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1.
Zhonghua Wai Ke Za Zhi ; 59(11): 940-946, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34743458

RESUMO

Objective: To investigate the safety and clinical efficacy of "zoning" style laminectomy by ultrasonic bone curette in patients with severe thoracic ossification of the ligamentum flavum(TOLF). Methods: The clinical data of 36 patients with severe TOLF treated by "zoning" style laminectomy at Department of Spinal Surgery,Zhengzhou Orthopaedic Hospital from October 2015 to October 2018 were respectively analyzed.There were 17 males and 19 females,aged(57.3±10.2)years(range:43 to 80 years).According to the anatomical characteristics of the thoracic ligamentum flavum and the pathological process of ossionization,each decompression segment was divided into the upper 1/3 area of the lamina,the bilateral area of the ossionum flavum,the transitional area,and the area of close contact between the ossionum flavum and the spinal cord.Different surgical strategies were used for decompression in turn.The modified Japanese Orthopedic Association (mJOA) was used to evaluate the neurological function status before and after surgery,to evaluate the surgical effect of patients,and to observe the surgical complications.Paired sample T test was used for data analysis. Results: All 36 patients successfully completed the operation,the operation time was (88.6±24.6) minutes(range:60 to 150 minutes).The intraoperative blood loss was (426.7±167.4) ml(range:250 to 800 ml).Follow-up time was (27.2±7.7) months(range:12 to 48 months).The mJOA score at the last follow-up was 9.0±1.5,which was statistically significant compared with the preoperative score 5.4±1.8 (t=13.59,P<0.01).The improvement rate of mJOA score was (65.7±22.1) %,of which 17 cases were excellent (47.2%),13 cases were good (36.1%),4 cases were normal (11.1%),2 cases were ineffective (5.6%).Ten patients had cerebrospinal fluid leakage during the separation or removal of dural ossification and were cured after a series of comprehensive conservative treatment.Two patients showed transient neurological deterioration,and the neurological function gradually recovered to the preoperative state after comprehensive treatment such as increasing the mean arterial pressure and using neurotrophic drugs.During the follow-up,no aggravation of neurological dysfunction and segmental kyphosis were found. Conclusions: The ultrasonic bone curette-assisted "zoning" style laminectomy for the treatment of severe TOLF can directly observed the position relationship between ossification of the ligamentum flavum and the spinal canal structure during the operation,and accurately guide the surgical decompression.It has the advantages of safe operation and complete decompression,which provides an important reference for the selection of clinical surgery.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Feminino , Humanos , Laminectomia , Ligamento Amarelo/cirurgia , Masculino , Ossificação Heterotópica/cirurgia , Osteogênese , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Ultrassom
2.
Medicine (Baltimore) ; 100(41): e27515, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731139

RESUMO

ABSTRACT: Retrospective cohort studyTo characterize the learning curve of a spine surgeon during the first 2 years of independent practice by comparing to an experienced colleague. To stratify learning curves based on procedure to evaluate the effect of experience on surgical complexity.The learning curve for spine surgery is difficult to quantify, but is useful information for hospital administrators/surgical programs/new graduates, so appropriate expectations and accommodations are considered.Data from a retrospective cohort (2014-2016) were analyzed at a quaternary academic institution servicing a geographically-isolated, mostly rural area. Procedures included anterior cervical discectomy and fusion, posterior cervical decompression and stabilization, single and 2-level posterior lumbar interbody fusion, lumbar discectomy, and laminectomy. Data related to patient demographics, after-hours surgery, and revision surgery were collected. Operative time was the primary outcome measure, with secondary measures including cerebrospinal fluid leak and early re-operation. Time periods were stratified into 6 month quarters (quarter [Q] 1-Q4), with STATA software used for statistical analysis.There were 626 patients meeting inclusion criteria. The senior surgeon had similar operative times throughout the study. The new surgeon demonstrated a decrease in operative time from Q1 to Q4 (158 minutes-119 minutes, P < .05); however, the mean operative time was shorter for the senior surgeon at 2 years (91 minutes, P < .05). The senior surgeon performed more revision surgeries (odds ratio [OR] 2.5 [95% confidence interval [CI] 1.7-3.6]; P < .001). Posterior interbody fusion times remained longer for the new surgeon, while laminectomy surgery was similar to the senior surgeon by 2 years. There were no differences in rates of cerebrospinal fluid leak (OR 1.2 [95% CI 0.6-2.5]; P > .05), nor reoperation (OR 1.16 [95% CI 0.7-1.9]; P > .05) between surgeons.A significant learning curve exists starting spine practice and likely extends beyond the first 2 years for elective operations.


Assuntos
Vazamento de Líquido Cefalorraquidiano/epidemiologia , Associações de Prática Independente/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Coluna Vertebral/cirurgia , Cirurgiões/estatística & dados numéricos , Adulto , Idoso , Canadá/epidemiologia , Vértebras Cervicais/cirurgia , Competência Clínica/estatística & dados numéricos , Descompressão Cirúrgica/métodos , Discotomia/métodos , Discotomia/tendências , Feminino , Humanos , Associações de Prática Independente/tendências , Laminectomia/métodos , Curva de Aprendizado , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/tendências , Estudos Retrospectivos , População Rural , Fusão Vertebral/métodos
3.
Spine (Phila Pa 1976) ; 46(21): 1509-1515, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34618710

RESUMO

STUDY DESIGN: Propensity-matched retrospective study of patients prospectively enrolled in Danespine. OBJECTIVE: The aim of this study was to report 5-year patient reported outcome in lumbar spinal stenosis (LSS) patients who underwent wide laminectomy (WL), segmental bilateral laminotomies (SBL), or unilateral hemilaminectomy (UHL) with bilateral decompression. SUMMARY OF BACKGROUND DATA: The optimal procedure for LSS remains controversial. Studies have shown no difference in short term outcomes among micro-laminectomy, hemi-laminotomies, broad laminectomy, and laminectomy with instrumented fusion. METHODS: Patients with spinal stenosis who were enrolled in DaneSpine at two spine centers from January 2010 until May 2014 and underwent WL0, SBL, or UHL with bilateral decompression were identified. Patients completed standard questionnaires preoperatively and 1, 2, and 5 years after surgery. Patients in the three cohorts were propensity-matched using age, sex, body mass index (BMI), smoking status, number of surgical levels, American Society of Anesthesiologists (ASA) score, and patient-reported outcome measures (PROMs). RESULTS: Propensity matching produced 62 cases in each group. There were no differences in PROM among the three cohorts at five years follow up. Twelve patients were re-operated at the index level. The most frequent indication of reoperation was repeat decompression after SBL. Regression analysis revealed no statistical significant associations between the incidence of reoperation and age, sex, number of operated levels, ASA score, BMI, center, smoking status, or having a dural tear at index operation. CONCLUSION: This study revealed no significant difference PROMs, reoperation rates or time to reoperation at five years follow up between SBLs, UHL, or WL in patients operated for central LSS.Level of Evidence: 4.


Assuntos
Laminectomia , Estenose Espinal , Descompressão Cirúrgica , Humanos , Laminectomia/efeitos adversos , Vértebras Lombares/cirurgia , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Estenose Espinal/cirurgia , Resultado do Tratamento
4.
BMC Musculoskelet Disord ; 22(1): 881, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654410

RESUMO

OBJECTIVES: To explore the factors associated with the increased spinal cord area in single-door cervical laminoplasty (SDCL) with miniplate fixation. METHODS: A retrospective study enrolled 83 patients underwent SDCL with miniplate fixation and the patient characteristics such as age, gender, tobacco use, alcohol use, diabetes mellitus, hypertension, diagnosis, operative level, etc., were obtained. The opening angle, door shaft position and spinal canal area of the patients were measured after surgery. The sagittal canal diameter (SCD), the C2-7 Cobb angle, the cervical curvature index (CCI), the range of motion (ROM) and the spinal canal area were measured before and after operation. The increased cervical spinal cord area was also measured before and after surgery, and the correlation between the above indicators and the increased cervical spinal cord area was studied through Pearson's correlation analysis and multivariate logistic regression analysis. RESULTS: There were 34 patients in small spinal cord area increment group (SAI group), 29 patients in middle spinal cord area increment group (MAI group) and 20 patients in large spinal cord area increment group (LAI group). The preoperative diagnosis(P = 0.001), door shaft position (P = 0.008), preoperative spinal canal area (P = 0.004) and postoperative spinal canal area (P = 0.015) were significant different among the 3 groups. The multivariate analysis showed that the preoperative diagnosis (OR = 2.076, P = 0.035), door shaft position (OR = 3.425, P = 0.020) and preoperative spinal canal area (OR = 10.217, P = 0.009) were related to increased spinal cord area. CONCLUSIONS: The preoperative diagnosis, door shaft position and preoperative spinal canal area might be associated with increased spinal cord area after cervical laminoplasty with miniplate fixation. Preoperative symptoms are mostly caused by compression of the spinal cord, so spinal cord area enlargement can bring a better recovery in patients alongside long-term. Spine surgeons should pay more attention to the accuracy of the preoperative diagnosis, the preoperative measurement of spinal canal area and the door shaft position during the operation.


Assuntos
Laminoplastia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Laminectomia , Laminoplastia/efeitos adversos , Análise Multivariada , Estudos Retrospectivos , Medula Espinal , Resultado do Tratamento
5.
Medicina (Kaunas) ; 57(10)2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34684162

RESUMO

Background and Objectives: To compare the long-term pain characteristics and its chronic management following minimally invasive spinal (MIS) decompression and open laminectomy with fusion for lumbar stenosis. Materials and Methods: The study cohort included patients with a minimum 5-year postoperative follow-up after undergoing either MIS decompression or laminectomy with fusion for spinal claudication. The primary outcome of interest was chronic back and leg pain intensity. Secondary outcome measures included pain frequency during the day, chronic use of non-opioid analgesics, narcotic medications, medical cannabinoids, and continuous interventional pain treatments. Results: A total of 95 patients with lumbar spinal stenosis underwent one- or two-level surgery for lumbar spinal stenosis between April 2009 and July 2013. Of these, 50 patients underwent MIS decompression and 45 patients underwent open laminectomy with instrumented fusion. In the fusion group, a higher percentage of patients experienced moderate-to-severe back pain with 48% compared to 21.8% of patients in the MIS decompression group (p < 0.01). In contrast, we found no significant difference in the reported leg pain in both groups. In the fusion group, 20% of the patients described their back and leg pain as persistent throughout the day compared to only 2.2% in the MIS decompression group (p < 0.05). A trend toward higher chronic dependence on analgesic medication and repetitive pain clinic treatments was found in the fusion group. Conclusions: MIS decompression for the treatment of degenerative spinal stenosis resulted in decreased long-term back pain and similar leg pain outcomes compared to open laminectomy and instrumented fusion surgery.


Assuntos
Fusão Vertebral , Estenose Espinal , Dor nas Costas , Descompressão , Humanos , Laminectomia/efeitos adversos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Resultado do Tratamento
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1318-1322, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651487

RESUMO

Objective: To investigate the effect of prophylactic C 4, 5 foraminal dilatation in posterior cervical open-door surgery on postoperative C 5 nerve root palsy syndrome. Methods: The clinical data of patients with cervical spondylotic myelopathy (cervical spinal cord compression segments were more than 3) who met the selection criteria between March 2016 and March 2019 were retrospectively analyzed. Among them, 40 patients underwent prophylactic C 4, 5 foraminal dilatation in posterior cervical open-door surgery (observation group) and 40 patients underwent simple posterior cervical open-door surgery (control group). There was no significant difference between the two groups ( P>0.05) in gender, age, disease duration, Nurick grade of spinal cord symptoms, and preoperative diameter of C 4, 5 intervertebral foramen, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score. The occurrence of C 5 nerve root paralysis syndrome was recorded and compared between the two groups, including incidence, paralysis time, recovery time, and spinal cord drift. VAS and JOA scores were used to evaluate the improvement of pain and function before operation and at 12 months after operation. Results: The incisions of the two groups healed by first intention, and there was no early postoperative complications such as cerebrospinal fluid leakage. Patients of both groups were followed up 12-23 months, with an average of 17.97 months. C 5 nerve root paralysis syndrome occurred in 8 cases in the observation group (3 cases on the right and 5 cases on the left) and 2 cases in the control group (both on the right). There was significant difference of the incidence (20% vs. 5%) between the two groups ( χ 2=4.114, P=0.043). Except for 1 case in the observation group who developed C 5 nerve root palsy syndrome at 5 days after operation, the rest patients all developed at 1 day after operation; the recovery time of the observation group and the control group were (3.87±2.85) months and (2.50±0.70) months respectively, showing no significant difference between the two groups ( t=-0.649, P=0.104). At 12 months after operation, the JOA score and VAS score of cervical spine in the two groups significantly improved when compared with those before operation ( P<0.05); there was no significant difference in the difference of the cervical spine JOA score and VAS score between at 12 months after operation and before operation and the degree of spinal cord drift between the two groups ( P>0.05). Conclusion: Prophylactic C 4, 5 foraminal dilatation can not effectively prevent and reduce the occurrence of postoperative C 5 root palsy, on the contrary, it may increase its incidence, so the clinical application of this procedure requires caution.


Assuntos
Laminoplastia , Vértebras Cervicais/cirurgia , Dilatação , Humanos , Laminectomia , Paralisia/etiologia , Paralisia/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
7.
Agri ; 33(4): 253-260, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34671955

RESUMO

OBJECTIVES: In our study, we aimed to evaluate the change in numerical rating scale (NRS) score and interventional procedures performed on patients with post-laminectomy syndrome whose NRS score 7 and above according to the NRS. METHODS: This study was carried out by examining the files of 107 patients, including 69 women and 38 men, aged 18 years and over who had applied between February 1, 2010, and February 1, 2015. Pain localization, post-operative periods, interventional procedures, and post-procedural pain status were determined using pain monitoring forms and hospital automation system in our clinic. Statistical significance of the obtained data was evaluated by Pearson Chi-square test, Kruskal-Wallis H test, Friedman test, and Mann-Whitney U-test. p>0.05 was not statistically significant, p<0.05 was considered statistically significant. RESULTS: With interventional procedures, 48.5% of patients had a reduction in pain of more than 50%. The success rate was 66.7% in patients with radicular pain. Pain palliation was achieved in 28.8% of patients who underwent transforaminal epidural steroid injection, whereas in patients undergoing dorsal root ganglion pulsed radiofrequency, this rate was 44.4%. When the pain scores of patients with permanent spinal cord stimulator (SCS) were compared with other patient groups, permanent SCS was found to be statistically and clinically significant (p<0.001). CONCLUSION: Post-laminectomy syndrome is not usually caused by a single pathology, and more than 1 intervention and recurrence are often needed. Post-laminectomy syndrome is a disease that requires a multidisciplinary approach and multiple treatment options must be decided according to the patient. More research is needed on treatment options.


Assuntos
Laminectomia , Tratamento por Radiofrequência Pulsada , Adolescente , Adulto , Feminino , Humanos , Masculino , Dor , Manejo da Dor , Estudos Retrospectivos
8.
Vet Comp Orthop Traumatol ; 34(6): 427-436, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34598302

RESUMO

OBJECTIVE: To describe the dorsal laminectomy, annulectomy and distraction stabilization with pins and polymethylmethacrylate technique, its complications and outcome in the management of canine degenerative lumbosacral stenosis. To determine pre- and post-surgical foraminal width and vertebral step changes. STUDY DESIGN: Multi-institutional retrospective clinical study. METHODS: Medical records (2005-2020) of dogs treated (n = 30). Clinical signs, Modified Frankel Score, Texas Spinal Cord Injury Score, pain score (dorsal palpation of spine, tail dorsiflexion), imaging findings and complications were retrieved pre-operatively, perioperatively and at long-term follow-up. RESULTS: The most common presurgical imaging findings were disc protrusion (24/25) and sclerosis of the caudal end-plate of L7 (23/30). On short- to long-term assessment 18 out of 21 dogs exhibited clinical improvement and all exhibited improved pain scores (p < 0.0001). Catastrophic complications occurred in 3 dogs, and major complications occurred in 5, of which 3 required additional surgery. Mean lumbosacral step defect reduced 60% (1.8 mm ± 2.5 mm pre-surgery to 0.7mm ± 0.9mm post-surgery, p = 0.1585). Mean foraminal width significantly increased 50% long-term (3.3 mm ± 1.0 mm pre-surgery to 5.0 mm ± 0.9 mm post-surgery, p < 0.0001). CLINICAL SIGNIFICANCE: Dorsal laminectomy, annulectomy and distraction stabilization is a complex procedure which can significantly increase foraminal width, reduce pain and improve gait characteristics in dogs in the short- to long-term, and should be performed by surgeons experienced in lumbosacral pin placement.


Assuntos
Doenças do Cão , Estenose Espinal , Animais , Pinos Ortopédicos , Constrição Patológica/veterinária , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Laminectomia/veterinária , Região Lombossacral/cirurgia , Estudos Retrospectivos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Estenose Espinal/veterinária , Resultado do Tratamento
9.
Bull Hosp Jt Dis (2013) ; 79(3): 197-199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34605758

RESUMO

A 43-year-old male with a congenital absence of his left T1 rib developed a left-sided T1-T2 spinal facet joint arthrosis and stenosis and clinical signs and symptoms of T1 radiculopathy. The patient was treated with a decompressive laminotomy and partial medial facetectomy resulting in immediate resolution of symptoms. This report should alert clinicians to consider this potential etiology when evaluating patients with thoracic radiculopathy.


Assuntos
Estenose Espinal , Adulto , Constrição Patológica , Descompressão Cirúrgica , Humanos , Laminectomia , Masculino , Costelas , Estenose Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
10.
Medicine (Baltimore) ; 100(36): e26220, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516486

RESUMO

BACKGROUND: Laminectomy with lateral mass screw fixation (LCS) is considered an effective surgical procedure for cervical spondylotic myelopathy. However, varying degrees of loss of the cervical curvature were noted in some patients postoperatively. The aim of this study was to observe the relationship between cervical curvature and spinal drift distance after LCS and to determine its effect on neurological function, axial symptoms, and C5 palsy. METHODS: A total of 117 consecutive cervical spondylotic myelopathy patients with normal cervical curvature underwent LCS from April 2015 to May 2017 in our institution. Of these patients, 90 patients who accepted to undergo an integrated follow-up were enrolled in this study. The patients were divided into 3 groups based on their postoperative cervical curvature. In group A (28 patients), the cervical curvature became straight postoperatively (0°≤cervical spine angle≤5°); in group B (36 patients), the cervical curvature decreased (5°16.5°). Spinal drift distance, neurological recovery, axial symptoms, and C5 palsy in the patients were recorded and analyzed. RESULTS: Postoperative measurements showed that there was no significant difference in laminectomy width between the groups (P > .05). The cervical spine angle was 2.7°â€Š±â€Š0.5° in group A, 11.2°â€Š±â€Š2.6° in group B, and 20.8°â€Š±â€Š4.1° in group C (P < .05), while the spinal drift distance was 1.2 ±â€Š0.2 mm, 1.8 ±â€Š0.4 mm, and 3.0 ±â€Š0.5 mm, respectively (P < .05). The postoperative Japanese Orthopedic Association score was significantly increased in all groups (P < .05), and there was no significant difference between the groups at different time points (P > .05). However, significant differences were noted between the groups in axial symptoms (P < .05), which were analyzed via the visual analog scale score. The occurrence of C5 palsy in groups A, B, and C was 7.1% (2/28), 8.3% (3/36), and 11.5% (3/26), respectively (P > .05). CONCLUSION: In LCS, the cervical curvature should be maintained at the normal angle to obtain a good spinal cord drift distance and a lower incidence of axial symptoms.


Assuntos
Parafusos Ósseos , Vértebras Cervicais/cirurgia , Medula Espinal/fisiopatologia , Espondilose/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Resultado do Tratamento
11.
Orthop Surg ; 13(7): 2051-2060, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34590777

RESUMO

OBJECTIVE: To evaluate the medium-term outcomes of one-stage posterior lumbosacral or lumbopelvic fixation treatment of lumbosacral junction tuberculosis in adults. METHODS: This retrospective study enrolled a total of 38 adult patients (24 males and 14 females) with an average age of 48.0 ± 13.0 years (range, 25-75 years) during the period from February 2008 to July 2015. All patients were treated by one-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage. After pedicle screw or iliac screw fixation, a hemi-laminectomy or laminectomy was performed on the severely damaged side of the lesion segment. Intervertebral bone grafting and intertransverse bone grafting were performed after clearing the focus of tuberculosis. All cases were followed up for at least 5 years. Intraoperative blood loss, operative time, erythrocyte sedimentation rate (ESR), pain intensity was assessed by visual analog scale (VAS) score; neurological function was assessed by Japanese Orthopaedic Association (JOA) score; quality of life was assessed by Oswestry Disability Index (ODI); functional outcome, lumbosacral angle, and fusion time were gathered and analyzed. All data expressed as mean ± standard deviation. RESULTS: During the 66.2 ± 4.4 months (range, 60-78 months) follow-up, all patients achieved clinical cure without severe complications. The intraoperative blood loss was 726.3 ± 151.9 mL (range, 400-1100 mL) and the operative time was 137.6 ± 22.5 min (range, 110-200 min). The ESR decreased to normal levels within (11.8 ± 2.6 mm/h) 3 months postoperatively. The VAS score significantly decreased from 6.8 ± 1.1 preoperatively to 0.8 ± 0.7 at the final follow-up (P < 0.01). The mean JOA improved from preoperative 18.5 ± 2.9 to 26.9 ± 1.1 at the last visit (P < 0.01). The mean ODI was 44.3 ± 6.7 and significantly decreased to 9.3 ± 1.9 at the final observation (P < 0.01). Patient-reported outcomes as measured by Kirkaldy-Willis criteria were excellent in 21 cases, good in 16 cases, and fair in one case; there were no poor outcomes. Lumbosacral angle increased from the preoperative values of 21.7° ± 1.8° to the postoperative values of 26.4° ± 1.4° (P < 0.01), with an angle loss of 1.2° ± 0.7° at the last follow-up. Bone fusion occurred on average 12.8 ± 1.9 months (range, 9-15 months) after surgery. No nonunion, pseudarthrosis, loosening or fracture of instruments occurred at the last follow-up. CONCLUSION: One-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage according to the severity of sacral destruction is an effective and highly safe procedure to treat lumbosacral junction tuberculosis in adults.


Assuntos
Desbridamento/métodos , Laminectomia/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Estudos Retrospectivos
12.
Ann Palliat Med ; 10(10): 10130-10146, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34551575

RESUMO

BACKGROUND: To determine the clinical and radiological outcomes of full-endoscopic (FE) versus microscopic (MI) lumbar decompression laminectomy in the treatment of lumbar spinal stenosis (LSS), we performed a meta-analysis to explore the best choice for patients with LSS requiring surgical relief. METHODS: Literature searches of the PubMed, the Cochrane Library, Embase, Medline, Embase, and Web of Science databases were performed. The searches covered all indexed studies published between 2008 and 2020, using keywords identifying the patient group (lumbar spine stenosis) and the interventions (full-endoscopic lumbar decompression laminectomy and microscopic lumbar decompression laminectomy). A total of 1,727 patients were included in 10 studies. The primary outcomes of the analysis were visual analogue scale (VAS) scores for leg and back pain, and Oswestry Disability Index (ODI) score. RESULTS: The meta-analysis of the VAS score for low back pain showed that in the first 24 hours postoperatively, participants who underwent FE had better pain control than those who underwent MI [FE: mean difference (MD) =-0.78, 95% confidence interval (CI): -1.11, -0.45; MI: MD =-1.53, 95% CI: -1.94, -1.12]. In all subgroup analyses, the VAS score for back pain was lower in the FE group than in the MI group (MD =-0.71, 95% CI: -0.96, -0.47). Regarding the VAS score for leg pain, the FE group had a significantly lower score than the MI group in the first 24 hours (Total: MD =-1.02, 95% CI: -1.31, -0.73). The meta-analysis demonstrated that the FE group had a significantly lower ODI score than the MI group (MD =-1.03, 9% CI: -1.54, -0.51). At 6 months, the MI group had a significantly lower score than the FE group (MD =1.09, 95% CI: 0.53, 1.64), but at 12 months, the FE group had a significantly lower score than the MI group (MD =-2.40, 95% CI: -3.12, -1.67). DISCUSSION: Compared to MI decompression, the FE decompression method resulted in better pain control in the early postoperative period, both in the lower back and legs, as well as shorter operative and shorter hospitalization times.


Assuntos
Estenose Espinal , Descompressão Cirúrgica , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Resultado do Tratamento
13.
Spine (Phila Pa 1976) ; 46(17): 1197-1205, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34384098

RESUMO

STUDY DESIGN: A retrospective cohort analysis. OBJECTIVE: The aim of this study was to investigate the impact of piecemeal versus en bloc laminectomies on spinal cord in thoracic ossification of ligamentum flavum (TOLF) through intraoperative changes of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs). SUMMARY OF BACKGROUND DATA: Surgical treatment is indicated for symptomatic TOLF, and both piecemeal and en bloc laminectomies are commonly used methods. However, few studies compared both intraoperative interference and prognostic impact of these two laminectomies on spinal cord in TOLF patients. METHODS: MEPs were recorded from abductor hallucis (AH) and tibialis anterior, and SEPs were performed on tibial nerve in 55 TOLF patients (piecemeal vs. en bloc: 23 vs. 32). Patients were categorized based on MEP/SEP improvement, deterioration, and no change, and MEP/SEP improvement rates were measured in the improvement group. Additionally, all patients were assessed by American Spinal Injury Association (ASIA) scores, Ashworth scores, and modified Japanese Orthopedic association (mJOA) scores before and after operation. RESULTS: The incidences of both MEP/SEP improvement and deterioration were similar between the two laminectomy groups (P > 0.05), and no significant difference is noted in both MEP and SEP amplitudes between the baseline and different critical manipulations in both laminectomy groups (P > 0.05). In the improvement group, patients receiving en bloc laminectomy exhibited increased improvement rates of both MEPs in bilateral AH and left-side SEPs compared to piecemeal laminectomy (P < 0.05). Clinically, all functional scales clearly improved in both laminectomy groups after operation (P < 0.05), and postoperative 1-year mJOA improvement rates were highly correlated with MEP improvement rates (P < 0.05). CONCLUSION: Intraoperative changes of MEPs and SEPs potentially provide a valid method for quantitatively evaluating the safety of different intraoperative manipulations and their prognostic impacts on spinal cord. Both laminectomies are safe and effective methods to treat TOLF, and en bloc laminectomy may cause relatively better spinal cord functional recovery.Level of Evidence: 3.


Assuntos
Ligamento Amarelo , Ossificação Heterotópica , Humanos , Laminectomia , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/cirurgia , Ossificação Heterotópica/cirurgia , Osteogênese , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 100(30): e25806, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397681

RESUMO

ABSTRACT: A few years ago, percutaneous transforaminal endoscopic discectomy (PTED) began to prevail in clinical treatment of recurrent lumbar disc herniation (RLDH), whereas traditional laminectomy (TL) was treated earlier in RLDH than PTED. This study aimed to compare the clinical efficacy of PTED and TL in the treatment of RLDH.Between November 2012 and October 2017, retrospective analysis of 48 patients with RLDH who were treated at the Cancer Hospital, Chinese Academy of Sciences, Hefei and Department of Orthopaedics, Second Affiliated Hospital of Anhui Medical University. Perioperative evaluation indicators included operation time, the intraoperative blood loss, length of incision and hospitalization time. Clinical outcomes were measured preoperatively, and at 1 days, 3 months, and 12 months postoperatively. The patients' lower limb pain was evaluated using Oswestry disability index (ODI) and visual analog scale (VAS) scores. The ODI is the most widely-used assessment method internationally for lumbar or leg pain at present. Every category comprises 6 options, with the highest score for each question being 5 points. higher scores represent more serious dysfunction. The VAS is the most commonly-used quantitative method for assessing the degree of pain in clinical practice. The measurement method is to draw a 10 cm horizontal line on a piece of paper, 1 end of which is 0, indicating no pain, which the other end is 10, which means severe pain, and the middle part indicates different degree of pain.Compared with the TL group, the operation time, postoperative bed-rest time, and hospitalization time of the PTED group were significantly shorter, and the intraoperative blood loss was also reduced. These differences were statistically significant (P < .01). There were no significant differences in VAS or ODI scores between the two groups before or after surgery (P > .05).PTED and TL have similar clinical efficacy in the treatment of RLDH, but PTED can shorten the operation time, postoperative bed-rest time and hospitalization time, and reduce intraoperative blood loss, so the PTED is a safe and effective surgical method for the treatment of RLDH than TL, but more randomized controlled trials are still required to further verify these conclusions.


Assuntos
Discotomia Percutânea/normas , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/normas , Adulto , Idoso , China , Discotomia Percutânea/métodos , Discotomia Percutânea/estatística & dados numéricos , Endoscopia/métodos , Endoscopia/normas , Endoscopia/estatística & dados numéricos , Feminino , Humanos , Laminectomia/métodos , Laminectomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
Medicine (Baltimore) ; 100(30): e26795, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397734

RESUMO

RATIONALE: Lumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by excessive overgrowth of extradural fat within the lumbar spinal canal. Surgical decompression is commonly performed to treat symptomatic SELs. Fenestration or laminectomy with epidural fat debulking was a routine surgical procedure according to the literature, that may be causing postoperative lumbar instability. In the present study, we presented a brief report of lumbar SEL and introduced another surgical approach. PATIENT CONCERNS: A 55-year-old man complained of severe low back pain and right leg radicular pain for a year, accompanied by neurogenic intermittent claudication. He received a variety of conservative treatments, including non-steroidal anti-inflammatory drugs, acupuncture, and physical therapy. However, his pain did not diminish. Finally, a posterior epidural mass in the dorsal spine extending from the L3 to L5 level, which caused dural sac compression was found on lumbar magnetic resonance imaging. This mass was homogeneously hyperintense in both T1W1 and T2W1 images, suggestive of epidural fat accumulation. DIAGNOSES: Lumbar SEL. INTERVENTIONS: The patient underwent lumbar laminectomy, epidural fat debulking, and spinous process-vertebral plate in situ replantations. OUTCOMES: The patient presented with complete recovery of radiculopathy and low back pain after surgery. Postoperative magnetic resonance imaging showed that the increased adipose tissue disappeared, and the dural sac compression was relieved. A computed tomography scan revealed the lumbar lamina in situ. He was able to walk normally and remained relatively asymptomatic for 12 months after the operation at the last follow-up visit. LESSONS: Lumbar laminotomy and replantation provide an ideal option to treat lumbar SEL because it can achieve sufficient and effective decompression, simultaneously reconstruct the anatomy of the spinal canal, and reduce the risk of iatrogenic lumbar instability.


Assuntos
Laminectomia , Lipomatose/cirurgia , Vértebras Lombares/cirurgia , Reimplante , Doenças da Coluna Vertebral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
16.
BMC Musculoskelet Disord ; 22(1): 667, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372819

RESUMO

BACKGROUND: To explore the clinical effect of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF. METHODS: A retrospective study was conducted on the clinical data of 142 patients with TOLF and laminectomy who underwent spine surgery at XXX Medical University from January 2003 to January 2018. According to whether the laminectomy was combined with instrumentation, the patients were divided into two groups: group A (laminectomy alone (LA), n = 77) and group B (laminectomy with instrumentation (LI), n = 65). Comparisons of possible influencing factors of demographic variables and operation-related variables were carried out between the two groups. In this study, the clinical effects of LA and LI in the treatment of TOLF were discussed. Thus, we explored the clinical effect of LA and LI in the treatment of TOLF. RESULTS: In terms of demographics, there was a statistically significant difference in BMI between group A and group B (P < 0.05). The differences in age, sex, smoking, drinking, heart disease, hypertension and diabetes were not statistically significant (P > 0.05). In terms of preoperative symptoms, there was a significant difference in gait disturbance, pain in the LE, and urination disorder between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). In terms of operation-related variables, there was a significant difference in the preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, operation time, pre-mJOA, post-mJOA at 1 year, and leakage of cerebrospinal fluid between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). The preoperative average JOA score of group A was 6.37 and that of group B was 5.19. In group A, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.87, 8.23 and 8.26, respectively, and the average JOA score improvement rate was 32.79 %, 38.32 and 38.53 %, respectively. In group B, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.74, 8.15 and 8.29, respectively, and the average JOA score improvement rate was 39.15 %, 46.86 and 47.12 %, respectively. CONCLUSIONS: Currently, there is no consensus on whether instrumentation is needed after laminectomy for TOLF. We found that for patients with a long duration of gait disturbance, urination disorder, preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT less than 60 %, and shape on the sagittal MRI being beak and low, pre-mJOA had better clinical effects after LI as compared to those after LA, and the incidence of perioperative complications was lower.


Assuntos
Laminectomia , Canal Medular , Vértebras Cervicais/cirurgia , Estudos Transversais , Humanos , Laminectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
17.
Comput Methods Programs Biomed ; 209: 106333, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34391999

RESUMO

BACKGROUND AND OBJECTIVE: The decompressive laminectomy is one of the most common operations to treat lumbar spinal stenosis by removing the laminae above the spinal nerve. Recently, an increasing number of robots are deployed during the surgical process to reduce the burden on surgeons and to reduce complications. However, for the robot-assisted decompressive laminectomy, an accurate 3D model of laminae from a CT image is highly desired. The purpose of this paper is to precisely segment the laminae with fewer calculations. METHODS: We propose a two-stage neural network SegRe-Net. In the first stage, the entire intraoperative CT image is inputted to acquire the coarse segmentation of vertebrae with low resolution and the probability map of the laminar centers. The second stage is trained to refine the segmentation of laminae. RESULTS: Three public available datasets were used to train and validate the models. The experimental results demonstrated the effectiveness of the proposed network on laminar segmentation with an average Dice coefficient of 96.38% and an average symmetric surface distance of 0.097 mm. CONCLUSION: The proposed two-stage network can achieve better results than those baseline models in the laminae segmentation task with less calculation amount and learnable parameters. Our methods improve the accuracy of laminar models and reduce the image processing time. It can be used to provide a more precise planning trajectory and may promote the clinical application for the robot-assisted decompression laminectomy surgery.


Assuntos
Robótica , Processamento de Imagem Assistida por Computador , Laminectomia , Redes Neurais de Computação , Coluna Vertebral
18.
Artigo em Russo | MEDLINE | ID: mdl-34463453

RESUMO

The authors describe the result of combined surgical treatment of a patient with symptomatic multiple-level cervical spine stenosis following ossification of posterior longitudinal ligament. The first stage included decompressive laminectomy and cervical spine fusion using a screw. At the second stage, CIV-CV-CVI-CVII corporectomy with total resection of the ossified posterior longitudinal ligament and CIII-ThI corporodesis with a bone autograft were carried out. This approach was valuable to minimize the risk of iatrogenic damage to the spinal cord, eliminate long spinal stenosis and perform circular fusion of the cervical spine. These measures led to regression of cervical myelopathy symptoms. A brief review is presented.


Assuntos
Ossificação do Ligamento Longitudinal Posterior , Doenças da Medula Espinal , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Humanos , Laminectomia/efeitos adversos , Ligamentos Longitudinais/diagnóstico por imagem , Ligamentos Longitudinais/cirurgia , Imageamento por Ressonância Magnética , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
19.
Artigo em Russo | MEDLINE | ID: mdl-34463455

RESUMO

Degenerative lumbar spine stenosis is one of the main causes of chronic pain and radiculopathy in advanced age people. Along with increase in average life expectancy, degenerative lumbar spine stenosis becomes the most common indication for spinal surgery. There is still no consensus regarding the most optimal surgical approach due to the variety of modern surgical methods. In recent years, minimally invasive spinal surgery has become a more advisable alternative to open surgery due to its advanced technical features combined with less soft tissue damage, lower risk of complications and shorter postoperative recovery.


Assuntos
Estenose Espinal , Constrição Patológica , Descompressão Cirúrgica , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Resultado do Tratamento
20.
Acta Neurochir (Wien) ; 163(10): 2777-2781, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34417877

RESUMO

BACKGROUND: Symptomatic midline sacral meningeal cysts (MSMC) are rare, and, as a consequence, so are reports on the surgical techniques to address these lesions. Here we provide a description of the senior author's (ATC) technique. METHOD: A sacral laminectomy is performed. The cyst's relation with the dural sac and sacral nerves is inspected; it is then opened and drained. Its lumen is explored for its point of communication with the dural sac, and this ostium is closed off with non-penetrating clips. A lumbar drain is inserted in select cases. CONCLUSION: Cyst wall resection is unnecessary and closing the ostium is sufficient to treat MSMC.


Assuntos
Cistos do Sistema Nervoso Central , Cistos , Meningocele , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/cirurgia , Cistos/cirurgia , Descompressão , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Meningocele/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia
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