEVF) vs conventional open laminectomy (OL) for surgical treatment of lumbar LRS. METHODS Ninety individuals with diagnosed LRS according to clinical and radiological criteria were included in this study. Patients were appropriately classified into 2 distinct groups according to received treatment. Group A was constituted from 48 patients subjected to FEVF. Contrariwise, the 42 patients of Group B underwent OL. All patients were consecutively evaluated with particular clinical scores preoperatively and at 6 weeks, 3, months, 6 months, 12 months, and 2 years postoperatively. Clinical assessment was conducted with the visual analog scale for leg pain (VAS-LP) and back pain (VAS-BP) and with the Short-Form 36 (SF-36) medical questionnaire. RESULTS Values of all studied indices in both groups featured a major clinical improvement in 6 weeks with subsequent quantitatively minor albeit still statistically significant amelioration until the end of follow-up at 2 years. Comparative evaluation of recorded parameters between the 2 groups disclosed that VAS-BP, bodily pain, and role emotional indices of SF-36 were quantitatively and statistically differentiated in favor of Group A in 6 weeks, featuring an amelioration that persisted until the end of follow-up. Registered values of the other parameters were not found to demonstrate a quantitatively and clinically noteworthy differentiation between the 2 groups. CONCLUSIONS FEVF represents a feasible, safe, and beneficial alternative for surgical therapy of patients with LRS, featuring comparable outcomes with conventional OL. CLINICAL RELEVANCE Lumbar LRS represents a frequent entity with remarkable clinical sequelae. FEVF represents a novel, groundbreaking and minimally invasive technique that should be considered as a safe and efficacious alternative over conventional open surgery in specific patients with LRS. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece .,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature. Am J Sports Med 2021; 49:3234-3241. [PMID: 34491150 DOI: 10.1177/03635465211032612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/31/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients. PURPOSE To study the particular outcomes of percutaneous transforaminal endoscopic discectomy (PTED) in competitive elite athletes with surgically treatable LDH. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 55 competitive elite athletes with diagnosed LDH based on clinical and radiologic criteria were enrolled in this prospectively designed study. All patients underwent successful PTED. Clinical evaluation was conducted with the well-established visual analog scale for lower limb and low back pain separately. The 36-Item Short Form Health Survey (SF-36) was implemented for health-related quality of life analysis. Patients were assessed preoperatively and at regular postoperative intervals: 6 weeks and 3, 6, and 12 months, as well as 2 years. RESULTS Operated levels were L3-L4 (5.5%), L4-L5 (69.1%), and L5-S1 (25.4%). No major perioperative complications were observed. All patients successfully reached the end of follow-up at 2 years. Both visual analog scale scores (lower limb and low back pain) showed clinically and statistically significant improvement at 6 weeks postoperatively, with subsequent minor improvement and stabilization. All recorded SF-36 parameters demonstrated major clinical amelioration at 6 weeks, with subsequent minor but constant statistically significant improvement until the end of follow-up. Comparative evaluation of the SF-36 revealed that the physical function, bodily pain, role-emotional, and mental health parameters showed quantitatively greater improvement in comparison with rest indices. CONCLUSION PTED constitutes a feasible and effective technique for surgical management of LDH in athletes, providing favorable outcomes in terms of postoperative pain and health-related quality of life. Proper performance of technique for specific cases of L5-S1 LDH may be more challenging, and these cases should be evaluated selectively for suitability for this procedure.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Gkantsinikoudis N, Kapetanakis S, Magras I, Tsiridis E, Kritis A. Tissue-Engineering of Human Intervertebral Disc: A Concise Review. Tissue Eng Part B Rev 2021; 28:848-860. [PMID: 34409867 DOI: 10.1089/ten.teb.2021.0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intervertebral disc (IVD) represents a structure of crucial structural and functional importance for human spine. Pathology of IVD institutes a frequently encountered condition in current clinical practice. Degenerative Disc Disease (DDD), the principal clinical representative of IVD pathology, constitutes an increasingly diagnosed spinal disorder associated with substantial morbidity and mortality in recent years. Despite the considerable incidence and socioeconomic burden of DDD, existing treatment modalities including conservative and surgical methods have been demonstrated to provide a limited therapeutic effect, being not capable of interrupting or reversing natural progress of underlying disease. These limitations underline the requirement for development of novel, innovative and more effective therapeutic strategies for DDD management. Within this literature framework, compromised IVD replacement with a viable IVD construct manufactured with Tissue-Engineering (TE) methods has been recommended as a promising therapeutic strategy for DDD. Existing preliminary preclinical data demonstrate that proper combination of cells from various sources, different scaffold materials and appropriate signaling molecules renders manufacturing of whole-IVD tissue-engineered constructs a technically feasible process. Aim of this narrative review is to critically summarize current published evidence regarding particular aspects of IVD-TE, primarily emphasizing in providing researchers in this field with practicable knowledge in order to enhance clinical translatability of their research and informing clinical practitioners about the features and capabilities of innovative TE science in the field of IVD-TE.
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Affiliation(s)
- Nikolaos Gkantsinikoudis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th.), Department of Physiology and Pharmacology , Thessaloniki, Greece.,School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), cGMP Regenerative Medicine Facility, Department of Physiology and Pharmacology, Thessaloniki, Greece;
| | - Stylianos Kapetanakis
- Interbalkan European Medical Center, Spine Department and Deformities, Thessaloniki, Greece;
| | - Ioannis Magras
- AHEPA University General Hospital, Aristotle University of Thessaloniki, Department of Neurosurgery, Thessaloniki, Greece;
| | - Eleftherios Tsiridis
- Papageorgiou General Hospital, Aristotle University Medical School, Academic Orthopaedic Department, Thessaloniki Ring Road, Nea Efkarpia, Greece.,Aristotle University Thessaloniki, Balkan Center, Buildings A & B, Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center of Interdisciplinary Research and Innovation (C.I.R.I.), Thessaloniki, 10th km Thessaloniki-Thermi Rd, Greece;
| | - Aristeidis Kritis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th.), Department of Physiology and Pharmacology , Thessaloniki, Greece.,School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (A.U.Th), cGMP Regenerative Medicine Facility, Department of Physiology and Pharmacology, Thessaloniki, Greece;
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Kapetanakis S, Gkantsinikoudis N, Gkasdaris G, Charitoudis G. Treatment of adjacent segment disease with percutaneous transforaminal endoscopic discectomy: Early experience and results. J Orthop Surg (Hong Kong) 2021; 28:2309499020960560. [PMID: 32990158 DOI: 10.1177/2309499020960560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/21/2022] Open
Abstract
PURPOSE Adjacent segment disease (ASD) constitutes a long-term complication of instrumented spinal fusion. Aim of this study is to analyze the utilization of percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of symptomatic ASD, emphasizing basically in the postoperative course. METHODS A prospective study with 35 patients was designed. Patients enrolled in our study were distributed in two different groups. Group A constituted of 15 patients featuring ASD as a complication of a previously conducted lumbar spinal fusion. Group B was composed of 20 patients, presenting simple lumbar disc herniation (LDH). All patients were subjected to successful PTED for LDH. Patients were evaluated at regular intervals in 6-week and 3-, 6-, and 12-month postoperatively. Visual analog scale was utilized for leg (VAS-LP) and low back pain (VAS-BP) evaluation. Health-related quality of life was assessed with short-form 36 health survey questionnaire (SF-36). RESULTS VAS-BP scores were statistically significantly differentiated between the two groups in all intervals of follow-up. In contrast, VAS-LP scores demonstrated statistically significant differentiation in none of follow-up intervals, indicating similar results between the two groups. Maximal improvement was in both cases for all patients observed in 6-week postoperatively, with subsequent stabilization. SF-36 preoperative evaluation denoted a statistically significant differentiation in bodily pain and role emotional parameters, which was continually until the end of follow-up observed. The other SF-36 parameters featured similar values between the two groups preoperatively as well as during the follow-up intervals. CONCLUSION PTED is capable of successfully dealing with LDH and furthermore with complications of fusion as ASD.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
| | - Nikolaos Gkantsinikoudis
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
| | - Grigorios Gkasdaris
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
| | - Georgios Charitoudis
- Spine Department and Deformities, 69021Interbalkan European Medical Center, Thessaloniki, Greece
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Nazir MS, Yazdani M, Draper JANE, Franks R, Lam S, Plein S, Kapetanakis S, Young A, Chiribiri A. The strain-7 study: multimodal, multivendor, multifield strength, scan:rescan comparison of global longitudinal and circumferential strain in healthy volunteers. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Insitute for Health Research
Background
There is clinical and prognostic evidence for global longitudinal strain (GLS) and circumferential strain (GCS). A range of techniques exist: 2-dimensional echocardiography (2Decho), 3-dimensional echocardiography (3Decho) and Cardiovascular Magnetic Resonance (CMR).
Purpose
To investigate inter-study repeatability and inter-method comparison of GLS and GCS techniques.
Methods
Volunteers underwent same day scan
rescan 2Decho, 3Decho, 1.5T Siemens CMR (Cine imaging and Displacement encoding with stimulated echoes [DENSE]), 3T Siemens CMR (Cine Imaging and DENSE) and 3T Philips CMR (Tagging and Fast strain-encoding [fSENC]) imaging. Strain was quantified for 2Decho (EchoPAC), 3Decho (TomTec), Feature tracking (FT) for cine imaging (CircleCVI), CIM (University of Auckland) for DENSE and Tag, and Myostrain (Myocardial solutions) for fSENC.
Results
20(6F) volunteers, mean age 33 ± 7 years, mean LVEF 62 ± 4%. All GLS and GCS methods had excellent inter-study agreement (ICC > 0.75) with coefficient of variation (CoV) between 4-8% (Table 1). Median and IQR are presented in Figure 1.
Friedman’s test revealed statistically significant inter-method differences for GLS (χ2 = 66.4,p < 0.0001) and GCS (χ2 = 50.9,p < 0.0001). Post hoc analysis using Dunn’s test with Bonferroni correction demonstrated significant differences:
-GLS: 2Decho vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.0116); 3Decho vs FT 3T (p = 0.049) and DENSE 1.5T (p < 0.0001); FT 1.5T vs DENSE 1.5T (p = 0.001) and Myostrain 3T (p = 0.01); FT 3T vs Myostrain 3T (p < 0.0001); DENSE 1.5T vs Tag 3T (p = 0.0008) and Myostrain 3T (p < 0.0001); Tag 3T vs Myostrain (p = 0.02).
-GCS: 3Decho vs DENSE 1.5T (P = 0.0005), FT 1.5T (p < 0.001), FT 3T (P < 0.001) and Myostrain (p = 0.003); FT 1.5T vs Tag 3T (p = 0.001), FT 3T vs Myostrain 3T (p = 0.04).
Conclusion
There is excellent interstudy agreement for GLS and GCS methods. However, there are important inter-method differences in absolute values, that need to be considered for clinical application as a surveillance method and longitudinal studies.
Table 1 Acquisiton Post processing GLS CoV(%) GLS ICC GCS CoV(%) GCS ICC 2DEcho EchoPAC 4.88 0.80 - - 3DEcho TomTec 4.77 0.86 3.97 0.85 Siemens 1.5T cine FT CircleCVI 8.30 0.79 6.00 0.85 Siemens 3T cine FT CircleCVI 6.21 0.89 4.76 0.94 Philips 3T Tag CIM 6.15 0.89 5.86 0.88 Siemens 1.5T DENSE CIM 4.36 0.90 4.65 0.89 Philips 3T fSENC Myostrain 8.45 0.81 4.06 0.90 Interstudy agreement for the different GLS and GCS methods. Abstract Figure 1
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Affiliation(s)
- MS Nazir
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Yazdani
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JANE Draper
- Guys and St Thomas Hospital, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - R Franks
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Lam
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - S Kapetanakis
- Guys and St Thomas Hospital, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Young
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - A Chiribiri
- Kings College London, Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
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Kapetanakis S, Gkantsinikoudis N, Thomaidis T, Georgoudis M. The endoscopic aspect of foraminal anatomy and dorsal root ganglion in percutaneous transforaminal endoscopic discectomy. Clin Case Rep 2020; 8:3616-3618. [PMID: 33364005 PMCID: PMC7752575 DOI: 10.1002/ccr3.3347] [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: 04/14/2020] [Revised: 07/02/2020] [Accepted: 08/20/2020] [Indexed: 12/03/2022] Open
Abstract
Percutaneous Transforaminal Endoscopic Discectomy (PTED) offers an exceptional visualization of foraminal anatomy. Dorsal root ganglion and adjacent foraminal structures are satisfactorily visualized, thereby minimizing the risk of their intraoperative injury.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and DeformitiesInterbalkan European Medical CenterThessalonikiGreece
- Department of Minimally Invasive and Endoscopic Spine SurgeryAthens Medical CenterAthensGreece
| | | | - Tryfon Thomaidis
- Spine Department and DeformitiesInterbalkan European Medical CenterThessalonikiGreece
| | - Michalis Georgoudis
- Department of Minimally Invasive and Endoscopic Spine SurgeryAthens Medical CenterAthensGreece
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Kapetanakis S, Gkantsinikoudis N. Anatomy of lumbar facet joint: a comprehensive review. Folia Morphol (Warsz) 2020; 80:799-805. [PMID: 33084010 DOI: 10.5603/fm.a2020.0122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/30/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
Lumbar Facet Joints (LFJs) are diathrodial joints which provide articulation between two adjacent lumbar vertebrae. LFJs represent complex anatomic structures with multifaceted biomechanic and functional characteristics. They are theorized as structures of crucial clinical significance since their degenerative morphologic alterations are frequently related to emergence of low back pain. Despite the emerging interest in describing LFJs anatomy in recent years, precise description of LFJs innervation remains controversial. In this comprehensive review, anatomy and biomechanical importance of LFJs and associated adjacent extra-articular structures are thoroughly presented. Furthermore, LFJs innervation in respect to current literature data is punctually analyzed. Knowledge of anatomy and innervation LFJs of critical importance for clinicians and spine surgeons, so that patients are properly evaluated and related therapeutic procedures are rationally performed.
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Affiliation(s)
- S Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.. .,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece.
| | - N Gkantsinikoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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12
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Kapetanakis S, Gkasdaris G, Georgoudis M, Dimitrakas K, Gkantsinikoudis N. Severe kyphoscoliosis in a 17-year-old patient with T11-T12 hemivertebra: X-ray imaging of the abnormal anatomy of the thoracolumbar spine. Clin Case Rep 2020; 8:1584-1585. [PMID: 32884801 PMCID: PMC7455407 DOI: 10.1002/ccr3.2921] [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: 02/03/2019] [Revised: 05/13/2019] [Accepted: 06/06/2019] [Indexed: 12/02/2022] Open
Abstract
Young patient exhibiting lumbar pain accompanied by severe kyphoscoliosis-hemivertebra of the thoracolumbar spine; a rare etiology with difficult surgical treatment.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Deparment and DeformitiesInterbalkan European Medical CenterThessalonikiGreece
| | - Grigorios Gkasdaris
- Fourth Surgical DepartmentPapanikolaou Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Michalis Georgoudis
- Spine Deparment and DeformitiesInterbalkan European Medical CenterThessalonikiGreece
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13
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Piagkou M, Kapetanakis S, Tsakotos G, Samolis A, Anastasopoulos N, Natsis K. A Rare Case of Posterior Tibial Artery Hypoplasia and Fibular Artery Enlargement and their Impact on the Arterial Supply of Posterior Crural Region. Folia Med (Plovdiv) 2020; 61:467-471. [PMID: 32337936 DOI: 10.3897/folmed.61.e39414] [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: 08/24/2019] [Accepted: 03/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Detailed knowledge of the popliteal artery division and possible anatomical variants is of paramount importance for vascular surgery. AIM The aim of the current study was to highlight a rare unilateral case of posterior tibial artery hypoplasia. MATERIALS AND METHODS A dissection was performed at the posterior surface of the tibia in a 78-year-old Caucasian male cadaver of Greek origin. RESULTS The findings were consistent with unilateral posterior tibial artery hypoplasia and fibular artery enlargement. The variant fibular artery supplied the posterior surface of the distal leg and foot. Clinical implications of the fibular artery dominance are discussed. CONCLUSIONS Rare anatomical variants of the tibial artery are of clinical significance to maximize safety and minimize intraoperative complications.
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Affiliation(s)
- Maria Piagkou
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Tsakotos
- National and Kapodistrian University of Athens, Athens, Greece
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14
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Kapetanakis S, Gkantsinikoudis N, Thomaidis T, Theodosiadis P. The role of full-endoscopic lumbar discectomy in patients with neurodegenerative disorders: Technical note and short literature review. Surg Neurol Int 2020; 11:23. [PMID: 32123611 PMCID: PMC7049887 DOI: 10.25259/sni_581_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/05/2019] [Accepted: 01/04/2020] [Indexed: 01/16/2023] Open
Abstract
Background: Motor neuron disease includes a spectrum of neurodegenerative diseases with progressive courses and unfavorable prognoses. Here, we described a patient with a lumbar disc herniation (LDH) and isolated bulbar palsy (IBP), who successfully underwent a transforaminal full-endoscopic discectomy (TFED) without incurring the added risks of general anesthesia. Case Description: A 58-year-old male with IBP had an LDH at the L4-L5 level. Avoiding general anesthesia, a TFED was successfully performed under local anesthesia with mild sedation. There were no perioperative complications, and the patient was discharged on the 1st postoperative day. The patient experienced complete relief of radicular symptomatology 1 year postoperatively. Conclusion: Here, we present a rare instance of a patient with IBP who successfully underwent a TFED for an LDH performed under local anesthesia utilizing mild sedation, avoiding the risks of general anesthesia.
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Affiliation(s)
- Stylianos Kapetanakis
- Athens Medical Center, Athens, Greece.,Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Tryfon Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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15
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Katranitsa L, Gkantsinikoudis N, Kapetanakis S, Charitoudis G, Christodoulou A, Givissis P. Perioperative Blood Management in Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: Original Study and Short Review of the Literature. Folia Med (Plovdiv) 2019; 60:200-207. [PMID: 30355823 DOI: 10.1515/folmed-2017-0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/04/2017] [Accepted: 10/06/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The potential hazards of allogeneic blood transfusion are well established in literature. Few things are known, however, about the results of combining different blood saving techniques and their results in avoiding allogeneic blood transfusion (ABT) in scoliosis surgery. AIM To report specific results about utilization of preoperative autologous blood donation (PABD) and intraoperative blood-saver (BLDS) in conjunction, aiming to minimize the need for ABT. MATERIALS AND METHODS Between 1989 and 2012, 107 patients underwent posterior instrumented fusion (PIF) for adolescent idiopathic scoliosis (AIS) correction. Retrospective evaluation was conducted. Patients were classified into two groups, according to the method utilized: group A with only allogeneic blood transfusion (ABT) and group B where PABD with BLDS intraoperatively was applied. Hematocrit and hemoglobin values were evaluated preoperatively, postoperatively, and at discharge. The variables we examined included also gender, age, levels fused and number of predeposited blood units, required transfused blood units (TBU), as well as ABT rates between the two groups. RESULTS More than 70% of the transfusions in both groups were needed intraoperatively. In group A, an average of 2.4 units per patient was transfused and ABT reached 76%. In contrast, in group B an average of 4.5 units per patient was transfused but ABT rate was only 7.3%, while the rest 92.7% was autologous blood. However, the wasted autologous blood reached 24.9%. CONCLUSIONS Our results demonstrated that PABD with intraoperative cell salvage (CS) is associated with statistically significant ABT rates decrement but the combination of these methods cannot assure ABT avoidance.
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Affiliation(s)
- Lamprini Katranitsa
- 1st Orthopaedic Department, G. Papanikolaou General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Gkantsinikoudis
- Department of Spinal Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Kapetanakis
- Department of Spinal Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Georgios Charitoudis
- Department of Spinal Surgery, European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Christodoulou
- 1st Orthopaedic Department, G. Papanikolaou General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, G. Papanikolaou General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Dyer BT, Swann F, Kadam M, Draper J, Mc Gill LA, Kapetanakis S, Ismail T, Carr-White G, Webb J. P6134Understanding non-attendance to an inner city tertiary centre heart failure clinic: a pilot project. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Tackling health inequalities is a priority in heart failure (HF). We do not fully understand why some patients do not attend their hospital HF clinic appointments. Currently when a patient DNAs (does not attend) they are offered a repeat appointment often months later or are discharged from the service with a request to the primary care physician to re-refer. Non-attendance represents a missed opportunity to improve patients' health.
Purpose
The purpose of this pilot was to look at the demographics and patient factors that contribute to non-attendance. The aim is to understand and personalise our DNA policy to reduce health inequality, improve outcomes, and reduce inefficiencies in our service.
Methods
The last consecutive 45 patients who DNAd HF clinic were identified and for each, a patient who did attend the same clinic date (Attender), was chosen at random (random.org). The demographics were obtained (age, ethnicity, contact details) and medical notes reviewed (LVEF%, co-morbidities). The patient address was scored for its Index of Multiple Deprivation (IMD) – a UK government dataset measuring relative deprivation by ranking 32,844 neighbourhoods nationally using 37 indicators across 7 domains of deprivation where neighbourhood 1 is the most deprived nationally. Patients were phoned up to three times to establish the patient's mode, duration and cost of their last journey to clinic and, for those patients who DNAd, to ascertain the reason for non-attendance.
Results
Demographic and medical history was obtained for all patients. It was not possible to contact 2/45 of the Attenders, and 13/45 of the DNA patients. There was no significant difference in age, gender, number of comorbidities, LVEF%, travel time, or travel cost between DNAs and attenders. The mean one-way journey time was 53.4 mins (range 15–210 mins) and the mean return journey cost was GBP ≤10.95 (range ≤0–≤80). Common reasons for non-attendance were not receiving appointment details, forgetting appointments, being unwell on the day and difficulties with travel. The IMD score for the patients who DNAd was significantly lower confirming these patients lived in more deprived areas (9436±5863 vs. 15414±7801, p<0.001) with 71% of DNA patient's addresses in the bottom third most deprived neighbourhoods nationally.
Figure 1
Conclusions
There was a significant difference in deprivation score between patients who attended and DNAd their clinics. In addition, we found that all patients were travelling up to an hour each way to attend clinic, and that the cost of travel may be a barrier to attendance, even in a healthcare system that is free at the point of delivery. Despite calling three times, we were unable to speak to 29% of patients who DNAd and 4% of the patients who attended their appointments. Work is ongoing to reduce our DNA rates and personalise our response in this deprived population, with the aim of improving engagement and health inequality.
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Affiliation(s)
- B T Dyer
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - F Swann
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - M Kadam
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J Draper
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - L A Mc Gill
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - S Kapetanakis
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - T Ismail
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - G Carr-White
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J Webb
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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17
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Natsis K, Piagkou M, Totlis T, Kapetanakis S. A prefix brachial plexus with two trunks and one anterior cord. Folia Morphol (Warsz) 2019; 79:402-406. [PMID: 31322725 DOI: 10.5603/fm.a2019.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/29/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/25/2022]
Abstract
The brachial plexus presents a great variability in formation, division and branching pattern. Its variants are of immense importance during axillary and arm surgery and nerve blockade. The current case highlights a unilateral atypical formation of brachial plexus, the so called prefix, in which the C4 root contributed a large branch to the superior trunk and further anastomosis with the inferior trunk. Thus, the prefix or high brachial plexus consisted of a superior and inferior trunk and one anterior cord. Coexisting neural and arterial variations are also discussed in relation to the data literature.
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Affiliation(s)
- K Natsis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Thessaloniki, Greece
| | - M Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Thessaloniki, Greece
| | - T Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, National and Kapodistrian University of Athens, Greece, Athens, Greece
| | - S Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.
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18
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Laliotis N, Kapetanakis S, Gkasdaris G, Konstantinidis P, Karoutsou R, Chourmouzi D, Giannakopoulou L. Salter-Harris type II fracture of the distal femur in a newborn: Acute anatomic imaging alterations after labor dystocia. Clin Case Rep 2019; 7:1450-1451. [PMID: 31360510 PMCID: PMC6637346 DOI: 10.1002/ccr3.2149] [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: 01/24/2019] [Revised: 02/23/2019] [Accepted: 03/21/2019] [Indexed: 11/30/2022] Open
Abstract
A rare clinical presence of Salter-Harris type II fracture of the distal femur in a newborn. The crucial role of imaging in depicting urgent anatomical alterations.
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Affiliation(s)
| | | | | | | | | | - Danae Chourmouzi
- Radiology DepartmentEuropean Interbalkan Medical CenterThessalonikiGreece
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19
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. The Role of Full-Endoscopic Lumbar Discectomy in Surgical Treatment of Recurrent Lumbar Disc Herniation: A Health-Related Quality of Life Approach. Neurospine 2019; 16:96-104. [PMID: 30943711 PMCID: PMC6449825 DOI: 10.14245/ns.1836334.167] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/30/2018] [Accepted: 03/17/2019] [Indexed: 12/17/2022] Open
Abstract
Objective To investigate the utility of full-endoscopic lumbar discectomy (FELD) in surgical treatment of recurrent lumbar disc herniation (RLDH).
Methods Forty-five patients were prospectively studied. All patients were subjected to FELD for RLDH. They were assessed preoperatively and in regular intervals at 6 weeks and 3 months, 6 months, and 12 months postoperatively. Evaluation was conducted with visual analogue scale for leg (VAS-LP) and low back (VAS-BP) pain. Short-Form 36 Health Survey Questionnaire was utilized for health-related quality of life assessment.
Results All studied parameters featured statistically significant amelioration at all follow-up intervals. Maximal improvement was in general at 6 weeks observed, with subsequent lesser improvement until 6 months and stabilization until the end of follow-up. Comparative assessment indicated that VAS-BP displayed quantitatively lower improvement, whereas physical function, bodily pain, and role-emotional parameters demonstrated greater amelioration.
Conclusion FELD is associated with a favorable impact in postoperative daily life of patients with RLDH.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.,Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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20
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Kapetanakis S, Chaniotakis C, Angoules AG. Full Endoscopic Discectomy Using Transforaminal Endoscopic Spine System Technique: A Mini Review of Complications. Open Orthop J 2019. [DOI: 10.2174/1874325001913010076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background:Full Endoscopic Discectomy (FED) is a minimally invasive technique for the treatment of Lumbar Disk Herniation (LDH) with increasing popularity among surgeons in the recent years. This alternative to conventional procedures surgical approach is generally a safe and efficient technique possessing many advantages such as less soft tissue trauma, preservation of dorsal musculature, and reduced perioperative morbidity and rapid recovery. However, FED is associated with a number of complications such as postoperative dysesthesia, nerve root injury, and dural tears.Methods:Α search of PubMed, Google Scholar and Scopus electronic databases was used to revised the literature on complications of full endoscopic discectomy using transforaminal endoscopic spine system techniqueConclusion:In this review complications associated with FED are analyzed, emphasizing on the potential beneficial role of Transforaminal Endoscopic Spine System (TESSYS) technique in reducing their frequency.
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21
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Kapetanakis S, Gkantsinikoudis N, Thomaidis T, Charitoudis G, Theodosiadis P. The Role of Percutaneous Transforaminal Endoscopic Surgery in Lateral Recess Stenosis in Elderly Patients. Asian Spine J 2019; 13:638-647. [PMID: 30909678 PMCID: PMC6680028 DOI: 10.31616/asj.2018.0179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022] Open
Abstract
Study Design Prospective clinical study. Purpose To investigate the effect of percutaneous transforaminal endoscopic surgery (PTES) for lateral recess stenosis (LRS)(LRS) in elderly patients and to assess patients’ health-related quality of life (HRQoL). Overview of Literature PTES is an increasingly used surgical approach, primarily employed for lumbar disc herniation treatment. However, indications for PTES have been increasing in recent years. PTES has been recommended as a beneficial alternative to open decompression surgery in specific LRS cases; PTES is termed as percutaneous endoscopic ventral facetectomy (PEVF) in such cases. Methods In total, 65 elderly patients with LRS were prospectively studied. Patients presented severe comorbidities (coronary insufficiency, heart failure, diabetes mellitus, and respiratory failure); thus, general anesthesia administration would potentially cause considerable hazards. All the patients underwent successful PEVF in 2015–2016. The patients were assessed preoperatively and at 6 weeks; 3, 6, and 12 months; and 2 years postoperatively. Patients’ objective assessment was conducted according to specific clinical scales; the Visual Analog Scale (VAS) was separately used for leg and low-back pain (VAS-LP and VAS-BP, respectively), whereas the Short Form 36 Health Survey Questionnaire was used for the HRQoL evaluation. Results All studied parameters presented maximal improvement at 6 weeks postoperatively, with less enhancement at 3 and 6 months with subsequent stabilization. Statistical significance was found in all follow-up intervals for all parameters (p<0.05). Parameters with maximal absolute amelioration were VAS-LP, bodily pain, and role limitations due to physical health problems. In contrast, VAS-BP, general health, and mental health were comparatively less enhanced. Conclusions PEVF was associated with remarkably enhanced HRQoL 2 years postoperatively. PEVF is thus a safe and effective alternative for LRS surgical management in elderly patients with severe comorbidities.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Tryfon Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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22
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Angoules AG, Angoules NA, Georgoudis M, Kapetanakis S. Update on diagnosis and management of cuboid fractures. World J Orthop 2019; 10:71-80. [PMID: 30788224 PMCID: PMC6379735 DOI: 10.5312/wjo.v10.i2.71] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/11/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
Cuboid fractures due to the particular bone anatomy and its protected location in the midfoot are rare, and they are usually associated with complex injuries of the foot. Clinical examination to diagnose these fractures should be detailed and the differential diagnosis, especially in the case of vague symptoms, should include the exclusion of all lateral foot pain causes. Conventional radiographs do not always reveal occult fractures, which can be under diagnosed especially in children. In this case, further investigation including magnetic resonance imaging or scintigraphy may be required. The treatment of these injuries depends on the particular fracture characteristics. Non-displaced isolated fractures of the cuboid bone can be effectively treated conservatively by immobilization and by avoiding weight bearing on the injured leg. In the case of shortening of the lateral column > 3 mm or articular displacement > 1 mm, surgical management of the fracture is mandatory in order to avoid negative biomechanical and functional consequences for the foot and adverse effects such as arthritis and stiffness as well as painful gait. In this review, an update on diagnosis and management of cuboid fractures is presented.
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Affiliation(s)
| | | | | | - Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki 55535, Greece
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23
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Kapetanakis S, Gkantsinikoudis N, Dermon A, Kommata V, Papathanasiou J, Soukakos P, Dermon C. Normal microscopic architecture of acetabular labrum of hip joint: a qualitative original study with clinical aspects. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2017.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Kapetanakis
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Greece
| | - N. Gkantsinikoudis
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Greece
| | - A. Dermon
- Department of Orthopaedic Surgery, Amalia Fleming Hospital, Athens, Greece
| | - V. Kommata
- Lab of Human and Animal Physiology, Department of Biology, University of Patras, Rion, Greece
| | - J. Papathanasiou
- Department of Medical Imaging, Allergology and Physiotherapy, Medical University of Plovdiv, Bulgaria Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Bulgaria
| | - P. Soukakos
- Department of Orthopaedic Surgery, Amalia Fleming Hospital, Athens, Greece
| | - C. Dermon
- Lab of Human and Animal Physiology, Department of Biology, University of Patras, Rion, Greece
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24
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Iatridou G, Dionyssiotis Y, Papathanasiou J, Kapetanakis S, Galitsanos S. Acute effects of stretching duration on sprint performance of adolescent football players. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2018.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- G. Iatridou
- Physical Therapy Unit, Aridaia, Pella; Physical Therapy Unit Physiospot, Athens, Greece
| | - Y. Dionyssiotis
- Physical Medicine and Rehabilitation Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - J. Papathanasiou
- Department of Kinestherapy, Faculty of Public Health, Medical University of Sofia, Bulgaria; Department of Imaging, Allergology and Physiotherapy, Medical University of Plovdiv, Bulgaria
| | - S. Kapetanakis
- BenficaLAB, SL Benfica, Lisbon, Portugal
- Spinal Unit Department, European Interbalkan Medical Center of Thessaloniki; Medical School of Alexandroupolis, Democritus University of Thrance, Greece
| | - S. Galitsanos
- Sport Medicine Department, European Interbalkan Medical Center, Thessaloniki, Greece
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25
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Kapetanakis S, Gkasdaris G, Daneva E, Givissis P, Papathanasiou J, Xanthos T. Mechanoreceptors of the Achilles tendon: a histomorphological study in pigs with clinical significance for humans. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2017.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Kapetanakis
- Spine Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - G. Gkasdaris
- Spine Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - E. Daneva
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P. Givissis
- First Orthopaedic Department of Aristotle University of Thessaloniki, Papanikolaou Hospital, Exohi, Thessaloniki, Greece
| | - J. Papathanasiou
- Spine Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - T. Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; European University Cyprus, School of Medicine, Nicosia, Cyprus
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26
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Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Kazakos K. Comparison of Quality of Life Between Men and Women Who Underwent Transforaminal Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation. Int J Spine Surg 2018; 12:475-482. [PMID: 30276108 DOI: 10.14444/5058] [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: 11/20/2022] Open
Abstract
Background Studies describing the efficacy of transforaminal percutaneous endoscopic discectomy (TPED) on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender, something that has never been reported before in the literature. The purpose of this study is to evaluate, in accordance with the sex of the patients, possible differences in the health-related quality of life of those who underwent TPED for lumbar disc herniation (LDH). Methods A total of 76 patients diagnosed and treated with TPED for LDH with 1-year follow-up were selected and divided into 2 groups of equal number depending on sex. Their quality of life was evaluated by using the 36-Item Short Form Health Survey before the operation, then 6 weeks and 3, 6, and 12 months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the 36-Item Short Form Health Survey, each time combining 2 chronological phases for the total number of patients, for each group, and between groups. Results Fifty-two (68.4%) patients were ≤63 years old, whereas the other 24 (31.4%) were >63 years old (mean ± SD = 56.5 ± 12.1 years). Apart from the physical function domain, the scores were higher in every visit for the 2 groups, but the change between groups was not significant. Women had a significantly higher increase of physical function score in 3 months after TPED and in the interval 6 weeks to 3 months compared with men. However, in the intervals 3 to 6 months and 3 to 12 months, men presented a significantly higher increase compared with women. Conclusions Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the 2 groups. With regard to the physical functioning, it appears to be a significant difference that is counterpoised over time. Level of evidence 2. Clinical relevance Transforaminal percutaneous endoscopic discectomy for LDH does not present major differences in the improvement of quality of life regarding gender.
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Affiliation(s)
| | | | | | | | - Konstantinos Kazakos
- Department of Orthopaedic Surgery, Medical School Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Giovannopoulou E, Gkasdaris G, Kapetanakis S, Kontomanolis E. Ankylosing Spondylitis and Pregnancy: A Literature Review. Curr Rheumatol Rev 2018; 13:162-169. [PMID: 28317489 DOI: 10.2174/1573397113666170317114857] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 02/12/2017] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ankylosing Spondylitis (AS) is the prototype of a group of systemic rheumatic diseases collectively referred to as Spondylarthitides (SpA). It has now become clear that AS is not as rare as previously thought and, although it has an early onset in life affecting patients in their reproductive years, it has not been proved to adversely affect fertility in females. OBJECTIVE The aim of this review is to summarize all the recent data on AS and pregnancy in terms of fertility, disease course and pregnancy outcome from a clinical perspective. METHOD A literature research was conducted based on the following medical databases: Pubmed/ Medline and the Cochrane Library. We searched for randomized controlled studies, casecontrol studies, cohort studies, patient and drug registers in relation to pregnancy and AS. RESULTS The existing data do not support a causal relationship between AS and infertility. The state of pregnancy is not associated with reduced disease activity in patients with AS. Additionally, AS tends to adversely affect health-related quality of life during pregnancy, in comparison with normal population and patients with rheumatoid arthritis. As far as the obstetrical outcome is concerned, there is no consensus on the significant association between AS and specific pregnancy, delivery and fetal complications. CONCLUSION Previous studies are highly heterogenous and mainly retrospective and thus, the existing data are controversial and inconclusive. Subsequent studies are required to enlighten our knowledge on the interaction between AS and pregnancy.
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Affiliation(s)
- Eirini Giovannopoulou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis. Greece
| | - Grigorios Gkasdaris
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis. Greece
| | - Stylianos Kapetanakis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis. Greece
| | - Emmanuel Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis. Greece
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Kapetanakis S, Gkantsinikoudis N, Chaniotakis C, Charitoudis G, Givissis P. Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation in Obese Patients: Health-Related Quality of Life Assessment in a 2-Year Follow-Up. World Neurosurg 2018; 113:e638-e649. [DOI: 10.1016/j.wneu.2018.02.112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 12/15/2022]
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Kapetanakis S, Dermon A, Gkantsinikoudis N, Kommata V, Soukakos P, Dermon CR. Acetabular labrum of hip joint in osteoarthritis: A qualitative original study and short review of the literature. J Orthop Surg (Hong Kong) 2018; 25:2309499017734444. [PMID: 29017383 DOI: 10.1177/2309499017734444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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
PURPOSE Histological architecture of normal acetabular labrum regarding free nerve endings (FNEs) and mechanoreceptors (MRs) has been satisfactorily described in the literature. However, the presence of FNEs and MRs in acetabular labrum of hip joint has been analyzed only once in patients with osteoarthritis (OA). Aim of this article is to report histological distribution pattern of FNEs and MRs in acetabular labrum of patients with severe OA, at the same time conducting a comparison with normal acetabular labrum described in the literature. METHODS Seven patients with severe hip OA were enrolled in this study. Patient selection was assisted by the utilization of specific clinical scales delineated by the American College of Rheumatology. After successful total hip arthroplasty, tissue samples of acetabular labra of seven patients were histologically processed and stained with the gold standard chloride method, which was subsequently examined under a compound microscope. RESULTS FNEs and MRs constituted the major histological structures. Identified MRs included Pacini corpuscles, Ruffini corpuscles, and Golgi-Mazzoni corpuscles. The presence of FNEs was predominant in the middle part of the acetabular labrum, featuring a remarkable decrease in peripheral parts. In contrast, MRs were detected basically in peripheral parts and less in the middle part. CONCLUSIONS Differentiation of the distribution pattern of MRs and FNEs in acetabular labrum of hip joint is remarkable between normal patients and patients with severe OA. The abundance of FNEs in the middle part of the pathologic labrum is mainly responsible for the observed discrimination. A "conversion" of MRs to FNEs may occur during OA progression, modulating therefore this pattern as well as the upcoming clinical manifestations.
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Affiliation(s)
- S Kapetanakis
- 1 Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Greece
| | - A Dermon
- 2 Department of Orthopaedic Surgery, Amalia Fleming Hospital, Athens, Greece
| | - N Gkantsinikoudis
- 1 Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Greece
| | - V Kommata
- 3 Laboratory of Human and Animal Physiology, Department of Biology, University of Patras, Rion, Greece
| | - P Soukakos
- 2 Department of Orthopaedic Surgery, Amalia Fleming Hospital, Athens, Greece
| | - C R Dermon
- 3 Laboratory of Human and Animal Physiology, Department of Biology, University of Patras, Rion, Greece
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Kapetanakis S, Gkasdaris G, Daneva E, Givissis P, Papathanasiou J, Xanthos T. Mechanoreceptors of the Achilles tendon: a histomorphological study in pigs with clinical significance for humans. Muscles Ligaments Tendons J 2018; 7:558-563. [PMID: 29721457 DOI: 10.11138/mltj/2017.7.4.558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/05/2023]
Abstract
Introduction Tendons contain neurosensory elements called mechanoreceptors which contribute to the neuromuscular system as sources of reflex signals. The literature is lacking in histological assessment of mechanoreceptors of the Achilles tendon in piglets and our aim was to indicate their types, location and quantity. Methods The study was performed using histological tissue samples from the Achilles tendon of ten healthy pigs, five left, five right, six males, four females. The samples were taken up to 12 hours after death. Immediately after removal, the tendons were placed in the laboratory where sections were taken and examined microscopically. The tendons were stained with the gold chloride method. Results The results showed that Golgi tendon organs, free nerve endings and Pacinian-like corpuscles were found in the Achilles tendon of pigs. Most structures were near the osteotendinous and myotendinous junctions, away from the middle portion of the tendon. Conclusion As shown in other studies and similarly in ours, mechanoreceptors tend to be close to the distant thirds and not in the middle third of the tendon. This study could have clinical application on human Achilles tendon and its repair after damage. Level of evidence IV.
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Affiliation(s)
| | | | - Eleni Daneva
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Panagiotis Givissis
- First Orthopaedic Department of Aristotle University of Thessaloniki, Papanikolaou Hospital, Exohi, Thessaloniki, Greece
| | | | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; European University Cyprus, School of Medicine, Nicosia, Cyprus
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Kapetanakis S, Chourmouzi D, Gkasdaris G, Katsaridis V, Eleftheriadis E, Givissis P. A rare case of spinal cord compression due to cervical spine metastases from paraganglioma of the jugular foramen-how should it be treated? J Surg Case Rep 2018; 2018:rjy005. [PMID: 29423169 PMCID: PMC5798035 DOI: 10.1093/jscr/rjy005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/07/2018] [Indexed: 11/14/2022] Open
Abstract
Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Involvement of the spine is rare. Even rarer is considered the involvement of the cervical spine. We report a case of a patient with a history of an extra-adrenal non-functional paraganglioma of the jugular foramen which was initially treated with intra-arterial embolization. After a 3-year disease-free follow-up, the patient was presented with symptoms of spinal cord compression due to spinal metastases in C2 and C3 vertebrae. The patient was then treated with surgical decompression and external beam radiation. Therapeutic management with additional treatment options is now under discussion by a multidisciplinary team. Paraganglioma of the jugular foramen with spinal metastasis is an uncommon presentation where increased physician awareness and long-term follow-up are mandatory for all patients with history of paraganglioma.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
- Correspondence address. Orthopaedic Surgeon-Spine Surgeon, Assistant Professor in Medical School, Democritus University of Thrace, Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece. Tel: +30-6972707384; Fax: +30-2541067200; E-mail:
| | - Danai Chourmouzi
- Radiology Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Grigorios Gkasdaris
- Papanikolaou Hospital, Thessaloniki, Greece & Interbalkan European Medical Center, Thessaloniki, Greece
| | - Vasileios Katsaridis
- Neurosurgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Panagiotis Givissis
- First Orthopaedic Department of ‘Aristotle University of Thessaloniki’, ‘Papanikolaou’ Hospital, Exohi, Thessaloniki, Greece
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Kapetanakis S, Chourmouzi D, Papadopoulou E, Oikonomou D, Gkantsinikoudis N. Clinical presentation and imaging of a rare case of Tarsal Tuberculosis. Clin Case Rep 2018; 6:450-451. [PMID: 29445499 PMCID: PMC5799645 DOI: 10.1002/ccr3.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
A 43‐year‐old woman arrived to emergency unit of our hospital, referring intense deteriorated pain and swelling of midfoot. Rapid clinical evolvement of osteoarticular tuberculosis represents a potential clinical scenario. Clinicians should always include foot tuberculosis in differential diagnosis, in cases of severe clinical and radiological manifestations.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities; Interbalkan European Medical Center; Thessaloniki Greece
| | - Danai Chourmouzi
- Spine Department and Deformities; Interbalkan European Medical Center; Thessaloniki Greece
| | - Elissavet Papadopoulou
- Spine Department and Deformities; Interbalkan European Medical Center; Thessaloniki Greece
| | - Dimitrios Oikonomou
- Spine Department and Deformities; Interbalkan European Medical Center; Thessaloniki Greece
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Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Kazakos K. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation. Int J Spine Surg 2018; 11:28. [PMID: 29372132 DOI: 10.14444/4028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/24/2023] Open
Abstract
Background Studies describing the efficacy of TPED on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender something that has never been reported before in the literature. The purpose of this study is to evaluate possible differences of the health-related quality of life in patients who underwent TPED for LDH in accordance with sex. Methods Seventy-six patients diagnosed and treated with TPED for LDH with 1 year follow-up were selected and divided into two groups of equal number depending on sex. Their quality of life was evaluated by using the SF-36 before the operation, six weeks, three, six and twelve months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the SF-36 combining each time two chronological phases in the total of patients, in each group and between groups. Results Fifty-two (68.4%) patients were ≤63 years old, while the rest 24 (31,4%) were >63 years old (mean ±SD = 56,5 ±12,1 years). Apart from the PF domain, the scores were higher in every visit for the two groups, but the change between groups was not significant. Women had a significantly higher increase of PF score in 3 months after TPED and in the interval 6 weeks-3 months comparing with men. However, in the intervals 3 months-6 months and 3 months-12 months men presented significantly higher increase compared to women. Conclusions Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the two groups. As regards to the physical functioning, it appears to be a significant difference which is counterpoised over time. Level of evidence 2. Clinical relevance TPED for LDH does not present major differences in the improvement of quality of life regarding gender.
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Kapetanakis S, Gkantsinikoudis N, Papathanasiou JV, Charitoudis G, Thomaidis T. Percutaneous endoscopic ventral facetectomy: An innovative substitute of open decompression surgery for lateral recess stenosis surgical treatment? J Craniovertebr Junction Spine 2018; 9:188-195. [PMID: 30443139 PMCID: PMC6187905 DOI: 10.4103/jcvjs.jcvjs_76_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 02/05/2023] Open
Abstract
Background: Percutaneous transforaminal endoscopic surgery (PTES) constitutes an innovative method principally recruited for the treatment of lumbar disc herniation. Indication spectrum of PTES is constantly widened in current years. Hence, PTES has been proposed to represent a satisfactory alternative for the treatment of lateral recess stenosis (LRS), being defined as percutaneous endoscopic ventral facetectomy (PEVF) in these cases. The aim of this original study is to determine, for the first time in the literature, the outcomes of PEVF, especially in otherwise healthy nonelderly patients with LRS, alongside with special focus in health-related quality of life (HRQoL) assessment. Materials and Methods: Eighty-five otherwise healthy individuals from 58 to 64 years were diagnosed with LRS, being subjected to successful PEVF. Patients were prospectively evaluated in 6 weeks, in 3, 6, and 12 months, and in 2 years postoperatively. Visual analog scales (VASs) were separately utilized for leg and low back pain evaluation (VAS-LP and VAS-BP, respectively), whereas Short Form-36 (SF-36) questionnaire was sequentially implemented for HRQoL assessment. Results: All indexes of SF-36 as well as VAS-LP featured maximal amelioration in 6 weeks postoperatively, with subsequent further enhancement until 3 months and successor stabilization until 2 years. In contrast, VAS-BP presented minimal quantitative amelioration in 6 weeks, featuring no additional alterations. Values of all indexes in all follow-up intervals were demonstrated to be statistically significant in comparison with preoperative values (P < 0.05). No remarkable differentiation was observed between distinct parameters of SF-36. Conclusions: PEVF implementation in nonelderly patients with LRS was displayed to be safe and effective, providing alongside considerable improvement in HRQoL 2 years postoperatively.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Jannis V Papathanasiou
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Tryfon Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Kapetanakis S, Gkantsinikoudis N, Dermon A, Kommata V, Papathanasiou J, Soukakos P, Dermon C. Normal microscopic architecture of acetabular labrum of hip joint: a qualitative original study with clinical aspects. Muscles Ligaments Tendons J 2017; 7:279-285. [PMID: 29264339 DOI: 10.11138/mltj/2017.7.2.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/05/2023]
Abstract
Background Normal histologic architecture of acetabular labrum, regarding presence of Free Nerve Endings (FNEs) and Nerve End Organs (NEOs) has been four times described. Nevertheless, elderly cadaveric specimens and individuals were recruited, leading to considerably high unreliability probability due to microscopic degenerative alterations. Aim of this paper is to analyze distribution pattern of FNEs and NEOs in acetabular labra of healthy middle-aged individuals, configuring thus more reliably acetabular labrum microscopic profile. Materials and methods Six patients with middle age 52 ± 2.5 years were enrolled in this study. Injury of acetabular labrum and normal hip radiograph were present in all cases. Patients were all subjected to successful hip hemi-arthroplasty and derived acetabular labra were subsequently histologically processed and observed under a compound microscope. Results FNEs and NEOs were detected in all specimens. All types of NEOs were identified, including Paccini, Golgi-Mazzoni, Ruffini and Krause corpuscles. FNEs and NEOs were both in ventral part and in chondral side of labrum predominantly detected. Conclusion FNEs and NEOs presence was greater in ventral side of labrum, being thus in partial agreement with previous studies results. Further study is required, in order to elucidate the exact acetabular labrum normal microscopic anatomy. Level of evidence IV.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Greece
| | - Nikolaos Gkantsinikoudis
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Greece
| | - Antonios Dermon
- Department of Orthopaedic Surgery, Amalia Fleming Hospital, Athens, Greece
| | - Vassiliki Kommata
- Lab of Human and Animal Physiology, Department of Biology, University of Patras, Rion, Greece
| | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology & Physiotherapy, Medical University of Plovdiv, Bulgaria Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Bulgaria
| | | | - Caterina Dermon
- Lab of Human and Animal Physiology, Department of Biology, University of Patras, Rion, Greece
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Kapetanakis S, Chaniotakis C, Kazakos C, Papathanasiou JV. Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature. Folia Med (Plovdiv) 2017; 59:377-386. [PMID: 29341941 DOI: 10.1515/folmed-2017-0038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 03/08/2017] [Indexed: 02/05/2023] Open
Abstract
AbstractCauda equina syndrome (CES) is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes). The diagnosis consists of two critical points: a) detailed history and physical examination and b) MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms. The surgery as an emergency situation is recommended in the fi rst 48 hours of onset of symptoms. Any delay in diagnosis and treatment leads to a poor prognosis of CES.
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Affiliation(s)
- Stylianos Kapetanakis
- 1Department of Spine Surgery and Deformities, European Interbalkan Center of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Chaniotakis
- 1Department of Spine Surgery and Deformities, European Interbalkan Center of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Kazakos
- 2Department of Orthopaedic Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Jannis V Papathanasiou
- 3Department of Medical Imaging, Allergology and Physical Medicine, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
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Kapetanakis S, Gkasdaris G, Angoules AG, Givissis P. Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid. World J Orthop 2017; 8:874-880. [PMID: 29312845 PMCID: PMC5745429 DOI: 10.5312/wjo.v8.i12.874] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/11/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
Transforaminal Percutaneous Endoscopic Discectomy (TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki 55535, Greece
| | - Grigorios Gkasdaris
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki 55535, Greece
| | - Antonios G Angoules
- Department of Medical Laboratories, Technological Educational Institute of Athens, Athens 12243, Greece
| | - Panagiotis Givissis
- First Orthopaedic Department of “Aristotle University of Thessaloniki”, “Papanikolaou” Hospital, Exohi, Thessaloniki 57010, Greece
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Kapetanakis S, Chourmouzi D, Terzoudi A, Georgiou N, Giovannopoulou E. Hirayama disease: diagnostic essentials in neuroimaging. Clin Case Rep 2017; 5:2151-2152. [PMID: 29225877 PMCID: PMC5715571 DOI: 10.1002/ccr3.1246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/18/2017] [Revised: 09/03/2017] [Accepted: 09/15/2017] [Indexed: 11/22/2022] Open
Abstract
A 22‐year‐old male presented with progressive muscular weakness of the upper extremities. MRI of the cervical spine established the final diagnosis of Hirayama disease (HD). HD is a rare disease with benign progress. Neurologists and radiologists should be aware of the specific neuroimaging signs of this rare clinical entity.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities Interbalkan European Medical Center Thessaloniki Greece
| | - Danae Chourmouzi
- Department of Radiology Interbalkan European Medical Center Thessaloniki Greece
| | - Aikaterini Terzoudi
- Department of Radiology Interbalkan European Medical Center Thessaloniki Greece
| | - Nikiforos Georgiou
- Spine Department and Deformities Interbalkan European Medical Center Thessaloniki Greece
| | - Eirini Giovannopoulou
- Spine Department and Deformities Interbalkan European Medical Center Thessaloniki Greece
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Kapetanakis S, Gkasdaris G, Thomaidis T, Charitoudis G, Nastoulis E, Givissis P. Postoperative Evaluation of Health-Related Quality-of-Life (HRQoL) of Patients With Lumbar Degenerative Spondylolisthesis After Instrumented Posterolateral Fusion (PLF): A prospective Study With a 2-Year Follow-Up. Open Orthop J 2017; 11:1423-1431. [PMID: 29387287 PMCID: PMC5748841 DOI: 10.2174/1874325001711011423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/13/2017] [Accepted: 11/23/2017] [Indexed: 11/22/2022] Open
Abstract
Background Several studies have compared instrumented PLF with other surgical approaches in terms of clinical outcomes, however little is known about the postoperative HRQoL of patients, especially as regards to degenerative spondylolisthesis. Methods A group of 62 patients, 30 women (48,4%) and 32 men (51,6%) with mean age 56,73 (SD +/- 9,58) years old, were selected to participate in a 2-year follow-up. Their pain was assessed via the visual analogue scale (VAS) for low back pain (VASBP) and leg pain (VASLP) separately. Their HRQoL was evaluated by the Short Form (36) Health Survey (SF-36). Both scales, VAS and SF36, were measured and re-assessed at 10 days, 1 month, 3 months, 6 months, 12 months and 2 years. Results VASBP, VASLP and each parameter of SF36 presented statistically significant improvement (p<0.01). VASBP, VASLP and SF36 scores did not differ significantly between men and women (p≥0.05). The most notable amelioration of VASBP, VASLP was observed within the first 10 days and the maximum improvement within the first 3 months. From that point, a stabilization of the parameters was observed. The majority of SF36 parameters, and especially PF (physical functioning) and BP (bodily pain), presented statistically significant improvement within the follow up depicting a very similar improvement pattern to that of VAS. Conclusion We conclude that instrumented PLF ameliorates impressively the HRQoL of patients with degenerative spondylolisthesis after 2 years of follow-up, with pain recession being the most crucial factor responsible for this improvement.
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Affiliation(s)
- S Kapetanakis
- Spine Department and Deformities, Interbalkan Medical Center, Thessaloniki, Greece
| | - G Gkasdaris
- Spine Department and Deformities, Interbalkan Medical Center, Thessaloniki, Greece.,Papanikolaou Hospital, Thessaloniki, Greece
| | - T Thomaidis
- Spine Department and Deformities, Interbalkan Medical Center, Thessaloniki, Greece
| | - G Charitoudis
- Spine Department and Deformities, Interbalkan Medical Center, Thessaloniki, Greece
| | - E Nastoulis
- Spine Department and Deformities, Interbalkan Medical Center, Thessaloniki, Greece
| | - P Givissis
- First Orthopaedic Department of Aristotle University of Thessaloniki, Papanikolaou Hospital, Exohi, Thessaloniki, Greece
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Kapetanakis S, Giovannopoulou E, Charitoudis G, Kazakos K. Health-related quality of life (HRQoL) following transforaminal percutaneous endoscopic discectomy (TPED) for lumbar disc herniation: A prospective cohort study - early results. J Back Musculoskelet Rehabil 2017; 30:1311-1317. [PMID: 28946526 DOI: 10.3233/bmr-169702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 02/04/2023]
Abstract
BACKGROUND Lumbar discectomy is among the most frequently performed procedures in spinal surgery. Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive technique that gains ground among surgeons in the recent years. TPED has been studied in terms of effectiveness, however little is known about its overall impact on health-related quality of life (HRQoL) of the patients. OBJECTIVE To investigate the progress of HRQoL following TPED. PATIENTS AND METHODS Seventy-six (76) patients were enrolled in the study. Mean age was 56.5 ±12.1 years with 38 (50%) males and 38 (50%) females. All patients underwent TPED at L3-L4 (27.6%), L4-L5 (52.6%) and L5-S1 (19.7%). SF-36 was used for the assessment of HRQoL preoperatively and at 6 weeks, at 3, 6 and 12 months after the procedure. RESULTS All aspects of SF-36 questionnaire showed statistically significant improvement one year after the procedure (p< 0.001). Role limitations due to physical problems, bodily pain and role limitations due emotional problems showed the highest improvement, followed by physical functioning, vitality, social functioning, mental health and general health. CONCLUSIONS TPED for lumbar disc herniation is associated with significant improvement in all aspects of health-related quality of life within 6 weeks postoperatively and the improvement remains significant one year after surgery, as measured by the SF-36 questionnaire.
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Affiliation(s)
- S Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, PC 57001, Greece
| | - E Giovannopoulou
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, PC 57001, Greece
| | - G Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, PC 57001, Greece
| | - K Kazakos
- Department of Orthopaedic Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, PC 68100, Greece
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Kapetanakis S, Chaniotakis C, Paraskevopoulos C, Pavlidis P. An Unusual Case Report of Bertolotti's Syndrome: Extraforaminal Stenosis and L5 Unilateral Root Compression (Castellvi Type III an LSTV). J Orthop Case Rep 2017; 7:9-12. [PMID: 29051870 PMCID: PMC5635197 DOI: 10.13107/jocr.2250-0685.782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Castellvi Type III lumbosacral transitional vertebrae (LSTV) is an unusual case of Bertolotti’s syndrome (BS) due to extraforaminal stenosis, especially manifesting in elderly patients. Case Report: We report a case of BS in a 62 years old Greek female. The signs of the clinical examination are low back pain, sciatica, hypoesthesia, and pain to the contribution of L5 nerve. Imaging techniques revealed an LSTV Type III a (complete sacralization between LSTV and sacrum). Conclusion: Despite the fact that LSTV is a congenital lesion, the clinical manifestation of BS may present in the elderly population. The accumulative effect of the gradual degeneration of intervertebral foramen (stenosis) may lead to the compression of extraforaminal portion of the nerve root.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Spine and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | | | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Kapetanakis S, Chourmouzi D, Gkasdaris G, Katsaridis V, Eleftheriadis E, Givissis P. Functional extra-adrenal paraganglioma of the retroperitoneum giving thoracolumbar spine metastases after a five-year disease-free follow-up: a rare malignant condition with challenging management. Pan Afr Med J 2017; 28:94. [PMID: 29255564 PMCID: PMC5724945 DOI: 10.11604/pamj.2017.28.94.13783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/03/2017] [Accepted: 09/12/2017] [Indexed: 11/11/2022] Open
Abstract
Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Extra-adrenal retroperitoneal paraganglioma with vertebral metastasis is considered very uncommon. Here, we present a case of a functional extra-adrenal paraganglioma of the retroperitoneum giving metastasis to T4 vertebra after five years of follow-up in a 48-year-old man who had been initially treated with complete resection of the primary tumor. The condition of the patient improved significantly after radiosurgery and somatostatin analogs treatment, until lumbar spine lesions appeared six months later. Our case demonstrates that retroperitoneal paraganglioma is a rare condition which should be considered in the differential diagnosis of a retroperitoneal mass combined with vertebral lesions. Additionally, increased physician awareness and long-term follow-up is mandatory for all patients with history of retroperitoneal paraganglioma since metastases may occur after long latent intervals from the initial diagnosis.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Danai Chourmouzi
- Radiology Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Grigorios Gkasdaris
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Vasileios Katsaridis
- Neurosurgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Panagiotis Givissis
- First Orthopaedic Department of 'Aristotle University of Thessaloniki', 'Papanikolaou' Hospital, Exohi, Thessaloniki, Greece
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Kapetanakis S, Gkasdaris G, Pavlidis P, Givissis P. Concurrent lumbosacral and sacrococcygeal fusion: a rare aetiology of low back pain and coccygodynia? Folia Morphol (Warsz) 2017; 77:397-399. [PMID: 28933804 DOI: 10.5603/fm.a2017.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/26/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 11/25/2022]
Abstract
Sacrum is a triangular bone placed in the base of the spine and formed by the synostosis of five sacral vertebrae (S1-S5). Its upper part is connected with the inferior surface of the body of L5 vertebra forming the lumbosacral joint, while its lower part is connected with the base of the coccyx forming the sacrococcygeal symphysis, an amphiarthrodial joint. The existence of four pairs of sacral fora-mina in both anterior and posterior surface of the sacrum is the most common anatomy. Nevertheless, supernumerary sacral foramina are possible to be created by the synostosis of lumbosacral joint or sacrococcygeal symphysis. We present a case of an osseous cadaveric specimen of the sacrum belonging to a 79-year-old Caucasian woman. A rare variation of the anatomy of the sacrum is reported; in which, the simultaneous fusion of the sacrum with both the L5 vertebra and the coccyx has created six pairs of sacral foramina. This variation should be taken into serious consideration, especially in the domain of radiology, neurosurgery, orthopaedics and spine surgery, because low back pain, coccygodynia and other neurological symptoms may emerge due to mechanical compression. (Folia Morphol 2018; 77, 2: 397-399).
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Affiliation(s)
- S Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece..
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Gkantsinikoudis N, Chaniotakis C, Gkasdaris G, Georgiou N, Kapetanakis S. Morphological approach of the sternal foramen: an anatomic study and a short review of the literature. Folia Morphol (Warsz) 2017; 76:484-490. [DOI: 10.5603/fm.a2017.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 11/25/2022]
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Kapetanakis S, Thomaidis T, Charitoudis G, Pavlidis P, Theodosiadis P, Gkasdaris G. Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life. J Spine Surg 2017; 3:312-322. [PMID: 29057338 DOI: 10.21037/jss.2017.06.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) constitutes the conventional treatment of cervical disc herniation due to degenerative disc disease (DDD). ACDF with plating presents a variety of complications postoperatively and stand-alone cages are thought to be a promising alternative. The aim of this study was firstly, to analyze prospectively collected data from a sample of patients treated with single ACDF using C-Plus self-locking stand-alone PEEK cage system, without the use of plates or screws, in order to evaluate pain levels of patients, utilizing Neck and Arm Pain scale as an expression of visual analogue scale (VAS). Secondly, we aimed to evaluate health-related quality of life, via the short-form 36 (SF-36) and Neck Disability Index (NDI). METHODS Thirty-six patients (19 male and 17 female) with mean age 49.6±7 years old who underwent successful single ACDF using self-locking stand-alone PEEK cage for symptomatic cervical DDD were selected for the study. Neck and Arm pain, as well as SF-36 and NDI were estimated preoperatively and 1, 3, 6, and 12 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological and radiological evaluation. RESULTS The clinical and radiological outcomes were satisfactory after a minimum 1-year follow-up. All results were statistically important (P<0.05), excluding improvement in NDI measured between 6 and 12 months. SF-36, Neck Pain, as well as Arm Pain featured gradual and constant improvement during follow-up, with best scores presenting at 12 months after surgery, while NDI reached its best at 6 months postoperatively. CONCLUSIONS Generally, all scores showed improvement postoperatively during the different phases of the follow-up. Subsequently, ACDF using C-Plus cervical cage constitutes an effective method for cervical disc herniation treatment, in terms of postoperative improvement on pain levels and health-related quality of life and a safe alternative to the conventional method of treatment for cervical DDD.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Tryfon Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - George Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Pavlos Pavlidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Grigorios Gkasdaris
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Kapetanakis S, Gkasdaris G, Nastoulis E, Stavrev V. Hemivertebra of the cervical spine: an uncommon background for neck pain, cervical scoliosis, and torticollis. Clin Case Rep 2017; 5:1718-1719. [PMID: 29026581 PMCID: PMC5628206 DOI: 10.1002/ccr3.1144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/30/2017] [Accepted: 07/26/2017] [Indexed: 11/24/2022] Open
Abstract
A 15‐year‐old female patient presented with neck pain accompanied by cervical scoliosis, on the existence of torticollis. Although rare, hemivertebra of the cervical spine is a congenital deformation associated with these three clinical features.
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Affiliation(s)
| | - Grigorios Gkasdaris
- Spine Department and Deformities Interbalkan Medical Center Thessaloniki Greece
| | | | - Vladimir Stavrev
- Department of Orthopedics and Traumatology Medical University Plovdiv Bulgaria
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Sioutas G, Karakasi MV, Kapetanakis S, Pavlidis P. Death due to fracture of thin calvarial bones after a fall: A forensic approach. Chin J Traumatol 2017; 20:180-182. [PMID: 28502604 PMCID: PMC5473721 DOI: 10.1016/j.cjtee.2017.01.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 12/28/2016] [Accepted: 01/10/2017] [Indexed: 02/04/2023] Open
Abstract
A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skull base. The patient's death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature.
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Affiliation(s)
- Georgios Sioutas
- Department of Anatomy, School of Medicine, Democritus University of Thrace, Dragana, GR 68100, Alexandroupolis, Greece
| | - Maria-Valeria Karakasi
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Dragana, GR 68100, Alexandroupolis, Greece
| | - Stylianos Kapetanakis
- Department of Anatomy, School of Medicine, Democritus University of Thrace, Dragana, GR 68100, Alexandroupolis, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Dragana, GR 68100, Alexandroupolis, Greece,Corresponding author.
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Kapetanakis S, Gkasdaris G, Chourmouzi D, Karagiannidis A. Spinal cord edema with contrast enhancement mimicking intramedullary tumor in patient with cervical myelopathy: A case report and a brief literature review. Surg Neurol Int 2017; 8:111. [PMID: 28680730 PMCID: PMC5482166 DOI: 10.4103/sni.sni_125_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/06/2017] [Indexed: 11/05/2022] Open
Abstract
Background: Cervical myelopathy (CM) is a clinical diagnosis that may be associated with hyperintense areas on T2-weighted magnetic resonance imaging (MRI) scan. The use of contrast enhancement in such areas to differentiate between neoplastic and degenerative disease has rarely been described. Case Description: We present a 41-year-old female with a 5-month course of progressive CM. The cervical MRI revealed spinal cord swelling, stenosis, and a hyperintense signal at the C5–C6 and C5–C7 levels. Both the neurologic and radiologic examinations were consistent with an intramedullary cervical cord tumor. To decompress the spinal canal, an anterior cervical discectomy and fusion was performed from C5 to C7 level. This resulted in immediate and significant improvement of the myelopathy. Postoperatively, over 1.5 years, the hyperintense, enhancing intramedullary lesion gradually regressed on multiple postoperative MRI scans. Conclusion: Spinal cord edema is occasionally seen on MR studies of the cervical spine in patients with degenerative CM. Contrast-enhanced MR studies may help differentiate hyperintense cord signals due to edema vs. atypical intramedullary tumors. Routine successive postoperative MRI evaluations are crucial to confirm the diagnosis of degenerative vs. neoplastic disease.
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Kapetanakis S, Charitoudis G, Thomaidis T, Theodosiadis P, Papathanasiou J, Giatroudakis K. Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation. J Craniovertebr Junction Spine 2017; 8:44-49. [PMID: 28250636 PMCID: PMC5324359 DOI: 10.4103/0974-8237.199872] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Many patients suffer from radiculopathy and low back pain due to lumbar disc hernia. Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive method that accesses the disc pathology through the intervertebral foramen. Health-related quality of life (HRQoL) has been previously assessed for this method. However, a possible effect of the level of operation on the postoperative progress of HRQoL remains undefined. PURPOSE The purpose of this study was to evaluate the impact of the level of operation on HRQoL, following TPED. PATIENTS AND METHODS A total of 76 patients diagnosed with lumbar disc hernia were enrolled in the study. According to the level of operation, they were divided into three groups: Group A (21 patients) for L3-L4, Group B (40 patients) for L4-L5, and Group C (15 patients) for L5-S1 intervertebral level. All patients underwent TPED. Their HRQoL was evaluated by the short-form-36 (SF-36) health survey questionnaire before the operation and at 6 weeks, 3, 6, and 12 months postsurgery. The progress of SF-36 was analyzed in relation to the operated level. RESULTS All aspects of SF-36 showed statistical significant improvement, at every given time interval (P ≤ 0.05) in the total of patients and in each group separately. Group A had a significantly higher increase in physical functioning (PF) score at 3 and 12 months postsurgery (P = 0.046 and P = 0.056, respectively). On the other hand, Group B had a significant lower increase in mental health (MH) score at 6 months (P = 0.009) postoperatively. CONCLUSION Our study concludes that the level of operation in patients who undergo TPED for lumbar disc herniation affects the HRQoL 1 year after surgery, with Group A having a significantly greater improvement of PF in comparison with Groups B and C.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Tryfon Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology and Physiotherapy, Faculty of Dental Medicine, Plovdiv Medical University, Plovdiv, Bulgaria
- Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria
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Nastoulis E, Karakasi MV, Couvaris CM, Kapetanakis S, Fiska A, Pavlidis P. Greenish-blue gastric content: Literature review and case report on acute copper sulphate poisoning. Forensic Sci Rev 2017; 29:77-91. [PMID: 28119268] [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: 06/06/2023]
Abstract
A literature review of cases of acute poisoning by copper sulfate was conducted, emphasizing therapeutic interventions, and a new fatality case is reported. Specifically, the relevant literature was reviewed for incidence rates, sociodemographic variables, pathophysiology, diagnosis, prognosis, and therapeutic outcome of copper sulfate poisoning. Results conclude that copper sulfate poisoning incidence varies in different regions. It is rare in western countries, while it is very common in South Asian countries. The majority of patients belong to rural populations and are males in the third decade of their lives. The lethal dose of ingested copper is considered to be 10-20 g; 14-36% of the patients pass away within a few hours of ingestion, while the average hospitalization time is more than 20 days. The clinical features of copper sulfate poisoning include erosive gastropathy, intravascular hemolysis, methemoglobinemia, hepatitis, and acute kidney injury. The therapeutic management focuses on absorption reduction, close observation for complications, supportive therapy, and chelation therapy.
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Affiliation(s)
- E Nastoulis
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - M V Karakasi
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
- Adult Psychiatry, Psychiatric Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - C M Couvaris
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - S Kapetanakis
- Department of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - A Fiska
- Department of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - P Pavlidis
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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