The effect of combined red, blue, and near-infrared light-emitting diode (LED) photobiomodulation therapy on speed of wound healing after superficial ablative fractional resurfacing.

Objective of the study is to assess the effects of wound healing with a commercially available light emitting diode (LED) photo biomodulation (PBM) device that emits three wavelengths (465, 640 and 880nm) after ablative fractional laser (AFL) treatment to healthy skin on the bilateral inner biceps. We conducted a prospective intraindividual randomized controlled study with 25 volunteers. AFL treatment was performed on healthy skin of the bilateral inner biceps. Subjects applied the LED light device for 30 min to the assigned bicep 3 times a week over 4 weeks, beginning on day 0. Subjects were followed up on days 2, 4, 6, 9, 13, 20 and 27 for treatment with the PBM device, clinical digital photography of the test and control sites, and in-person subject assessment, with follow ups on days 34 and 55 for clinical photography and assessment. Three blinded evaluators were asked to determine which bicep healed faster between day 0 to day 13. Pain, discomfort, and itch were also assessed. The three blinded evaluators chose the treatment arm as the faster healed arm in greater than 50% of the images, although the results were not statistically significant. There was no statistically significant difference between test and control arms in terms of pain, discomfort and itch. In conclusion, PBM therapy has the potential to improve wound healing. In this study, a three wavelength PBM device resulted in some subjects achieving faster healing after AFL but the results were not statistically significant.

Neutralizing Antibody Formation with OnabotulinumtoxinA (BOTOX®) Treatment from Global Registration Studies across Multiple Indications: A Meta-Analysis.

Though the formation of neutralizing antibodies (NAbs) during treatment with botulinum neurotoxin is rare, their presence may nonetheless affect the biological activity of botulinum toxin and negatively impact clinical response. The goal of this updated meta-analysis was to evaluate and characterize the rate of NAb formation using an expanded dataset composed of 33 prospective placebo-controlled and open-label clinical trials with nearly 30,000 longitudinal subject records prior to and following onabotulinumtoxinA treatment in 10 therapeutic and aesthetic indications. Total onabotulinumtoxinA doses per treatment ranged from 10 U to 600 U administered in ≤15 treatment cycles. The NAb formation at baseline and post-treatment was tested and examined for impact on clinical safety and efficacy. Overall, 27 of the 5876 evaluable subjects (0.5%) developed NAbs after onabotulinumtoxinA treatment. At study exit, 16 of the 5876 subjects (0.3%) remained NAb positive. Due to the low incidence of NAb formation, no clear relationship was discernable between positive NAb results and gender, indication, dose level, dosing interval, treatment cycles, or the site of injection. Only five subjects who developed NAbs post-treatment were considered secondary nonresponders. Subjects who developed NAbs revealed no other evidence of immunological reactions or clinical disorders. This comprehensive meta-analysis confirms the low NAb formation rate following onabotulinumtoxinA treatment across multiple indications, and its limited clinical impact on treatment safety and efficacy.

Does curve magnitude in adolescent idiopathic scoliosis (AIS) affect frequency and quality of sport participation? A feasibility study.

BACKGROUND: This pilot study explores whether large adolescent idiopathic scoliosis (AIS) curves (≥ 45°) lead to decreased frequency and quality of sport participation, lower health-related quality of life (HRQL), and more pronounced shortness of breath (SOB) as compared to smaller curvatures (< 45°). METHODS: Patients were divided into two groups based on their spinal curvature: Cobb angle < 45° (n = 31) and ≥ 45° (n = 21). We assessed feasibility outcomes including agreement to be approached, participation, recruitment rates and missing data. All participants completed five questionnaires to assess the frequency and quality of sport participation, HRQL and SOB outcomes. Estimates of effects 95% confidence intervals (CIs) were reported. RESULTS: This study enrolled 52 surgically untreated AIS patients between the ages of 10 and 18 (44 females, 8 males, mean age = 14.60). All feasibility threshold criteria were successfully met (100% agreement to be approached, 100% participation with n ≥ 12 in each group, and 94.2% of patients without missing data). AIS patients with large curvatures (≥ 45°) trended towards decreased frequency and quality of sport participation, more pronounced SOB and worse HRQL outcomes, as compared to patients with smaller curve sizes. CONCLUSION: The study findings show that a study addressing sport participation in the setting of AIS is feasible. The size of curvature in AIS may have an impact on sport participation, HRQL and SOB, but larger studies are required.

Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up.

PURPOSE: The purpose of this study is to report on the global distribution and clinical outcomes of published articles related to trochleoplasty. METHODS: The online databases OVID Medline, OVID EMBASE, and the Cochrane Library were searched for the literature assessing trochleoplasty performed for lateral patellofemoral instability (LPI). Study data were abstracted looking at global trends in the literature, as well as clinical and patient-reported outcomes following this technique. RESULTS: For the assessment of global distribution, 29 studies including 998 patients met the inclusion criteria. The majority of the studies were conducted in Europe (93%) and most used an open thin flap technique (52%). For the secondary analysis of clinical outcomes, 21 studies were included with significant heterogeneity in patient selection, reporting on the degree of trochlear dysplasia, and patient-reported outcomes. All trochleoplasty techniques showed statistically significant improvement in clinical outcomes at average 50 months (range 3-228 months) post-operative, with most patients being satisfied with their procedure. Re-dislocation and complication rates were low. CONCLUSIONS: European centers have published majority of data on trochleoplasty surgery, which has been shown to be an acceptable procedure for patients with high-grade trochlear dysplasia and LPI. Trochleoplasty has demonstrated good clinical outcomes, a low re-dislocation rate, and an acceptable complication profile in both short and long-term follow-up. This study highlights the difficulty in reporting outcomes in this group of patients due to heterogeneity in patient selection, grading of trochlear dysplasia, and the lack of disease-specific outcome measures. LEVEL OF EVIDENCE: IV.

Limited microdiscectomy for lumbar disk herniation: a retrospective long-term outcome analysis.

OBJECTIVE AND SUMMARY OF BACKGROUND DATA: Surgical treatment of lumbar disk herniation is traditionally accomplished by removal of the extruded fragment as well as an aggressive decompression of the disk space. This retrospective study evaluates the long-term results of limited discectomy, otherwise known as fragmentectomy, for lumbar disk herniation using a minimally invasive technique. Although there are ample studies in literature regarding short-term outcome after limited microdiscectomy, there is a paucity of literature for long-term outcomes after fragmentectomy. We present long-term outcomes averaging 7 years after limited discectomy. STUDY DESIGN AND METHODS: A total of 152 patients were operated on between January 1, 2001 and June 30, 2003 for single-level herniated lumbar disks. All patients had microsurgical fragmentectomy performed through a small skin incision off the midline using a tubeless retraction system. Fifty-four patients participated in the study, whereas 98 patients were lost to long-term follow-up. Long-term outcome was assessed by telephone survey or mail-in survey using the Oswestry Low Back Pain Disability Index and a patient outcome survey. After Institutional Review Board approval and patient consent, all 54 patients had a thorough chart review for evaluation of further lumbar surgeries. The mean long-term follow-up was 86.2 months (range, 72-104 mo) or about 7.2 years. RESULTS: Forty-eight of the 54 patients (88.9%) reported an excellent (26 patients) or good (22 patients) long-term outcome with surgery. Long-term back and leg pain improvement was seen in 44 of 49 (89.8%) and 44 of 50 (88.0%) patients reporting back or leg pain, respectively. The mean Oswestry Disability Index for long-term follow-up was 8.89, indicating minimal disability. Same-level recurrences requiring reoperation were seen in 6 of the 54 patients who participated (11.1%) within the average 86.2-month follow-up. Four of 34 (11.85%) known contained herniations and 2 of 20 (10.0%) known extruded herniations presented for same-level surgical recurrence. All recurrences were successfully treated with reexploration and fragmentectomy. Two patients from the recurrence group and 1 from the original 54 progressed to need an arthrodesis at the initial operated level (5.6%). One patient in the same-level recurrence group and 2 patients from the original 54 developed an operative herniated disk at an adjacent level (5.6%). CONCLUSIONS: Our long-term outcome study shows that a minimally invasive approach to microdiscectomy with removal of the fragment only is an effective way to treat lumbar disk herniation. The rate of recurrence in our long-term study seems slightly higher compared with previously published studies, which generally had shorter follow-up periods. Long-term patient outcomes for back and leg pain were also very low. No appreciable difference in operative reherniation could be found with patients who had contained verses extruded fragments. It is difficult to predict from this study whether a simple fragmentectomy was the cause of the progression to further surgeries or whether this was the natural progression of a degenerative spine. Further prospective trials are necessary to fully understand the factors associated with limited microdiscectomy.

In vivo retrieval of a trapped Merci embolectomy device: technical case report.

BACKGROUND AND IMPORTANCE: This technical note describes a complication related to the use of the Merci embolectomy device not previously reported. The device can induce critical flow limitation within an accessed vessel because of a combination of vasospasm and anatomic conformational changes. Furthermore, this can limit the safe removal of the device from intracranial vasculature. We present a novel rescue technique that can be used to safely retrieve the entrapped Merci device without inciting localized vessel injury. CLINICAL PRESENTATION: A 51-year-old male with embolic occlusion of the distal basilar artery and dissection-related occlusion of the left cervical vertebral underwent mechanical thrombolysis. Flow-limiting vasospasm and/or anatomic conformational changes/ telescoping of the intracranial right vertebral artery segment was induced during deployment with subsequent entrapment of the device. Reclamation of the entrapped device was performed by initially removing the Merci microcatheter. The entrapped and fixated device was then resheathed into a 4F slip catheter within the intracranial vertebral artery. The Merci device and the slip catheter were then removed. Right vertebral and proximal basilar artery flow was reestablished after removal of the Merci device. Successful clot extraction was thereafter performed using a microsnare. CONCLUSION: In vitro assessment of the device has demonstrated its propensity to induce vasospasm. In vivo entrapment of the device has not been previously reported. Successful retrieval can be achieved if the Merci device becomes entrapped and fixated. This may be an important consideration as increased utilization of the device occurs.

Symptomatic calvarial cavernous hemangioma: presurgical confirmation by scintigraphy.

Hemangiomas are rare tumors in the calvarium and represent 2% of osseous calvarial lesions. Dynamic Tc-99m RBC blood pool scintigraphy has a high positive predictive value for cavernous hemangiomas of the liver. This scintigraphic technique can be used for identifying cavernous hemangiomas at other anatomic sites. We present a case in which a tagged RBC blood pool scan was used for further characterizing a symptomatic calvarial lesion as a cavernous hemangioma. This avoided an unnecessary workup for metastatic disease and was valuable in surgical planning for anticipated increased intra-operative blood loss. Histological confirmation of a cavernous hemangioma was made after surgical resection.