Effect of training and structured medication review on medication appropriateness in nursing home residents and on cooperation between health care professionals: the InTherAKT study protocol.

BACKGROUND: Pharmacotherapy in residents of nursing homes is critical due to the special vulnerability of this population. Medical care and interprofessional communication in nursing homes are often uncoordinated. As a consequence, polypharmacy and inappropriate medication use are common and may lead to hospitalizations and health hazards. The aim of this study is to optimize communication between the involved professional groups by specific training and by establishing a structured medication review process, and to improve medication appropriateness and patient-relevant health outcomes for residents of nursing homes. METHODS/DESIGN: The trial is designed as single-arm study. It involves 300 nursing home residents aged ≥ 65 years and the members of the different professional groups practising in nursing home care (15-20 general practitioners, nurses, pharmacists). The intervention consists of interprofessional education on safe medication use in geriatric patients, and a systematic interprofessional therapy check (recording, reviewing and adapting the medication of the participating residents by means of a specific online platform). The intervention period is divided into two phases; total project period is 3 years. Primary outcome measure is the change in medication appropriateness according to the Medication Appropriateness Index. Secondary outcomes are cognitive performance, occurrence of delirium, agitation, tendency of falls, total number of drugs, number of potentially dangerous drug-drug interactions and appropriateness of recorded analgesic therapy regimens according to the Medication Appropriateness Index. Data are collected at t0 (before the start of the intervention), t1 (after the first intervention period) and t2 (after the second intervention period). Cooperation and communication between the professional groups are investigated twice by qualitative interviews. DISCUSSION: The project aims to establish a structured system for monitoring of drug therapy in nursing home residents. The newly developed online platform is designed to systematize and to improve the communication between the professional groups and, thus, to enhance quality and safety of drug therapy. Limitations of the study are the lack of a control group and the non-randomly recruited study sample. TRIAL REGISTRATION: DRKS Data Management, DRKS-ID: DRKS00007900.

Does an additional structured information program during the intensive care unit stay reduce anxiety in ICU patients?: a multicenter randomized controlled trial.

BACKGROUND: Communication and information in order to reduce anxiety in the intensive care unit (ICU) has been described as area needing improvement. Therefore, the aim of this trial was to evaluate whether a structured information program that intensifies information given in standard care process reduces anxiety in ICU patients. METHODS: Multicenter, two-armed, non-blinded, parallel-group randomized controlled trial in hospitals in the cities of Marburg, Halle, and Stuttgart (Germany). The trial was performed in cardiac surgery, general surgery, and internal medicine ICUs. Two-hundred and eleven elective and non-elective ICU patients were enrolled in the study (intervention group, n = 104; control group, n = 107). The experimental intervention comprised a single episode of structured oral information that was given in addition to standard care and covered two main parts: (1) A more standardized part about predefined ICU specific aspects - mainly procedural, sensory and coping information, and (2) an individualized part about fears and questions of the patient. The control group received a non-specific episodic conversation of similar length additional to standard care. Both conversations took place at the beginning of the ICU stay and lasted 10-15 minutes. Study nurses administered both interventions. The primary outcome ICU-related anxiety (CINT-Score, 0-100 pts., higher scores indicate higher anxiety) was assessed after admission to a regular ward. RESULTS: The primary outcome could be measured in 82 intervention group participants and 90 control group participants resulting in mean values of 20.4 (SD 14.4) compared to 20.8 (SD 14.7) and a mean difference of -0.2 (CI 95% -4.5 to 4.1). CONCLUSIONS: A structured information intervention additional to standard care during ICU stay had no demonstrated additional benefit compared to an unspecific communication of similar duration. Reduction of anxiety in ICU patients will probably require more continuous approaches to information giving and communication. TRIAL REGISTRATION: ClinicalTrials.gov NCT00764933.

Mapping Motor Neuroplasticity after Successful Surgical Brachial Plexus Reconstruction Using Navigated Transcranial Magnetic Stimulation (nTMS).

Brachial plexus reconstruction (BPR) consists of the complex surgical restoration of nerve structures. To further understand the underlying motor cortex changes and evaluate neuroplasticity after a successful surgery, we performed a navigated transcranial magnetic stimulation (nTMS) study mapping the postoperative motor representation of the formerly plegic arm. We conducted a prospective nTMS study mapping the musculocutaneous nerve as a representative, prominent target of BPR including a patient (n = 8) and a control group (n = 10). Measurements like resting motor threshold (RMT), cortical motor area location, and size were taken. Mathematical analysis was performed using MATLAB 2022, statistical analysis was performed using SPSS 26, and nTMS mapping was performed using the Nexstim NBS 5.1 system. Mapping was feasible in seven out of eight patients. Median RMT on the affected hemisphere was 41% compared to 50% on the unaffected hemisphere and they were 37% and 36% on the left and right hemispheres of the control group. The motor area location showed a relocation of bicep brachii representation at the middle precentral gyrus of the corresponding contralateral hemisphere. Motor area size was increased compared to the control group and the patient's unaffected, ipsilateral hemisphere. Understanding cortical reorganization is important for potential future treatments like therapeutic nTMS. The issue of motor neuroplasticity in patients with brachial plexus lesions is worth exploring in further studies.

Pituitary Stalk Morphology as a Predictor of New-Onset Adrenocortical Insufficiency and Arginine Vasopressin Deficiency after Transsphenoidal Resections of Pituitary Macroadenomas: A Retrospective Single-Center Study with a Focus on iMRI.

BACKGROUND: A new-onset adrenocortical insufficiency (NAI) is the most critical postoperative endocrinological complication after transsphenoidal surgery for macroadenomas. Because of increased mortality risk, arginine vasopressin deficiency (AVP-D) is also a relevant postoperative complication. This study aimed to identify easy-to-acquire magnet resonance imaging (MRI) aspects of the pituitary stalk to predict these insufficiencies after transsphenoidal surgery. METHODS: Pituitary stalk morphology was reviewed intraoperatively and three months postoperatively in the MRIs of 48 transsphenoidal surgeries for macroadenomas. NAI was validated in endocrinological follow-up controls 10-14 months post-surgery. RESULTS: Intraoperative pituitary stalk diameters were 0.5 mm larger in patients who developed NAI and AVP-D. The odds ratio was 29 for NAI and 6 for AVP-D in binary regression analysis. A value of 2.9 mm was identified as the optimal cut-off for the minimal pituitary stalk diameter regarding NAI, with a high specificity of 89%. There was no difference in pituitary stalk diameter regarding these insufficiencies three months post-surgery. CONCLUSIONS: We identified an increased pituitary stalk diameter in intraoperative MRIs as a predictive factor of NAI and AVP-D after transsphenoidal surgery. These findings might improve the early detection of NAI and, thus, optimal management. However, validating these retrospective findings in prospective studies is obligatory.

Plastid DNA sequences and oospore characters of some European taxa of Tolypella section Tolypella (Characeae) identify five clusters, including one new cryptic Tolypella taxon from Sardinia, but they do not coincide with current morphological descriptions.

In Europe, the genus Tolypella (Characeae) comprises four to eight Tolypella taxa in sections Rothia and Tolypella that have been distinguished by vegetative morphology and gametangial characters such as antheridial size and oospore wall ornamentation. However, morphological differentiation is difficult in some cases due to overlapping and variable vegetative features, which in many cases are difficult to observe clearly. To clarify the taxonomic status of the five European taxa of Tolypella in section Tolypella, sequence data of the plastid genes atpB, rbcL and psbC for Tolypella glomerata (Desv.) Leonh., Tolypella hispanica Allen, Tolypella nidifica (O.F. Müll.) A. Braun, Tolypella normaniana (Nordst.) Nordst. and Tolypella salina Cor. were combined with data on oospore morphology, including oospore wall ornamentation. Gene sequence data identified five distinct clusters, but they were not consistent with the morphologically identified five taxa. T. glomerata consisted of some of the samples morphologically identified as T. glomerata and seven samples of T. normaniana, while the remaining T. glomerata samples clustered with specimens of unclear affiliation (Tolypella sp.). We identified two clusters of T. hispanica within the European material: cluster T. hispanica I consisted of samples from various locations, whereas the second cluster (T. hispanica II) consisted of samples of T. hispanica from Sardinia Island. The remaining cluster consisted of all the specimens that had been determined as T. salina or T. nidifica in addition to two specimens of T. normaniana. Oospore morphology was most clearly distinguishable for T. glomerata. Oospore characteristics for all other taxa were not as informative but showed some geographical and/or environmentally influenced differences, especially for T. nidifica and T. salina. Our results suggest the need to further check the different taxonomy of Tolypella sect. Tolypella in which specimens normally identified as T. glomerata might be two different taxa, T. glomerata and an unidentified taxon; T. nidifica and T. salina are not separate taxa; T. normaniana is a diminutive variant of two different Tolypella taxa; and T. hispanica comprises two different taxa, one from the Mediterranean island Sardinia.

Influence of intraventricular application of baclofen on arterial blood pressure and neurotransmitter concentrations in the hypothalamic paraventricular nucleus of rats.

The hypothalamic paraventricular nucleus (PVN) is a key site for regulating neuroendocrine functions in the magnocellular part and autonomic activities in the parvocellular part. Its anatomical proximity to the third ventricle could be a good target for intrathecal injection of baclofen. We investigated the correlation of intrathecal application of baclofen (a specific GABAB receptor agonist) and the release of epinephrine, norepinephrine, dopac, homovanillinic acid (HVA), glutamate and aspartate from the PVN. The decomposition products HVA, dopa and dopac of norepinephrine, epinephrine and dopamine, respectively, were used as parameters for the secretion of dopamine. We implanted a microdialysis probe in the PVN of 25 Wistar rats. In 13 rats, 1.5 µg baclofen was injected in the lateral ventricle and the equivalent quantity of Ringer's lactate solution injected in the remaining 12 rats as a control group. Neurotransmitters and amino acids were quantified by high-performance liquid chromatography. There was a conspicuous but not significant effect of baclofen concerning the secretion of epinephrine, norepinephrine, dopac, glutamate and aspartate from the PVN. A significant increase in HVA concentration was observed only in rats treated with baclofen compared with the control group. These findings suggest that baclofen influences the secretion of neurotransmitters and amino acids involved in autonomic activities mediated by GABAB receptors.

Evidence-based decision-making in nursing - development and piloting of a train-the-trainer concept for teachers at schools for health care professionals: A pilot study.

BACKGROUND: Train-the-trainer concepts (TTT concepts) to impart evidence-based practice competences aim at promoting the implementation of evidence-based practice. The aim of this study was to develop and pilot-test a TTT training program for teachers at schools for health care professionals. The program is based on the core curriculum "Evidence-based Decision-making" set up by the German Network for Evidence-based Medicine e.V. (DNEbM). METHOD: The study was conducted according to the UKMRC framework for complex interventions and consisted of Phase 1 (Development) and Phase 2 (Piloting). In Phase 1, the intervention was modelled on the basis of a systematic literature search. In Phase 2, the TTT concept was piloted with teachers at two schools for health care professionals. For the evaluation, short interviews with the participants were carried out after each module; classroom observations took place during the training and were followed by a focus group interview. In addition, baseline characteristics were collected prior to the training and descriptively evaluated. Critical health competence was surveyed using the Critical Health Competence Test (CHC test) before and after the course. The questionnaires, interviews and classroom observation protocols were processed according to Mayring's qualitative content analysis. Person parameters ±SD were calculated to determine the level of competence. RESULTS: Piloting took place in September 2018 and from September to November 2019. Eight teachers from two training institutions participated. The evaluation of the focus group interviews and the classroom observation protocols resulted in a category system comprising 6 main and 17 subcategories. The feasibility of the materials and methods could be demonstrated in both pilot tests. Reactivation and extension of prior knowledge were confirmed by the participants. The small group size was appreciated; the participants took an active part during the lessons and were stimulated to plan their own lessons. The evaluation of the CHC test revealed average person parameters of 432 ± 45 (pretest, n=8) and 512 ± 65 (posttest, n=8). DISCUSSION: Using mixed methods, the results show the feasibility of the curriculum. CONCLUSION: Further evaluation in a randomized controlled trial (RCT) is needed to prove the efficacy of the curriculum.

Chara zeylanica J.G.Klein ex Willd. (Charophyceae, Charales, Characeae): First European Record from the Island of Sardinia, Italy.

The first record of a species belonging to the genus Chara L. subgenus Chara R.D.Wood section Grovesia R.D.Wood subsect. Willdenowia R.D.Wood from Europe is presented here, thus challenging the interpretation of its distribution pattern as an intertropical group of charophytes. The morphological characters of the specimens, as well as the results of a phylogenetic analysis, clearly identified them as Chara zeylanica J.G.Klein ex Willd. Although the subsection Willdenowia has yet to receive a thorough taxonomic treatment, a discussion of its relationship to other taxa of this subsection is provided despite the lack of a commonly agreed upon taxonomic concept. The ecological conditions of the Sardinian site of C. zeylanica are presented. Moreover, the status of and threats to this taxon, and hypotheses regarding potential pathways through which it reached Europe, are discussed.

Decision aid and cost compensation influence uptake of PSA-based early detection without affecting decisional conflict: a cluster randomised trial.

International guidelines recommend to inform men about the benefits and harms of prostate specific antigen (PSA) based early detection of prostate cancer. This study investigates the influence of a transactional decision aid (DA) or cost compensation (CC) for a PSA test on the decisional behaviour of men. Prospective, cluster-randomised trial to compare two interventions in a 2 × 2 factorial design: DA versus counselling as usual, and CC versus noCC for PSA-testing. 90 cluster-randomised physicians in the administrative district of Muenster, Germany recruited 962 participants aged 55-69 yrs. in 2018. Primary endpoint: the influence of the DA and CC on the decisional conflict. Secondary endpoints: factors which altered the involvement of the men regarding their decision to take a PSA-test. The primary endpoint was analysed by a multivariate regression model. The choice to take the PSA test was increased by CC and reduced by the DA, the latter also reduced PSA uptake in men who were offered CC. The DA led to an increase of the median knowledge about early detection, changed willingness to perform a PSA test without increasing the level of shared decision, giving participants a stronger feeling of having made the decision by themselves. The DA did not alter the decisional conflict, as it was very low in all study groups. DA reduced and CC increased the PSA uptake. The DA seemed to have a greater impact on the participants than CC, as it led to fewer PSA tests even if CC was granted.Trial registration: German Clinical Trial Register (Deutsches Register Klinischer Studien DRKS00007687). Registered: 06/05/2015. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007687 .

Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica.

OBJECT: Neurosurgical textbooks describe an infrainguinal approach as the standard or preferred option for the surgical treatment of meralgia paresthetica (MP), the most frequent entrapment neuropathy of the lower limb. However, inhomogeneous results led the authors to adopt a suprainguinal, retroperitoneal approach for decompression of the lateral femoral cutaneous nerve. In this paper the authors' aim was to study the outcome of patients harboring MP treated via this different surgical approach. METHODS: The outcome of 55 consecutive patients who underwent surgery for MP via the suprainguinal retroperitoneal approach during a 15-year period was ascertained through postal questionnaires (in 47 patients) and follow-up visits (in 8 patients). The male to female ratio was 1:0.67, and the mean patient age was 50 +/- 12.9 years. The mean follow-up was 3.2 +/- 3.3 years. Seven of the patients underwent bilateral surgery. RESULTS: Intraoperatively the lateral femoral cutaneous nerve was consistently found in close anatomical relationship to the anterior superior iliac spine, although some variations regarding the diameter, number of branches, and underlying pathological entity were observed. Eighty-seven percent of patients showed improvement (21 patients) or complete remission (27 patients) of painful dysesthesia in the anterolateral thigh, and 13% (7 patients) remained unchanged. In addition 82% had improvement (31 patients) or complete remission (14 patients) of hypesthesia, leaving 18% with unchanged (9 patients) or worsened (1 patient) hypesthesia. In the patient-evaluated group 66% (31 of 47) were completely satisfied with the outcome, 23% (11 of 47) were partially satisfied, and 11% (5 of 47) were not satisfied with the outcome. Two cases each of recurrence, seroma, wound infection, and 1 case of hematoma requiring revision were encountered as complications. CONCLUSIONS: The suprainguinal retroperitoneal approach is a viable first-choice option for the surgical relief of MP.

Haemorrhagic small bowel melanoma metastasis: a clinical rarity.

We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest-abdomen-pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.

Development and Prospective Randomized Evaluation of a Decision Aid for Prostate-specific Antigen-based Early Detection of Prostate Cancer in Men Aged Between 55 and 69Yr: The PSAInForm Trial.

For men interested in early detection of prostate cancer, the potential impact on decisional conflict of a decision aid with or without cost compensation for the prostate-specific antigen test will be investigated.

Cavernoma of the trochlear nerve.

Here we present the case of a 53-year old man with progressive double vision due to isolated left trochlear nerve palsy. Cranial magnetic resonance imaging (MRI) showed a small tumor within the left quadrigeminal cistern that did not increase in size after several months. Explorative neurosurgical intervention revealed a left trochlear nerve cavernoma. The lesion was microsurgically excised followed by end-to-end anastomosis of the trochlear nerve. After a one-year follow up, double vision totally disappeared and cranial MRI showed no recurrence. Cerebral cavernous malformations usually become symptomatic in seizures or focal neurological deficits after intracerebral hemorrhage. Rarely, cavernomas arise from cranial nerves. To the authors' knowledge, this is the first report on a symptomatic cavernous malformation arising from the trochlear nerve and on its successful surgical management.

A non-aqueous organometallic route to highly monodispersed copper nanoparticles using [Cu(OCH(Me)CH2NMe2)2].

Good quality, highly monodispersed capped copper metal nanoparticles have been synthesised in a non-hydrolytic approach using thermal decomposition of the Cu(II) precursor [Cu(OCH(Me)CH2NMe2)2] in a hot coordinating solvent without further reducing agents; the copper nanoparticles have been characterised by optical spectroscopy (UV/VIS), electron microscopy (TEM), electron diffraction (SAED), and dynamic light scattering (DLS).

Mononuclear precursor for MOCVD of HfO2 thin films.

We report the precursor characteristics of a novel mononuclear mixed alkoxide compound [Hf(O(i)Pr)2(tbaoac)2] and its application towards MOCVD of HfO2 thin films in a production tool CVD reactor.

Effects of clozapine and its metabolites on the 5-HT2 receptor system in cortical and hippocampal cells in vitro.

PURPOSE: The goal of the present study was to determine the effects of clozapine (Cloz) and its metabolites norclozapine (Norcloz) and clozapine-N-oxide (Cloz-N-oxide) on the 5-HT(2) receptor system on the levels of protein and gene expression in in vitro systems of primary cortical cells of the rat and human hippocampal SHS5Y5 neuroblastoma cells. METHODS: Clinically relevant concentrations of Cloz (200/400 ng/ml) and its metabolites (200 ng/ml) were used for the examination of the effects of Cloz and its metabolites on serotoninergic 5-HT(2) receptor parameters (density, affinity and mRNA levels) as well as on glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA levels in primary cortical cells of the rat after treatment for 24 h under in vitro conditions. To compare the results to human cells, we also measured treatment-induced changes in 5-HT(2) and GAPDH mRNA levels in human hippocampal SHS5Y5 cells. RESULTS: A significant decrease was found in primary cortical cells for 5-HT(2) receptor density (Cloz 200/Cloz 400/Norcloz 200 and Cloz-N-oxide 200 vs. control) and 5-HT(2A) receptor mRNA levels (Cloz 200 vs. control). 5-HT(2A) receptor mRNA levels were also significantly reduced (Norcloz 200 vs. control) in SHS5Y5 cells. GAPDH mRNA levels were not affected. CONCLUSIONS: The results of the present study show that Cloz and Norcloz induce significant alterations on the 5-HT(2) receptor system in primary cortical cells of the rat and in human hippocampal cells.

Role of nitric oxide in the regulation of spinal arteriolar tone.

OBJECTIVE: The important role played by nitric oxide (NO) in the maintenance of cerebral arterial tone, both in the resting state and after injury, has been demonstrated, but the role of NO in spinal arteries is unknown. The aim of this study was to verify, by topical application of a NO synthase inhibitor in vivo, the hypothesis that NO plays an important role in the maintenance of spinal arteriolar tone. METHODS: Closed spinal windows were prepared at the C6 level, for observation of arteriolar reactivity. Male Wistar rats were divided into four groups in the resting state and three groups in the compressed state (which was produced by increasing the intrathecal window pressure). The control group underwent superfusion of artificial cerebrospinal fluid into the spinal window. The nitro-L-arginine-methyl ester (L-NAME) and nitro-D-arginine-methyl ester groups underwent superfusion of the NO synthase inhibitor L-NAME and its inactive enantiomer nitro-d-arginine-methyl ester, respectively. The L-NAME/S-nitroso-acetylpenicillamine (SNAP) group underwent mixed superfusion of L-NAME and the direct NO donor SNAP, for investigation of the effects of an exogenous NO donor. RESULTS: In the resting state, the arterioles constricted significantly in the L-NAME group, compared with values before L-NAME superfusion and those for the other groups. In the L-NAME/SNAP group, the arterioles dilated significantly after SNAP superfusion, compared with values before superfusion and those for the other groups. In the compressed state, the arterioles dilated after compression in all three groups but the dilation was significantly attenuated in the L-NAME group, compared with values for the control and nitro-D-arginine-methyl ester groups. CONCLUSION: It is suggested that NO plays an important role in the maintenance of spinal arteriolar tone in the resting and compressed states of the spinal cord.

Serotonergic effects of clozapine and its metabolites in hippocampal HT22 cells.

In the hippocampal neuronal in vitro system of HT22 cells, we studied the effects of clozapine (Cloz) and its metabolites clozapine-N-oxide (Cloz-N-oxide) and norclozapine (Norcloz) on 5-HT transporter affinity (K(M)) and uptake (V(max)), MAO-B affinity (K(M)) and maximal velocity (V(max)), as well as on 5-HT(2) receptor affinity and density. Clinically relevant concentrations of Cloz (200 and 400 ng/ml) and its metabolites (100 and 200 ng/ml) were used for the examination of the effects after short-term (4 h) and long-term (24 h) incubation. Statistical evaluation revealed that a significantly lowered 5-HT transporter affinity (higher K(M)) was related to higher concentrations of Cloz and its metabolites. A significantly higher 5-HT transporter uptake was dependent on both high concentrations of drugs and an increased time of incubation. No significant influence of the investigated independent variables on MAO-B affinity could be demonstrated, whereas a significant drug-related increase of MAO-B velocity was detectable. Additionally, low and high concentrations of Cloz and its metabolites induced a higher 5-HT(2) receptor affinity (lower K(D)). No significant influences of the investigated independent variables on 5-HT(2) receptor density were detectable. The results of the present study show that Cloz and its metabolites induce significant alterations in serotoninergic parameters of hippocampal HT22 cells, validating the system of hippocampal HT22 cells for further examinations of the mechanisms of action of atypical neuroleptics.

Meat consumption and commitments on meat policy: combining individual and public health.

Although meat consumption plays a significant role for individual and public health, there is only little empirical research on the motives of meat consumption informed by health psychology and hardly any on socio-political commitments concerning general meat production taking on a public health perspective. To fill this gap, a questionnaire study was conducted to examine the links between both disciplines. Correlational and multiple regression analyses reveal that individual meat consumption is primarily based on self-centred judgments of control beliefs protecting ones health and of taste, whereas socio-political commitments are based on a mixture of self-centred judgments and animal ethics. Based on these results, it is concluded, that models on health behaviour should integrate the social perspective, and that in intervention programs issues of individual as well as public health should be given equal importance.

Long-term clinical and radiological postoperative outcomes after an interspinous microdecompression of degenerative lumbar spinal stenosis.

STUDY DESIGN: A retrospective study to evaluate the clinical outcome and the risk of postoperative instability 5 years after microsurgical management of lumbar spinal stenosis using the interspinous approach. OBJECTIVE: To evaluate the long-term outcome and the risk of postoperative instability after the microsurgical interspinous decompression of lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: The interspinous approach involves partial resection of the supraspinous ligament followed by resection of the interspinous ligament, partial resection of the caudal aspect of the superior spinous process and resection of the ligamentum flavum, producing a central fenestration through which the decompression of the cauda equina and the nerve roots can be effected with an undercutting technique, with tailored partial resection of the lamina and the medial aspects of the facet joints. In this article, we investigated the long-term clinical outcome and the long-term risk for instability after using this approach. METHODS: One hundred and 6 patients undergoing decompressive surgery for lumbar spinal stenosis using the interspinous approach, including cases with spondylolisthesis without instability, were included in this study. The long-term outcome was evaluated in a follow-up study, 5 years after surgery. The clinical long-term outcome was evaluated retrospectively using self-rating questionnaires: the Oswestry Disability Index, visual analogue scale (0-10), walking capacity (1-5), progress in walking capacity and global activity, and level of satisfaction. The risk of postoperative instability was evaluated on the basis of dynamic radiographs of the lumbar spine. RESULTS: The Oswestry Disability Index showed a mean improvement in symptoms from 58.20% to 21.61%, and the visual analogue scale showed that the intensity of leg and back pain decreased from 8.62 and 8.69 points to 2.33 and 3.48 points, respectively. Walking capacity increased from 3.37 (severely restricted) to 1.81 (slightly restricted), and 93.23% of cases indicated that they were moderately satisfied or very satisfied. Dynamic radiographs revealed no postoperative instability after decompression using the interspinous approach. CONCLUSION: The clinical outcome 5 years postoperatively after using the interspinous approach for lumbar spinal stenosis showed a favorable maintenance of improvement in symptoms. Radiological data showed that this approach does not alter the stability of the spine. LEVEL OF EVIDENCE: 4.