Full-Endoscopic Ventral Facetectomy vs Open Laminectomy for Lumbar Lateral Recess Stenosis: A Comparative Study and Brief Literature Review.

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.

The Efficacy of High-Intensity Preoperative Physiotherapy Training on Postoperative Outcomes in Greek Patients Undergoing Total Knee Arthroplasty: A Quasi-Experimental Study.

PURPOSE: Several studies have shown that patients with severe osteoarthritis (OA) of the knee can reduce their knee pain, improve their quadriceps strength, and improve their functional ability through regular exercise training. The purpose of this study was to investigate the efficacy of a six-week supervised high-intensity preoperative training program on muscle strength, functional performance, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA). METHODS: Ninety-eight patients scheduled for unilateral TKA for severe OA were allocated to an intervention group (N = 49) who completed a six-week preoperative training program, five days per week prior to surgery, and a control group (N=49) who did not follow any preoperative training program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), quadriceps strength, 20-meter walk test, and 30-second chair stand test were assessed at six weeks before surgery (T0), just before surgery (T1), four weeks (T2) and finally 12 weeks (T3) after TKA. RESULTS: Of 98 patients included in our study, 10 individuals withdrew from the study at different stages. Finally, 44 patients were allocated to the intervention group and 44 patients to the control group. When comparing the changes from baseline to the primary test points at T1, T2, and T3, we found a significant group difference in favor of the intervention group for quadriceps strength (<0.001, 0.001, 0.009), 20-meter walk test (<0.001, 0.023, 0.032), 30-second chair stand test (0.001, <0.001, <0.001) and all patient-reported outcomes WOMAC (<0.001, 0.001, 0.007) except from KOOS that showed significant difference only at T1 (<0.001) at T2 (0.048) but not at T3 (0.087). CONCLUSIONS: Our study demonstrated that a six-week preoperative physiotherapy training program supervised by a physiotherapist before TKA is efficacious for decreasing knee pain, improving knee function, and enhancing daily living activities.

Does preoperative physiotherapy improve outcomes in patients undergoing total knee arthroplasty? A systematic review.

OBJECTIVE: To systematically review the scientific literature and to investigate the effectiveness of preoperative rehabilitation on subjective and objective outcomes after total knee arthroplasty (TKA) when compared with patients in a control group. DATA SOURCES: A search was conducted in PubMed, PubMed Central, Embase, Cochrane Library and Physiotherapy Evidence Database databases in May 2021. STUDY SELECTION: randomized controlled trials (RCTs) were reviewed if they compared a preoperative physiotherapy exercise intervention with no intervention group for patients undergoing TKA for severe Osteoarthritis (OA). A total of 24 RCTs were included at the end of the evaluation process. By the end of the evaluation process, a total of 24 RCTs were included. DATA EXTRACTION: Two authors independently screened the literature, extracted data, and assessed the quality of included studies. The outcomes were knee extension, knee flexion, pain Visual Analogue Scale (VAS), overall Western Ontario and McMaster Universities OA Index, 6 min walking test, and Timed Up and Go test. RESULTS: The majority of the studies included in this systemic review demonstrated a comparable trend of long-term postoperative improvement of knee extension strength, VAS, range of movement and functional scores, and those of quality of life between two groups. Many studies showed a significant improvement in terms of preoperative pain, length of hospital stay and functional performance shortly after the operation, but all studies failed to show a prolonged effect on knee motion or patient function between 3 and 12 months. CONCLUSIONS: Low to moderate evidence from mostly small RCTs demonstrated that preoperative physiotherapy interventions reduce pain and improve functional performance for patients with knee OA prior shortly after the TKA.

Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature.

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.

Treatment of adjacent segment disease with percutaneous transforaminal endoscopic discectomy: Early experience and results.

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.

Hand disorders demographics in rural areas: A 15-year analysis of demographic characteristics overtime in a stable population.

OBJECTIVE: The aim of this study was to determine the incidence of hand disorders in a general rural area, record the demographic characteristics for each condition, and evaluate the tendencies overtime in the incidence of these conditions. METHODS: Using nationwide census data, we identified a health network system serving a geographic area with stable population. Subsequently, we retrospectively analyzed all the patient records (n=731 patients) with hand disorders documented between 2001 and 2015. We performed a retrospective review and collected demographic data for the patients and disorders treated surgically. We calculated the incidence of these conditions based on the census data and performed qualitative and categorical analysis with different demographic and disease-related variables. RESULTS: We reviewed surgically treated 204 male and 527 female patients with hand disorders. The mean annual incidence was 222.5 cases per 100,000 individuals per year. More than 55% of the patients were between 50 and 69 years old. Trigger finger (TF) accounted for approximately 42% of patients, followed by 35% with carpal tunnel syndrome (CTS). TF and CTS were related to hand dominance, and right hand was affected in 53.4% of the patients. CONCLUSION: Hand disorders in a rural area seem to correlate with the occupational sector activities, such as farming and agriculture. CTS was the most common disorder in the past; however, the dramatic increase in the incidence rate of TF made it the most common hand disorder in the last decade. Incidence rates in both males and females showed an increasing trend.

The Role of Full-Endoscopic Lumbar Discectomy in Surgical Treatment of Recurrent Lumbar Disc Herniation: A Health-Related Quality of Life Approach.

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.

The Role of Percutaneous Transforaminal Endoscopic Surgery in Lateral Recess Stenosis in Elderly Patients.

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.

Percutaneous endoscopic ventral facetectomy: An innovative substitute of open decompression surgery for lateral recess stenosis surgical treatment?

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.

Comparison of Quality of Life Between Men and Women Who Underwent Transforaminal Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation.

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.

Perioperative Blood Management in Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: Original Study and Short Review of the Literature.

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.

Clinicopathological characteristics of incidental parathyroidectomy after total thyroidectomy: The effect on hypocalcemia. A retrospective cohort study.

BACKGROUND: The reported rate of incidental parathyroidectomy (IP) during total thyroidectomy varies between 6.4 and 31.1%. The aim of this study was to investigate the clinicopathological characteristics associated with IP. MATERIALS AND METHODS: This is a retrospective cohort study which included 2556 patients who underwent total thyroidectomy between 2002 and 2012 at a single tertiary institution. Demographics, clinicopathological risk factors, and postoperative calcium levels were compared between IP and control group. RESULTS: Incidental parathyroidectomy occurred in 18.3% of patients. IP patients had higher risk of postoperative biochemical (40.3% vs 17.3%, p < 0.001) and symptomatic hypocalcemia (14.3% vs 7.3%, p < 0.001) than no-IP group. Multivariate analysis showed malignancy, tumor size >10 mm, thyroid capsule invasion, extrathyroidal extension, lymph node metastases and central neck dissection, operation time, RLN injury, thyroid gland dimensions were independent risk factors for IP. CONCLUSIONS: Our results indicate that patients with certain preoperative findings such as larger thyroid dimensions, diagnosis of malignancy and especially tumor >10 mm, extrathyroidal extension, and lymph node metastasis are at higher risk of IP and postoperative symptomatic hypocalcemia and these patients should be adequately informed and treated. Α meticulous intraoperative identification and the preservation of all parathyroid glands results in lower incidence of IP and postoperative hypocalcemia.

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.

BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) is a minimally invasive surgical technique used principally for the treatment of lumbar disc herniation (LDH). LDH is a frequent spinal ailment in obese individuals. The aim of this prospectively designed study was to assess for the first time in the literature the impact of PTED in postoperative parameters of health-related quality of life (HRQoL) in obese patients with LDH within a 2-year follow-up period, to further evaluate the effectiveness of PTED. METHODS: Patients with surgically treatable LDH were divided into 2 groups. Group A constituted 20 obese patients, and group B was composed of 10 patients with normal body mass index (BMI). A visual analog scale was used for pain evaluation, and the Short Form SF-36 Medical Survey Questionnaire contributed to HRQoL assessment. Follow-up was conducted preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively. RESULTS: Two of the 20 patients (10%) presented with severe postoperative pain, necessitating conventional microdiscectomy. All studied parameters exhibited maximal improvement at 6 months in group A and at 6 weeks in group B, with subsequent stabilization. Obese patients scored lower in all parameters compared with their healthy counterparts with normal BMI, acquiring a less favorable clinical benefit. CONCLUSIONS: PTED appears to be a generally safe and effective method for treating obese patients with LDH. However, major technical challenges that lead to a higher frequency of complications, as well as the lesser acquired clinical benefit, in obese patients may contribute to the further consideration for PTED in specific obese patients, especially on the grounds of low surgical experience.

Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation.

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.

Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation.

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.

Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy.

Importance: Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection. Objective: To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy. Design, Setting, and Participants: This cohort study included 2556 patients who underwent total thyroidectomy between January 2002 and December 2012 in the Department of Otolaryngology-Head and Neck Surgery of Venizeleio General Hospital, Heraklion, Greece. Patients who had IONM during the procedure (n = 1481) were compared with patients who underwent surgery with nerve visualization alone (n = 1075). All patients underwent indirect laryngoscopy-fiberoptic nasopharyngoscopy both preoperatively and on day 2 after surgery to assess vocal cord motility. Main Outcomes and Measures: Use of IONM and incidence of RLN injury. Results: A total of 2556 patients (2028 women and 528 men [5112 RLNs at risk]; mean [SD] age, 51.35 [14.18] years; age range, 18-89 years) underwent total thyroidectomy. Univariate analysis showed that the use of IONM resulted in a significant reduction in RLN injury incidence (3.3% vs 0.7%) with a relative risk reduction of 2.6% (odds ratio [OR], 5.15; 95% CI, 3.12-8.49; number needed to treat, 19). Multivariate logistic regression showed that no use of IONM was an independent risk factor for RLN injury in patients who underwent total thyroidectomy (adjusted OR [AOR], 5.44; 95% CI, 3.26-9.09). Additional risk factors for RLN injury were operative time (AOR, 12.91; 95% CI, 6.66-25.06), maximum diameter greater than 45 mm of right thyroid lobe (AOR, 4.91; 95% CI, 3.12-8.56) and left thyroid lobe (AOR, 2.24; 95% CI, 1.39-4.32), extrathyroid extension (AOR, 3.26; 95% CI, 1.62-6.59), incidental parathyroidectomy (AOR, 3.30; 95% CI, 2.13-5.09), and tumor size larger than 10 mm (AOR, 3.24; 95% CI, 1.59-6.62). Conclusions and Relevance: Our findings showed that the use of IONM decreased significantly both temporary and permanent RLN injuries. The technology of IONM is safe and reliable, and this technique is an important adjunct in nerve dissection and functional neural integrity. The routine use of IONM reduced pitfalls and provided guidance for our surgeons in difficult cases, reoperations, and high-risk patients.

Thyroglobulin antibodies as a potential predictive marker of papillary thyroid carcinoma in patients with indeterminate cytology.

BACKROUND: We investigated the efficacy of thyroglobulin antibodies (TgAb) in detecting malignancy in indeterminate thyroid nodules and evaluated the possible association between TgAb and autoimmunity in papillary thyroid carcinoma (PTC). METHODS: This retrospective, nonrandomized study included 1,646 patients who had undergone preoperative fine-needle aspiration biopsy to evaluate their thyroid nodules, and then standard total thyroidectomy. Of 194 patients (11.8%) with indeterminate nodules, 61 (31.4%) had PTC and 133 (68.6%) had benign nodules at the final histologic examination. RESULTS: Univariate analysis showed that multifocality (P = .002), bilaterality (P = .003), lymph-node metastasis (P = .030), and capsule penetration (P = .003) were significantly associated with positive TgAb in patients with indeterminate cytology and histopathologic diagnosis of PTC. The multivariate analysis showed that TgAb positivity (P < .001) and preoperative thyroid-stimulating hormone levels (P = .022) were independent predictive factor for PTC diagnosis in patients with indeterminate cytology. CONCLUSIONS: Preoperative TgAb could be a marker for PTC in patients with indeterminate thyroid nodules, increasing diagnostic accuracy. TgAb positivity could also influence the clinical assessment and subsequent selection of total thyroidectomy.

Detection of tumour cells in the bloodstream of patients with uveal melanoma: influence of surgical manipulation on the dissemination of tumour cells in the bloodstream.

AIM: The detection of circulating tumour cells in the bloodstream before and after surgical manipulation, and the qualitative detection of potential shedding of tumour cells during surgical manipulation of patients with uveal melanoma. METHODS: 202 patients treated for a newly diagnosed uveal melanoma were included in the study. Blood samples were acquired 24 h before and 30 min after the basic surgical steps. Detection of potential circulating melanoma cells was extrapolated from the presence of tyrosinase and MelanA/Mart1 transcripts by reverse transcription PCR. RESULTS: Based on the measurement of tyrosinase transcripts, as a result of the first and second surgical manipulation there were three and zero transitions from negative to positive respectively, while there were two and one transitions from positive to negative, respectively. According to MelanA/Mart1 transcripts, there were 19 and 5 transitions from negative to positive respectively, and 15 and 2 transitions from positive to negative, respectively. No statistically significant differences were documented, concerning the presence of circulating tumour cells in the blood samples acquired before and after the first surgical manipulation or the second one. CONCLUSION: The change in the percentage of patients with detected tumour cells in their bloodstream was not statistically significant. The frequent shifts from negative to positive samples as well as from positive to negative samples comparing preoperative to postoperative samples indicates discontinuous shedding or variation due to measurements close to the threshold of detection. As a conclusion, the surgical manipulation does not seem to have a measurable contribution to the spread of melanoma cells in the bloodstream.

Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: A case control study.

BACKGROUND: Appropriate surgical treatment of papillary thyroid carcinomas (PTC) located in the isthmus remains controversial. The aim of this study was to evaluate the clinicopathological characteristics of PTC of the isthmus compared to tumors located in the thyroid lobes, to identify differences between PTC and microcarcinomas of the isthmus, and to use these findings to establish total thyroidectomy as an appropriate surgical resection for treating these tumors. METHODS: We retrospectively analyzed 2239 patients subjected to total thyroidectomy. PTC was diagnosed in 575 patients, of whom 521 had dominant malignant nodule located in thyroid lobes and 54 had a dominant carcinoma located in the isthmus. Patients with isthmic PTC were divided in Group A (n = 27) with PTC >10 mm and Group B (n = 27) with microcarcinoma ≤ 10 mm. RESULTS: In univariate analysis, multifocality (p = 0.019), lymph node metastasis (p < 0.001), mean tumor size (p = 0.028) and age ≥ 45 (p = 0.036) were significantly associated with PTC with dominant nodule in the isthmus. Additional analysis of PTC groups (>10 mm vs ≤ 10 mm) in isthmus showed that multifocality, bilaterality, histological subtype and lymph node metastasis were not significantly different between the two groups. CONCLUSIONS: Our results suggest that PTCs located in the isthmus were more likely to be associated with multifocal disease, lymph node involvement and capsule invasion, than carcinomas in other thyroid regions. Therefore, total thyroidectomy could be considered as an appropriate surgical treatment for papillary carcinomas located in the isthmus regardless of size.

Thyroglobulin antibodies could be a potential predictive marker for papillary thyroid carcinoma.

BACKGROUND: Hashimoto thyroiditis (HT) is associated with an increased risk of developing papillary thyroid carcinoma (PTC). The relationship between thyroid autoimmunity and cancer remains controversial. The purpose of this study was to investigate whether the preoperative TgAb could be a potential predictor of PTC in patients with thyroid nodules and to assess whether there is an association of preoperative TgAb with lymph node metastases. METHODS: This retrospective, nonrandomised study included 854 patients who underwent standard total thyroidectomy. Benign thyroid nodules were diagnosed in 447 patients, and 407 presented with malignant nodules. The examined parameters included the clinical characteristics, preoperative TSH and TgAb levels, and the histopathological characteristics of the tumour. RESULTS: Tumour size >10 mm (p = 0.01), the presence of PTC (p < 0.001), elevated TSH levels (2.64 ± 1.28 µU/ml vs. 2.09 ± 0.98 µU/ml, p = 0.001), HT (p < 0.001), and lymph node metastasis (p = 0.005) were significantly associated with positive TgAb. Additionally, tumour size >10 mm (p < 0.001), preoperative TgAb positivity (p = 0.003), and elevated TSH levels (TSH > 3.4 µU/ml, p = 0.038) were independent risk factors for PTC based on the multivariate logistic regression analysis. CONCLUSIONS: This study showed that TgAb positivity was an independent risk factor for PTC. A positive correlation between TgAb and PTC in patients with indeterminate nodules was existed. Additionally, a positive correlation existed between TgAb and lymph node metastases in patients with PTC. Prospective studies with a larger number of patients and long-term follow-up are needed clarify the potential role of positive serum TgAb in the prediction of PTC.