Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.329
Filtrar
1.
Neurology ; 96(1): e131-e140, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33093228

RESUMO

OBJECTIVE: To test the hypothesis that there was a temporal change in the retinal microstructure after decompression surgery for chiasmal compression, the 1-year longitudinal changes in the inner and outer retinal thickness after decompression surgery were analyzed using spectral-domain optical coherence tomography (SD-OCT) with linear mixed-effects models. METHODS: SD-OCT was obtained from 87 eyes with chiasmal compression and compared to 100 healthy controls. The preoperative and 1-year postoperative longitudinal changes in the retinal layer thickness were measured. The thickness of each of the following retinal layers was analyzed: the macular retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), the inner plexiform layer (IPL), the inner nuclear layer, the outer plexiform layer, the outer nuclear layer, and the photoreceptor layer. RESULTS: The RNFL, GCL, and IPL showed thinning at a rate of 1.068 µm/y (95% confidence interval [CI], 0.523, 1.613), 1.189 µm/y (95% CI 0.452, 1.925), and 1.177 µm/y (95% CI 0.645, 1.709), respectively, after decompression surgery. The preoperative thickness of the intraretinal layer was associated with postoperative visual field recovery (RNFL, odds ratio [OR] 1.221, 95% CI 1.058, 1.410; GCL, OR 1.133, 95% CI 1.024, 1.254; and IPL, OR 1.174, 95% CI 1.002, 1.376). CONCLUSIONS: The changes in retinal microstructure persisted and progressed in eyes with chiasmal compression after decompression surgery. The findings provide insight into the biological and anatomical sequelae following chiasmal compression. The preoperative thickness of the inner retinal layers was associated with postoperative visual field recovery.


Assuntos
Síndromes de Compressão Nervosa/cirurgia , Quiasma Óptico/cirurgia , Recuperação de Função Fisiológica , Retina/patologia , Adulto , Idoso , Estudos de Coortes , Descompressão Cirúrgica/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/patologia , Quiasma Óptico/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Campos Visuais
2.
Medicine (Baltimore) ; 99(52): e23853, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350777

RESUMO

INTRODUCTION: The association of human immunodeficiency virus (HIV) infection with Burkitt lymphoma is related to the presence of Epstein Barr virus infection and the impact of the HIV antigen on the expansion of B-polyclonal cells. In Southeast Europe, the association is rare, and recognizing this is important in the therapeutic decision to increase patient survival rate. The association of HIV with Burkitt lymphoma and tuberculosis is even more rarely described in the literature. PATIENT CONCERNS: We present the case of a 40-year-old patient who presented with a 3-week history of fever (max. 38.7 °C), painful axillary swelling on the right side, lumbar pain, gait disorders, headache, and night sweats. Clinical manifestations included marked weight loss (about 30 kg in the last 2 months before his admission). DIAGNOSIS: A LyCD4 count of 38/µL and a HIV1 viral load of 384,000/mm3, classified the patient into a C3 stage. A biopsy of the right axillary lymph node was performed for suspected ganglionic tuberculosis due to immunodeficiency. Histopathological examination confirmed the diagnosis of Burkitt lymphoma. Cultures on Löwenstein-Jensen medium from sputum harvested at first admission were positive for Mycobacterium tuberculosis. INTERVENTIONS: Highly active antiretroviral therapy, chemotherapeutic agents for Burkitt lymphoma, anti-tuberculous drug therapy, neurosurgical intervention of spinal cord decompression, and antibiotic therapy of the associated bacterial infection. OUTCOME: Burkitt lymphoma disseminated rapidly, with central nervous system, spinal cord, osteomuscular, adrenal, and spleen involvement. The evolution under treatment was unfavorable, with patient death occurring 6 months after diagnosis. CONCLUSIONS: The association of HIV infection with Burkitt lymphoma and tuberculosis is rare in the highly active antiretroviral therapy (HAART) era, posing prompt and multidisciplinary therapeutic management issues. Similar cases of HIV-TB and Burkitt lymphoma association have been described, but none of the other cases showed the involvement of the central nervous system or of the bilateral adrenal glands.


Assuntos
Antineoplásicos/administração & dosagem , Terapia Antirretroviral de Alta Atividade/métodos , Antituberculosos/administração & dosagem , Encéfalo , Linfoma de Burkitt , Infecções por HIV , Medula Espinal , Tuberculose Pulmonar , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Linfoma de Burkitt/complicações , Linfoma de Burkitt/patologia , Linfoma de Burkitt/fisiopatologia , Linfoma de Burkitt/cirurgia , Contagem de Linfócito CD4/métodos , Deterioração Clínica , Descompressão Cirúrgica/métodos , Evolução Fatal , Infecções por HIV/sangue , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Medula Espinal/cirurgia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/fisiopatologia , Tuberculose Pulmonar/terapia , Carga Viral/métodos
3.
JAMA Netw Open ; 3(11): e2024352, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33231636

RESUMO

Importance: Cubital tunnel syndrome is the second most common compressive neuropathy, affecting 6% of the population. Numerous different operations are performed globally to treat it; however, prior conventional (pairwise) meta-analyses have been unable to determine which procedure is associated with the best outcomes and fewest complications. Objective: To evaluate which operation for cubital tunnel syndrome is associated with the greatest likelihood of symptomatic cure. Data Sources: PubMed, EMBASE, and CENTRAL were searched from database inception to March 2, 2019, with no restrictions on the setting or design of studies. Study Selection: Experimental and observational studies directly comparing the outcomes of at least 2 surgical treatments for adults with primary cubital tunnel syndrome were included. Case reports were excluded, and when comparative studies had subgroups with 1 participant, the single-participant subgroup was excluded. The treatments had to be in situ decompression with or without medial epicondylectomy or an anterior subcutaneous, subfascial, intramuscular, or submuscular transposition. The access could be open, minimally invasive, or endoscopic. The comparator could be sham surgery or any operation mentioned earlier. Data Extraction and Synthesis: Data were extracted by 2 independent reviewers, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and the PRISMA Network Meta-analysis extension statement. Network meta-analysis was used to estimate the relative efficacy and safety associated with interventions using relative risks. Surgical techniques were ranked by their probability of being the best (P score) and interpreted in terms of their clinical impact. Main Outcomes and Measures: The primary outcome was response to treatment (ie, symptomatic improvement). The secondary outcomes were perioperative complications, reoperation, and recurrence. Results: A total of 30 studies of 2894 limbs undergoing 8 different operations were included. Across the studies, 56% of participants were men, the mean (SD) age was 48 (8) years, and patients had symptoms for a mean (SD) of 15 (7) months. Overall, 87% (95% CI, 92%-91%) of patients improved with surgery; all forms of in situ decompression were more effective than any type of transposition procedure; for example, open in situ decompression with epicondylectomy was associated with higher success rates than subcutaneous transposition (relative risk, 1.13; 95% CI, 1.01-1.25). Postoperatively, 3% (95% CI, 2%-4%) of patients developed complications, and in situ decompressions were ranked as the least risky, although there was considerable uncertainty in this outcome. Overall, 2% (95% CI, 1%-3%) of patients required reoperation; open in situ decompression was associated with the fewest reoperations; in comparison, submuscular transposition was associated with 5 times the risk of reoperation (relative risk, 5.08; 95% CI, 2.06-12.52). During surveillance, 3% (95% CI, 1%-4%) of patients developed recurrence, and open in situ decompression with epicondylectomy was ranked as the safest operation, although there was uncertainty in the estimates. Conclusions and Relevance: In this network meta-analysis, open in situ decompression (with or without medial epicondylectomy) appeared to be the safest operation and also was associated with the best outcomes for patients with primary cubital tunnel syndrome. Future research should focus on better defining this disorder and developing core outcome measures.


Assuntos
Síndrome do Túnel Ulnar/cirurgia , Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Adulto , Síndrome do Túnel Ulnar/diagnóstico , Descompressão Cirúrgica/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/epidemiologia , Recidiva , Reoperação/estatística & dados numéricos , Segurança , Resultado do Tratamento
5.
Clin Orthop Surg ; 12(3): 330-336, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32904063

RESUMO

Backgroud: Biportal endoscopic unilateral laminectomy for bilateral decompression (ULBD) is an emerging minimally invasive procedure for spinal stenosis. However, reports of the results associated with this surgical method are still lacking. Methods: We conducted a retrospective study of 60 patients who underwent bilateral decompression for lumbar central canal stenosis. The patients were divided into 2 groups according to the surgical method (endoscopic ULBD vs. microscopic ULBD). We compared the outcomes between the 2 groups in terms of postoperative segmental spinal instability, dura expansion, operation time, estimated blood loss, serum creatine kinase (CK), serum C-reactive protein (CRP), visual analog scale (VAS) score, Oswestry Disability Index (ODI), modified MacNab score, and the incidence of complications. Results: The mean VAS, ODI, and modified MacNab score improved significantly from the preoperative period to the last follow-up in both groups and were better in the endoscopic ULBD group until the first day after treatment. The degree of horizontal displacement was lower in the endoscopic ULBD group than in the microscopic ULBD group at postoperative 12 months. Dura expansion, operation time, and estimated blood loss did not differ significantly between the 2 groups. Serum CK and CRP on the first day after treatment were lower in the endoscopic ULBD group than in the microscopic ULBD group. Conclusions: This study shows that both endoscopic ULBD and microscopic ULBD can provide favorable outcomes for lumbar central canal stenosis. However, compared to microscopic ULBD, endoscopic ULBD has advantages in terms of postoperative segmental spinal instability, pain control, and serum CK and CRP.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Laminectomia/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Medição da Dor , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(38): e21973, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957316

RESUMO

OBJECTIVE: The goal of this study was to review relevant studies in order to determine the efficacy of decompression with fusion versus decompression in the treatment of lumbar spinal stenosis. METHODS: Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios, mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. RESULTS: We found 13 studies that were consistent with this meta-analysis with a total of 29066 patients. Compared with decompression, decompression with fusion significantly increased the incidence of complications (RR: 1.41, 95%CI: 1.26-1.57), the length of hospital stay (WMD: 1.868, 95%CI: 1.394-2.343), operative time (WMD: 80.399, 95%CI: 44.397-116.401), estimated blood loss (WMD: 309.356, 95%CI: 98.008-520.704) and Zurich claudication questionnaire in symptom severity (WMD: 0.200, 95%CI: 0.006-0.394). The reoperation rate was lower in the decompression with fusion group than the decompression group but without significant difference (RR: 0.91, 95%CI: 0.82-1.00). There was no significant difference between 2 groups in visual analog scale (leg pain and back pain), ODI, Short Form 36 Health Survey physical component summary, Short Form 36 Health Survey mental component summary, and Zurich claudication questionnaire physical function. CONCLUSION: Decompression with fusion has no significant clinical advantages in treatment of lumbar spinal stenosis when compared with decompression.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação
7.
JAMA Netw Open ; 3(9): e2015015, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32910195

RESUMO

Importance: Conflicting evidence and large practice variation are present in the surgical treatment of degenerative spondylolisthesis. More than 90% of surgical procedures in the United States include instrumented fusion compared with 50% or less in other countries. Objective: To evaluate whether the effectiveness of microdecompression alone is noninferior to decompression with instrumented fusion in a real-world setting. Design, Setting, and Participants: This multicenter comparative effectiveness study with a noninferiority design assessed prospective data from the Norwegian Registry for Spine Surgery. From September 19, 2007, to December 21, 2015, 1376 patients at 35 Norwegian orthopedic and neurosurgical departments underwent surgery for lumbar spinal stenosis with degenerative spondylolisthesis without scoliosis. After excluding patients undergoing laminectomy alone, fusion without instrumentation, or surgery in more than 2 levels and those with a former operation at the index level, 794 patients were included in the analyses, regardless of missing or incomplete follow-up data, before propensity score matching. Data were analyzed from March 20 to October 30, 2018. Exposures: Microdecompression alone or decompression with instrumented fusion. Main Outcomes and Measures: A reduction from baseline of 30% or greater in the Oswestry Disability Index at 12-month follow-up. Results: After propensity score matching, 570 patients (413 female [72%]; mean [SD] age, 64.7 [9.5] years) were included for comparison, with 285 undergoing microdecompression (mean [SD] age, 64.6 [9.8] years; 205 female [72%]) and 285 undergoing decompression with instrumented fusion (mean [SD] age, 64.8 [9.2] years; 208 female [73%]). The proportion of each type of procedure varied between departments. However, changes in outcome scores varied within patients but not between departments. The proportion of patients with improvement in the Oswestry Disability Index of at least 30% was 150 of 219 (68%) in the microdecompression group and 155 of 215 (72%) in the instrumentation group. The 95% CI (-12% to 5%) for the difference of -4% was above the predefined margin of noninferiority (-15%). Microdecompression alone was associated with shorter operation time (mean [SD], 89 [44] vs 180 [65] minutes; P < .001) and shorter hospital stay (mean [SD], 2.5 [2.4] vs 6.4 [3.0] days; P < .001). Conclusions and Relevance: Among patients with degenerative spondylolisthesis, the clinical effectiveness of microdecompression alone was noninferior to that of decompression with instrumented fusion. Microdecompression alone was also associated with shorter durations of surgery and hospital stay, supporting the suggestion that the less invasive procedure should be considered for most patients.


Assuntos
Descompressão Cirúrgica , Vértebras Lombares , Fusão Vertebral , Estenose Espinal , Espondilolistese , Pesquisa Comparativa da Efetividade , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Noruega , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Sistema de Registros/estatística & dados numéricos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/cirurgia , Espondilolistese/diagnóstico , Espondilolistese/etiologia , Espondilolistese/cirurgia , Resultado do Tratamento
8.
Pain Physician ; 23(5): E475-E486, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32967398

RESUMO

BACKGROUND: Previous surgical procedures for the treatment of thoracic myelopathy (TM) due to ossification of the ligamentum flavum (OLF) were accompanied by significant trauma and risk. OBJECTIVES: Report a novel minimally invasive technique, translaminar osseous channel-assisted posterior percutaneous full-endoscopic flavectomy (p-PEF), as an alternative surgical strategy for the treatment of OLF-related TM. STUDY DESIGN: A retrospective cohort study. SETTING: A center for spine surgery and pain medicine. METHODS: Thirteen patients with TM caused by isolated OLF who underwent translaminar osseous channel-assisted p-PEF were retrospectively analyzed. Preoperative and postoperative radiographic findings and clinical results were compared to confirm the efficacy of the procedure and perioperative complications were investigated to evaluate the technical safety. RESULTS: All 13 patients with 23 isolated ossified sites were successfully treated with the translaminar osseous channel-assisted p-PEF technique and no additional internal fixation was needed. With an average follow-up of 29.2 months (range, 24-36 months), no local instability was detected. The preoperative and final follow-up cross-sectional area of the stenotic dural sac was 47.87 ± 8.98 mm2 and 130.47± 19.07 mm2, respectively (P < 0.0001). The mean modified Japanese Orthopaedic Association score was significantly improved from 3.54 ± 1.26 points preoperatively to 9.07 ± 1.48 points at final follow-up (P < 0.0001). The Visual Analog Scale scores of thoracolumbar backaches were 5.3 ± 1.2 before surgery and 0.69 ± 0.75 at final follow-up (P = 0.001). No serious complications ensued. LIMITATIONS: This was a retrospective study with several limitations, including the lack of a control group, small number of included samples and unavoidable nature of the single-center study design. CONCLUSIONS: Translaminar osseous channel-assisted p-PEF technique, with less tissue trauma and impact on the stability of the spine, can provide adequate decompression and satisfying outcomes in the treatment of OLF-related TM and should be considered as an alternative procedure for isolated OLF.


Assuntos
Descompressão Cirúrgica/métodos , Neuroendoscopia/métodos , Ossificação do Ligamento Longitudinal Posterior/complicações , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Adulto , Idoso , Feminino , Humanos , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas/cirurgia
9.
Artigo em Inglês | MEDLINE | ID: mdl-32910565

RESUMO

Thoracic outlet syndrome is a collective term for symptoms that occur due to the impingement of the neurovascular structures in the thoracic outlet. Diagnosing thoracic outlet syndrome can be challenging since it can give rise to a broad spectrum of symptoms. Transaxillary or supraclavicular first rib resection are the most commonly used approaches for surgical treatment after failure of conservative measures.  In this video tutorial we demonstrate a robotic-assisted thoracoscopic surgery first rib resection for achieving a decompression of the thoracic outlet.


Assuntos
Descompressão Cirúrgica , Procedimentos Cirúrgicos Robóticos/métodos , Síndrome do Desfiladeiro Torácico/cirurgia , Procedimentos Cirúrgicos Torácicos , Adulto , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Feminino , Humanos , Síndrome do Desfiladeiro Torácico/fisiopatologia , Procedimentos Cirúrgicos Torácicos/instrumentação , Procedimentos Cirúrgicos Torácicos/métodos , Resultado do Tratamento
10.
Sci Rep ; 10(1): 14135, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32839532

RESUMO

Despite the importance of sleep and the evidence on its relationship with various chronic diseases, quality of sleep is not considered in patients with lumbar spinal stenosis (LSS). This prospective comparative study aimed to investigate the changes in sleep disturbance after treatment in patients with LSS. Patients with LSS and sleep disturbance (n = 201; 147 conservatively treated and 54 patients with surgical treatment) were included. The Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality. Propensity score matching was used to attenuate the potential bias. Clinical outcome of surgery, as determined by the Oswestry disability index, and the PSQI was compared between the two groups at 6 weeks, 3 months, and 6 months after enrollment. Multivariate logistic analysis was performed to adjust for possible confounders within the matched cohorts. Among the 201 patients, 96 (47.7%) patients were finally matched (48 patients in each group). Sleep quality was initially improved after treatment, regardless of the treatment method. Sleep quality in the surgical group was improved by 6 weeks after surgery and consistently improved during the 6-month follow-up period, despite less use of pain killer. Conversely, the improvement in sleep quality at 6-weeks following conservative treatment was not maintained during the follow-up, although the treatment outcome for LSS measured by ODI was continuously improved. After multivariate logistic regression analysis within propensity score matched cohorts, surgical treatment had a significantly greater chance to improve sleep quality compared to conservative treatment. The failure of sleep improvement in conservative group was significantly associated with depression presented by worse score in Hamilton depression rating scale, and more severe degree of foraminal-type stenosis, which should be carefully considered for conservative treatment of LSS patients with sleep disturbance.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Transtornos do Sono-Vigília/terapia , Sono/fisiologia , Estenose Espinal/cirurgia , Idoso , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Depressão/complicações , Feminino , Gabapentina/uso terapêutico , Humanos , Vértebras Lombares/patologia , Masculino , Pregabalina/uso terapêutico , Pontuação de Propensão , Estudos Prospectivos , Medicamentos Indutores do Sono/uso terapêutico , Inquéritos e Questionários , Resultado do Tratamento
11.
Clin Interv Aging ; 15: 1213-1219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821088

RESUMO

Purpose: Percutaneous transforaminal endoscopic decompression (PTED) is an ultra-minimally invasive surgical option for patients that does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy. The objective of this study was to describe the procedure of PTED under local anesthesia for geriatric patients with central spinal stenosis and degenerative lumbar spondylolisthesis (CSS-DLS). Materials and Methods: From January 2016 to December 2018, 30 consecutive geriatric patients who underwent surgery for single-level CSS-DLS were retrospectively reviewed. All patients were followed for at least 12 months (12-24 months). The visual analog scale (VAS) scores, Oswestry disability index (ODI) scores and modified MacNab criteria were used to evaluate the clinical results. Results: The mean age was 73.1±6.0 years. Follow-up ranged from 12 to 36 months. The mean±SD values of the preoperative VAS for leg pain and ODI were 7.4±1.0 and 67.2±8.4, respectively. The values improved to 2.2±1.1 and 19.9±8.1 at 12 months postoperatively. The outcomes of the modified MacNab criteria showed that 93.3% of patients obtained a good-to-excellent rate. The percent slippage of spondylolisthesis before surgery (13.8±2.5%) and at the end of follow-up (14.0±2.5%) was not significantly different. Conclusion: PTED under local anesthesia could be a useful supplement to traditional decompression in geriatric patients with CSS-DLS.


Assuntos
Descompressão Cirúrgica/métodos , Região Lombossacral/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Idoso , Endoscopia/métodos , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
12.
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
13.
World Neurosurg ; 140: 527-533, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32797985

RESUMO

BACKGROUND: Patient satisfaction is becoming an increasing factor worthy of consideration when evaluating the surgical quality. The correlation between patient satisfaction and surgical outcomes 5 years after cervical hybrid surgery (HS), which incorporates anterior cervical decompression and fusion and cervical disk arthroplasty techniques in multilevel cervical degenerative disk disease, has not been evaluated. METHODS: The aim of this study was firstly to analyze prospectively collected data from a sample of patients (n = 50) treated with cervical HS for selected cases of radiculopathy and myelopathy in order to evaluate pain levels of patients, using the Neck and Arm Pain scale as an expression of visual analog scale. Secondly, we aimed to evaluate health-related quality of life, via the short-form 36, Neck Disability Index, and Japanese Orthopedic Association score. Patients were followed up for more than 5 years. Intraoperative parameters, clinical features, and outcome scores were recorded. Radiologic investigations including disk height and changes in adjacent disk spaces were assessed. RESULTS: Clinical improvements were observed in all outcomes; significant improvements on the Neck Disability Index, visual analog scale, short-form 36, and Japanese Orthopedic Association scores were maintained at 5 years (P < 0.05). The mean disk height resulted restored in all the cases. Temporary dysphagia was rarely observed (3%). No surgery for adjacent-level disease was required. There was no significant difference in the outcomes between radiculopathy and myelopathy groups (P > 0.05). CONCLUSIONS: HS is an effective and safe procedure for the treatment of multilevel cervical degenerative disk disease. Such a surgical construct offers postoperative improvement on pain levels and health-related quality of life.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Degeneração do Disco Intervertebral/cirurgia , Qualidade de Vida , Radiculopatia/cirurgia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Substituição Total de Disco/métodos , Adulto , Idoso , Terapia Combinada , Transtornos de Deglutição/epidemiologia , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Radiculopatia/etiologia , Radiculopatia/fisiopatologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Resultado do Tratamento
14.
World Neurosurg ; 140: 548-555, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32797986

RESUMO

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a degenerative disease that represents the most common spinal cord disorder in adults. The best treatment option has remained controversial. We performed a prospective study to evaluate the clinical, radiographic, and neurophysiologic outcomes for anterior cervical corpectomy in the treatment of CSM. METHODS: From January 2011 to January 2017, 60 patients with CSM were prospectively enrolled in the present study. The patients were divided according to the modified Japanese Orthopaedic Association scale (mJOA) score into 2 groups: group A, patients with mild to moderate CSM (mJOA score ≥13); and group B, patients with severe myelopathy (mJOA score <13). Data were collected for each participating subject, including demographic information, symptoms, medical history, radiologic and neurophysiologic features, and functional impairment. RESULTS: Of the 60 patients, 35 were men (58.3%) and 25 were women (41.7%). Their average age was 57.48 ± 10.60 years. The mean symptom duration was 25.33 ± 16.00 months; range, 3-57 months). Of the 60 patients, 22 had undergone single-level corpectomy and 36 multilevel corpectomy. A significant improvement in the motor evoked potentials was observed in both groups. CONCLUSIONS: Single- and multilevel corpectomy are valid and safe options in the treatment of CSM. In the present prospective study, a statistically significant improvement in the mJOA score and neurophysiologic parameters was observed for both moderate and severe forms of CSM.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Compressão da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Estudos Prospectivos , Índice de Gravidade de Doença , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Fusão Vertebral , Espondilose/complicações , Espondilose/fisiopatologia , Resultado do Tratamento , Adulto Jovem
15.
Sci Rep ; 10(1): 13432, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778718

RESUMO

There are a few studies on the postoperative changes in sagittal alignment and corresponding factors, including hand grip strength (HGS) and muscle performance tests for lumbar spinal stenosis (LSS). Thus, we aimed to determine whether HGS can be a surrogate marker for global sagittal alignment changes after decompression with fusion surgery for LSS. This retrospective observational study included 91 patients who underwent spine fusion surgery for LSS. Radiological spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), global tilt (GT), and T1 pelvic angle (T1PA), were analyzed preoperatively and 1 year after posterior decompression and fusion surgery. To assess muscle performance, the 6-m walk (SMT), timed up and go (TUGT), and sit-to-stand (STS) tests were conducted. The relationship between HGS and postoperative SVA was examined through multiple linear regression analysis. Additionally, the relationship between HGS and preoperative/postoperative radiologic spinopelvic parameters and muscle performance test results was analyzed through Pearson's correlation. HGS was significantly correlated with age, preoperative and postoperative SVA, and the muscle performance tests. Furthermore, HGS was a factor that can significantly influence postoperative SVA changes in multiple linear regression analyses. Therefore, HGS may be a good predictor of postoperative SVA change.


Assuntos
Força da Mão/fisiologia , Mãos/fisiologia , Estenose Espinal/cirurgia , Idoso , Biomarcadores , Descompressão Cirúrgica/métodos , Feminino , Humanos , Lordose/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Pacientes , Pelve/fisiologia , Período Pós-Operatório , Postura , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico por imagem , Resultado do Tratamento
16.
Sci Rep ; 10(1): 13472, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778796

RESUMO

Cold sensitivity is common following nerve injuries in the upper extremity, but is less well studied in carpal tunnel syndrome (CTS). We investigated cold sensitivity in CTS and its effects on surgical outcome. A search of the Swedish National Registry for Hand Surgery (HAKIR) for open carpal tunnel releases (OCTR) from 2010-2016 identified 10,746 cases. Symptom severity questionnaires (HQ-8; HAKIR questionnaire 8, eight Likert-scale items scored 0-100, one item on cold sensitivity) and QuickDASH scores before and after surgery were collected. Patient mean age was 56 ± SD 16 years, and 7,150/10,746 (67%) were women. Patients with severe cold sensitivity (defined as cold intolerance symptom severity score > 70; n = 951), scored significantly higher on QuickDASH at all time points compared to those with mild cold sensitivity (cold intolerance symptom severity scores ≤ 30, n = 1,532); preoperatively 64 [50-75] vs. 40 [25-55], at three months 32 [14-52] vs. 18 [9-32] and at 12 months 25 [7-50] vs. 9 [2-23]; all p < 0.0001. Severe cold sensitivity predicted higher postoperative QuickDASH scores at three [12.9 points (95% CI 10.2-15.6; p < 0.0001)] and at 12 months [14.8 points (11.3-18.4; p < 0.0001)] compared to mild cold sensitivity, and adjustment for a concomitant condition in the hand/arm, including ulnar nerve compression, did not influence the results. Cold sensitivity improves after OCTR. A higher preoperative degree of cold sensitivity is associated with more preoperative and postoperative disability and symptoms than a lower degree of cold sensitivity, but with the same improvement in QuickDASH score.


Assuntos
Síndrome do Túnel Carpal/complicações , Síndrome do Túnel Carpal/cirurgia , Temperatura Baixa/efeitos adversos , Adulto , Idoso , Descompressão Cirúrgica/métodos , Feminino , Mãos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Inquéritos e Questionários , Suécia , Avaliação de Sintomas , Sensação Térmica/fisiologia , Resultado do Tratamento
17.
Orv Hetil ; 161(31): 1302-1306, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750016

RESUMO

Our objective is to propose a novel surgical technique, the microscope-assisted odontoid resection via submandibular retropharyngeal "key-hole" approach. The patient suffered a traumatic cervical spine injury due to a motorcycle accident. We removed the upper two-thirds of the CII vertebra's odontoid process along with the cortical fragment causing the medullar compression. With this surgical technique the velopharyngeal insufficiency, occurring at the traditional transoral surgery, is avoidable while the access to the odontoid process is insured. The MRI confirmed ventral injury to the meninges, which increases the risk of wound healing complications and sepsis so along with the high risk of velopharyngeal insufficiency occurring at the transoral surgery, stood in favour of the new method. During the submandibular "key-hole" technique besides the use of tissue-glue, tamponing the meninges damage with multiple layers of viable soft tissue could be performed. The postoperative CT and MR imaging confirmed the complete decompression of the medulla oblongata. The patient's tetraplegic state entirely regressed, and eight months after the surgery he became self-sufficient. From now on, the surgical method we used could be a considerable alternative to the classic transoral transpharyngeal or endoscopic endonasal odontoid resection. Orv Hetil. 2020; 161(31): 1302-1306.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Processo Odontoide/cirurgia , Compressão da Medula Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Processo Odontoide/diagnóstico por imagem , Período Pós-Operatório , Compressão da Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
18.
Lancet Neurol ; 19(9): 784-796, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822636

RESUMO

Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.


Assuntos
Gerenciamento Clínico , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/fisiopatologia , Animais , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Carbamazepina/farmacologia , Carbamazepina/uso terapêutico , Descompressão Cirúrgica/métodos , Humanos , Neuroimagem/métodos , Oxcarbazepina/farmacologia , Oxcarbazepina/uso terapêutico , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Neuralgia do Trigêmeo/classificação , Neuralgia do Trigêmeo/terapia
19.
Medicine (Baltimore) ; 99(29): e21049, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702846

RESUMO

Lateral recess stenosis is a common pathology causing clinical syndromes in the elderly population, and there is some concern regarding the number of comorbidities that can occur when performing surgery for this condition in the elderly. However, little research has focused on the issues related to older age, and limited data is available to help the clinician counsel elderly patients undergoing percutaneous endoscopic transforaminal decompression. The present study aimed to explore the safety and efficacy of percutaneous endoscopic transforaminal decompression for lumbar degenerative disease in elderly patients with lumbar lateral recess stenosis and to determine whether age and comorbidity affect the outcome and complication rate.We identified 117 patients in our patient database who underwent percutaneous endoscopic transforaminal decompression for single-level lumbar lateral recess stenosis. Data regarding the Oswestry Disability Index and visual analog scale for back and leg pain were collected preoperatively, postoperatively, and at the last follow-up. Other data, including preoperative comorbidities, operation time, and intraoperative and postoperative complications, were recorded.The average follow-up period was 29.9 ±â€Š5.5 months, with a mean age of 69.8 ±â€Š5.4 years in elderly patients (group A) and 50.4 ±â€Š6.4 years in younger patients (group B). Group A had a higher percentage of comorbidity than group B (83.9% vs 18.0%, P < .001). Both visual analog scale scores for leg pain and Oswestry Disability Index were significantly improved in the 2 groups, and no difference was found between the groups regarding both parameters (P >.05). The elderly patients had the same high rate of favorable outcomes as group B (P > .05). Moreover, there was no difference in surgical complications, recurrence, and neurologic deficit recovery rate between both groups. No major complications or perioperative deaths occurred in both groups.The present study demonstrates that percutaneous endoscopic transforaminal decompression for lateral recess stenosis in elderly patients may be a reasonable treatment associated with substantial benefit.


Assuntos
Fatores Etários , Descompressão Cirúrgica/métodos , Região Lombossacral/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/estatística & dados numéricos , Endoscopia/métodos , Feminino , Humanos , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/epidemiologia , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(29): e21188, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702880

RESUMO

Retrospective single institution observational study.The aim of the present study was to analyze the influence of early extensive posterior decompression on complications in patients with severe traumatic cervical spinal cord injury (tcSCI).Cervical SCI is associated with a high prevalence of hyponatremia and cardiopulmonary dysfunction. However, very few studies have focused on this exploration to reduce the incidence of SCI early complications.We reviewed the medical records of consecutive patients undergoing extensive posterior decompression within 24 h for severe tcSCI (American Spinal Injury Association Impairment Scale [AIS] A to C) admitted between January 2009 and January 2018. The data collected retrospectively included age, gender, mechanism, and level of SCI, AIS grade, fracture or dislocation, electrolyte, and cardiopulmonary complications.Of the 97 enrolled patients, the baseline AIS grade was AIS A in 14, AIS B in 31, and AIS C in 52. Improvement of at least two AIS grades was found in 26 (26.8%), and improvement of at least one grade was found in 80.4% of patients at discharge. Twenty-nine (29.9%) patients had mild hyponatremia, 8 (8.2%) had moderate hyponatremia, and 3 (3.1%) had severe hyponatremia during hospitalization. The incidences of hyponatremia, hypotension, and tracheotomy were 41.2%, 13.4%, and 6.2%, respectively. The mean forced vital capacity (FVC) on admission and at discharge was 1.34 ±â€Š0.46 L and 2.21 ±â€Š0.41 L (P < .0001), respectively. Five patients developed pneumonia.Our results suggest that early expansive posterior decompression significantly reduces the incidence of hyponatremia, hypotension, and tracheotomy by promoting recovery of spinal cord function after severe tcSCI.


Assuntos
Medula Cervical/fisiopatologia , Descompressão Cirúrgica/reabilitação , Hiponatremia/etiologia , Traumatismos da Medula Espinal/cirurgia , Disfunção Ventricular/etiologia , Adulto , Medula Cervical/lesões , Medula Cervical/cirurgia , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Traumatismos da Medula Espinal/sangue , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento , Disfunção Ventricular/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA