Five-year Follow-up Evaluation Research Articles

Five-year Follow-up Evaluation of Surgical Treatment for Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament

Prospective, comparative clinical study. To compare the clinical outcome of anterior decompression and fusion with floating method and laminoplasty in the treatment of cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). There have been no reports that have accurately and prospectively compared surgical outcomes after anterior decompression and posterior decompression. For cervical myelopathy caused by OPLL, we performed anterior decompression and fusion with floating method (ADF) in 1997, 1999, 2001, 2003, and 2004 and French-door laminoplasty (LAMP) in 1996, 1998, 2000, and 2002 at one institution. Twenty patients in the ADF group and 22 patients in the LAMP group were evaluated for 5 years' follow-up. The following criteria were evaluated: operation time, blood loss, complications, and Japanese Orthopedic Association score. For radiographic evaluation, canal narrowing ratio of OPLL, lordotic angle at C2-C7, and postoperative progression of the ossified lesion were measured. The operation time in the ADF group was longer than that in the LAMP group. The average blood loss showed no statistical difference between the 2 groups. Complications occurred in 5 cases in the ADF group, but none occurred in the LAMP group. The mean Japanese Orthopedic Association score system for cervical myelopathy and the recovery rate in the ADF group were superior to those in the LAMP group, especially for cases with greater than 50% of the spinal canal compromised by OPLL or kyphotic alignment of the cervical spine, preoperatively. Postoperative progression of OPLL was observed in 5% of the ADF group and 50% of the LAMP group. ADF is considered especially suitable for cases with massive OPLL and preoperative kyphotic alignment of the cervical spine, although it leads to a higher incidence of surgery-related complications compared with LAMP.

POD-10.02: Evaluation of the Transurethral Protease Ablation of the Prostate for Benign Prostatic Hyperplasia (BPH) Accompanied by Low Urinary Tract Symptoms: A Five-Year Follow-up Evaluation

POD-10.02: Evaluation of the Transurethral Protease Ablation of the Prostate for Benign Prostatic Hyperplasia (BPH) Accompanied by Low Urinary Tract Symptoms: A Five-Year Follow-up Evaluation

Five-year follow-up evaluation of nasolabial folds treated with a novel polymethylmethacrylate collagen filler (a follow up study of subjects treated in the pivotal FDA trial)

Five-year follow-up evaluation of nasolabial folds treated with a novel polymethylmethacrylate collagen filler (a follow up study of subjects treated in the pivotal FDA trial)

Nerve Root Blocks in the Treatment of Lumbar Radicular Pain

In a previous prospective, randomized, controlled, double-blinded study on the effect of nerve root blocks on the need for operative treatment of lumbar radicular pain, we found that injections of corticosteroids were more effective than bupivacaine for up to thirteen to twenty-eight months. We performed a minimum five-year followup of those patients who had avoided surgery. All of the patients were considered to be operative candidates by the treating surgeon, and all had initially requested operative intervention. They had then been randomized to be treated with a selective nerve-root block with either bupivacaine or bupivacaine and betamethasone. Both the treating physician and the patient were blinded to the type of medication. Of fifty-five randomized patients, twenty-nine avoided an operation in the original study. Twenty-one of those twenty-nine patients were reevaluated with a follow-up questionnaire at a minimum of five years after the initial block. Seventeen of the twenty-one patients still had not had operative intervention. There was no difference between the group treated with bupivacaine alone and the group treated with bupivacaine and betamethasone with regard to the avoidance of surgery for five years. At the five-year follow-up evaluation, all of the patients who had avoided operative treatment had significant decreases in neurological symptoms and back pain compared with the baseline values. The majority of patients with lumbar radicular pain who avoid an operation for at least one year after receiving a nerve root injection with bupivacaine alone or in combination with betamethasone will continue to avoid operative intervention for a minimum of five years.

NERVE ROOT BLOCKS IN THE TREATMENT OF LUMBAR RADICULAR PAIN

Background: In a previous prospective, randomized, controlled, double-blinded study on the effect of nerve root blocks on the need for operative treatment of lumbar radicular pain, we found that injections of corticosteroids were more effective than bupivacaine for up to thirteen to twenty-eight months. We performed a minimum five-year followup of those patients who had avoided surgery. Methods: All of the patients were considered to be operative candidates by the treating surgeon, and all had initially requested operative intervention. They had then been randomized to be treated with a selective nerve-root block with either bupivacaine or bupivacaine and betamethasone. Both the treating physician and the patient were blinded to the type of medication. Of fifty-five randomized patients, twenty-nine avoided an operation in the original study. Twenty-one of those twenty-nine patients were reevaluated with a follow-up questionnaire at a minimum of five years after the initial block. Results: Seventeen of the twenty-one patients still had not had operative intervention. There was no difference between the group treated with bupivacaine alone and the group treated with bupivacaine and betamethasone with regard to the avoidance of surgery for five years. At the five-year follow-up evaluation, all of the patients who had avoided operative treatment had significant decreases in neurological symptoms and back pain compared with the baseline values. Conclusions: The majority of patients with lumbar radicular pain who avoid an operation for at least one year after receiving a nerve root injection with bupivacaine alone or in combination with betamethasone will continue to avoid operative intervention for a minimum of five years. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Fluoxetine in Adolescents with Comorbid Major Depression and an Alcohol Use Disorder: A Five-Year Follow-Up Study

ABSTRACT The goal of this five-year follow-up evaluation was to characterize the long-term (five-year) clinical course following the completion of an acute phase study with fluoxetine in comorbid adolescents. At the five-year follow-up evaluation, the group continued to demonstrate significantly fewer DSM criteria for an Alcohol Use Disorder (AUD) and fewer BDI depressive symptoms, and also consumed fewer standard drinks than they had demonstrated at the baseline of the acute phase study. Also, between the three- and five-year follow-up assessments, the level of self-reported depressive symptoms showed a significant decrease. Three of the 10 participants demonstrated Major Depressive Disorder (MDD) at the five-year follow-up assessment, but only one demonstrated Alcohol Dependence (AD), and none demonstrated Cannabis Dependence (CD). Eight of the 10 participants (80%) had demonstrated MDD at some time during the five-year follow-up study. The presence of a current AUD was significantly associated with the presence of a current MDD episode at both the one-year and the three-year follow-up evaluations. Six of the participants (60%) restarted SSRI medications at some point during the five-year follow-up period, but none were still taking SSRI antidepressants at the time of the 5-year assessment. Despite their substantial residual depression and alcohol use, a strong majority (8/10, 80%) of the subjects graduated from college during the five-year follow-up period. We conclude that the long-term (5-year) prognosis for the AUD, CD, and academic functioning of comorbid adolescents following acute phase treatment with SSRIs is surprisingly good. However, the long-term prognosis for their depression was surprisingly poor, and was worse than is typically seen among non-comorbid adolescents or adults.

The Chevron Osteotomy for Correction of Hallux Valgus

The chevron osteotomy, an accepted method for the correction of mild and moderate hallux valgus, is generally advocated for patients younger than the age of fifty years. The purposes of this prospective study were to compare the short-term (two-year) and intermediate-term (five-year) results of this operation with respect to patient satisfaction, flexion and extension of the metatarsophalangeal joint, maintenance of correction, and development of arthrosis and to determine whether the effectiveness of the procedure was limited by age. Between April 1991 and September 1992, the chevron osteotomy was performed for the treatment of mild-to-moderate hallux valgus deformity in sixty-six consecutive feet. Forty-three patients (fifty-seven feet) were available for follow-up at both two and five years postoperatively. The two-year and five-year clinical assessments were based on the American Orthopaedic Foot and Ankle Society's hallux-metatarsophalangeal-interphalangeal scale. Between the two-year and five-year follow-up evaluations, there was only a minimal change in overall patient satisfaction, and the average score on the hallux-metatarsophalangeal-interphalangeal scale was unchanged. The passive range of motion of the first metatarsophalangeal joint decreased between the preoperative assessment and the two-year follow-up evaluation and was unchanged at the five-year follow-up evaluation. Radiographic evaluation showed no changes in the hallux valgus or intermetatarsal angle between the two-year and five-year evaluations, although the number of feet with arthrosis of the metatarsophalangeal joint increased slightly, from eight to eleven. Patients aged fifty years or older did as well as younger patients. At these two follow-up periods, the chevron osteotomy was found to be a reliable procedure for the correction of mild and moderate hallux valgus deformity, and outcome did not differ on the basis of age.

Five-Year Follow-Up Evaluation of the Program of Clinic Visits for Humanity Education

Five-Year Follow-Up Evaluation of the Program of Clinic Visits for Humanity Education

A Prospective, Randomized Study of Three Operations for Acute Rupture of the Anterior Cruciate Ligament. Five-Year Follow-up of One Hundred and Thirty-one Patients*

A five-year, prospective, randomized follow-up study was done to compare three methods for repair of a rupture of the anterior cruciate ligament of the knee; acute primary repair (Group 1), acute repair with a synthetic ligament-augmentation device (Group 2), and acute repair augmented with an autologous bone-patellar ligament-bone graft (Group 3). One hundred and fifty patients who had an acute rupture of the anterior cruciate ligament were randomized to one of the three repair groups, with fifty patients in each group. The patients were between sixteen and fifty years old (mean, twenty-nine years old). All patients had the operation within ten days after the injury. The rehabilitation protocol was identical for each group. The patients were evaluated prospectively at one, two, and five years with use of the Tegner scoring system for level of activity and the scoring system of Lysholm and Gillquist for function, and the stability of the knee was assessed with clinical examination and with use of the KT-1000 arthrometer. One hundred and thirty-one patients completed the study and ten other patients were known to have had a failure of the procedure, a 94 percent rate of follow-up. All three groups had a lower level of activity at the five-year follow-up evaluation than they had had before the injury. The patients who had had augmentation with a patellar-ligament graft had a significantly higher mean level of activity at two years than those who had had non-augmented repair with (p = 0.002) and those who had had repair with a synthetic ligament-augmentation device (p = 0.01). They also had a significantly higher mean level of function at two years than those who had had non-augmented repair (p = 0.0001) and those who had had repair with a synthetic ligament-augmentation device (p = 0.03) and a significant higher mean level of function at five years than those who had had non-augmented repair (p = 0.004). The ability to attain full extension improved significantly in all three groups during the five-year follow-up period; the highest gains occurred in the group that had had augmentation with a patellar-ligament graft. Rotatory and anterior instability progressively increased during the follow-up period for all three groups. At one, two, and five years, the knees that had had repair with a patellar-ligament graft were significantly more stable than those that had had non-augmented repair and those that had had repair with a ligament-augmentation device (p < 0.0001 to p = 0.03). The findings of this study reinforce the conclusions of our two-year follow-up report that a non-augmented primary repair should not be performed, a repair with a ligament-augmentation device has an unacceptably high rate of failure (more than one-third of the patients), and a repair that is augmented with the patellar ligament has the best outcome.

Five-year Follow-Up Evaluation of the Noncemented Press-Fit Titanium Hip-Joint Endoprosthesis

A series of 260 noncemented total hip arthroplasties with a titanium alloy stem and fixation by the Zweymüller press-fit and an Endler polyethylene threaded cup was reviewed in detail. The minimum follow-up period was 48 months and the maximum 72 months, with an average of 60 months. A scale from zero to five points was applied to evaluate pain, mobility, and motion for a total possible accumulation of 15 points. The global results of the different etiologic groups (arthrosis, femoral head necrosis, rheumatoid arthritis, and subcapital hip fractures) have been very good and good (12-15 points) in 67.5% of the cases and fairly good and bad in 32.3%. These results have been better in femoral head necrosis than in arthrosis or rheumatoid arthritis, but not as good in subcapital hip fractures. The age groups below 60 had better results than the above 60 groups. The Singh index higher than 3 was correlated with better-than-average results. The polyethylene cup migrated horizontally (more than 4 mm) in 7.6% of the cases and vertically (more than 5 mm) in 10%. The non-evolutionary cortical remodelation of the femur does not influence the results. Prosthetic stem sinking less than 4 mm has been found in 62% of the cases, from 4 to 9 mm in 21%, and greater than 9 mm in 6%. No alterations with clinical consequences attributable to stress-shielding have been detected.

Use of Bipolar Hip Arthroplasty in States of Acetabular Deficiency

Bipolar hip arthroplasty was performed on 557 hips from December 1980 to June 1988. The clinical results and serial roentgenograms of 37 hips with acetabular deficiency, treated by arthroplasty from December 1980 to June 1983, were followed for a minimum of five years. The longest follow-up period was seven years and six months after the operation. The clinical score was assessed by the hip rating score of the Japanese Orthopaedic Association, which assigns a maximum of 100 points. The preoperative clinical score ranged from 24 to 56 points (mean, 42.2 points). The postoperative score improved to a range of 71-100 points (mean, 82.7 points). Of 37 hips examined, 31 hips were pain-free. As measured from the serial roentgenograms after the operation, the overall distance of central migration of the prosthesis in 37 hips was 0-5 mm, with an average of 1.4 mm, two years after the operation. At the five-year follow-up evaluation, 27 of 37 hips showed no additional central migration. The overall distance of superior migration of the prosthesis in 37 hips was from 0 to 8 mm, with an average of 2.6 mm, two years after the operation. Additional superior migration was noticed in 18 of 37 hips (48.6%) at the time of this five-year follow-up evaluation.

Charnley Total Hip Arthroplasty

The long-term results of 325 consecutive Charnley total hip arthroplasties (THAs) were assessed at an average of 62 and 140 months (five-year and ten-year follow-up examinations) postoperatively. Cases developing deep infection during the first five years were not included. Pain, walking ability, and mobility were rated as advocated by Charnley. The results were then graded as excellent, good, fair (clinically successful), and failure. At the five-year follow-up evaluation, 77 hips were excluded; 92% (228/248) of the results were successful. At the ten-year follow-up examination, interest was focused on the 228 hips graded as successful after five years. Sixty-six were excluded, one that had not been included at the five-year evaluation was traced, and 92% (150/163) were again clinically successful. The failure rate owing to mechanical causes during the first five years and between the five-year and ten-year follow-up examinations was 6.9% and 6.7%, respectively. The clinical results were considered highly satisfactory because only 50% of the hips judged successful at the ten-year examination had roentgenographically intact components. There is good reason to have great confidence in the Charnley THA.

Continuing education and training

Abstract Periodically, a review of selected comprehensive training programs in family therapy will be published in this section. The master's degree program at Hahnemann, introduced by Israel Zwerling in 1976, is an innovative program within a social psychiatry context, and is described here by its director, Robert Garfield. Of special interest is the fact that coauthor, Gary Lord, includes a five-year follow-up evaluation. A previous issue of the Journal carried an article on the current state of accreditation in the field of marriage and family therapy (Shalett & Everett, 1981), and the fact that there are now possibly as many as 75 accredited master's programs testifies to the rapid development of training in this field.