Cervical Approach Research Articles

Treatment of cicatricial tracheal stenosis and tracheoesophageal fistula in patients with COVID-19 pneumonia

To describe treatment of cicatricial tracheal stenosis and tracheoesophageal fistula in patients with COVID-19 pneumonia. There were 91 patients with cicatricial tracheal stenosis for the period from August 2020 to April 2022 (21 months). Of these, 32 (35.2%) patients had cicatricial tracheal stenosis, tracheoesophageal fistula and previous coronavirus infection with severe acute respiratory syndrome. Incidence of iatrogenic tracheal injury following ventilation for viral pneumonia in the pandemic increased by 5 times compared to pneumonia of other genesis. Majority of patients had pneumonia CT grade 4 (12 patients) and grade 3 (8 patients). Other ones had pulmonary parenchyma lesion grade 2-3 or mixed viral-bacterial pneumonia. Isolated tracheoesophageal fistula without severe cicatricial stenosis of trachea or esophagus was diagnosed in 4 patients. In other 2 patients, tracheal stenosis was combined with tracheoesophageal fistula. Eight (25%) patients had tracheostomy at the first admission. This rate was almost half that of patients treated for cicatricial tracheal stenosis in pre-pandemic period. Respiratory distress syndrome occurred in 1-7 months after discharge from COVID hospital. All patients underwent surgery. In 7 patients, we preferred palliative treatment with dilation and stenting until complete rehabilitation. In 5 patients, stent was removed after 6-9 months and these ones underwent surgery. There were 3 tracheal resections with anastomosis, and 2 patients underwent tracheoplasty. Resection was performed in 3 patients due to impossible stenting. Postoperative course in these patients was standard and did not differ from that in patients without viral pneumonia. In case of tracheoesophageal fistula, palliative interventions rarely allowed isolation of trachea. Four patients underwent surgery through cervical approach. There were difficult surgeries in 2 patients with tracheoesophageal fistula and cicatricial tracheal stenosis. One of them underwent separation of fistula and tracheal resection via cervical approach at primary admission. In another patient with thoracic fistula, we initially attempted to insert occluder. However, open surgery was required later due to dislocation of device. Absolute number of patients with tracheal stenosis, tracheoesophageal fistula and previous COVID-19 has increased by several times compared to pre-pandemic period. This is due to greater number of patients requiring ventilation with risk of tracheal injury, non-compliance with preventive protocol for tracheal injury including anti-ischemic measures during mechanical ventilation. The last fact was exacerbated by involvement of allied physicians with insufficient experience of safe ventilation in the «red zone», immunodeficiency in these patients aggravating purulent-inflammatory process in tracheal wall. The number of patients with tracheostomy was 2 times less that was associated with peculiarity of mechanical ventilation in SARS-CoV-2. Indeed, tracheostomy was a poor prognostic sign and physicians tried to avoid this procedure. Incidence of tracheoesophageal fistula in these patients increased by 2 times compared to pre-pandemic period. In subacute period of COVID-associated pneumonia, palliative measures for cicatricial tracheal stenosis and tracheoesophageal fistula should be preferred. Radical treatment should be performed after 3-6 months. Absolute indication for circular tracheal resection with anastomosis is impossible tracheal stenting and ensuring safe breathing by endoscopic methods, as well as combination of cicatricial tracheal stenosis with tracheoesophageal fistula and resistant aspiration syndrome. Incidence of postoperative complications in patients with cicatricial tracheal stenosis and previous mechanical ventilation for COVID-19 pneumonia and patients in pre-pandemic period is similar.

Video asistirana torakoskopska resekcija ektopičnih medijastinalno lokalizovanih paratireoidnih žlezda - iskustva našeg centra

Introduction: The majority of mediastinal ectopic parathyroid glands (MEPTG) can be successfully removed through the cervical approach, including parathyroid glands (PTG) located in the upper mediastinum. However, 1% - 3% of patients with hyperparathyroidism (HPT) require the thoracic surgical approach. The success of surgical treatment depends on the precise preoperative localization of MEPTGs and on the choice of the appropriate approach. In this group of patients, video assisted thoracoscopic excision of MEPTGs can be used as a reliable method, in order to avoid open surgery, but also because of its other advantages. We present the first 11 patients with MEPTGs who were successfully surgically treated at the Clinic for Cardiothoracic Surgery of the Military Medical Academy (MMA). Previous video assisted thoracoscopic resections in Serbia have not been reported. Materials and methods: Between March 2014 and October 2022, 11 patients with biochemically proven hyperparathyroidism were surgically treated at the Clinic for Cardiothoracic Surgery of the MMA. MEPTGs were identified preoperatively with a Tc-99m sestamibi scan, a CT scan of the chest, and single photon emission computed tomography (SPECT). Results: All MEPTGs were successfully excised using video assisted thoracoscopic surgery (VATS). There was no need for an open thoracic surgical approach (sternotomy or thoracotomy). The average length of the surgery was 80 minutes (between 34 and 150 minutes). The average length of hospitalization was 7 days. Postoperative wound infection occurred in one patient. Conclusion: MEPTGs can be safely and successfully excised using VATS, thus avoiding classical chest opening. VATS provides good visualization of the tumor, low tissue trauma, short duration of surgery and hospitalization, a low rate of complications, and a good cosmetic/aesthetic effect.

Predicting spontaneous PTB risk is improved when quantitative ultrasound data are included with clinical data

Predicting women at risk for spontaneous preterm birth (sPTB) has been medically challenging due to the lack of signs and symptoms of preterm labor until intervention is too late. Hypothesis: Predicting the sPTB risk level is enhanced when using both historical clinical (HC) data and quantitative ultrasound (QUS) data compared to using only HC data, with HC data being defined as birth history prior current pregnancy as well as, from the current pregnancy, a clinical cervical length assessment, and data from a physical exam. Study population included 250 full-term births (FTBs) and 25 sPTBs. QUS scans (Siemens S2000 & MC9-4) were performed using a standard cervical length approach by RDMS sonographers. QUS is a measure of cervical remodeling at the microstructure level. Two cervical QUS scans were conducted at 20±2 and 24±2 weeks’ gestation. Multiple QUS features were evaluated from calibrated raw radiofrequency backscattered ultrasonic signals. Two statistical models designed to determine sPTB risk were compared: 1) HC data alone and 2) combined HC and QUS data. Test ROC AUC compared both models. The study’s birth outcomes were only FTBs or sPTBs; medically induced preterm births were not included. Combined HC and QUS data identified women at sPTB risk with better AUC (0.68; 95% CI, 0.58-0.78) than that of HC data alone (0.52; 95% CI, 0.38-0.65). A likelihood ratio test for significance of QUS features in the classification model was highly statistically significant (p < 0.01). Traditional risk factors for sPTB (age, parity, previous history of PTB, cervical length < 25 mm, smoking, BMI and alcohol use) were not predictive of sPTB in our sample of participants. Cervical length measurements and HC have been the mainstay of risk assessment for sPTB for years because no other credible biomarkers were available. Even with only 25 sPTBs, there was value-added for predicting sPTB when QUS data were included with HC data.

Management of Spinal Injuries Secondary to Rockfall in Traditional Mines

Introduction: Spinal injuries represent the whole of the mechanisms responsible for vertebral, disco-ligamentary and spinal cord injuries. Spinal cord injury is life-threatening and is responsible for functional consequences that make the subsequent socio-economic integration of victims difficult. In developing countries, spinal injuries in traditional gold mining are becoming more and more frequent. Purpose: The purpose of this study was to describe the anatomopathological aspects and the results of surgical treatment of spinal injuries secondary to traditional mine collapses at the University Hospital of Kati. Patients and Methods: This was a prospective, descriptive study over 18 months, from November 2017 to May 2019. Included in this study were patients operated on for spinal trauma secondary to rockfall in traditional mines. The neurological status was assessed in each patient since admission to the department using the Fr&#228nkel score. Decompression by laminectomy combined with titanium device placement was preferred in lumbar, thoracic and thoraco-lumbar surgery. We performed an anterior cervical spine approach with SENEGAS plate placement in cervical injuries. Motor physiotherapy was associated whenever recovery was not complete. At a minimum follow-up of 6 months, all our patients were re-evaluated by the Fr&#228nkel score. Results: The mean age was 31 years with extremes of 10 and 49 years. The majority of patients were men, 95%. Twenty patients underwent surgery. According to the spinal segments, the cervical spine was affected in 05 cases, the thoracic spine in 08 cases and the lumbar spine in 17 cases. The neurological examination revealed tetraplegia (n = 5), paraplegia (n = 12) and paraparesis (n = 3). According to the types of lesions, we collected 12 cases of fractures, 4 cases of fracture-luxations and 04 cases of pure luxations. According to the site, the fracture was uni-articular (n = 3), corporal (n = 15) and transverse apophyseal (n = 1). According to the type of line, the fracture was simple (n = 6), with compression (n = 11) and comminuted (n = 2). The dislocation was anterior in all 08 cases. The spinal cord injuries were concussion (n = 3), contusion (n = 6) and transection (n = 11). Sphincter disorders such as leakage or retention of urine were present in all our patients. At a minimum follow-up of 6 months, all our patients classified as Fr&#228nkel D and C had a complete motor recovery. Of the 5 patients classified as Fr&#228nkel B, 2 had complete motor recovery and one had partial recovery. Of 12 patients classified as Fr&#228nkel A, one patient had partial recovery. Conclusion: The severity of the neurological lesions in spinal injuries due to rockfalls in traditional gold mining is certain. These traumas are of high velocity and provide extensive spinal cord injuries. The dorsolumbar hinge is the most affected segment. Fractures of the first lumbar vertebra and the twelfth thoracic vertebra are the most frequent. Settling fractures are by far the most frequent fracture types. T12-L1 dislocation is the most frequent. Early osteosynthesis by spinal stabilization after reduction improves the Fr&#228nkel score. This study shows the need for public awareness of the dangers of traditional gold panning.

Two Cases of Kittens Treated Surgically for Cranial Growth Plate Fracture of the Seventh Cervical Vertebra

Two kittens with cranial growth plate fractures of the seventh cervical vertebra were treated with a ventral median cervical approach to repair the fracture and fixed using titanium screws and polymethylmethacrylate. In both cases, postoperatively osteophyte formation progressed gradually in the ventral part of the fifth cervical vertebra, and in one case, deformity was observed in the thoracic cage and thoracic cranial region. Although the etiology of the fractures is unknown, no implant failure or loosening was observed after surgery, the clinical symptoms improved, and these kittens were able to walk, suggesting that the technique described in this study may be an effective treatment option.

Minimally Invasive Posterior Cervical Fusion: A Handsome Option.

Cervical spondylosis is the leading cause of cervical myelopathy. When surgery is indicated, it is commonly addressed through an anterior or posterior cervical approach, such as cervical discectomy and fusion (ACDF) or laminectomy and fusion (LMF). Besides their own merits, each one has specific approach- or device-related complications, such as dysphagia, significant postoperative pain, wound infection, adjacent segment degeneration (ASD), and pseudoarthrosis. Through a tissue-sparing minimally invasive technique, posterior cervical fusion (PCF) has shown unfolding compelling evidence of biomechanical stability, good clinical outcomes, and high fusion rates, with fewer complications and better econometrics. On the basis of our own experience, we discuss here the indications, advantages, and drawbacks of minimally invasive PCF.

Surgical Management of Post-Intubation Tracheal Injuries: A Single-Center Experience from Nepal

Introduction: Despite various improvements in technology and patient care, tracheal intubation and tracheostomy still result in significant tracheal injuries like stenosis and airway fistula. Pressure necrosis by the inflated balloon is the commonest culprit. Post-intubation tracheal stenosis is a major indication for tracheal resection and anastomosis. This study was done to find out the indications and results of surgery for post-intubation tracheal lesions. Methods: It was a descriptive observational study of patients with post- intubation tracheal lesions managed in Manmohan Cardiothoracic Vascular and Transplant Center over a period of 20 years (2001 to 2021). Results: Twenty-five patients were treated for post-intubation tracheal lesions. Four had isolated tracheo-esophageal fistula (TEF); eighteen had an isolated tracheal stenosis and three had both. Most had a tracheal resection and end-end anastomosis (REEA) via a cervical approach, resecting an average of 2.7 cm of tracheal length. The average size of stenotic lumen was 4.32 mm. There were no operative deaths. Two patients expired within a month of surgery: one due to fatal restenosis and the other due to sepsis. There were a few immediate and a few long-term complications. The average follow-up period was 5 years. Conclusion: Among the various post-intubation lesions, tracheal stenosis is the commonest indications for surgery. The management is challenging but safe and feasible, with a multidisciplinary team approach.

Incidentally detected retrosternal goitre with posterior mediastinal extension causing compression of airway: a case report

&lt;p class="abstract"&gt;Retrosternal goitre (RG) is an enlarged thyroid gland which extends below the clavicle and sternum. Most patients have slow-growing enlargement without any symptoms but may develop symptoms related to compression of aerodigestive tract like dyspnoea, choking, sleep disturbance, dysphagia and hoarseness. Surgical removal is the treatment of choice either through a cervical approach or combination with sternotomy or thoracotomy. Here we present a case of a 51 years female without any symptoms, detected incidentally to have mediastinal mass on imaging during routine health checkup. On evaluation, she was found to have no significant neck swelling or any evidence of vascular obstruction or neurological compression. Contrast enhanced computed tomography showed large heterogeneous mass lesion extending from posteroinferior aspect of (right) thyroid lobe extending into mediastinum till tracheal bifurcation. Due to the mediastinal extension, multispecialty team approach involving oncosurgeon, ear nose and throat (ENT) surgeon and cardiothoracic surgeon was done. The patient underwent (R) hemithyroidectomy with excision of posterior mediastinal component through combined cervical and mediastinal approach under general anaesthesia. Histopathological examination revealed adenomatous goitre. Post operatively patient was symptom free and is on regular follow-up.&lt;/p&gt;

Surgical Treatment of Sublingual Gland Ranulas.

Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.

Colon patch esophagoplasty for esophageal strictures refractory to multi-modal treatment revisited.

Esophageal strictures due to caustic ingestion (CI) may require repeat esophageal dilations and dilation adjuvants, including local anti-fibrinogenic injection therapy, stent placement, and radial stricture incisions. Refractory strictures require surgical intervention. Pedicled colon patch esophagoplasty (CPE) may avoid the morbidity associated with total esophageal replacement, although reports of its use are limited. Indications and outcomes for CPE in patients undergoing repeat esophageal stricture dilations following caustic ingestion are described according to our local experience and literature reports. A retrospective review of indications for surgical management of esophageal strictures to tertiary pediatric surgical services between 2015 and 2020 focused on patients undergoing CPE. English-language literature (PubMed, Google Scholar, and Scopus) describing CPE was also reviewed. Eight (12%) out of 65 patients with esophageal strictures requiring 7 or more esophageal dilations with poor response underwent surgical stricture management over a 6year period, which included stricture resection and re-anastomosis in 2 patients, total esophageal replacement with colon graft in 2 patients, gastric pull-up in 1 patient, and CPE in 3 patients. The patients undergoing CPE were aged 3-8years and had 17 to more than 25 dilations following caustic ingestion over a 2-5year period. One patient had a 4cm stricture; the other 2 had strictures 7cm in length. A transverse colon patch based on the middle and left colic vessels was utilized in all three, with the vascular pedicle placed retrogastrically via the esophageal hiatus and the patch inlay esophagoplasty concluded via right thoracotomy. Post-operative contrast studies showed near-normal anatomy, and the patients could tolerate full oral diets. During a 9-36month follow-up period, only 2 patients required dilations of a proximal anastomotic stricture at 1 and 5months postoperatively. One patient required additional proximal stricturoplasty with advancement of the original graft across the stricture via a cervical surgical approach. Colon patch esophagoplasty to restore esophageal luminal continuity and allow a normal diet should be considered for refractory esophageal strictures. CPE had excellent functional outcomes in our 3 patients and should be considered in selected cases instead of total esophageal replacement.

Clinical outcomes of combined cervical and transthoracic surgical approaches in patients with advanced thyroid cancer.

Advanced thyroid disease involving the mediastinum may be managed surgically with a combined transcervical and transthoracic approach. Contemporary analysis of this infrequently encountered cohort will aid the multidisciplinary team in personalizing treatment approaches. Retrospective review of patients undergoing combined transcervical and transthoracic surgery for thyroid cancer at a single high-volume institution from 1994 to 2015. Thirty-eight patients with median age 59 years (range 28-76) underwent surgery without perioperative mortality. Most patients had primary disease. A majority had distant metastases outside the mediastinum but had locoregionally curable disease. Common complications were temporary (39%) and permanent (18%) hypoparathyroidism, and wound infection (13%). One-year overall survival was 84%; 1-year locoregional disease-free survival was 64%. Median time to locoregional recurrence was 36 months. Only esophageal invasion was associated with worse oncologic outcomes. Combined transcervical and transthoracic surgery for advanced thyroid cancer can be performed without mortality and with acceptable morbidity.

Benign submandibular gland tumours: outcomes of gland-preserving excision by endoscopic or conventional approach

Endoscope-assisted surgery is becoming a preferred technique in salivary gland surgery. However, this technique has not yet been applied in submandibular gland (SMG) preservation surgery. This retrospective study was performed to evaluate the outcomes of endoscope-assisted gland-preserving surgery through a hairline incision in patients with benign SMG tumours. The study included 38 patients with benign SMG tumours who underwent tumour excision with gland preservation: 19 who underwent local excision of the tumour through an endoscope-assisted hairline approach and 19 who received the conventional cervical approach. The feasibility of the surgical procedure, perioperative patient variables, and postoperative appearance and functional outcomes were evaluated. Patients in both groups had their tumours removed successfully with tumour-free margins. The intraoperative blood loss, postoperative amount of drainage, mean length of the incision, and unstimulated saliva flow rate did not differ between the two groups. There was no difference in the stimulated saliva flow rate between the preserved gland and unaffected SMG. The aesthetic result was better in the endoscope-assisted hairline incision group. No tumour recurrence occurred during follow-up (range 12–52 months). Thus, gland-preserving tumour dissection appears to be a safe method for benign SMG tumours, with good functional results. Furthermore, the endoscope-assisted hairline incision is a feasible method with excellent cosmetic results.

Surgical Steps of Gasless Transaxillary Endoscopic Thyroidectomy: From A to Z.

In the past 30 years, the incidence of differentiated thyroid cancer (DTC) has been increasing rapidly and has become one of the most common malignant tumors in females. Currently, the main surgical treatment for DTC is standard open thyroidectomy (SOT) via a traditional Kocher mid-cervical incision, but postoperative neck scarring was associated with significantly worse health-related quality of life (HRQOL) scores. To offer better cosmesis, robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular, or transoral approaches have been developed over the past 20 years. In general, gasless transaxillary endoscopic thyroidectomy (GTET) has advantages in terms of convenience, clarity of vision, and aesthetic incision. The current work aims to provide a step-by-step description of GTET, supported by a high-quality, pictorial guide.

Transdural Approach for Resection of Craniovertebral Junction Cysts: Case Series.

Craniovertebral junction (CVJ) cysts, including retro-odontoid pseudotumors, are challenging pathologies to treat and manage effectively. Surgical intervention is indicated when these lesions result in progressive myelopathy, intractable pain, or instability. To present a case series of older patients who underwent successful resection retro-odontoid lesions using transdural approach. A single-center, retrospective observation study of older patients who underwent transdural resection of CVJ cysts at a single institution was performed. Summary demographic information, clinical presentation, perioperative and intraoperative imaging, and Nurick scores were collected and analyzed. Eight patients were included (mean age [±SD] 75.88 ± 9.09 years). All patients presented with retro-odontoid lesions resulting in severe cervical stenosis, cord compression, and myelopathy. The mean duration of surgery was 226 ± 83.7 minutes. The average intraoperative blood loss was 181.2 cc. The average hospital stay was 4.5 days ± 1.3 (range, 3-7 days). The average follow-up time was 12.5 ± 9.5 months. No intraoperative complications were encountered. The Nurick classification score for myelopathy improved at the final postoperative examination (2.38 ± 1.06 vs 1 ± 1.07). Three patients demonstrated a pre-existing deformity prompting an instrumented fusion. Both computed tomography and MRI evidence of complete regression of retro-odontoid cyst were noted in all patients on the final follow-up. Posterior cervical transdural approach for ventral lesions at the CVJ is a safe and effective means of treating older patients with progressive myelopathy. This technique provides immediate spinal cord decompression while limiting neurological complications commonly associated with open or endoscopic anterior transpharyngeal approaches.

Ultrasound-guided Percutaneous Laser Disc Decompression (PLDD) with Fluoroscopic Validation for the Treatment of Cervical Disc Herniation: Technical Note.

Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. Technical note. We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach. We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound guidance for the treatment of contained cervical disc herniation using a 1,470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs. A significant NRS reduction between baseline and 1 month (P = .0002) and between baseline and 12 months (P = .0007) was observed. Our results support the conclusion that ultrasound guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.

A Dosimetric Analysis of Modified Volumetric Modulated Arc Therapy for Bone Marrow Sparing Radiotherapy in Cervical Cancer-An alternative Approach to Conventional VMAT

External beam radiotherapy remains the primary treatment modality in cervical cancer. Nowadays Intensity Modulated Radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) are increasingly being used to reduce normal tissue toxicity. The drawback of conventional VMAT is that a considerable volume of pelvic bone marrow receives a low dose. We analyzed whether there was a way to reduce the volume of the low dose regions of bone marrow, and assessed the potential benefit of conventional-4Arc (C-4Arc VMAT), and Modified-4Arc (M-4Arc VMAT) over the conventional 2 ARC VMAT. Twelve clinically proven locally advanced cervical cancer patients treated with concurrent chemo-radiotherapy by Conventional VMAT (RapidArc) in dual rotation mode (C-2Arc VMAT) were selected for this study.C-4Arc VMAT and M-4Arc VMAT dose plans were generated for these twelve patients and these three different types of plans were evaluated for the quality and compared dosimetrically. M-4Arc VMAT designs exhibited a greater bone marrow sparing when compared with conventional VMATs with respect to volume receiving 5Gy to 35Gy without compromising PTV dose coverage. M-4Arc VMAT plans, the bone marrow volume receiving 30 Gy (V30Gy),40Gy (V40Gy), and mean doses were lower than the C- 4 Arc plan and a similar result was observed for V50(Gy) also when comparing with the standard 2 Arc plan. In modified VMAT plans, the rectum and bladder dose volumes were lower than standard VMAT. Similarly, the bowel bag V35(Gy), V40(Gy), V50(Gy), mean doses. The right and left femoral head doses were reduced significantly when compared to conventional VMAT plans. The M-4Arc VMAT plans are better than the C-2Arc and C-4Arc VMAT plans for reducing the dose to bone marrow by limiting the MLC field width travel.

Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application

BackgroundAnterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy (CSM), however, ACDF may cause pseudoarthrosis, accelerated degeneration of adjacent segments, loss of activity of fused segments and other complications. The full-endoscopic technique can treat CSM, without the aforementioned complications above. Therefore, it is of great clinical value to investigate the surgical scheme of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC).MethodsA total of 28 cases with single-segment Cervical spondylotic myelopathy (CSM) from April 2017 to July 2019 were involved in this study. The size of the disc-osteophyte complex was measured using imaging data prior to the operation. The diameter and direction of the bony passage was determined according to the size and central position of the complex, respectively. Twenty-eight patients underwent the above scheme for CSM. The clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores. The imaging assessment included MRI, CT and X-rays.ResultsThe diameter of the designed bony passage was about 6.9 mm, and directed toward the lower edge of the diseased lower vertebral body oblique to the center of the disc-osteophyte complex. All patients successfully completed the operation. The postoperative neck pain VAS and JOA were significantly improved compared to preoperative values (p < 0.01). Postoperative MRI indicated complete decompression of the spinal cord. CT scanning 1 year after the operation revealed an almost healed bony passage and X-ray imaging showed satisfactory physiological curvature of the cervical spine, without cervical instability.ConclusionBased on the diameter and direction of the bony passage, as determined by the size and position of the disc-osteophyte complex, indicated by MRI and CT scanning, anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord offers good decompression of the spinal cord and ensures excellent therapeutic outcome.

Barbed Suture versus Interrupted Suture in Posterior Cervical Spine Surgery: Are They Equivalent?

Posterior cervical spine approaches have been associated with increased rates of wound complications compared to anterior approaches. While barbed suture wound closure for lumbar spine surgery has been shown to be safe and efficacious, there is no literature regarding its use in posterior cervical spine surgery. In a cohort of patients undergoing elective posterior cervical spine surgery, we sought to compare postoperative complication rates between barbed and traditional interrupted suture closure. A retrospective review of demographics, past medical history, and operative and postoperative variables collected from a prospective registry between July 1, 2016, and June 30, 2020 was undertaken. All patients 18 years old and above undergoing elective posterior cervical fusion were included. The primary outcome of interest was wound complications, including surgical site infection (SSI), dehiscence, or hematoma. In addition, numerical rating scale (NRS) neck pain (NP), NRS arm pain (AP), Neck Disability Index (NDI), and operative time were collected. A variety of statistical tests were used to compare the two suture groups. Of 117 patients undergoing posterior cervical fusion, 89 (76%) were closed with interrupted suture and 28 (24%) with barbed suture. The interrupted cohort were more likely to have >1 comorbidity (p<0.001), diabetes mellitus (p=0.013), and coronary artery disease (p=0.002). No difference in postoperative wound complications between interrupted/barbed sutures was observed after univariate (OR 1.07, 95% CI: 0.27-4.25, p=0.927) and multivariable logistic regression analysis (OR 0.77, 95% CI: 0.15-4.00, p=0.756). Univariate logistic regression revealed no differences in achieving minimal clinically important difference (MCID) NRS-NP (OR 0.73, 95% CI: 0.28-1.88, p=0.508) or NRS-AP (OR 0.68, 95% CI: 0.25-1.90, p=0.464) at 3 months between suture groups. The interrupted suture group was less likely to achieve MCID NDI at 3 months (OR 0.29, 95% CI: 0.11-0.80, p=0.016). Barbed suture closure in posterior cervical spine surgery does not lead to higher rates of postoperative wound complications/SSI compared to traditional interrupted fascial closure.

Sternotomy in thyroid surgery

Introduction: A bulky retrosternal goiter means for the surgeon to consider an extracervical approach, usually from a partial sternotomy. Methods: Retrospective evaluation of a group of thyroid operations requiring sternotomy in a ten-year period (year 2012–2021), in an attempt to predict the need for sternotomy. Results: We performed a total of 1254 thyroid operations, with partial sternotomy required in 11 cases (0.88%): in 6 women and 5 men aged 43–84 years (mean 73.1 years). For these, 3 total thyroidectomies and 6 hemithyroidectomies (lobectomies) were performed. In 2 cases, we operated on the mediastinal residue, or regenerate, after a previous thyroidectomy from the cervical approach. The duration of hospitalization was 5–14 days, once there was bleeding with the need for operative revision, otherwise the procedures were without complications, including phonation. The border of the lower part of the thyroid gland in relation to the upper border of the aortic arch was in the range of +20 to -22 mm. The mean was -8.5 mm. Conclusion: All sternotomy thyroidectomies performed by us had a close relationship to, or overlapped with the upper line of the aortic arch. Significantly retrosternal propagating goiters are mostly eufunctional (81.9 % in our group) and develop in patients in the seventh or eighth decade of life. Therefore, if only one lobe propagates intrathoracically, a hemithyroidectomy is sufficient. A carcinoma is rarely present; in one case in our group. We believe that the necessity of sternotomy cannot be accurately predicted, but it is necessary to be prepared for it, especially in the case of a goiter exceeding the level of the aortic arch. In case of greater retrosternal propagation, it is certainly appropriate to perform a CT, for surgical reasons (possibility of sternotomy, risk of leaving part of the gland) and anesthetic reasons (compression and deviation of the trachea).

Classification of microscopic cervical blood cells using inception ResNet V2 with modified activation function

Cervical cancer is the most frequent and fatal malignancy among women worldwide. If this tumor is detected and treated early enough, the complications it causes can be minimized. Deep learning demonstrated significant promise when imposed on biomedical difficulties such as medical image processing and disease prognostication. Therefore, in this paper, an automatic cervical cell classification approach named IR-PapNet is developed based on Inception-ResNet which is an optimized version of Inception. The learning model’s conventional ReLu activation is replaced with the parametric-rectified linear unit (PReLu) to overcome the nullification of negative values and dying ReLu. Finally, the model loss function is minimized with the SGD optimization model by modifying the attributes of the neural network. Furthermore, we present a simple but efficient noise removal technique called 2D-Discrete Wavelet Transform (2D-DWT) algorithm for enhancing image quality. Experimental results show that this model can achieve a top-1 average identification accuracy of 99.8% on the pap smear cervical Herlev datasets, which verifies its satisfactory performance. The restructured Inception-ResNet network model can obtain significant improvements over most of the state-of-the-art models in 2-class classification, and it achieves a high learning rate without experiencing dead nodes.