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1.
Medicine (Baltimore) ; 100(14): e24775, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832066

RESUMO

BACKGROUND: The new emerging application of decompression combined with fusion comes with a concern of cost performance, however, it is a lack of big data support. We aimed to evaluate the necessity or not of the addition of fusion for decompression in patients with lumbar degenerative spondylolisthesis. METHODS: Potential studies were selected from PubMed, Web of Science, and Cochrane Library, and gray relevant studies were manually searched. We set the searching time spanning from the creating date of electronic engines to August 2020. STATA version 11.0 was exerted to process the pooled data. RESULTS: Six RCTs were included in this study. A total of 650 patients were divided into 275 in the decompression group and 375 in the fusion group. No statistic differences were found in the visual analog scales (VAS) score for low back pain (weighted mean difference [WMD], -0.045; 95% confidence interval [CI], -1.259-1.169; P = .942) and leg pain (WMD, 0.075; 95% CI, -1.201-1.35; P = .908), Oswestry Disability Index (ODI) score (WMD, 1.489; 95% CI, -7.232-10.211; P = .738), European Quality of Life-5 Dimensions (EQ-5D) score (WMD, 0.03; 95% CI, -0.05-0.12; P = .43), Odom classification (OR, 0.353; 95% CI 0.113-1.099; P = .072), postoperative complications (OR, 0.437; 95% CI, 0.065-2.949; P = .395), secondary operation (OR, 2.541; 95% CI 0.897-7.198; P = .079), and postoperative degenerative spondylolisthesis (OR = 8.59, P = .27). Subgroup analysis of VAS score on low back pain (OR = 0.77, 95% CI, 0.36-1.65; P = .50) was demonstrated as no significant difference as well. CONCLUSION: The overall efficacy of the decompression combined with fusion is not revealed to be superior to decompression alone. At the same time, more evidence-based performance is needed to supplement this opinion.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Dor Lombar/cirurgia , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Escala Visual Analógica
2.
Spine (Phila Pa 1976) ; 46(1): 29-34, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32925688

RESUMO

STUDY DESIGN: Retrospective database analysis. OBJECTIVE: This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and older. SUMMARY OF BACKGROUND DATA: Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined. METHODS: The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared. RESULTS: The matched cohort included 89,388 total patients (n = 44,694 for each study arm). Compared to the under 75 age group, the 75 and older age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, P = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and older (9.66% vs. 9.28%, P = 0.051), although the 75 and older age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867, respectively, P = 0.013 and <0.001, respectively). The 75 and older age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement. CONCLUSION: Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates. LEVEL OF EVIDENCE: 3.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/economia , Vértebras Lombares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Discotomia/efeitos adversos , Discotomia/economia , Feminino , Humanos , Laminectomia/efeitos adversos , Laminectomia/economia , Região Lombossacral/cirurgia , Masculino , Medicare , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/economia , Estudos Retrospectivos , Fusão Vertebral , Estados Unidos
3.
Tech Vasc Interv Radiol ; 23(4): 100700, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308584

RESUMO

Degenerative lumbar spine disorder (DLSD) is a ubiquitously occurring event that may be induced or accelerated by multiple factors such as from overuse, trauma, genetic predisposition, nutrition deficiency, and others. While our understanding of this degenerative disorder is limited, in terms of prevention, the symptoms from DLSD can be significant and may lead to the reduction in the patient's quality of life and loss of work time. In the Global Burden of Disease Study, low back pain was ranked the highest of 291 different conditions, due to the number of years lost to disability, amounting to 83 million disability-adjusted life years lost in 2010. DLSD contains conditions involving disc degeneration, lumbar spinal stenosis, and spondylolisthesis, including symptoms ranging from low back pain to lower extremity radicular pain and weakness. In this issue, we will be discussing treatments for patients suffering with chronic low back pain from endplate disruption, utilizing basivertebral nerve radiofrequency ablation, also known as the INTRACEPT procedure. This issue will also cover minimally invasive lumbar decompression from lumbar spinal stenosis, due to contributory ligamentum flavum hypertrophy, utilizing the percutaneous image-guided lumbar decompression technique known as the MILD procedure.


Assuntos
Dor Crônica/cirurgia , Descompressão Cirúrgica , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Doenças da Coluna Vertebral/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Manejo da Dor/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(51): e23337, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371065

RESUMO

ABSTRACT: Recently, trans-sacral epiduroscopic laser decompression (SELD) using flexible epiduroscopy and laser system is 1 of the options for minimally invasive surgery in herniated lumbar disc. However, outcomes after SELD in patients with disc herniation of lumbar spine are not proven worldwide. The authors reported clinical, surgical, and radiological outcome after SELD in patients with mild to moderate disc herniation.Between 2015 and 2018, eighty-two patients who underwent SELD for single level disc herniation with a minimum follow-up of 6.0 months were investigated retrospectively. Clinical outcomes were assessed using the visual analog scale for low back and leg pain and Odom's criteria for patient satisfaction. Also, surgical outcomes, including complications, recurrences, and revision surgeries, and radiological outcomes using regular simple radiograph were analyzed.The mean visual analog scale score of low back pain and leg pain improved from 5.43 ±â€Š1.73 and 6.10 ±â€Š1.67 to 2.80 ±â€Š1.43 and 3.58 ±â€Š2.08 at the final follow-up (p < 0.001). On the other hand, according to Odom's criteria, the success rate (excellent or good results at 6 months after surgery) was 58.5%. Surgical complications occurred in 7 patients (8.5%), including dura puncture during the procedure, transient headache or nuchal pain, and transient mild paralysis. The rate of additional procedures after SELD was 17.1% (6 patients of revision surgery and 8 patients of an additional nerve block).Our findings demonstrated that SELD for lumbar disc herniation achieved less favorable patient satisfaction compared with previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.


Assuntos
Descompressão Cirúrgica/métodos , Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Fatores Etários , Índice de Massa Corporal , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Terapia a Laser/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Retorno ao Trabalho/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais
5.
Middle East Afr J Ophthalmol ; 27(2): 142-144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874051

RESUMO

A cerebrospinal fluid (CSF) leak is a rare complication after orbital surgery. We reported a 49-year-old man who presented with CSF leakage after transcaruncular medial wall decompression for proptosis due to thyroid eye disease. He underwent an endoscopic endonasal approach to surgical repair of the defect with nasoseptal flap. Rhinorrhea was stopped immediately after endoscopic repair.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Oftalmopatia de Graves/cirurgia , Pneumocefalia/etiologia , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Exoftalmia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X
6.
Plast Reconstr Surg ; 146(2): 187e-195e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740592

RESUMO

BACKGROUND: Recent clinical experience with migraine surgery has demonstrated both the safety and the efficacy of operative decompression of the peripheral nerves in the face, head, and neck for the alleviation of migraine symptoms. Because of the perceived novelty of these procedures, and the paranoia surrounding a theoretical loss of clinical territory, neurologists have condemned the field of migraine surgery. The Patient Safety Subcommittee of the American Society of Plastic Surgeons ventured to investigate the published safety track record of migraine surgery in the existing body of literature. METHODS: A comprehensive review of the relevant published literature was performed. The relevant databases and literature libraries were reviewed from the date of their inception through early 2018. These articles were reviewed and their findings analyzed. RESULTS: Thirty-nine published articles were found that demonstrated a substantial, extensively replicated body of data that demonstrate a significant reduction in migraine headache symptoms and frequency (even complete elimination of headache pain) following trigger-site surgery. CONCLUSIONS: Migraine surgery is a valid method of treatment for migraine sufferers when performed by experienced plastic surgeons following a methodical protocol. These operations are associated with a high level of safety. The safety and efficacy of migraine surgery should be recognized by plastic surgeons, insurance companies, and the neurology societies.


Assuntos
Descompressão Cirúrgica/métodos , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nervos Periféricos/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Medição da Dor , Resultado do Tratamento
7.
Spine (Phila Pa 1976) ; 45(15): 1017-1023, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675598

RESUMO

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To evaluate the efficacy of the postoperative single-shot bolus of epidural Fentanyl and Bupivicaine in providing pain relief postlumbar decompression surgery. SUMMARY OF BACKGROUND DATA: Despite lumbar decompression's success in alleviating symptoms of sciatica, radiculopathy, and neurogenic claudication, transient back and buttock pain has been a common complaint postoperatively. Providing good postoperative pain alleviation predicts patient's quality of recovery. METHODS: We performed a randomized, double-blinded, clinical trial. Forty-five patients scheduled for lumbar decompression for a year's period who were randomly assigned to receive a postoperative bolus of 10-mL solution of 50 mcg of Fentanyl, 0.125% Bupivacaine, and 0.9% saline solution via an intraoperatively placed epidural catheter immediately after wound closure, before dressing application. Facial pain scale scores (from 0 to 10) were measured at three time points after surgery (fully awake at recovery room, transfer to ward, first postoperative day). Postoperative need for oral analgesics, time to independent ambulation, associated adverse events, and time to hospital discharge were also evaluated. RESULTS: Pain scores were noted to be significantly lower at all time points in the epidural group (P < 0.001). In turn, they also received less on-demand oral pain medications than those in the control group (P = 0.000). The mean time to ambulation was 0.09 days in the epidural group and 0.91 days in the decompression-alone group (P = 0.000). Criteria for hospital discharge were usually met on Day 0 in the epidural and Day 1 in the control group (P = 0.000). Within the study period, only one infection was noted in the epidural group which necessitated additional lumbar spine surgery (4.3%). No adverse events or complications related to Fentanyl use were observed. CONCLUSIONS: A postoperative bolus of Fentanyl and Bupivacaine is effective in reducing early postoperative pain without the related complications of opiod administration. LEVEL OF EVIDENCE: 2.


Assuntos
Analgesia Epidural/métodos , Bupivacaína/administração & dosagem , Descompressão Cirúrgica/tendências , Fentanila/administração & dosagem , Vértebras Lombares/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/tendências , Analgésicos Opioides/administração & dosagem , Descompressão Cirúrgica/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Estudos Prospectivos
8.
Spine (Phila Pa 1976) ; 45(15): E903-E908, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675600

RESUMO

STUDY DESIGN: Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens, which has not previously been reported. OBJECTIVE: Our aim was to explore the possible topographic correlation of the C5 nerve root with regards to its course and regional relation to C6 Chassaignac tubercle. SUMMARY OF BACKGROUND DATA: C5 palsy is reported amongst the most frequent postoperative complications of cervical spinal procedures. We hypothesized that etiologic mechanisms proposed thus far in the current literature, although with some plausible explanation, still cannot explain why the C5 nerve root and not any other level suffer a postoperative palsy. METHODS: Six fresh cadavers had extensive layer by layer dissection performed by two surgeons (one of whom has experience as an anatomy demonstrator and dissector). Roots of brachial plexus were exposed in relation to cervical transverse processes. Photographs were taken at each stage of the exposure. RESULTS: We observed a close relation of the path of the C5 nerve root with the C6 tubercle bilaterally. Moreover, we noted a steeper descent of C5 in comparison with the other adjacent roots. CONCLUSION: Steeper angle of the C5 nerve root and close proximity to C6 Chassaignac tubercle may play a role in predisposing it to neuropraxia. Detailed anatomical photographs on fresh unprocessed cadaveric specimens are novel. Peculiar anatomical features and recent experimental evidence discussed do highlight a postganglionic extraforaminal etiology corresponding well to the demographic meta-analysis data on clinical features of postoperative C5 palsy. Exploring an alternative unified "neurophysiologic stress and critical tipping point" etiological model that encompasses current theories and correlates known metanalyses observations, we believe further studies would be prudent to ascertain/refute these findings. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Paralisia/etiologia , Raízes Nervosas Espinhais/lesões , Raízes Nervosas Espinhais/cirurgia , Cadáver , Vértebras Cervicais/patologia , Descompressão Cirúrgica/métodos , Dissecação/efeitos adversos , Feminino , Humanos , Masculino , Paralisia/patologia , Complicações Pós-Operatórias/etiologia , Raízes Nervosas Espinhais/patologia
9.
Orthop Clin North Am ; 51(3): 361-368, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498954

RESUMO

Carpal tunnel is the most common peripheral compressive neuropathy. Nonoperative management may provide temporary alleviation of symptoms, but in most cases surgical decompression is warranted. There are a multitude of approaches ranging from open release under general anesthesia to wide awake in-office endoscopic carpal tunnel release. The present article describes the technical considerations for the single incision, antegrade approach to endoscopic carpal tunnel release using the SEGWay system and technique.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Nervo Mediano/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Descompressão Cirúrgica/efeitos adversos , Endoscopia/efeitos adversos , Humanos , Resultado do Tratamento
10.
J Vasc Interv Radiol ; 31(5): 795-800, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32359526

RESUMO

From 2015 to 2019, 9 patients underwent ultrasound-guided intranodal lymphangiography for the treatment of a chyle leak following thoracic outlet decompression surgery. Chyle leaks were identified by Lipiodol (Guerbet, Roissy, France) extravasation near the left supraclavicular surgical bed in all patients. The technical success rate of thoracic duct embolization was 67% (6 of 9), including fluoroscopic transabdominal antegrade access (n = 4) and ultrasound-guided retrograde access in the left neck (n = 2). Clinical success was achieved in 89% of patients (8 of 9). The mean interval from lymphangiography to drain removal was 6.6 days (range, 4-18 d). No patients had a chyle leak recurrence during clinical follow-up (mean, 304 d).


Assuntos
Quilo/diagnóstico por imagem , Descompressão Cirúrgica/efeitos adversos , Embolização Terapêutica , Linfografia , Ducto Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Ducto Torácico/lesões , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
Ann Vasc Surg ; 68: 141-150, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32439529

RESUMO

BACKGROUND: Vertebral artery (VA) stenosis as a cause of ischemic events and its surgical treatment is an overlooked subject. After reporting our initial results, the results of VA stenosis operations and the follow-up studies are analyzed. MATERIAL AND METHODS: This retrospective, single-center study includes 43 symptomatic proximal VA stenosis patients between September 2012 and March 2019. The demographics and clinical data were obtained from the hospital records. Doppler ultrasonography and computed tomography angiography were used to establish the diagnosis and for follow-up. The surgical procedures were as follows: VA transposition in 30 (69.8%), VA bypass 8 (18.6%), saphenous vein interposition in VA in 4 (9.3%), and decompression of kinking in 1 (2.3%) patient. Eleven patients (25.5%) had concomitant carotid surgery. The Kaplan-Meier method was used to calculate the survival and patency rates. RESULTS: Most common symptoms were vertigo and loss of balance in 38 (88.4%) and 14 (32.6%) patients, respectively. Twenty-five patients were males (58.1%), and the average age was 64.6 ± 9.8 (50-90) years. The 30-day death, 30-day stroke, and 30-day death/stroke rates were 2.3%, 4.7%, and 7%, respectively. Ten patients (23.3%) had morbidities which were related to the intervention. Horner syndrome was found in 5 (11.6%) patients, and facial nerve injury was found in one (2.3%) patient. Three (7.1%) patients died during the follow-up period, and overall survival of the patients at 3 years was 91.4% ± 5.8%. Two (4.7%) patients had cerebrovascular events (CVEs) occurred during the follow-up. One- and three-year CVE-free survivals were 97.1% ± 2.9% and 90.1% ± 7.2%, respectively. Two patients (5.4%) had restenosis. One- and three-year patency of VA after procedure was 89.1% ± 7.4%. Thirty-seven (86%) patients had complete recovery of symptoms after surgery; 5 patients (11.6%) kept their preoperative symptoms in different levels. CONCLUSIONS: Vertebral artery surgery can be performed with acceptable mortality and morbidity rates. Restenosis-free, CVE-free, and overall survival rates are satisfactory.


Assuntos
Descompressão Cirúrgica , Veia Safena/transplante , Enxerto Vascular , Insuficiência Vertebrobasilar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/mortalidade , Grau de Desobstrução Vascular , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade , Insuficiência Vertebrobasilar/fisiopatologia
13.
J Clin Neurosci ; 77: 157-162, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32387254

RESUMO

Menopause leads to fluctuations in androgenic hormones which directly affect bone metabolism. Bone resorption, mineralization, and remodeling at fusion sites are essential in order to obtain a solid and biomechanically stable fusion mass. Bone metabolic imbalance seen in the postmenopausal state may predispose to fusion related complications. The aim of this study was to investigate fusion outcomes in lumbar spinal fusion surgery in women based on menopausal status. A retrospective analysis of all female patients who underwent posterior lumbar decompression and fusion at a single institution from 2013 to 2017 was performed. A total of 112 patients were identified and stratified into premenopausal (n = 25) and postmenopausal (n = 87) groups. Clinical and radiographic data was assessed at 1 year follow up. Postmenopausal patients had a higher rates of pseudarthrosis (11.63% vs 0%, p = 0.08), PJK (15.1% vs 4%, p = 0.14), and revision surgery (3.5% vs 0%, p = 0.35). The number of levels fused was associated with increased risk of pseudarthrosis (OR 1.4, p = 0.02); however, there was no association between age, hormonal use, prior tobacco use, or T-score. Age was associated with increased risk of developing PJK (OR = 1.11, p = 0.01); however, PJK was not associated with menopause, hormonal use, prior tobacco use, or T-score. Revision surgery was not associated with age, hormonal use, prior tobacco use, or T-score. This study suggests that postmenopausal women may be prone to have higher rates of pseudarthrosis, PJK and revision surgery, although our results were not statistically significant. Larger studies with longer follow up will help elucidate the true effects of menopause in spine surgery.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Cifose/cirurgia , Menopausa/fisiologia , Complicações Pós-Operatórias/epidemiologia , Pseudoartrose/epidemiologia , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Cifose/epidemiologia , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade
14.
J Clin Neurosci ; 77: 181-184, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32360164

RESUMO

Degenerative Cervical Myelopathy (DCM) is a common condition which causes significant disability and reduces health-related quality of life. The only evidence-based treatment and current management guidance is surgery to decompress the spinal cord and stop further damage in moderate to severe cases. However, this guidance is mainly informed by studies that only include first time surgery and/or single level disease, but DCM can reoccur after primary surgery and affect multiple levels of the spine. It is unclear whether patients in these subgroups; repeat surgery and multi-level DCM, differ significantly in their baseline and disease characteristics from those with single-level, single-operation disease. To investigate this, we conducted an online survey of people with DCM looking at key demographic, disease (e.g. mJOA) and treatment characteristics. We received a total of 778 respondents, of which 159 (20%) had undergone surgery for DCM. Around 75% of these respondents had a single operation and 65% at a single level. We found no statistically significant difference in key participant and disease characteristics between respondents with single-level or single-operation and those with multi-level DCM or multiple operations. These data support generalisability of research to these subgroups but also warrants further investigations as these subgroups are underrepresented in current research.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Degeneração do Disco Intervertebral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Qualidade de Vida
15.
World Neurosurg ; 139: 526-534, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360928

RESUMO

BACKGROUND: Patient counseling and selection for surgical therapy in adult Chiari malformation type I (CM-1) remain debatable. We aimed to develop a clinical calculator predicting the risk of nonhome discharge and reoperation using the American College of Surgeons-National Surgical Quality Improvement Program database. METHODS: The database from years 2011 through 2017 was queried to identify the subset of CM-1 patients undergoing suboccipital decompression. Univariable analysis was conducted to identify baseline factors associated with nonhome discharge and 30-day reoperation following the initial decompression procedure. Logistic regression and the Akaike Information Criterion were used to identify the optimal models predictive of both outcomes. Performance was assessed using receiver operating curves and validated with bootstrapping. RESULTS: In 706 CM-1 patients, the rate of nonhome discharge was 5.2% and the reoperation rate was 6.6% with most reoperations consisting of cerebrospinal fluid flow diversion and cerebrospinal fluid leak repair. The optimal model predictive of nonhome discharge consisted of age (odds ratio [OR] = 1.05, P = 0.001), diabetes (OR = 2.44, P = 0.080), and American Society of Anesthesiologists class (OR = 1.94, P = 0.082) with an area under the curve of 0.720. The optimal model predictive of reoperation consisted of female sex (OR = 0.48, P = 0.031), body mass index (OR = 1.05, P = 0.002), and ASA class (OR = 3.44, P = 0.001) with an area under the curve of 0.726. A calculator for both outcomes was deployed under the following URL: https://jhuspine3.shinyapps.io/Discharge_Reop_Calculator/. CONCLUSIONS: We have used a large international database to develop a simple risk calculator based on readily available preoperative variables. Following subsequent validation, this tool can help optimize patient counseling and decision making in adult CM-1.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Bases de Dados Factuais/normas , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/normas , Internacionalidade , Lobo Occipital/cirurgia , Adulto , Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/epidemiologia , Estudos de Coortes , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/normas , Readmissão do Paciente/normas , Reoperação/efeitos adversos , Reoperação/métodos , Reoperação/normas , Medição de Risco/normas
16.
Ann Vasc Surg ; 68: 28-33, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32335257

RESUMO

BACKGROUND: Short-term outcomes in patients with all forms of TOS have been widely reported in the literature and have established that rib resection can be beneficial in decompressing the thoracic outlet and relieving pressure on traversing structures. We sought to determine long-term functional outcomes using the Disability of the Arm, Shoulder, and Hand (QuickDASH) survey in patients with TOS who underwent rib resection. METHODS: Clinical records for patients who underwent rib resection for TOS at a single institution were retrospectively reviewed. All patients were contacted via telephone and long-term functional outcome was assessed at latest follow-up via the 11-item version of the QuickDASH questionnaire. Demographics, TOS type, preoperative QuickDASH score, and athletic status were recorded. Patients were asked if they returned to baseline activity since their surgery, would have the procedure again, and if they were subjectively better postoperatively. RESULTS: From 2000 to 2018, 261 patients underwent rib resection surgery. One hundred seventy patients (65.1%) were able to be contacted via telephone for long-term follow-up. A total of 188 surgeries (102 neurogenic thoracic outlet syndrome, 82 venous thoracic outlet syndrome, 4 arterial thoracic outlet syndrome) were performed in these 170 patients. The mean follow-up time for the cohort was 5.3 years (range 1-18). Overall, 167 (88.9%) patients returned to baseline activity postoperatively. Postop QuickDASH decreased to 12 from 44 preoperatively for the cohort. CONCLUSIONS: First rib resection and thoracic outlet decompression for all forms of TOS is a durable surgical treatment which results in excellent long-term functional outcomes as determined by both the QuickDASH score and subjective patient reporting.


Assuntos
Descompressão Cirúrgica/métodos , Osteotomia , Costelas/cirurgia , Síndrome do Desfiladeiro Torácico/cirurgia , Atividades Cotidianas , Adolescente , Adulto , Descompressão Cirúrgica/efeitos adversos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Satisfação do Paciente , Recuperação de Função Fisiológica , Estudos Retrospectivos , Volta ao Esporte , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Plast Reconstr Surg ; 145(5): 1197-1203, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332539

RESUMO

BACKGROUND: The authors conducted a prospective study to compare patients' intraoperative experience of open carpal tunnel release under "wide awake, local anesthesia, no tourniquet" (WALANT) on the one hand and intravenous regional anesthesia on the other. The authors hypothesized that WALANT would offer a better intraoperative experience than intravenous regional anesthesia. METHODS: Twenty-four patients with bilateral carpal tunnel syndrome had one hand operated on using WALANT and the contralateral hand with the intravenous regional anesthesia method. At the postoperative second hour, patients completed a questionnaire to quantify their pain levels on a numerical rating scale and compare the operation with dental procedures. They were also asked about their expectations and feelings about reoperation with the anesthesia methods. The results were compared for the two anesthesia methods. RESULTS: There were no significant differences between numerical rating scale pain values during anesthetic administration or for surgical site pain on the WALANT and intravenous regional anesthesia sides. Patients reported moderate tourniquet pain for intravenous regional anesthesia sides. For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than dental procedures (91.6 percent WALANT and 37.5 percent intravenous regional anesthesia). For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than they expected (91.6 percent WALANT and 50 percent intravenous regional anesthesia). For the reoperation, 83.3 percent of patients preferred WALANT, 8.3 percent preferred intravenous regional anesthesia, and 8.3 percent reported no preference. CONCLUSIONS: WALANT offered a better intraoperative experience. Tourniquet pain, preoperative preparation basics, and the extended anesthesia duration are likely the major drawbacks of the intravenous regional anesthesia method.


Assuntos
Anestesia Intravenosa/métodos , Anestesia Local/métodos , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/efeitos adversos , Dor Pós-Operatória/diagnóstico , Adulto , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Preferência do Paciente , Estudos Prospectivos , Torniquetes/efeitos adversos , Vigília
18.
World Neurosurg ; 138: e515-e522, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147550

RESUMO

OBJECTIVE: For adult patients undergoing surgical decompression for Chiari malformation type I (CM-I), the patient-level factors that influence extended length of stay (LOS) are relatively unknown. The aim of this study was to investigate the impact of patient-baseline comorbidities, demographics, and postoperative complications on extended LOS after intervention after adult CM-I decompression surgery. METHODS: A retrospective cohort study using the National Inpatient Sample years 2010-2014 was performed. Adults (≥18 years) with a primary diagnosis of CM-I undergoing surgical decompression were identified. Weighted patient demographics, comorbidities, complications, LOS, disposition, and total cost were recorded. A multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. RESULTS: A total of 29,961 patients were identified, 6802 of whom (22.7%) had extended LOS. The extended LOS cohort had a significantly greater overall complication rate (normal LOS, 10.6% vs. extended LOS, 29.1%; P < 0.001) and total cost (normal LOS, $14,959 ± $6037 vs. extended LOS, $25,324 ± $21,629; P < 0.001) compared with the normal LOS cohort. On multivariate logistic regression, black race, income quartiles, private insurance, obstructive hydrocephalus, lack of coordination, fluid and electrolyte disorders, and paralysis were all independently associated with extended LOS. Additional duraplasty (P = 0.132) was not significantly associated with extended LOS after adjusting for other variables. The odds ratio for extended LOS was 2.07 (95% confidence interval, 1.59-2.71) for patients with 1 complication and 9.47 (95% confidence interval, 5.86-15.30) for patients with >1 complication. CONCLUSIONS: Our study shows that extended LOS after adult CM-I decompression surgery may be influenced by multiple patient-level factors.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Descompressão Cirúrgica/efeitos adversos , Adulto , Fatores Etários , Dura-Máter/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
19.
World Neurosurg ; 138: 73-76, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32145413

RESUMO

BACKGROUND: Minimally invasive endoscopic spine surgery is useful for the treatment of various spinal conditions. Although surgery-related complications such as dural injury, exiting nerve root injury, incomplete decompression, and hematoma have been reported, there are few reports of late complications after endoscopic surgery. CASE DESCRIPTION: A 51-year-old man complained of radiating pain to the right leg. The patient underwent endoscopic foraminal decompression under the diagnosis of foraminal stenosis with isthmic type spondylolisthesis (L5-S1). The lower extremity radiating pain was improved after surgery. Six weeks after surgery, the patient's symptoms recurred. The patient experienced a sudden onset of severe low back pain, which was aggravated by any motion of the lumbar spine. Computed tomography scan and magnetic resonance imaging revealed a fracture line with a sclerotic margin at the base of the right pedicle at the L5 level. Because the symptoms significantly interfered with his normal activities of daily living, the patient was treated with a total laminectomy, followed by posterior instrumented fusion. As the indication for endoscopic spinal surgery is widening, endoscopic decompression surgery is being performed for patients with low-grade lumbar spondylolisthesis, regardless of the presence of advanced spinal instability. However, endoscopic decompression surgery may cause damage to the posterior facet joint, which may have worsened the instability and lead to late complications such as progression of spondylolisthesis and pedicle stress fracture. CONCLUSIONS: The surgeon should carefully review risk factors such as isthmic type spondylolisthesis before planning spine surgery and minimize facet joint damage during endoscopic decompression.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Endoscopia/efeitos adversos , Forame Magno/cirurgia , Fraturas de Estresse/etiologia , Fraturas de Estresse/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Espondilolistese/complicações , Espondilolistese/cirurgia , Lateralidade Funcional , Humanos , Instabilidade Articular/cirurgia , Laminectomia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fusão Vertebral
20.
Zhonghua Yan Ke Za Zhi ; 56(3): 183-188, 2020 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-32187946

RESUMO

Objective: To evaluate the effect of extraocular muscle surgery in treating secondary esotropia with diplopia after orbital decompression for thyroid-associated ophthalmopathy (TAO). Methods: Retrospective case series study. Eleven secondary esotropic patients with diplopia after orbital decompression for TAO who underwent extraocular muscle surgery during March 2016 and October 2018 in Tianjin Eye Hospital were included. All patients had new onset esotropia after decompression surgery and underwent strabismus surgery. Deviation angle, diplopia, and ocular movement were observed preoperatively and postoperatively. Surgeries were carried out under the monitored anesthesia care combined with local anesthesia, and the eye alignment was adjusted to orthotropia with no diplopia in the operation with the technique of intraoperative adjustable suture and forced duction test results. All the patients were followed up. Results: The ages of the patients were from 26 to 42 years (1 male and 10 females). The deviation angles were 10-98 prism diopter. Orbital CT scan showed that the horizontal rectus thickness was increased at different levels, and the thickness of the medial rectus was increased more than that of the lateral rectus. Two patients had monocular medial rectus recession only, 2 had bilateral medial rectus recession only, 2 had monocular medial rectus recession combined with lateral rectus resection, and the other 5 had bilateral medial rectus recession with monocular lateral rectus resection. The recession of medial rectus muscle was 3.5 to 7.5 mm in 11 patients and 2.0 to 6.0 mm in 7 patients with the resection of lateral rectus muscle. Diplopia of the 11 patients disappeared with orthotropia at primary gaze position after the extraocular muscle surgery. The limitation of abduction changed from preoperative (-1.91±1.04) to postoperative (-0.64±0.81). All the patients were satisfied with the surgical results. At the end of the follow-up (6 to 24 months), the results of the patients were stable, and no over-correction was found. Conclusion: Extraocular muscle surgery with intraoperative adjustable suture technique can effectively treat TAO patients with secondary esotropia with diplopia after orbital decompression. (Chin J Ophthalmol, 2020, 56: 183-188).


Assuntos
Descompressão Cirúrgica/efeitos adversos , Diplopia/etiologia , Esotropia/etiologia , Oftalmopatia de Graves/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Estrabismo/cirurgia , Adulto , Feminino , Humanos , Masculino , Músculos Oculomotores/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Visão Binocular
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