RESUMEN
PURPOSE OF REVIEW: This systematic review investigates the recent literature and aims to determine the approach, efficacy, and timing of facial nerve decompression with or without grafting in temporal bone fractures with facial palsy. RECENT FINDINGS: The surgical management of facial palsy is reserved for a small population of cases in which electrophysiologic tests indicate a poor likelihood of spontaneous recovery. The transmastoid (TM), middle cranial fossa (MCF), and translabyrinthine (TL) approaches to the facial nerve provide access to the entire intracranial and intratemporal segments of the facial nerve. In temporal bone (TB) related facial palsy, the peri-geniculate and labyrinthine portions of the facial nerve are most commonly affected by either direct trauma and/or subsequent edema. When hearing is still serviceable, the combined TM/MCF approach provides the best access to these regions. In the presence of severe sensorineural hearing loss (SNHL), the TL approach is the most appropriate for total facial nerve exploration (this can be done in conjunction with simultaneous cochlear implantation if the cochlear nerve has not been avulsed). Grade I to III House-Brackmann (HB) results can be anticipated in timely decompression of facial nerve injury caused by edema or intraneuronal hemorrhage. Grade III outcomes, with slight weakness and synkinesis, is the outcome to be expected from the use of interpositional grafts or primary neurorrhaphy. In addition to good eye care and the use of systemic steroids (if not contraindicated in the acute trauma setting), surgical decompression with or without grafting/neurorrhaphy may be offered to patients with appropriate electrophysiologic testing, physical examination findings, and radiologic localization of injury. SUMMARY: Surgery of the facial nerve remains an option for select patients. Here, we discuss the indications and results of treatment as well as the best surgical approach to facial nerve determined based on patient's hearing status and radiologic data. Controversy remains about whether timing of surgery (e.g., immediate vs. delayed intervention) impacts outcomes. However, no one with facial palsy due to a temporal bone fracture should be left with a complete facial paralysis.
Asunto(s)
Descompresión Quirúrgica , Parálisis Facial , Fracturas Craneales , Hueso Temporal , Humanos , Parálisis Facial/cirugía , Parálisis Facial/etiología , Descompresión Quirúrgica/métodos , Hueso Temporal/lesiones , Hueso Temporal/cirugía , Fracturas Craneales/complicaciones , Fracturas Craneales/cirugía , Nervio Facial/cirugíaRESUMEN
INTRODUCTION: Spinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST. METHODS: We conducted a retrospective review of our institutional pediatric oncology and neurosurgery database, examining 14 patients under 18 years admitted with ST due to oncological diseases since 2005. We analyzed the clinical presentations, evaluations, molecular diagnostics and treatments for these patients. RESULTS: The study spanned 15 years and included 14 pediatric patients, each diagnosed with distinct spinal tumor entity. The mean patient age was approximately 19.6 ± 10.1 months. Severe axial pain along the vertebral column was observed in 13 patients, while acute neurological deterioration manifested in 7 patients. As a first-line intervention, 13 patients underwent decompressive surgery through laminectomy and tumor resection, and only one patient received chemotherapy solely. Before surgery, seven patients were unable to walk; post-surgery, six of them regained their ability to ambulate. The diagnosis encompassed a range of neoplasms: two instances of Ewing sarcoma, 3 instances of teratoma, one case presenting an atypical teratoid Rhabdoid tumor, two instances each of low-grade astrocytoma and neuroblastoma, and single instances of ependymoma, meningioma, rhabdomyosarcoma, and embryonal tumors with multilayered rosettes (ETMRs). Three patients succumbed two years after initiating therapy. CONCLUSION: Despite their rarity, intraspinal tumors in pediatric patients pose substantial therapeutic challenges. The intertwined complexities of the disease entity and the patient's neurological status demand swift initiation of an individualized therapeutic strategy. This crucial step helps optimize outcomes for this patient cohort, who frequently grapple with debilitating health conditions. Inclusion of these patients within a registry is mandatory to optimize treatment outcomes due to their rarity in pediatric population.
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Neoplasias de la Columna Vertebral , Humanos , Masculino , Femenino , Estudios Retrospectivos , Preescolar , Niño , Lactante , Adolescente , Resultado del Tratamiento , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Sarcoma de Ewing/cirugía , Sarcoma de Ewing/terapia , Sarcoma de Ewing/complicaciones , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/complicaciones , Ependimoma/terapia , Ependimoma/cirugía , Ependimoma/diagnóstico , Laminectomía , Descompresión Quirúrgica/métodos , Teratoma/complicaciones , Teratoma/cirugía , Teratoma/diagnóstico , Teratoma/terapia , Procedimientos Neuroquirúrgicos/métodos , Neuroblastoma/cirugía , Neuroblastoma/complicaciones , Astrocitoma/complicaciones , Astrocitoma/cirugía , Astrocitoma/terapia , Tumor Rabdoide/terapia , Tumor Rabdoide/complicaciones , Meningioma/cirugía , Meningioma/terapia , Meningioma/complicaciones , Meningioma/diagnósticoRESUMEN
INTRODUCTION: the pandemic of COVID-19 has led to clinical complications such as avascular necrosis of the femoral head (AVNFH) associated with the use of corticosteroids. The aim of the study is to report the functional and radiographic results of 13 patients with post-COVID-19 ANFH after decompression using Forage and bone marrow aspirate concentrate (BMAC). MATERIAL AND METHODS: single-center, prospective, uncontrolled clinical study. From April 2020 to September 2021, 13 patients (21 hips) with post-COVID-19 ANFH were treated. All received corticosteroids during infection (average daily dose: 480 mg). Clinical, radiographic and magnetic resonance imaging evaluations were performed; the Ficat classification was applied for the classification of AVNFH. The surgical technique used was decompression with Forage and ACMO. RESULTS: the mean age was 47 years, with a follow-up of 30.4 months. Symptoms appeared with a mean of 4.2 months after COVID-19 infection. Harris score improved from 41.2 ± 5.2 to 86.6 ± 3.4. Radiographic evaluation showed that 14.3% of the sample experienced femoral head collapse and underwent total hip arthroplasty. CONCLUSIONS: post-COVID-19 ANFH is a clinical entity with rapid progression and different degrees of severity. Decompression with Forage and ACMO seems a promising initial treatment, however, the variable response and the probability of collapse emphasize the importance of long-term follow-up and identification of patients who may require additional interventions.
INTRODUCCIÓN: la pandemia de COVID-19 ha dado lugar a complicaciones clínicas como la necrosis avascular de la cabeza femoral (NAVCF) asociada con el uso de corticoesteroides. El objetivo del estudio es reportar los resultados funcionales y radiográficos de 13 pacientes con NAVCF post-COVID-19, después de la descompresión utilizando Forage y aspirado de células de medula ósea (ACMO). MATERIAL Y MÉTODOS: estudio clínico unicéntrico, prospectivo, no controlado. Desde Abril de 2020 hasta Septiembre de 2021, se trataron 13 pacientes (21 caderas) con NAVCF post-COVID-19. Todos recibieron corticoesteroides durante la infección (dosis promedio diaria: 480 mg). Se realizaron evaluaciones clínicas, radiográficas y por resonancia magnética nuclear; se aplicó la clasificación de Ficat para la clasificación de NAVCF. La técnica quirúrgica empleada fue descompresión con Forage y ACMO. RESULTADOS: la edad promedio fue 47 años, con un seguimiento de 30.4 meses. Los síntomas aparecieron con una media de 4.2 meses después de la infección por COVID-19. La escala de Harris mejoró de 41.2 ± 5.2 a 86.6 ± 3.4. La evaluación radiográfica demostró que 14.3% de la muestra experimentó colapso de la cabeza femoral por lo que se les realizó artroplastía total de cadera. CONCLUSIONES: la NAVCF post-COVID-19 es una entidad clínica con rápida progresión y diferentes grados de severidad. La descompresión con Forage y ACMO parece un tratamiento inicial prometedor; sin embargo, la respuesta variable y la probabilidad de colapso, enfatizan la importancia de seguimiento a largo plazo e identificación de los pacientes que puedan requerir intervenciones adicionales.
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COVID-19 , Descompresión Quirúrgica , Necrosis de la Cabeza Femoral , Humanos , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/etiología , COVID-19/complicaciones , Descompresión Quirúrgica/métodos , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Adulto , Resultado del Tratamiento , Trasplante de Médula Ósea/métodos , Corticoesteroides/uso terapéutico , Corticoesteroides/administración & dosificación , Imagen por Resonancia Magnética , Estudios de SeguimientoAsunto(s)
Descompresión Quirúrgica , Trombosis Intracraneal , Accidente Cerebrovascular , Trombosis de la Vena , Humanos , Trombosis Intracraneal/cirugía , Trombosis Intracraneal/complicaciones , Trombosis de la Vena/cirugía , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/cirugía , Descompresión Quirúrgica/métodos , Femenino , MasculinoRESUMEN
INTRODUCTION: Visual loss secondary to a vascular loop or atherosclerotic carotid has been a controversial topic for many years with contemporary data supporting its existence. The role of surgery in the management of this entity is not well defined. We performed a systematic review describing the different surgical techniques and outcomes. METHOD: A search strategy was devised in accordance with the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. An electronic search was performed from the databases Pubmed, Google scholar, Scopus and Web of Science databases. The search was performed from inception until the 10th of December 2023. RESULTS: A total of 2469 articles were screened with 15 articles describing 18 patients being included. Of these cases, eleven involved compression due to unilateral or bilateral dolichoectatic internal carotid artery (ICA), three for a dolichoectatic anterior cerebral artery (ACA), two for a combination of a dolichoectatic ICA with a dorsolateral ophthalmic artery and two for a combination of a dolichoectatic ICA and ACA. CONCLUSION: Two distinct compressive entities can be differentiated. Compressive optic neuropathy at the entrance of the optic canal due to pinching between an ectatic carotid and the falciform ligament. A second entity is due to compression of the cisternal optic nerve or chiasm secondary tot a vascular loop. A variety of surgical techniques have been described and include: unroofing of the optic canal with sectioning of the falciform ligament; microvascular decompression with a Teflon® pellet, a muscle patch or, rerouting of the offending vessel with a sling. Larger and prospective studies are needed to better define the role of surgery in this, probably, underreported pathology.
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Arteria Carótida Interna , Vías Visuales , Humanos , Vías Visuales/cirugía , Arteria Carótida Interna/cirugía , Arteria Oftálmica/cirugía , Arteria Cerebral Anterior/cirugía , Síndromes de Compresión Nerviosa/cirugía , Procedimientos Neuroquirúrgicos/métodos , Descompresión Quirúrgica/métodos , Enfermedades del Nervio Óptico/cirugíaRESUMEN
BACKGROUND: Posterolateral decompression and fusion with internal fixation is a commonly used surgical approach for treating degenerative lumbar spinal stenosis (DLSS). This study aims to evaluate the impact of preserving a portion of the unilateral facet joint during decompression on surgical outcomes and long-term recovery in patients. METHODS: This study analyzed 73 patients with DLSS accompanied by bilateral lower limb neurological symptoms who underwent single-level L4/5 posterolateral decompression and fusion surgery from January 2022 to March 2023. Patients were categorized into two groups based on the type of surgery received: Group A comprised 31 patients who underwent neural decompression without facet joint preservation, while Group B consisted of 42 patients who underwent neural decompression with preservation of partial facet joints on one side. Regular follow-up evaluations were conducted, including clinical and radiological assessments immediately postoperatively, and at 3 and 12 months thereafter. Key patient information was documented through retrospective chart reviews. RESULTS: Most patients in both groups experienced favorable surgical outcomes. However, four cases encountered complications. Notably, during follow-up, Group B demonstrated superior 1-year postoperative interbody fusion outcomes (P < 0.05), along with a trend towards less interbody cage subsidence and slower postoperative intervertebral disc height loss. Additionally, Group B showed significantly reduced postoperative hospital stay (P < 0.05). CONCLUSION: Under strict adherence to surgical indications, the posterior lateral lumbar fusion surgery, which preserves partial facet joint unilaterally during neural decompression, can offer greater benefits to patients.
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Descompresión Quirúrgica , Vértebras Lumbares , Fusión Vertebral , Estenosis Espinal , Articulación Cigapofisaria , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Fusión Vertebral/métodos , Masculino , Femenino , Estudios Retrospectivos , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano , Persona de Mediana Edad , Descompresión Quirúrgica/métodos , Articulación Cigapofisaria/cirugía , Articulación Cigapofisaria/diagnóstico por imagen , Resultado del Tratamiento , Extremidad Inferior/cirugía , Estudios de SeguimientoRESUMEN
BACKGROUND AND OBJECTIVES: Cubital tunnel syndrome is the second most common nerve entrapment, and understanding the anatomy is crucial for the success of the nerve release. During ulnar nerve release for cubital tunnel syndrome, a motor branch is frequently encountered crossing anteriorly over the ulnar nerve from its medial/ulnar side proximally to the lateral/radial side distally. Little has been noted about this crossing branch in the literature. In this anatomic study, we sought to characterize this branch further and discuss its potential significance in cubital tunnel release. METHODS: We performed a cadaveric dissection of 48 elbow specimens as if performing a cubital tunnel release. We assessed for the presence of the crossing motor branch of the ulnar nerve and measured the distance from the medial epicondyle to the branch takeoff and to its target of innervation. RESULTS: Of our 48 specimens, 34 (71%) were noted to have a crossing motor branch at the area of compression by the deep flexor carpi ulnaris muscle fascia (common aponeurosis). On average, the distance from the medial epicondyle to the branch origin from the ulnar nerve was 18.2 mm and to the target muscle innervation was 28.4 mm. CONCLUSION: Identifying this branch is important for performing a cubital tunnel release, and awareness of this anatomy during ulnar nerve decompression procedures may help avoid injury to this motor branch.
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Cadáver , Síndrome del Túnel Cubital , Codo , Nervio Cubital , Humanos , Nervio Cubital/anatomía & histología , Síndrome del Túnel Cubital/cirugía , Codo/inervación , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Persona de Mediana Edad , Descompresión Quirúrgica/métodosRESUMEN
Lumbar stenosis (LS) often leads to debilitating symptoms due to nerve compression in the spinal canal. As this condition becomes increasingly prevalent among the elderly, innovative surgical techniques are crucial. This letter examines a recent advancement introduced by Marco Aurélio Moscatelli et al., who have developed an ipsilateral interlaminar endoscopic approach for decompression at the L5-S1 level. Their study, involving 30 patients with degenerative stenosis, reports significant improvements in quality-of-life metrics, including the Oswestry Disability Index (ODI) and visual analog scales (VAS) for pain. The new approach not only overcomes anatomical challenges specific to the L5-S1 region but also offers enhanced visualization and extensive decompression without destabilizing the spine. This letter highlights the promising results of this technique, the utility of the FAPDIS algorithm in guiding surgical choices, and the broader implications for minimally invasive lumbar surgery. The findings underscore a potential shift towards more effective and safer interventions for lumbar stenosis, paving the way for better patient outcomes in spinal decompression.
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Descompresión Quirúrgica , Vértebras Lumbares , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Vértebras Lumbares/cirugía , Descompresión Quirúrgica/métodos , Resultado del Tratamiento , Endoscopía/métodos , Región Lumbosacra/cirugía , Calidad de Vida , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
PURPOSE: The objective of this systematic review and metaanalysis is to compare the efficacy and safety of decompression alone versus decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. METHODS: A comprehensive search of the PubMed, Embase, Cochrane Library, and Ovid Medline databases was conducted to find randomized control trials (RCTs) or cohort studies that compared decompression alone and decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. Operation time; reoperation; postoperative complications; postoperative Oswestry disability index(ODI) scores and scores related to back and leg pain were collected from eligible studies for meta-analysis. RESULTS: We included 3 randomized controlled trials and 9 cohort studies with 6182 patients. The decompression alone group showed less operative time(P < 0.001) and intraoperative blood loss(p = 0.000), and no significant difference in postoperative complications was observed in randomized controlled trials(p = 0.428) or cohort studies(p = 0.731). There was no significant difference between the other two groups in reoperation(P = 0.071), postoperative ODI scores and scores related to back and leg pain. CONCLUSIONS: In this study, we found that the decompression alone group performed better in terms of operation time and intraoperative blood loss, and there was no significant difference between the two surgical methods in rate of reoperation and postoperative complications, ODI, low back pain and leg pain. Therefore, we come to the conclusion that decompression alone is not inferior to decompression and fusion in patients with single-level lumbar spinal stenosis with spondylolisthesis.
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Descompresión Quirúrgica , Vértebras Lumbares , Fusión Vertebral , Estenosis Espinal , Espondilolistesis , Humanos , Estenosis Espinal/cirugía , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/efectos adversos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Espondilolistesis/cirugía , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Tempo Operativo , ReoperaciónRESUMEN
An infant with a history of intestinal atresia type IV repaired at birth presented to the emergency department with recurrent abdominal distension. She was admitted 1 month before for abdominal distension secondary to formula intolerance. Hypothermia and mild respiratory distress prompted an evaluation with imaging, laboratory investigations, and blood and urine cultures. She was admitted to the intensive care unit and management included immediate surgical consultation, nothing by mouth, nasogastric tube placement for decompression and initiation of intravenous fluids and antibiotics. Her clinical status deteriorated within hours, requiring intubation and initiation of pressors. She responded to resuscitation but developed signs of abdominal compartment syndrome (ACS), prompting surgical decompression. The patient had a prolonged hospital stay and was discharged with total parenteral nutrition and G-tube feeds. This case highlights the importance of prompt recognition of risk factors, symptoms and management of paediatric ACS facilitating a reduction in morbidity and mortality.
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Hipertensión Intraabdominal , Humanos , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/diagnóstico , Hipertensión Intraabdominal/terapia , Femenino , Lactante , Descompresión Quirúrgica/métodos , Atresia Intestinal/complicaciones , Atresia Intestinal/cirugía , Recién NacidoRESUMEN
BACKGROUND: Unilateral laminotomy for bilateral decompression (ULBD) has yielded positive results in the treatment of lumbar spinal stenosis (LSS). Unilateral biportal ULBD (UB-ULBD) and percutaneous endoscopic ULBD (PE-ULBD) are gaining popularity because of the progress that has been made in minimally invasive surgery (MIS). The objective of this study was to evaluate and compare the radiographic and clinical results of UB-ULBD and PE-ULBD. METHODS: This study retrospectively enrolled patients who underwent ULBD surgery for LSS. The patients were categorized into two groups on the basis of the surgical method: the UB-ULBD group and the PE-ULBD group. Data on the general demographic data, surgical details, clinical efficacy, radiography and complications were compared between the two groups were compared. The minimum follow-up duration was 12 months. RESULTS: A total of 113 LSS patients who had undergone ULBD at our institution were included, of whom 61 patients underwent UB-ULBD surgery and 52 underwent PE-ULBD surgery. The UB-ULBD group had a significantly shorter operation time (P < 0.05). The facet was significantly better preserved in the UB-ULBD group than in the PE-ULBD group, and the angle of ipsilateral facet joint resection in the UE-ULBD group was significantly smaller (P < 0.05). The ODI score, VAS score and modified Macnab criteria improved postoperatively in both groups. The UB-ULBD group had a 95.08% rate of excellent or good patient outcomes, whereas the PE-ULBD group had a 92.30% rate. CONCLUSION: Both UB-ULBD and PE-ULBD can provide favourable clinical outcomes when used to treat LSS. UB-ULBD is beneficial because of its shorter operation time, smaller angle of ipsilateral facet joint resection and better facet preservation, making it a viable and safe option for treating LSS while ensuring spinal stability.
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Descompresión Quirúrgica , Endoscopía , Laminectomía , Vértebras Lumbares , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Femenino , Masculino , Estudios Retrospectivos , Descompresión Quirúrgica/métodos , Laminectomía/métodos , Persona de Mediana Edad , Anciano , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Resultado del Tratamiento , Endoscopía/métodos , Estudios de Seguimiento , Tempo OperativoRESUMEN
BACKGROUND: To evaluate the treatment outcomes of lateral interbody bone graft surgery and posterior percutaneous screws for lumbar spinal stenosis Methods: This is a cross-sectional descriptive study. There were 27 patients with 30 segments of surgery diagnosed with lumbar spinal stenosis that were surgically treated with the XLIF method. Clinical outcomes measured included VAS scores for lower back pain and leg pain, ODI, and JOA scores. Magnetic resonance imaging of the lumbar spine after surgery was used to evaluate indirect decompression. X-ray or CT scan to evaluate bone fusion after 6 months of surgery. Differences were determined by independent T-test. RESULTS: There were 27 patients with 30 segments of surgery. They were 12 males and 15 females with an average age of 58.81±8.1. There was significant improvement in VAS for lower back pain from 7.11±1.31 to 3.67±1.3, VAS for leg pain from 6.81±2.19 to 1.59±1.89, ODI from 26.41±8.95 to 13.69±8.34, and JOA score from 7.63±2.87 to 13.5±1.73. A-P diameter increased 134%, lateral diameter increased 120%, lateral recess depth increased 166%, disc height increased 126%, foraminal height increased 124%, spinal canal area increased 30%. The p-values were all <0.001. The average hospital stay was 6.79±3.01 days. Complications included 1 pedicle screw malformation, 1 ALL avulsion fracture, 1 abdominal herniation, 1 venous damage, 1 failure. CONCLUSION: XLIF surgery presents a favorable option for patients with lumbar spinal stenosis. This is a minimally invasive surgical method that reduces pain, reduces bleeding, and is effective in indirectly decompressing the spinal canal both clinal and imaging.
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Vértebras Lumbares , Fusión Vertebral , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Masculino , Femenino , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Fusión Vertebral/métodos , Estudios Transversales , Imagen por Resonancia Magnética , Descompresión Quirúrgica/métodos , Dolor de la Región Lumbar/cirugía , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/etiología , Trasplante Óseo/métodos , Tomografía Computarizada por Rayos X , Tornillos ÓseosRESUMEN
ABSTRACT: Migraine headaches are a significant global health concern, frequently managed with varying levels of success. Compression of the greater occipital nerve (GON) is hypothesized to contribute to pathology in some migraine patients, making extracranial nerve decompression surgery a potential intervention for refractory cases. However, accurate methods to image the GON along its tortuous course still need to be explored. Our group has developed magnetic resonance imaging sequences to track the GON. Yet, many challenges were met, which included navigating the GON's complex anatomy, understanding anatomical variants, and designing advanced magnetic resonance imaging sequences and coils to image the posterior scalp. Addressing these hurdles is vital to capture and understand GON pathology and guide potential interventions.
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Imagen por Resonancia Magnética , Trastornos Migrañosos , Humanos , Imagen por Resonancia Magnética/métodos , Trastornos Migrañosos/diagnóstico por imagen , Trastornos Migrañosos/cirugía , Nervios Espinales/diagnóstico por imagen , Nervios Espinales/anatomía & histología , Descompresión Quirúrgica/métodos , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/diagnóstico por imagenRESUMEN
BACKGROUND: Recurrent ulnar nerve compression after primary anterior subcutaneous transposition is relatively rare, and revision surgery is challenging. This study retrospectively evaluated the clinical outcomes of revision anterior subcutaneous transposition for recurrent ulnar nerve compression. METHODS: Eight patients who underwent revision anterior subcutaneous transposition for recurrent ulnar nerve compression were enrolled in this study. The outcomes were based on preoperative and postoperative symptoms, physical examination findings, and electromyographic evaluation. RESULTS: Ulnar nerve enlargement was preoperatively found in all patients with a mean cross sectional area of 0.15 cm2 (range, 0.14-0.18 cm2). Intraoperative findings showed that recurrent compression occurred in three areas, including the medial intermuscular septum (n = 5), the medial epicondyle (n = 6) and nerve entrance to forearm fascia (n = 1). Post-operation, significant improvements were observed in ring/little finger numbness (from severe to mild, p = 0.031), grip strength (from 48.00% to 80.38% of the intact side, p < 0.001) and McGowan grade (from Grade III to Grade I, p = 0.049). Postoperative electromyography test also showed significant improvement in motor nerve conduction at elbow (velocity, 23.30 ± 9.598 vs. 35.30 ± 9.367, p = 0.012; amplitude, 3.40 ± 3.703 vs. 5.65 ± 2.056, p = 0.007) and sensory nerve conduction at wrist (velocity, 27.04 ± 22.450 vs. 36.45 ± 18.099, p = 0.139; amplitude, 1.44 ± 1.600 vs. 4.00 ± 2.642, p = 0.011). Seven of the eight patients reported satisfaction with the postoperative results. CONCLUSIONS: Revision anterior subcutaneous transposition was an effective treatment for recurrent ulnar nerve compression from prior failed procedures.
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Reoperación , Síndromes de Compresión del Nervio Cubital , Humanos , Masculino , Femenino , Reoperación/métodos , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Síndromes de Compresión del Nervio Cubital/cirugía , Nervio Cubital/cirugía , Anciano , Resultado del Tratamiento , Descompresión Quirúrgica/métodos , RecurrenciaRESUMEN
BACKGROUND: Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy of the posterior tibial nerve. Surgery can be performed less invasively under local anesthesia. We adopted zig-zag skin incision to prevent postoperative wound complications. METHODS: Between July 2022 and June 2023, we operated on 19 legs of 14 consecutive TTS patients (5 males, 11 females; average age 73.3 years). We made a 2- to 3-cm zig-zag skin incision on the tarsal tunnel. After posterior tibial nerve decompression by posterior tibial artery (PTA) transposition, the subcutaneous layer was tightly sutured with 4-0 PDS and the skin was closed with Dermabond Advanced. We investigated adverse events that developed during the first 30 postoperative days and recorded surgical outcomes at the final visit. RESULTS: In all patients the nerves were successfully decompressed with PTA transposition. There were no intraoperative complications. During the 30 postoperative days there were no adverse events, including wound complications, and patients' symptoms improved significantly. CONCLUSION: Zig-zag skin incision was easy and convenient for surgical TTS treatment and may be useful for preventing postoperative wound complications.
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Descompresión Quirúrgica , Complicaciones Posoperatorias , Síndrome del Túnel Tarsiano , Humanos , Femenino , Masculino , Síndrome del Túnel Tarsiano/cirugía , Anciano , Descompresión Quirúrgica/métodos , Resultado del Tratamiento , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Persona de Mediana Edad , Anciano de 80 o más Años , Nervio Tibial/cirugía , Procedimientos Quirúrgicos Dermatologicos/métodos , Procedimientos Quirúrgicos Dermatologicos/efectos adversosRESUMEN
To enhance the decompression and drainage effects after marsupialization of large odontogenic keratocysts (OKCs) in the jawbone, a novel cyst plug was designed, and its clinical feasibility was investigated. A total of 42 patients with large OKCs requiring decompression were divided into 2 groups: the control group (nâ =â 21), which underwent traditional drainage tube insertion, and the experimental group (nâ =â 21), which received a personalized wing-shaped plug. The clinical efficacy of the wing-shaped plug was assessed, and postoperative recovery times were compared between the 2 groups. The average duration of use for the wing-shaped plug was approximately 14 months. Compared to the control group, the treatment duration in the experimental group was reduced by about 3 months. The wing-shaped plug demonstrated superior fit, comfort, reduced food residue, minimal irritation to surrounding tissues, a more aesthetically pleasing appearance, and less reported pain. The adaptive wing-shaped plug offers improved prognosis for patients undergoing decompression of OKCs and shows significant potential for clinical application.
Asunto(s)
Descompresión Quirúrgica , Quistes Odontogénicos , Humanos , Quistes Odontogénicos/cirugía , Masculino , Femenino , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/instrumentación , Adulto , Persona de Mediana Edad , Drenaje/métodos , Drenaje/instrumentación , Resultado del Tratamiento , Adulto Joven , Estudios de FactibilidadRESUMEN
BACKGROUND: We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHODS: We retrospectively evaluated 51 patients followed for ≥10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression. RESULTS: A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade. CONCLUSIONS: Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Descompresión Quirúrgica , Osificación del Ligamento Longitudinal Posterior , Calidad de Vida , Fusión Vertebral , Vértebras Torácicas , Humanos , Osificación del Ligamento Longitudinal Posterior/cirugía , Masculino , Femenino , Descompresión Quirúrgica/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Estudios de Seguimiento , Anciano , Resultado del Tratamiento , AdultoRESUMEN
BACKGROUND: The L5-S1 interlaminar access described in 2006 by Ruetten et al. represented a paradigm shift and a new perspective on endoscopic spinal approaches. Since then, the spinal community has shown that both the traditional ipsilateral and novel contralateral interlaminar approaches to the L5-S1 foramen are good alternatives to transforaminal access. This study aimed to provide a technical description and brief case series analysis of a new endoscopic foraminal and extraforaminal approach for pathologies at the lumbar L5-S1 level using a new ipsilateral interlaminar approach. METHODS: Thirty patients with degenerative stenotic conditions at the L5-S1 disc level underwent the modified interlaminar approach. The surgical time, blood loss, occurrence of complications, and clinical outcomes were recorded. The data were compiled in Excel and analyzed using R software version 4.2. All continuous variables are presented as the mean, median, minimum, and maximal ranges. For categorical variables, data are described as counts and percentages. RESULTS: Thirty patients were included in the study. The cohort showed significant improvements in all quality-of-life scores (ODI, visual analog scale of back pain, and visual analog scale of leg pain). Five cases of postoperative numbness and three cases of postoperative dysesthesia have been reported. No case of durotomy or leg weakness has been reported. CONCLUSIONS: The fundamental change proposed by this procedure, the new ipsilateral approach, presents potential advantages to surgeons by overcoming anatomical challenges at the L5-S1 level and by providing surgeon-friendly visualization and access. This approach allows for extensive foraminal and extraforaminal decompression, including the removal of hernias and osteophytosis, without causing neural retraction of the L5-S1 roots while maintaining the stability of the operated level.
Asunto(s)
Descompresión Quirúrgica , Vértebras Lumbares , Humanos , Femenino , Masculino , Descompresión Quirúrgica/métodos , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Anciano , Adulto , Sacro/cirugía , Endoscopía/métodos , Estenosis Espinal/cirugía , Resultado del Tratamiento , Neuroendoscopía/métodosRESUMEN
OBJECTIVE: To assess whether decompression alone is non-inferior to decompression with instrumented fusion five years after primary surgery in patients with degenerative lumbar spondylolisthesis. DESIGN: Five year follow-up of a randomised, multicentre, non-inferiority trial (Nordsten-DS). SETTING: 16 public orthopaedic and neurosurgical clinics in Norway. PARTICIPANTS: Patients aged 18-80 years with symptomatic lumbar spinal stenosis and a spondylolisthesis of 3 mm or more at the stenotic level. INTERVENTIONS: Decompression surgery alone and decompression with additional instrumented fusion (1:1). MAIN OUTCOME MEASURES: The primary outcome was a 30% or more reduction in Oswestry disability index from baseline to five year follow-up. The predefined non-inferiority margin was a -15 percentage point difference in the proportion of patients who met the primary outcome. Secondary outcomes included the mean change in Oswestry disability index, Zurich claudication questionnaire, numeric rating scale for leg and back pain, and EuroQol Group 5-Dimension (EQ-5D-3L) questionnaire. RESULTS: From 12 February 2014 to 18 December 2017, 267 participants were randomly assigned to decompression alone (n=134) and decompression with instrumented fusion (n=133). Of these, 230 (88%) responded to the five year questionnaire: 121 in the decompression group and 109 in the fusion group. Mean age at baseline was 66.2 years (SD 7.6), and 69% were women. In the modified intention-to-treat analysis with multiple imputation of missing data, 84 (63%) of 133 people in the decompression alone group and 81 (63%) of 129 people in the fusion group had a at least a 30% reduction in Oswestry disability index, a difference of 0.4 percentage points. (95% confidence interval (CI) -11.2 to 11.9). The respective results of the per protocol analysis were 65 (65%) of 100 in the decompression alone group and 59 (66%) of 89 in the fusion group, a difference of -1.3 percentage points (95% CI -14.5 to 12.2). Both 95% CIs were higher than the predefined non-inferiority margin of -15%. The mean change in Oswestry disability index from baseline to five years was -17.8 in both groups (mean difference 0.02 (95% CI -3.8 to 3.9)). Results of the other secondary outcomes were in the same direction as the primary outcome. From two to five year follow-up, a new lumbar operation occurred in six (5%) of 123 people in the decompression group and 11 (10%) of 113 people in the fusion group, with a total from baseline to five years of 21 (16%) of 129 people and 23 (18%) of 125, respectively. CONCLUSIONS: In participants with degenerative spondylolisthesis, decompression alone was non-inferior to decompression with instrumented fusion five years after primary surgery. Proportions of subsequent surgeries at the index level or an adjacent lumbar level were no different between the groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT02051374.
Asunto(s)
Descompresión Quirúrgica , Evaluación de la Discapacidad , Vértebras Lumbares , Fusión Vertebral , Espondilolistesis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Descompresión Quirúrgica/métodos , Estudios de Seguimiento , Vértebras Lumbares/cirugía , Noruega , Fusión Vertebral/métodos , Estenosis Espinal/cirugía , Espondilolistesis/cirugía , Resultado del TratamientoRESUMEN
Spinal robotics has rounded out twenty years in clinical, is mainly used for pedicle screw placement at present, can significantly increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. In the future, haptic feedback, automatic collision avoidance, and other technologies will further expand its application to complete precise operations such as decompression and correction, providing safety guarantee for the implementation of complex spinal surgery.