Average VAS Score Research Articles

Clinical Efficacy and Complications of Spinal Surgery Unilateral Biportal Endoscopy for Cervical Spondylosis: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the clinical efficacy and complications of unilateral biportal endoscopy (UBE) for treating cervical spondylosis (CS), providing evidence-based guidance for optimal treatment decisions. Relevant studies on UBE for CS were identified through comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library up to April 22, 2024. Studies included patients diagnosed with CS who underwent UBE surgery and reported outcomes such as VAS scores, NDI scores, and postoperative complications. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Stata 15, employing random-effects models due to significant heterogeneity (I2 > 50%). Nine publications, comprising 353 patients and 400 operation levels, met the inclusion criteria. The mean follow-up duration was 17.01 months, and the operative time for a single level was 71.29 minutes. The average VAS score for neck pain decreased from 6.08 preoperatively to 1.52 postoperatively, the average VAS score for arm pain decreased from 7.13 to 1.35, and the average NDI decreased from 34.61 to 6.83 at the final follow-up. The mean satisfaction rate (good or excellent using the Macnab criteria) was 91%. The overall complication rate was 5%, with the most frequent complication being a dural tear (1%), followed by nerve root injury or transient hypoesthesia (0.3%). UBE demonstrates strong efficacy and safety in treating CS, with significant improvements in pain and disability scores, shorter operative times, and lower complication rates.

Evaluation of biopsychosocial model for pain management in postoral cancer therapy patients

Background. Approximately 50 % of cancer patients have pain in their daily lives, which is multifaceted sensation goes beyond basic biochemical signal of pain. Oral mucositis is one of the negative consequences with intense pain, discomfort, challenges in speaking and eating. These components collectively influence patient's total quality of life across mental, biological, social aspects. Biopsychosocial model (BPS) is an effective technique for understanding and addressing conceptualization and treatment of pain in cancer patients. The aim of this study is to assess efficacy of the BPS in managing post-cancer distress and potential to improve quality of life for individuals with cancer. Material and Methods. This study evaluated 30 cancer patients who completed radiotherapy and were referred from cancer hospital. The examination encompasses three distinct categories: biological, psychological, and social components. The biological aspect was documented based on mucosal lesions and VAS scores for individuals; followed by photo-biomodulation was given. Palliative care was provided in psychological aspect through implementation of exercise, meditation, music therapy. The social component encompasses community engagement, social activities, counseling services for family members. Patients were categorized into 3 groups – A, B, C. All three components were carefully evaluated and one-month follow-up was done. Results. The outcome derived from statistical analysis of the data collected from groups A, B, and C. When group A was compared to group B, there was 46 % increase in quality of life. When group C was compared to group A, 65 % of patients exhibited favorable quality of life. The average VAS score of patients decreased from 9.2 to 4.5 after Low-Level Laser Therapy (LLLT), demonstrating gradual decrease in discomfort. P value showed statistically significant (<0.05). Conclusion. Healthcare providers can enhance their treatment efficiency, addressing root cause of illness, and enhance overall well-being by incorporating BPS into their practice. Addressing the various elements of biological, psychological, and social factors would have beneficial effect on overall quality of life.

Poster 135: Tranexamic Acid for Rotator Cuff Repair: A Systematic Review & Meta-Analysis of Randomized Controlled Trials

Objectives: The purpose of this study was to perform a systematic review of the randomized controlled trials in the literature to evaluate the use of tranexamic on arthroscopic rotator cuff repair. Methods: Two independent reviewers performed the literature search based on the PRISMA guidelines with a third author resolving any discrepancies. RCTs comparing TXA to a control in ARCR were included. Visualization, postoperative pain, operative time, pump pressures and shoulder swelling. A p value < 0.05 was deemed statistically significant. Results: Six RCTs with 450 patients were included in this review. Overall, 6 studies evaluated intra-operative visualization with 4 studies finding a significant difference in favor of TXA. With TXA patients had a lower average postoperative VAS score of 3.3, and with the control, patients had an average VAS score of 4.1, which was statistically significant (p = 0.001). With TXA the average weighted operation time was 79.3 minutes and with the control the average operation time was 88.8 minutes, which was statistically significant (p = 0.001). No study found any difference in post-operative pump pressures or swelling. Conclusions: TXA improved visualization, operative time and subsequent postoperative pain levels in patients undergoing ARCR.

Multiple Level Anterior Cervical Discectomy and Fusion with PEEK Cage without Plating: Clinical Outcomes

Abstract Background: Anterior cervical discectomy and fusion is a common procedure done to treat cervical disk disease. The role of plating in the treatment of multilevel disc disease in the absence of instability has been debated with some claiming no difference in the clinical outcomes. Objective: The aim of the study was to assess the long term clinical outcomes of patients who underwent two or three level discectomies with PEEK cage placement without plating. Material and Methods: We collected the required data of all patients. Patients were contacted and completed clinical outcome questionnaires including NDI and VAS-Neck. All data was tabulated and statistical analysis was done. Results: Data of 72 patients was collected. The average age of the patients was 52.73 years. The mean follow-up was 62.4 months. 37 patients presented with Myelopathy (51%), 24 with radiculopathy (33%), 11 with myeloradiculopathy. The average VAS scores for neck pain preoperatively was 6.29 (Range: 4–9) and postoperatively improved to an average of 3.18 (Range: 0–7). The average neck disability index preoperatively was 37.86 (Range: 28–47) and the average postoperative NDI score being 19.02 (Range: 9 to 28). Our patients had a preoperative mean mJOA score of 11.68 (Range:3–17) and a mean postoperative mJOA score of 14.66 (3–17) with a mean difference of 3 points. Conclusion: The clinical outcomes of multiple-level cervical fusion without plating and with plating are similar. The best surgical option is one that requires minimal disruption of normal tissue, simple in technique and provides the patient with immediate- and long-term relief.

Closing the Gap: The Incidence of Complications in Minimally Invasive Tubular, Endoscopic, and Robotic-Assisted Transforaminal Lumbar Interbody Fusion Procedures

Background ContextThe aim of the current study was to compare the incidence of postoperative complications between MIS tubular, endoscopic and Robot-assisted TLIF techniques. MethodsConsecutive patients who underwent single or multi-level TLIF between 2020 and 2022. Pre-operative and post-operative patient reported outcomes (VAS Leg and ODI), demographic, and intra-operative variables were recorded. One way ANOVA with Bartlett’s equal-variance and Pearson chi-squared tests were used. ResultsThe current study included a total of 170 TLIF patients: 107 (63%) tubular, 42 (25%) endoscopic, and 21 (12%) robot-assisted. All three TLIF techniques had similar complication rates: tubular 6 (5.6%), endoscopic 2 (4.8%), and robot-assisted 1 (4.8%) all occurring within the first two weeks. Tubular TLIF reported the lowest incidence of new onset neurological symptoms, primarily radiculitis or numbness/tingling, at two weeks postoperatively (p<0.05) with 21 (20%) tubular, 17 (41%) endoscopic, and 9 (43%) robot-assisted patients. There were two revisions in the robot-assisted group, while tubular and endoscopic each had one within one year. There was no statistical difference in pre- or postoperative PROs between the TLIF groups. ConclusionsThe current study demonstrated that tubular, endoscopic, and robot-assisted TLIF procedures had similar complication rates. The tubular MIS TLIF reported less new neurological symptoms compared to endoscopic and robot-assisted TLIF procedures at two weeks postoperative, with all groups declining in symptom persistency at later time intervals. Average VAS scores continuously improved up to one year postoperatively amongst all groups.

Spondylolisthesis treatment using vertaux pedicle screw system, osteobone dual threaded screw, and occipital system: A study

Background: Pedicle screw fixation has its origins in Europe. Spinal screw most commonly pedicle screws, play a major role in different spinal surgeries by providing stabilization to vertebrae that promote healing, and correction of deformities. In the recent era spondylolisthesis issue is more common. So, we have retrospectively analyzed using three different spinal screws of Titanium Alloy as per EN ISO 5832‐3:2021 to treat the spondylolisthesis issue in the lower lumbar spine, which were manufactured by Auxein Medical Private Limited. Materials and Methods: Spinal screws consist of a variety of shapes and sizes. In this analysis total 45 patients with one year follow up were analyzed. The Spondylolisthesis related spinal issue of lower lumbar spine were treated by using different spine screws: VERTAUX Monoaxial Pedicle Screw with Cap (⌀ 5.5 mm, L 35 mm); Osteobone Multiaxial Pedicle Fenestrated Dual Thread Screw (⌀ 5 mm, L 25 mm) and VERTAUX - Occipital Polyaxial Pedicle Screw, Partial Thread (⌀ 5 mm, L 25 mm) of Ti-6Al-4V material which was manufactured by Auxein Medical Private Limited, India. X‐ray was used to examine the pre and post clinical conditions. In addition, the functional outcomes were assessed with Average VAS score. Results: X‐ray showed good outcomes. Prior to the surgery the average VAS score was 8.1 and after one-year completion the average VAS score was seen 0.4 only. After 1 month, 3 months, 5 months and 9 months and 12 months the average VAS score were calculated as 6.2, 4.7, 3.3 and 1.9 respectively. Conclusion: The treatment by using VERTAUX 5.5mm Pedicle Screw System, VERTAUX Osteobone Dual Threaded Screw and VERTAUX Occipital System showed good results with less complications.

The Outcomes of Mini-Plate Fixation for Unstable Wagstaffe Tubercle Fracture, an Indirect Syndesmosis Injury in Rotational Ankle Fracture.

Background: Wagstaffe fracture constitutes an indirect injury to the AITFL and can precipitate syndesmotic instability. The prevailing fixation methods often involve the use of mini-screws or K-wires, with absorbable suture repair reserved for cases with small or comminuted fragments exhibiting instability. In this study, we devised a mini-plate fixation method capable of securing the fracture fragment irrespective of its size or condition. Methods: A retrospective chart review was conducted on patients who underwent surgery for ankle fractures between May 2022 and October 2023. The surgical technique involved direct fixation of the Wagstaffe fracture using mini-plate fixation. Radiologic evaluation was performed using postoperative CT images, and clinical outcomes were assessed using the OMAS and VAS. Results: Fourteen patients with an average age of 62.5 years were included. Most fractures were associated with the supination-external rotation type. The average preoperative OMAS significantly improved from 5.95 to 83.57 postoperatively. The average VAS score decreased from 7.95 preoperatively to 0.19 postoperatively. Conclusions: The mini-plate technique for Wagstaffe fractures exhibited dependable fixation strength, effective fracture reduction, a minimal complication rate, and judicious surgical procedure duration.

Role of placental membrane in ACL graft healing – A series of 18 patients

IntroductionACL injuries are common and the standard treatment remains to be ACL reconstruction. Controversy still remains around graft ligamentisation and various methods have been experimented to augment this process. In this series we discuss the outcome of using dehydrated umbilical cord derived membrane in ACL reconstruction. Material and methodA prospective Level IV analysis of outcome in 30 consecutive patients of complete isolated ACL tear presenting to us between May 2022 to September 2022 was done. There was no age or sex restriction. Revision cases were excluded from this series. ACL reconstruction was done using standard all inside technique using the ipsilateral semitendinosus graft which was wrapped with dehydrated umbilical cord derived membrane (5*3 cm2) after soaking in normal saline (Cord Thick - Life Cell; LifeCell international private limited, Chennai, Tamil Nadu, India) and secured with Monocryl 3-0 sutures in a continuous manner. Results18 patients completed the one year follow up and were analysed for final results. Eleven of the patients followed up were females and seven males, with an average age of 30.3 years.The average VAS score at 6 weeks was 2.2. The mean KOOS score at the follow up visits were 72.3, 82.3, 90.7, 95.8. The mean SANE score reported at 6 weeks, 3 months, 6 months and 1 year were 68.8, 80, 87.5, 95.1.The follow up MRI's confirmed good ligamentisation of the graft even as early as 6 weeks with minimal fluid in the tunnel. ConclusionThe use of dehydrated umbilical cord derived membrane augmentation to potentiate graft integration in ACL reconstruction seems promising and helps improve patient outcomes.

EVALUATION OF SURGICAL OUTCOMES OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE PATIENTS TREATED BY KYPHOPLASTY, AT MILITARY HOSPITAL 105

Purpose: To evaluate the surgical outcomes of osteoporotic vertebral fracture patients treated by kyphoplasty at Military Hospital 105. Subjects and Methods: A descriptive, retrospective study of 34 osteoporotic fractures patients who were treated by kyphoplasty at Military Hospital 105 from January 2021 to December 2021. Results: Immediately post operation, 100% of patients had significant pain relief compared to preoperation (average VAS score after surgery 1.91 ± 1.22); 100% of patients had vertebral body height restored (with moderate level 36.4%, good level 39.4%); The kyphosis corrected spine has statistical significance compared to before treatment (with p &lt; 0.05).

Comparison of Outcomes between Open and Arthroscopic Rotator Cuff Repair.

The objective of this retrospective cohort study is to evaluate the long-term clinical and functional outcomes of two surgical techniques for rotator cuff repair, namely, open and arthroscopic methods. A total of 100 patients diagnosed with rotator cuff tears and treated at Seyhan State Hospital in the past five years were enrolled, considering the same inclusion criteria for both groups. The study groups consisted of 50 patients who underwent open rotator cuff repair and 50 patients who underwent arthroscopic rotator cuff repair. We used the SPSS programme to analyse the data, focusing on parameters such as postoperative recovery time, functional capacity scores, pain levels measured by the VAS scale, quality of life evaluated by the SF-36 scores, and complication rates. Both methods resulted in similar recovery times and functional capacity scores, but patients treated with the open method reported slightly lower pain levels (average VAS score: 2.8) compared to those treated with the arthroscopic method (average VAS score: 3.1). The study also found slightly better quality of life scores in the arthroscopic group (average SF-36 score: 71.4) compared to the open surgery group (average SF-36 score: 68.7). The complications rates were lower in the arthroscopic group (2%) than in the open surgery group (4%), but these differences were not statistically significant. The study suggests that, while there are no significant differences in terms of clinical outcomes between the two surgical methods, short-term pain levels may be influenced by the more frequent application of acromioplasty in arthroscopic methods. Therefore, the choice of the surgical method should be made based on the unique characteristics, including the location and size, the patient's overall health status, and the surgeon's experience. These findings should be used as a guide and not as absolute results.

Surgical Treatment of Patients with Damage to the Ligaments Holding the Long Head of the Biceps (Pulley Lesion) in Combination with Contracture of the Shoulder Joint

Background. Damage to the ligaments holding the long head of the biceps, or Pulley Lesion injuries, are often accompanied by contracture of the shoulder joint.&#x0D; Objective. The objective of the study was to compare the treatment outcomes of patients with Pulley Lesion injuries and secondary adhesive capsulitis.&#x0D; Material and Methods. The study included 82 patients with contracture of the shoulder joint and damage to the ligaments holding the long head of the biceps. The patients were divided into 2 groups depending on the extent of surgical intervention: group 1 underwent subpectoral tenodesis and selective capsulotomy of the shoulder joint; group 2 underwent subpectoral tenodesis without selective capsulotomy of the shoulder joint. The function of the shoulder joint was assessed using the Constant Shoulder Score and VAS scales before surgery, at 3 and 6 months after the surgery.&#x0D; Results. At 3 months follow-up, the average functional result according to the Constant Shoulder Score was somewhat worse in group 2 (14.5±5.2 points) than in group 1 (8.5±6.4 points), p = 0.031. At 6 months follow-up, the average functional result according to the Constant Shoulder Score was 5.1±5.6 points in group 1 and 10.1±4.1 points in group 2 (p = 0.024). At 3 months follow-up, the average VAS score was worse in group 2 than in group 1 and reached 2.81±0.7 points. At 6 months follow-up, the average VAS score in group 2 was also worse than in group 1 (p = 0.051).&#x0D; Conclusions. Performing selective capsulotomy and subpectoral tenodesis in patients with secondary adhesive capsulitis and damage to the ligaments holding the long head of the biceps (Pulley Lesion injuries) allows us to achieve better functional results both according to the Constant Shoulder Score and the VAS scale at 3 and 6 months after the surgery.

Radiological and Functional Outcomes of Conservatively Managed Osteoporotic Vertebral Fractures at the Thoracolumbar Junction: A Cross Sectional Study

OBJECTIVE This study examined how osteoporotic vertebral fracture (OVF) patients treated conservatively at a multi-specialty hospital were progressing clinically and radiologically. METHODS This cross sectional, observational study was conducted at Sir Ganga Ram Hospital, New Delhi, India during the period of July 2021 to October 2021. Cases with at least a 6-month follow-up were evaluated. VAS pain score, Oswestry Disability Index (ODI), and local kyphotic angle (COBB’s angle) at the time of fracture and at the latest follow-up were recorded and analyzed. RESULTS There were 30 patients (female: male = 2.75:1) with a mean age of 67.37 years (45-85). The average VAS score at the time of fracturewas 8 (6 to 10) and at the time of final follow-up was 2 (1 to 6) (p = 0.001). The average ODI score at the time of fracture was 44 (35 to 62) and at the time of final follow up was 5 (4 to 40) (p = 0.001). The average Cobb’s angle at the time of fracture was 14.31o and at the final follow up was 15.66o (p = 0.011). CONCLUSIONS Conservative management of OVF can lead to an increase in the local kyphotic angle. The fact that the patients experienced significant decreases in VAS pain scores and ODI scores by the final follow-up leads to the conclusion that patients can have a good quality of life even with conservative management of osteoporotic vertebral fractures. KEYWORDS conservative management, osteoporotic, thoracolumbar, vertebral fracture

Treatment Effect of Zoledronic Acid in Chronic Non-bacterial Osteomyelitis of the Jaw: A Case Series

Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory, osteolytic bone disorder sometimes localized to a unifocal site in the jaw, causing long-term pain and reduced function. The aim of this study was to describe the patients with CNO of the jaw, focusing on treatment with zoledronic acid for pain relief. An analysis of medical records of 24 patients with CNO of the jaw, including treatment with zoledronic acid and effects on pain relief. Descriptive statistics and nonparametric tests were used to describe the population and compare treatment effects, respectively. The average treatment period was 33.4 months (median 23; Q1 11.5; Q3 42.0) with an average of 4.1 infusions (median 3; Q1 2; Q3 5) of zoledronic acid. The average pain VAS score (visual analogue scale) was significantly reduced from 7.7 (median 8; Q1 6.5; Q3 8.5) to 2.5 points (median 2; Q1 0.5; Q3 4.5) (p < 0.001). At final visit, 46% of patients reported no pain and 38% reported a reduction of pain. At least 67% of patients had at least one episode of pain recurrence, and most patients experienced the first recurrence within a year of initial treatment. Four patients (16%) had no pain relief from the treatment. In this group of patients with CNO of the jaw, there was a positive response to treatment with zoledronic acid on pain relief, averaging 5.2 points on a pain VAS score, with 84% of patients treated experiencing either a partial or a total reduction in pain after about 2.5 years.

Risk Factors for Residual Back Pain After PVP Treatment for osteoporotic Thoracolumbar Compression Fractures: A Retrospective Cohort Study

To explore the risk factors of residual back pain after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). We retrospectively reviewed the records of 675 patients with OVCF treated with PVP from January 2015 to January 2020. Postoperative back pain intensity was assessed by the VAS score. Residual back pain was defined as the presence of postoperative moderate-severe pain (average VAS score≥4), and the variables included patient characteristics, baseline symptoms, imaging data and operation-related factors. Risk factors were identified with univariate and multivariate logistic regression analysis. Residual back pain occurred in 46 of the 675 patients included in the study, with an incidence rate of 6.8%. Multivariate logistic regression analysis showed that low Pre-BMD (OR=3.576, P= 0.041), multiple vertebral fractures (OR=2.795, P= 0.026), posterior fascia injury (OR=4.083, P= 0.032), cement diffusion volume rate <0.2 (OR=3.507, P= 0.013), facet joint violation (OR=11.204, P < 0.001), and depression (OR=3.562, P= 0.035) were positively correlated with residual back pain after PVP. Low pre-BMD (pre-bone mineral density), multiple vertebral fractures, posterior fascia injury, cement diffusion volume rate <0.2, facet joint violation and depression were the independent risk factors of residual back pain after PVP.

Empowerment and enablement and their associations with change in health-related quality of life after a supported osteoarthritis self-management programme – a prospective observational study

BackgroundOsteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP.MethodsPatients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1–5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0–12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations.ResultsOne hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05).ConclusionsHealth-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP.Trial registrationClinicalTrials.gov. Identification number: NCT 02974036. First registration 28/11/2016, retrospectively registered.

Outcome of Operative Treatment of Intraarticular Fractures of Calcaneum

Introduction: Calcaneum is the most commonly fractured tarsal bone and account for approximately 2% of all fractures. Controversy continues regarding the management of calcaneal fractures. Earlier conservative management was preferred, and surgical management considered inappropriate for these fractures. This trend is gradually changing with better understanding of disabling nature of injuries in combination with improved implant and routine use of intra-operative imaging. However, still clinical evidence supporting operative treatment is limited and complications are frequently documented. Thus, this study aims to investigate the functional and radiological outcome of intra-articular calcaneal fracture treated with calcaneal plate. Methods: This study is a prospective analytic study. The study was conducted in the Department of Orthopaedics, B.P Koirala Institute of Health Sciences, a tertiary care hospital in Eastern Nepal, over a period of twelve months from September 2018 to August 2019. Patients presenting with calcaneal fracture were screened for eligibility by clinico-radiological evaluation. Twenty-eight cases that presented to BPKIHS and gave consent and fulfilled the inclusion criteria were selected. Two cases were lost to follow up. So, 26 cases of were included in the final analysis. Results: Average age of the patients was 32 years (22-54) years. There was male predominance with M:F ratio of 10:3. Most common mode of injury was fall from height (24) followed by RTA (2). Sanders’ type 2B was the most common fracture pattern. There was significant improvement in Bohler angle (25.1°), calcaneal height (4.3cm) and width(3.9cm). Average AOFAS score at final follow up was 81.4 (81% had score &gt; 75). Average VAS score at final follow up was 7.9±1.3. Conclusion: Open reduction and internal fixation with plate is associated with good clinical and functional outcome in Sander type II and III fractures. With good surgical techniques, improved implant and proper use of fluoroscopy, proper restoration of Bohler angle, calcaneal height and width can be achieved. Key Words: Calcaneum, Intraarticular, Plate fixation.

Microwave-induced hyperthermia in situ in the treatment of tumors of proximal humerus: long-term results with functionary sparing surgery

BackgroundThe present study aimed to evaluate the indications, feasibility, clinical effectiveness and complications of the treatment with microwave in situ inactivation followed by curettage and bone grafting assisted with internal fixation, for the proximal humerus tumors.MethodsThe clinical data of 49 patients with primary or metastatic tumor of the proximal humerus who received intraoperative microwave inactivation in situ with curettage and bone grafting in our hospital from May 2008 to April 2021 were retrospectively analyzed.ResultsThere were 25 males and 24 females, with an average age of 57.6 ± 19.9 years (range, 20–81). All patients were followed up for 7 to 146 months, with an average period of 69.2 ± 39.8 months. Up to the last follow-up, 14 patients died. The 5-year overall survival was 67.3%, and 5-year tumor-specific survival was 71.4%. The 5-year tumor-specific survival rates were 100% for aggressive benign tumors or low potential malignancy tumors, 70.1% for primary malignancies, and 36.9% for metastatic tumors. The average preoperative MSTS, constant-Murley and VAS scores were 16.81 ± 3.85, 62.71 ± 12.56 and 6.75 ± 2.47, which were all significantly improved at 6 weeks after operation and at the final follow-up (P < 0.05).ConclusionsMicrowave inactivation in situ and curettage and bone grafting are a feasible treatment for tumors of proximal humeral, especially for malignant tumors and metastases, without the necessity of the replacement of the shoulder, with little trauma and good upper limb function, and with low local recurrence and distant metastasis.

Integration of prolapsing technique and one-stitch method of ileostomy during laparoscopic low anterior resection for rectal cancer: a retrospective study.

Prolapsing technique is a type of natural orifice specimen extraction surgery that can overcome the difficulty of precise transection of the distal rectum and subsequent anastomosis in a narrow pelvic space. Currently, protective ileostomy is widely utilized in low anterior resection for low rectal cancer, which may reduce the severe consequences caused by anastomotic leakage. The study aimed to combine the prolapsing technique with a one-stitch method of ileostomy and evaluate the surgical outcomes. A retrospective analysis was conducted on patients with low rectal cancer who underwent protective loop ileostomy in laparoscopic low anterior resection between January 2019 and December 2022. The patients were divided into prolapsing technique combined with the one-stitch method of ileostomy (PO) group and traditional method (TM) group, and the intraoperative details and early postoperative outcomes of the two groups were measured. A total of 70 patients met the inclusion criteria, including 30 patients who underwent PO and 40 patients who underwent the traditional procedure. The PO group had a shorter total operative time than the TM group (197.8 ± 43.4 vs. 218.3 ± 40.6 min, P = 0.047). The time of intestine function recovery in the PO group was shorter than that in the TM group (24.6 ± 3.8 vs. 32.7 ± 5.4 h, P < 0.001). Compared with the TM group, the average VAS score was significantly lower in the PO group (P < 0.001). The incidence of anastomotic leakage in the PO group was significantly lower than that in the TM group (P = 0.034). The operative time of loop ileostomy was 2.0 ± 0.6 min in the PO group, which was significantly less than 15.1 ± 2.9 min in the TM group. Skin irritation was observed in 2 patients in the PO group and 10 patients in the TM group; therefore, there was a significant difference (P = 0.044). This method is safe and feasible, which reduces the technical difficulty and achieves rapid postoperative recovery with few complications.

PC46. MRI Neurography as an Adjunct for the Diagnosis of Meralgia Paresthetica

PURPOSE: Meralgia paresthetica (MP) is a sequela of Lateral Femoral Cutaneous Nerve (LFCN) compression characterized by numbness, tingling, and burning sensation in the outer thigh. Traditional methods of diagnosis are usually extremely limited to provide a certain diagnosis. MRI neurography (MRN) is a tissue-specific imaging that provides excellent characterization of nerve anatomy. We propose MRN as an adjunct for the diagnosis and management of meralgia paresthetica. METHODS: We reviewed 13 consecutive patients who were surgically treated for MP in the last 2 years. Treatment protocol offered patients with VAS scores 3-4 with nerve release, 5-7 either LFCN decompression or resection with regenerative peripheral nerve interface (RPNI), and 8-10 RPNI. Since MRN was only recently introduced into our practice, 7 out of 13 patients had MRN pre-operatively. RESULTS: Patients presented with hypersensitivity and burning pain to the LFCN distribution with an average VAS score of 7.8. Of the 7 patients with MRN, 6 patients had complete resolution of symptoms, 1 patient with history of complex regional pain syndrome still reported improvement of symptoms. The 6 patients that didn’t get MRN were treated according to VAS score, EMG, and clinical assessment. 5 of them had complete resolution of symptoms after surgery with 1 reporting significant improvement. CONCLUSION: MRN is a useful resource for the evaluation of peripheral nerves. The ability to provide a comprehensive evaluation of the regional neuromuscular structures helps the diagnosis and management of MP. Nevertheless, larger prospective studies are still warranted to further investigate its utilization and accuracy.

The AAHKS Clinical Research Award: Oral Dexamethasone Following Total Knee Arthroplasty: A Double-Blind, Randomized Controlled Trial

BackgroundIntravenous dexamethasone has been shown to reduce pain in total joint arthroplasty. This double-blind, randomized, placebo-controlled trial investigated the postoperative effects and safety of oral dexamethasone as a potential augment to multimodal pain management in outpatient knee arthroplasty. MethodsThe authors prospectively randomized 109 consecutive patients undergoing primary total knee arthroplasty. Patients assigned to Group A (57 patients) received 4 mg of dexamethasone by mouth twice per day starting postoperative day (POD) 1 for 4 days and those assigned to Group B received placebo capsules. All healthcare professionals and patients were blinded to group allocation. The primary outcome was defined as postoperative pain scores. Secondary outcomes included 90-day postoperative complications, nausea and vomiting, daily opioid usage, assistance for ambulation, difficulty sleeping, and early patient reported outcomes. Demographics were similar between groups. ResultsThe patients who received dexamethasone had a statistically significant decrease in VAS scores when averaging POD 1 to 4 (P = .01). The average VAS scores among individual days were significantly lower with dexamethasone on POD 2, 3, and 4. While taking dexamethasone, morning and mid-day VAS scores were significantly lower. There was no difference between the groups with opioid use, nausea or vomiting, 90-day complications, ability to walk with/without assistance, difficulty sleeping, and early patient reported outcomes. ConclusionThis double-blind, randomized, placebo-controlled trial demonstrated that oral dexamethasone following primary total knee arthroplasty can reduce postoperative pain. This may be a beneficial option in ambulatory surgery where intravenous limitations exist, but larger series are needed to further evaluate the safety profile in this population.