APPLICATION OF ANTERIOR MINI-INCISION VERTEBROPLASTY IN CERVICAL METASTASES

To determine the relationship between the serum urate (SU) level, neutrophil / lymphocyte ratio (NLR), and pain severity using preoperative and postoperative visual analogue scale (VAS) scores in patients with lumbar disc herniation (LDH). This single-center, cross-sectional study included 20 consecutive patients who were operated for LDH by the same surgeon. The patients'pre- and postoperative UA levels, NLRs, and intensity severity VAS scores were investigated. Preoperative magnetic resonance imaging (MRI) findings, serum UA levels, and neutrophil and lymphocyte counts were recorded. Pain severity was recorded preoperatively and at 6 months postoperatively. Effects of the preoperative SU levels and NLRs on the pre- and postoperative VAS scores were statistically assessed. Statistically significant positive correlation coefficients were determined between NLR and the preoperative and postoperative VAS scores. Negative correlation coefficients were found between the SU levels and preoperative VAS scores; in contrast, positive correlation coefficients were found between the SU levels and the postoperative VAS scores. Our results demonstrate the importance of not ignoring the serum UA level and NLR in pre- and postoperative pain in patients with LDH. Nevertheless, further extensive studies are warranted.

The objective was to evaluate the long-term outcome of microvascular decompression (MVD) utilizing autologous muscle for trigeminal neuralgia (TGN). A retrospective review was performed of all first-time MVD patients for typical classic TGN without prior surgical intervention who were treated between 2000 and 2019 at a tertiary supraregional neurosurgery practice. Demographic characteristics, surgical findings, operative results, complications, and recurrence rates at 1 year, 5 years, and last follow-up were collected. Pain outcome was assessed using the Barrow Neurological Institute (BNI) pain score. The chi-square test with continuity correction was used to compare categorical variables, and Kaplan-Meier curves and Cox regression were used to identify factors associated with recurrence. In total, 1025 patients were studied with a median (interquartile range [IQR]) (range) follow-up of 8 (5-13) (3-20) years. In the immediate postoperative period, 889 patients (86.7%) had complete pain relief and 106 (10.3%) had partial pain relief; neither group required medication, and 30 patients (2.9%) had no relief. One hundred forty-one recurrences (13.8%) occurred over a median (IQR) of 3 (2-6) years after surgery. The proportion of patients without recurrence was 97% at 1 year, 90% at 5 years, 85% at 10 years, 82% at 15 years, and 81% at 20 years. There was no significant difference in the probability of recurrence between patients with complete (114/907 [12.6%] recurrences) or partial (19/106 [17.9%] recurrences) postoperative pain relief (p = 0.124, log-rank test). Patients with venous compression (n = 322) had a significantly higher rate of MVD failure (n = 16 [5%]) compared to those with arterial compression (14/703 [2%]) (p = 0.015, chi-square test). In the Cox proportional hazards model, venous compression and lack of immediate postoperative pain relief had hazard ratios of 1.62 (95% CI 1.16-2.27) and 2.65 (95% CI 1.45-4.82) for recurrence, respectively. One hundred twenty-four (12.1%) complications were documented, including facial numbness (44 [4.3%]), facial nerve palsy (37 [3.6%]), CSF leak (13 [1.3%]), and diplopia (5 [0.5%]), which resolved in all patients. MVD with autologous muscle provides long-lasting pain relief in TGN patients with vascular compression with minimum morbidity and is a viable alternative to synthetic materials.

Arthroscopic resection of the talocalcaneal coalition (TCC) has been reported to be associated with good short-term outcomes. However, the midterm outcomes of this approach remain uncertain. We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed. Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0±8.5 years, and the mean follow-up period was 56.9±18.0 months. Thirteen (41%) patients were in group P, whereas 19 (59%) patients were in group MP. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0±7.0 vs 85.8±10.8, P = .532) and VAS score (2.1±1.7 vs 4.0±2.6, P = .537) between patients with the ratio of coalition/posterior facet more than or less than 50%. There were no statistical differences in postoperative VAS score (1.8±1.3 vs 2.6±2.2, P = .236) and AOFAS score (92.5±5.6 vs 89.2±8.7, P = .297) between group P (n=13) and group MP (n=19), either. Three patients (9.4%) had complications, including these notable findings: 1 patient complained of restricted dorsal flexion, 1 with computed tomography-proven coalition recurrence, and 1 with partial tibial nerve injury. We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up. Level IV, case series.

Percutaneous transpedicular vertebroplasty with polymethyl methacrylate for pathological fracture of the spine

Aim: Lumbar microdiscectomy (LMD) is considered as a gold standard surgical technique for the treatment of patients with lumbar disc hernia (LDH) although various types of treatment are being developed. This study aimed to investigate the safety and efficacy of LMD in our clinic.Material and Methods: The study exclusively included 271 patients undergoing LMD due to LDH. Preoperative and postoperative (10th day, 1st month, and long-term) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared. Clinical outcomes were analyzed retrospectively based on modified Macnab criteria. Complications were noted. SPSS Statistics 22.0 software package was used to analyse the data for pre- and postoperative VAS and ODI scores. A p value of 0.05 was considered statistically significant.Results: The mean length of stay in the operating room and hospital was 165.04±36.99 min and 1642.02±574.90 min, respectively. There was a significant decrease in postoperative VAS and ODI (%) scores compared to preoperative scores. Preoperative VAS and postoperative long-term VAS scores were 8.99±0.62 and 1.38±0.95, respectively whereas preoperative ODI (%) and postoperative long-term ODI (%) scores were 85.33±6.74 and 12.96±9.58, respectively (p0.001). The success rate for excellent or good outcomes according to the modified Macnab criteria was 87.45%. During surgery, cerebrospinal fluid (CSF) leak and dura defect developed in four patients (1.48%) and there was only dura defect in two patients (0.73%). After the surgery, recurrent LDH, spinal infection, and spinal epidural hematoma developed in seven (2.58%), three (1.11%), and one patient (0.37%), respectively.Conclusion: LMD is an effective and safe method in the treatment of LDH as it has low complication rates and high success rates.

Objective: This study aims to evaluate the results of disc restoration hydrogel implanted (GelstixTM) lumber disc hernia patients. Materials and Method: Patients suffering from chronic back pain diagnosed with lumber disc hernia who were admitted to Firat University Algology Clinic and treated with disc restoration hydrogel between January 2013 and January 2014 were evaluated. Cases were evaluated for demographic characteristics, magnetic resistance imaging findings, preoperative and postoperative visual analog scale (VAS) scores, complications, side effects, and patient satisfaction after the procedure. Results: Of the operated 62 patients were 25 male (40.3%) and 37 female (59.7%). The mean age of all patients was 49.18±14.18 years, the mean age of female patients was 50.81±13.37 years and the mean age of male patients was 46.76±15.27 years. The mean duration of pain in female and male patients was 37.81±37.92 months and 25.36±33.58 months, respectively. Preoperative and postoperative VAS scores of female patients were 8.24±1.09 and 3.56±2.11; male patients were 7.88±1.01 and 3.76±2.17, respectively. Of the 62 patients suffered from 16 right leg pain (25.8%), 20 left leg pain (32. 3%), and 26 bilateral lower limb pain (41.9%). Of 62 patients 31 had no additional disorders (50%), 12 had cardiac disorders (19.4%), 3 had (4.8%) respiratory disorders, 7 had endocrine disorders (11.3%), 4 had both endocrine and cardiac disorders (6.5%), 2 had both cardiac and respiratory disorders (3.2%), 1 had both endocrine and respiratory disorders (1.6%), and 2 had both endocrine, cardiac and respiratory disorders (3.2%). Of the 62 patients 25 had bulging (40.3%), 5 had protrusion (8.1%), 4 had narrowed neural foramen (6.5%), 18 had bulging+narrowed neural foramen (29%), 3 had narrowed neural foramen + protrusion (4.8%) and 7 had bulging + protrusion (11.3%). Thirteen patients hadn’t had previous therapy (20.97%), transforaminal steroid injection was applied to 29 patients (46.77%), and medical therapy (such as NSAID, miyorelactants) was applied to 20 (32.26%). Levels of complaints were 2 at L2-L3 (3. 2%), 17 at L3-L4 (27.4%), 28 at L4-L5 (45.2%), and 15 at L5-S1 (24.2%). Without L2-L3 level other operated levels had significant differences between preoperative VAS scores and postoperative VAS scores. The number of unsatisfied patients was 9 (14.5%), moderated satisfied patients number 16(25.8%), good satisfied patients number was 16 (25. 8%), and perfectly satisfied patients number was 21 (33.9%). Conclusion: Disc restoration hydrogel is a safe minimal invasive technique with satisfactory results, low complication rates, and low side effect risk especially in young and middle-aged patients.

Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with medically refractory trigeminal neuralgia (TN). The authors began use of this technique at our center in 1992 and have evaluated outcomes serially. Independently acquired data from 220 patients with idiopathic TN that had Gamma Knife radiosurgery was reviewed. The median radiosurgery dose was 80 Gy with a range of 60 to 90 Gy. Most patients had features of typical TN, although 16 (7.3%) described additional atypical features. One hundred thirty-five patients (61.4%) had prior surgery. Patients were followed to a maximum of 6.5 years (median, 2 years). Complete or partial pain relief was achieved in 85.6% of patients at 1 year. Complete pain relief was achieved in 64.9 % of patients at 6 months, 70.3% at 1 year, and 75.4% patients at 33 months. Patients with an atypical pain component had a lower rate of achieving pain relief ( p = 0.025). Due to recurrences, 55.8% of patients had complete or partial pain relief at 5 years. The absence of preoperative sensory disturbance or prior surgery correlated with an increased proportion of patients in complete or partial pain relief over time. Ten percent of patients developed new or increased subjective facial paresthesia or facial numbness. Radiosurgery for idiopathic TN was safe and effective, and provided benefit to a patient population with a high frequency of prior surgical intervention. It is an important addition to the surgical armamentarium for TN.

Lumbar epidural steroid injection can be accomplished by one of three methods: caudal (C), interlaminar (IL), or transforaminal (TF). In this study we sought to determine the efficacy of these techniques for the management of radicular pain associated with lumbar disk herniations. Ninety patients aged 18-60 years with L5-S1 disk herniations and radicular pain were randomly assigned to one of these groups to have epidural steroid injection therapy every 2 wk for a maximum of three injections. Pain relief, disability, and activity levels were assessed. Pain relief was significantly more effective with TF injections. At 24 wk from the initiation of this study, pain relief was as follows: C: complete pain relief: 1/30, partial pain relief: 16/30, and no relief: 13/30; IL: complete pain relief: 3/30, partial pain relief: 15/30, and no relief: 12/30; and TF: complete pain relief: 9/30, partial pain relief: 16/30, and no relief: 5/30. The TF route of epidural steroid placement is more effective than the C or IL routes. We attribute this observation to a higher incidence of steroid placement in the ventral epidural space when the TF method is used.

Objective: To explore the efficacy and technical features of fully endoscopic microvascular decompression(MVD) in primary trigeminal neuralgia(PTN) via keyhole approach. Methods: The clinical data of 97 patients with PTN underwent fully endoscopic MVD via keyhole approach in the Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from December 2014 to February 2019 was collected. During fully endoscopic MVD in PTN via keyhole approach, performer use natural clearance without grinding except developed rock bone crest or excessive retraction of the brain tissue, visually and panoramically observe and evaluate the CPA area, accurately identify the responsible vessels, to avoid the omission of responsible vessels or insufficient decompression. And the use of preplaced technology, bridging technology and submersible technology, ensure the efficacy of surgery and reduce the surgical side injuries.Barrow Neurological Institute (BNI) pain score was used to evaluate the efficacy and identify the recurrence. The surgical efficacy was analyzed. Results: The offending vessels were identified under endoscope in 96 cases. Among them, arterial compression was found in 77 cases, venous compression in 6 cases, and both arterial and venous compression in 13 cases. About the pain outcomes, 87 cases had immediate and complete relief of pain, 5 cases had almost relief of pain, 4 cases had partial relief of pain, and still needed medication control, but the dose was lower than that before operation, and 1 case had no obvious relief of pain. About complications, there were 4 cases of temporary facial numbness, 1 case of temporary hearing loss, both of them recovered after symptomatic treatment. There was no cerebral infarction or hemorrhage, intracranial or incision infection. All cases were followed up for 3.0-38.0 months with a median period of(22.4±2.2) months. During the follow-up periods, postoperative recurrence occurred in 3 cases. Conclusion: Fully endoscopic MVD for PTN through keyhole approach, provides panoramic view to avoid omission of offending vessels and reduce complications, seemed to be a safe and effective surgical method.

Surgical management of neuromas is difficult, with no consensus on the most effective surgical procedure to improve pain and quality of life. This study evaluated the surgical treatment of neuromas by neurectomy, crush, and proximal transposition on improvement in pain, depression, and quality of life. Patients who underwent neuroma excision and proximal transposition were evaluated. Preoperative and postoperative visual analogue scale scores for pain (worst and average), depression, and quality of life were assessed using linear regression, and means were compared using paired t tests. The Disabilities of the Arm, Shoulder, and Hand questionnaire score was calculated preoperatively and postoperatively for upper extremity neuroma patients. Patients with long-term follow-up were analyzed using repeated measures analysis of variance comparing preoperative, postoperative, and long-term visual analogue scale scores. Seventy patients (37 with upper extremity neuromas and 33 with lower extremity neuromas) met inclusion criteria. Statistically significant improvements in visual analogue scale scores were demonstrated for all four patient-rated qualities (p < 0.01) independent of duration of initial clinical follow-up. The change in preoperative to postoperative visual analogue scale scores was related inversely to the severity of preoperative scores for pain and depression. Neuroma excision and proximal transposition were equally effective in treating lower and upper extremity neuromas. Upper extremity neuroma patients had a statistically significant improvement in Disabilities of the Arm, Shoulder, and Hand questionnaire scores after surgical treatment (p < 0.02). Surgical neurectomy, crush, and proximal nerve transposition significantly improved self-reported pain, depression, and quality-of-life scores. Surgical intervention is a viable treatment of neuroma pain and should be considered in patients with symptomatic neuromas refractory to nonoperative management. Therapeutic, IV.

Category: Arthroscopy; Hindfoot Introduction/Purpose: Arthroscopic resection3-term outcomes. However, the midterm outcomes of this approach remain uncertain. Methods: We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot &amp; Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed. Results: Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0 8.5 years, and the mean follow-up period was 56.9 18.0 months. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0 7.0 vs 85.8 10.8, P = .532) and VAS score (2.1 1.7 vs 4.0 2.6, P = .537) between patients with the ratio of coalition/posterior facet more than or less than 50%. Conclusion: We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up.

Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with trigeminal neuralgia. In this study, the authors investigate the clinical outcomes in patients treated with this procedure. Independently acquired data from 220 patients with idiopathic trigeminal neuralgia who underwent gamma knife radiosurgery were reviewed. The median age was 70 years (range 26-92 years). Most patients had typical features of trigeminal neuralgia, although 16 (7.3%) described additional atypical features. One hundred thirty-five patients (61.4%) had previously undergone surgery and 80 (36.4%) had some degree of sensory disturbance related to the earlier surgery. Patients were followed for a maximum of 6.5 years (median 2 years). Complete or partial relief was achieved in 85.6% of patients at 1 year. Complete pain relief was achieved in 64.9% of patients at 6 months, 70.3% at 1 year, and 75.4% at 33 months. Patients with an atypical pain component had a lower rate of pain relief (p = 0.025). Because of recurrences, only 55.8% of patients had complete or partial pain relief at 5 years. The absence of preoperative sensory disturbance (p = 0.02) or previous surgery (p = 0.01) correlated with an increased proportion of patients who experienced complete or partial pain relief over time. Thirty patients (13.6%) reported pain recurrence 2 to 58 months after initial relief (median 15.4 months). Only 17 patients (10.2% at 2 years) developed new or increased subjective facial paresthesia or numbness, including one who developed deaf-ferentation pain. Radiosurgery for idiopathic trigeminal neuralgia was safe and effective, and it provided benefit to a patient population with a high frequency of prior surgical intervention.

Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with trigeminal neuralgia. In this study, the authors investigate the clinical outcomes in patients treated with this procedure. Independently acquired data from 220 patients with idiopathic trigeminal neuralgia who underwent gamma knife radiosurgery were reviewed. The median age was 70 years (range 26-92 years). Most patients had typical features of trigeminal neuralgia, although 16 (7.3%) described additional atypical features. One hundred thirty-five patients (61.4%) had previously undergone surgery and 80 (36.4%) had some degree of sensory disturbance related to the earlier surgery. Patients were followed for a maximum of 6.5 years (median 2 years). Complete or partial relief was achieved in 85.6% of patients at 1 year. Complete pain relief was achieved in 64.9% of patients at 6 months, 70.3% at 1 year, and 75.4% at 33 months. Patients with an atypical pain component had a lower rate of pain relief (p = 0.025). Because of recurrences, only 55.8% of patients had complete or partial pain relief at 5 years. The absence of preoperative sensory disturbance (p = 0.02) or previous surgery (p = 0.01) correlated with an increased proportion of patients who experienced complete or partial pain relief over time. Thirty patients (13.6%) reported pain recurrence 2 to 58 months after initial relief (median 15.4 months). Only 17 patients (10.2% at 2 years) developed new or increased subjective facial paresthesia or numbness, including one who developed deafferentation pain. Radiosurgery for idiopathic trigeminal neuralgia was safe and effective, and it provided benefit to a patient population with a high frequency of prior surgical intervention.

To investigate the mid-to-long-term efficacy of patients with chronic ankle instability combined with posterior impingement syndrome after 3-9 years of follow-up, and to analyze the influencing factors. From February 2010 to December 2015, 46 patients underwent concurrent lateral ankle ligament repair with posterior ankle arthroscopic surgery at the Institute of Sports Medicine, Peking University Third Hospital. The patient was first placed in a prone position and underwent arthroscopic debridement for the posterior impingement. After finishing the posterior arthroscopy, the surgeon and assistants first translated the patient to the affected side, then turned to the healthy side, and changed the position to the supine position. During the turning over, another assistant held the arthroscope and the instrument to ensure that it was sterile and could be used without replacement. The anterior ankle arthroscopy was operated if necessary and the lateral ankle ligament repair was anatomic repaired with anchors. The 42 patients were followed up, including 26 males and 16 females. The average age was (28.9±10.0) years. The patient's clinical symptoms, joint stability, mobility and motor function were compared by questionnaire and physical examination. The preoperative and postoperative visual analogue scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Tegner scores were compared, and the clinical scores and the patient age, gender, height and weight were compared. The correlations between body mass index (BMI), preoperative duration, surgery duration, and cartilage injury were analyzed. The mean follow-up time was (71.8±22.8) months. The postoperative VAS scores (1.0 vs. 5.0, P<0.001), AOFAS scores (92 vs. 80, P<0.001), and Tegner scores (6.5 vs. 2, P<0.001) were significantly superior to the preoperative levels. The excellent and good rate was 97.6%. The postoperative VAS score (t=2.719, P=0.10), AOFAS score (t=-2.853, P=0.10), Tegner score (t=-3.443, P=0.001) and time to return exercise (t=2.814, P=0.008) were negatively correlated with the patient age, and the postoperative VAS score was negatively correlated with cartilage injury (Z=-2.195, P=0.028). The mid-to-long-term clinical outcomes of the chronic ankle ligament instability combined with the posterior impingement were good. The age of the patients was negatively correlated with the clinical outcome. The combined cartilage injury could aggravate the postoperative pain.

Aims: The aim of our study is to evaluate the effects of ultrasound – guided erector spinae plane block (ESPB) on intraoperative opioid requirement, postoperative analgesic consumption and patient satisfaction in laparoscopic cholecystectomy (LC) procedures. Methods: Ninety patients aged 18–65 years with American Society of Anesthesiologists (ASA) risk classification I–III who underwent elective laparoscopic cholecystectomy between December 2018 and December 2020 were retrospectively analyzed. Patients were divided into three groups: control (no block), preoperative ultrasound-guided ESPB, and postoperative ESPB performed just before extubation. Intraoperative opioid consumption, postoperative Visual Analog Scale (VAS) scores, additional analgesic requirements, and patient satisfaction were evaluated. Results: There were no significant differences among the groups regarding age, sex, height, or ASA physical status (p &gt; 0,05). However, significant differences were observed in mean body weight and body mass index (BMI) values (p = 0.006 and p = 0.007, respectively). Pairwise comparisons revealed no significant differences in body weight or BMI between the preoperative and postoperative ESPB groups (p = 0.787 and p = 0.882); however, both block groups had significantly higher values compared with the control group (p &lt; 0.05). VAS scores, postoperative analgesic requirements, and patient satisfaction differed significantly among the groups at postoperative 0, 1, 2, 6, 12, and 24 hours, in favor of both ESPB groups (p &lt; 0.001). Postoperative VAS scores at 0, 1, 2, and 6 hours were significantly lower in the preoperative ESPB group compared with the postoperative ESPB group (p &lt; 0.001). Intraoperative opioid consumption and postoperative additional analgesic requirements were also significantly lower in the preoperative ESPB group than in the other two groups (p &lt; 0.001). However, VAS scores and patient satisfaction at 12 and 24 hours were comparable between the two ESPB groups. In the control group, VAS scores at postoperative 0, 1, 2, 6, 12, and 24 hours were significantly higher (p &lt; 0.001), resulting in a significantly greater need for additional analgesia. Conclusion: Preemptive ESPB reduces the need for intraoperative opioids and maximizes patient satisfaction with postoperative low VAS scores.