Follow-up VAS Research Articles

Do preoperative scapular fractures affect long-term outcomes after reverse shoulder arthroplasty?

Postoperative scapular stress fractures (SSFs) are a formidable problem after reverse shoulder arthroplasty (RSA). Less is known about patients who have these fractures preoperatively. The primary aim of this study was to examine postoperative satisfaction in patients undergoing primary RSA who have preoperative SSF and compared to a matched cohort without preoperative fracture. The secondary aim was to examine the differences in patient-reported outcomes between and within study cohorts. A retrospective chart review of primary RSAs performed by a single surgeon from 2000 to 2020 was conducted. Patients diagnosed with cuff tear arthropathy (CTA), massive cuff tear (MCT), or rheumatoid arthritis (RA) were included. Five hundred twenty-five shoulders met inclusion criteria. Fractures identified on preoperative computed tomography scans were divided into 3 groups: (1) os acromiale, (2) multifragments (MFs), and (3) Levy types. Seventy-two shoulders had an occurrence of SSF. The remaining 453 shoulders were separated into a nonfractured cohort. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and visual analog scale (VAS) scores were compared pre- and postoperatively in the total fracture group and the nonfractured group cohort. The multifragment subgroup was also compared to the pooled Os/Levy subgroup. The total incidence of SSF in all shoulders was 13.7%. There was a difference in satisfaction scores at all time points between the nonfracture (7.9±2.8) and total fracture group (5.4±3.6, P <.001, at last visit). There was also a greater ASES total score in the nonfractured group vs the total fracture group at the final visit (69.4±23.4 and 62.1±24.2; P=.02). The MF group had worse ASES functional or VAS functional scores than the Os/Levy group at all time points: at 1 year, ASES function: MF 24.2±14.5 and Os/Levy 30.7±14.2 (P=.045); at 2 years, ASES function: MF 21.4±14.4 and Os/Levy 35.5±10.6 (P <.001); and at last follow-up, VAS function: MF 4.8±2.8 and Os/Levy 6.4±3.2 (P=.023). Scapular fractures were proportionally most common in patients diagnosed with CTA (16.3%) compared with a 9.2% and 8.6% incidence in patients diagnosed with MCT and RA, respectively. Patients with preoperative SSF still see an improvement in ASES scores after RSA but do have lower satisfaction scores compared with the nonfractured cohort. The multifragment fracture group has lower functional and satisfaction scores at all postoperative time points compared with both the nonfracture and the Os/Levy fracture group.

A PROSPECTIVE STUDY OF EFFICACY AND OUTCOME ANALYSIS OF ROLE OF PRP INJECTION IN OSTEOARTHRITIS OF KNEE JOINT 40 CASES PROSPECTIVE ANALYSIS

Background: Knee osteoarthritis is a progressive debilitation degenerative disease of the cartilage of the knee. In severe conditions, the patient is unable to do basic activities of daily living also. The pain associated with severe cartilage degeneration is excruciating. Platelet rich plasma being autologous in nature, the chances of disease transmission are also very less. This study aims to evaluate the efficacy in terms of pain relief and functional outcome of platelet rich plasma in patients with knee osteoarthritis with Kellgren-Lawrence Grade I, II and III. Material and Method: This study was conducted in the Department of Orthopedics, Arihant Hospital and Research Centre, Indore during the study period of 2 years. We included 29 patients with primary osteoarthritis of knee with age more than 35 years and who were willing to undergo this procedure. After preliminary evaluation of the knee with radiograph and confirming the fitness of the patient for the procedure, these patients were given injection of PRP and were instructed on post procedure precautions. The second injection was given at 3rd week and 3rd injection at 6th week, and these patients were followed up till 12 months. At each follow-up WOMAC score and VAS scores were evaluated. Pairedt test was applied to evaluate the change in mean WOMAC and VAS scores at each follow-up. A p value of &lt; 0.05 was taken as statistically significant. Result and Conclusion: We had included 40 knees (29 patients) with a mean age of 55.89 ± 9.14 years. Female predominance was seen in our study (75.9%). Only Kellgren-Lawrence osteoarthritis grades I, II and III were included and Grade IV were excluded. The left knee involvement (52.5%) was slightly higher in comparison to the right knee. The mean WOMAC score preinjection was 75.65 ± 5.54, at 3 weeks it was 66.23 ± 6.95 and at 6 weeks and 43.93 ± 14.11 at 6 months. There was a significant improvement (P&lt;0.05) in WOMAC scores over the follow-up till 6 months. The mean WOMAC score along with its 3 subscales showed significant deterioration at 12 months in comparison to 6 months, scores (P&lt;0.05). Likewise, the mean VAS preinjection was 7.18 ± 0.93, which significantly decreased at postinjection (at 6 months) to 3.90 ± 1.19 (P&lt;0.05), but by 12 months the mean VAS showed significant increase to 6.38 ± 1.01 (P&lt;0.05). No major complications were noted, except for pain and swelling at the site of injection. These were managed conservatively and responded well to the given treatment.

Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study

Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the "bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)" technique in CSM patients. The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images. Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50±3.42, kyphosis angles were-13.34±13.69° and spinal canal areas were 87.11±28.30mm2. In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94±3.09, kyphosis angles were-15.07±12.78° and spinal canal areas were 149.65±42.57mm2. A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P= 0.198), and no instability was observed in any patient in long-term follow-up. The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.

Clinical efficacy of different open approaches in the surgical treatment of thoracolumbar tuberculosis: a single-center retrospective comparative study

ObjectiveTo assess the clinical efficacy of three different surgical approaches in the treatment of thoracolumbar tuberculosis.MethodsA total of 138 patients with thoracolumbar tuberculosis treated by open surgery were retrospectively analyzed. The surgical methods were divided into anterior, posterior and anterior–posterior combined. The hospital stays, amount of bleeding, operative time, preoperative, postoperative and last follow-up ESR, CRP, Frankel score, ODI, VAS, correction and loss rate of kyphosis, fusion rate and complications were recorded and analyzed.ResultsThe average follow-up was 66 months. The average hospital stay, operative time and amount of bleeding of the anterior–posterior combined group were higher than other groups (P < 0.05). ESR and CRP of all patients were reduced postoperatively (P < 0.05). No significant difference among the three groups was found in the postoperative correction angle of kyphosis (P < 0.05), while the pre- and postoperative Cobb angle as well as correction rate had significant differences. The posterior approach could achieve better correction, and the loss of correction was more in the anterior group, 40.9 percent of patients performed correction loss. The Frankel score, VAS and ODI were significantly reduced among the three groups, and the incidence rate of complications of the anterior approach was lower than the other groups, with a significant difference (P < 0.05).ConclusionThe anterior approach has more advantages and fewer complications, which is supposed to give preference to and could not be replaced by the posterior and anterior–posterior combined approach.

Decision to Preserving Ankle Joint Function in Neglected Neck Talus Fracture with Type 2 Diabetic Mellitus Patient : A Case Report

Talus fractures are rare injuries to the hindfoot that still challenging in treatment. The anastomotic ring is likely to be damaged in neck talus fractures, which disrupt the blood flow and cause significant problems affecting fracture healing. Poor fracture healing and an increased risk of surgical complications were also associated with complex diabetes mellitus. We follow the progress of the illness from a 47 year old female complaint pain on her left ankle after falling down 6 months before outpatient. Physical examination shows swelling and varus deformed on affected ankle. Ankle x-ray and CT scan were done. Patient diagnosed as neglected close fracture left neck talus Hawkins type IV with type 2 diabetes mellitus. Then patient undergo an ankle arthroscopy to evaluate ankle joint and preserving ankle joint procedure by subtalar arthrodesis and iliac bone graft. This procedure achieved an excellent result in preserve ankle aligment, stability and soft tissue management. After 2 weeks wound heals without signs of infection and 3 weeks of followup VAS score mention from 0 to 1, with good compliance of the patient. Arthroscopy is safe procedure obtaining anatomical joint surface and reduce tissue damage. While arthrodesis enhance blood supply to encourage bone union, though loss of its ankle motion also has significant effect on ambulation.

Randomized Control Trial of Functional Outcome between Instrumented Posterior Lumbar Interbody Fusion and Posterolateral Fusion in Degenerative and Isthmic Adult Spondylolisthesis.

Spondylolisthesis is a spinal condition that affects the lumbosacral vertebrae. This disease causes one of the lower vertebrae to slip forward onto the bone directly beneath it. It's a painful condition but treatable in most cases. Although spondylolisthesis can be asymptomatic, patients with degenerative and isthmic spondylolisthesis typically present with low back pain, neurologic symptoms, and/or radicular symptoms. The surgical treatment of spondylolisthesis is indicated for cases of neurogenic claudication, intractable radicular pain, severe low-back pain, presence of neurological symptoms, failure of conservative management, radiological instability, progressive worsening of the listheses, Meyerding grade III and IV listhesis, and spondylosis. The ideal surgical treatment remains controversial. We have compared the functional outcome following instrumented posterior lumbar interbody fusion and posterolateral fusion for adult spondylolisthesis in our study. The prospective study was conducted in the Department of Orthopaedics. A total of 30 patients who satisfied both the inclusion and exclusion criteria and gave informed consent were recruited for the study from January to December 2019. The patients were randomized into two groups. Of 30 patients, Group 1(n=18) underwent Posterior lumbar interbody fusion and Group 2 (n=12) underwent Posterolateral fusion. Random number generators were used for allotting the patients to the specified group. Using Oswestry Disability Index, Japanese Orthopaedic Association Score and Visual Analog Score were used for pre-operative and post-operative functional scoring. The mean age among those who received PLIF was 53.67 years and among those who received PLF was 55.17 years. Spondylolisthesis at L4-L5 comprised 66.7% among those who received PLIF and 58.3 % among those who received PLF. Neurological deficit was present in 66.7% of the participants who had received PLIF and 100% of the participants who have received PLF. Concerning those who had received PLIF as treatment, 11 patients had excellent and 7 patients had better outcome in PLIF group, 7 patients had excellent and 5 patient had better outcome in PLF group.. The mean JOAS pre-intervention score was 6.66 and 6.40 for PLIF and PLF groups, respectively. In the 6th month mean JOAS score of the PLIF group was 11.16 and that of the PLF group was 10.16. The pre-intervention mean VAS score was 6.44 and 6.50 for PLIF and PLF groups, respectively. In both, the groups over the follow-up period mean VAS score had shown a decreasing trend. Our study did not show any significant difference in functional outcome between both groups, however there seems to better short term (3 months) and mid-term (6 months) pain relief in PLIF group when compared to PLF group. Long term follow-up studies along with radiological outcome may help in establishing superiority between both procedures.

3D accuracy and clinical outcomes of corrective osteotomies with patient-specific instruments in complex upper extremity deformities: an approach for investigation and correlation

BackgroundCorrective osteotomies of the upper extremities with patient-specific instruments (PSIs) are increasingly used. In this context, the concordance between planning and postoperative 3D radiographs as well as the association between 3D accuracy and clinical outcome has rarely been evaluated. In this pilot study, we aimed to investigate our clinical mid-term outcome and 3D accuracy as well as their possible correlation, including identifying aspects critical to reaching optimal correction results.MethodsFrom October 2018 to January 2020, we used PSIs for 12 corrective osteotomies of the upper extremity in 11 bones of 8 patients (congenital or posttraumatic deformities in 2 elbows, 3 forearms, 3 distal radii). In follow-up examination (10–25 months postoperatively), patient satisfaction, grip strength, ROM, VAS, and DASH were evaluated. Three-dimensional radiological accuracy was determined with 3D-reconstructed postoperative CT scans. With the software tool “Part Comparison” of Mimics® Innovation Suite Software/Materialise, surface differences of pre-planned and postoperative 3D models were compared.ResultsCompared to the preoperative situation pain and function were better at follow-up: The average VAS score significantly decreased from 6.5 ± 4.1 cm preoperatively to 2.3 ± 2.6 cm at the follow-up time point (p = 0.008). The average DASH score significantly improved, from 48.4 ± 30.9 to 27.0 ± 25.2 (p = 0.015). In the part comparison analysis “planned vs postoperative comparison”, significantly more points in percent (= 3D accuracy) were in a −3 mm to 3 mm interval than in the “preoperative vs planned comparison” (87.3 ± 13.8% vs 48.9 ± 16.6%, p = 0.004). After surgery, the maximum deviation value over all cases was 4.5 ± 1.1 mm, and the minimum deviation value was − 4.5 ± 1.2 mm vs preoperatively 12.9 ± 6.2 mm (p = 0.004) and − 7.2 ± 2.1 mm (p = 0.02), respectively. Clinically, in all cases with higher accuracy (> 90%), an improvement of either DASH or VAS or both of > 60% to the preoperative values occurred. There was a significant correlation between accuracy (%) and ΔVAS (p = 0.004). There were no method-related complications.ConclusionsOur data after PSI-based corrective osteotomy in complex deformities of the upper extremity in a limited number of cases indicate a positive correlation between 3D accuracy and clinical outcomes. Examination of 3D accuracy to analyse sources of error in the hole procedure from initial CT scan to end of surgery even in patients with not fully satisfactory clinical results is required for further development of the method to achieve optimal correction results with nearly 100% congruence between the planned and postoperative 3D bone position.Trial registration This retrospective study was registered in the Center for Translational & Clinical Research Aachen (CTC-A) with the number 20-514 on November 20, 2021

Tension-Free Vaginal Tape and Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: 3-Year Followup from a Randomized Clinical Trial.

We sought to determine whether polyacrylamide hydrogel (PAHG) is noninferior to tension-free vaginal tape (TVT) in the treatment of women with primary stress urinary incontinence (SUI). In this noninferiority trial, 223 women eligible for operative SUI treatment were randomized for TVT (110) or PAHG (113). Primary outcome was patient satisfaction and the noninferiority margin for the difference was 20%. Secondary outcomes were effectiveness and complications. At 3 years, 188 (84.3%) women attended the followup. The satisfaction score (visual analogue scale 0-100) median was 98.5 (IQR 90-100) in the TVT group and 90.0 (IQR 70-100) in the PAHG group, whereas a score ≥80 was reached in 87 (94.6%) and 65 (67.7%), respectively (difference 26.9%, 95% CI 16.7% to 36.8%). Thus, PAHG did not meet the noninferiority criteria set in our study. The cough stress test was negative in 88 (95.7%) of TVT patients vs 75 (78.1%) of PAHG patients (difference 17.5%, 95% CI 8.6% to 26.9%). Any peri- or postoperative complication before crossover between the groups was detected in 40 (43.5%) women in the TVT group and 23 (24.0%) women in the PAHG group (difference 19.5%, 95% CI 6.8% to 31.4%). In midterm followup, PAHG did not reach in patient satisfaction the noninferiority set in our study. Furthermore, mid urethral TVT slings show better subjective and objective cure rates than PAHG. However, complications were more often associated with TVT. Since the majority of PAHG treated women were also cured or improved, primary SUI women can be offered PAHG as a safe and durable alternative treatment.

Remodeling of Epidural Fluid Hematoma after Uniportal Lumbar Endoscopic Unilateral Laminotomy with Bilateral Decompression: Comparative Clinical and Radiological Outcomes with a Minimum Follow-up of 2 Years.

Retrospective cohort study. To evaluate the clinical and radiological effects of epidural fluid hematoma in the medium term after lumbar endoscopic decompression. There is limited literature comparing the effect of postoperative epidural fluid hematoma after uniportal endoscopic decompression. Magnetic resonance imaging (MRI) and clinical evaluation were performed for patients with single-level uniportal endoscopic lumbar decompression with a minimum follow-up of 2 years. A total of 126 patients were recruited with a minimum follow-up of 26 months. The incidence of epidural fluid hematoma was 27%. Postoperative MRI revealed a significant improvement in the postoperative dura sac area at postoperative day 1 and at the upper endplate at 6 months in the hematoma cohort (39.69±15.72 and 26.89±16.58 mm2) as compared with the nonhematoma cohort (48.92±21.36 and 35.1±20.44 mm2), respectively (p <0.05); and at the lower endplate on postoperative 1 day in the hematoma cohort (51.18±24.69 mm2) compared to the nonhematoma cohort (63.91±27.92 mm2) (p <0.05). No significant difference was observed in the dura sac area at postoperative 1 year in both cohorts. The hematoma cohort had statistically significant higher postoperative 1-week Visual Analog Scale (VAS; 3.32±0.68) pain and Oswestry Disability Index (ODI; 32.65±5.56) scores than the nonhematoma cohort (2.99±0.50 and 30.02±4.84, respectively; p <0.05). No significant difference was found at the final follow-up VAS, ODI, and MRI dura sac area. Epidural fluid hematoma is a common early postoperative MRI finding in lumbar endoscopic unilateral laminotomy with bilateral decompression. Conservative management is the preferred treatment option for patients who do not have a neurological deficit. Symptoms last only a few days and are self-limiting. A common endpoint is a remodeled fluid hematoma and the subsequent expansion of the dura sac area.

Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case–control study

BackgroundWith the widespread use of the posterior surgery, more and more surgeons chose posterior surgery to treat thoracic and lumbar tuberculosis. But others still believed that the anterior surgery is more conducive to eradicating the lesions, and easier to place larger bone pieces for bone graft fusion. We compared the clinical and radiological outcomes of anterior and posterior surgical approaches and presented our views.MethodsThis study included 52 thoracic and lumbar tuberculosis patients at Sun Yat-sen Memorial Hospital from January 2010 to June 2018. All cases underwent radical debridement, nerve decompression, intervertebral bone graft fusion and internal fixation. Cases were divided into anterior group (24 cases) and posterior group (28 cases). Statistical analysis was used to compare the clinical effectiveness, radiological outcomes, complications and other related information.ResultsPatients in the anterior group and the posterior group were followed up for an average of 27.4 and 22.3 months, respectively. There were no statistically significant differences between groups in the preoperative, postoperative and last follow-up VAS score, ASIA grade and Cobb angle of local kyphosis. Moreover, there were no statistically significant differences in the improvement of neurological function, loss of kyphotic correction, total incidence of complications, operative time, intraoperative blood loss and hospital stay between the two groups (P > 0.05). But there was greater correction of kyphosis, earlier bone fusion, lower incidence of poor wound healing, less interference with the normal spine and less internal fixation consumables and medical cost in the anterior group (P < 0.05).ConclusionsBoth anterior and posterior approaches are feasible for thoracic and lumbar tuberculosis. While for thoracic and lumbar tuberculosis patients with a single lesion limited in the anterior and middle columns of the spine without severe kyphosis, the anterior approach surgery may have greater advantages in kyphosis correction, bone fusion, wound healing, protection of the normal spine, and medical consumables and cost.

'XX'-Sacroplasty: A Novel Technique for Management of "H-Type" Sacral Insufficiency Fractures.

ObjectiveExamine the feasibility, safety, and results of a novel sacral percutaneous injection technique (“XX”) addressing both the vertical and horizontal aspects of sacral insufficiency fractures (SIF).MethodsProspective cohort study. Eight consecutive SIF patients with immobility and pain investigated using CT and nuclear imaging confirmed “H"-type fracture. Demographics, pain level, and ambulation status were recorded. The long-term quality of life was evaluated using the ODI questionnaire and pain VAS scores. Sacroplasty procedures in prone positioning using fluoroscopy were used to insert 2 bone trochars through the S1 pedicles and 2 trochars through the sacral ale aiming toward the SIJ, thus forming 2 “X” trochar formations. Balloon kyphoplasty was done through the trocars, and PMM was injected. Postoperative ambulation and VAS were recorded.ResultsAverage age was 81.5 years (±3.4 years). The time from presenting symptoms to hospital admission was 2 days to 4 months. All patients were significantly limited with ambulation. None had a neurologic compromise. Sacroplasty was performed with 2 cases that required additional lumbar kyphoplasty. The mean operative time was 54 min (±14). The average exposure was 19 mGy (±12 mGy). Two patients had cement leaks. CT and X-rays revealed good cement filling of the fractures sacral alae and body of S1. The average postoperative hospitalization was 10 days. All patients reported postoperatively pain relief immediately and were able to walk better. Follow-up time was 17 ± 12 months. Follow-up VAS was 2.7 (±2) and ODI was 57.3% (±21%).Conclusion“XX” technique showed good outcomes for patients with higher complexity SIF, using the same principles as for lumbar VPL/KPL, and was found to be safe and effective.

Predictors of 90-Day All-Cause Morbidity, Mortality and Poor Functional Outcome Scores Following Elective Total Knee Arthroplasty in a High-Volume Setting: A Prospective Cohort Study.

The primary objective was to ascertain the predictors of 90-day all-cause morbidity, mortality and poor functional outcome scores following primary total knee arthroplasty (TKA). The study population comprised 3645 patients who underwent elective primary unilateral TKA at our institution. Demographic variables, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) grade and the Deyo-Charlson comorbidity scores were ascertained. The Functional outcomes, perioperative complications, mortality and readmission rates were monitored prospectively for 90days and analysed. Patients were assessed twice: at baseline and at 90days postoperatively. Odds ratio and the corresponding 95% confidence intervals were calculated to quantify the risk. A p < 0.05 for two-tailed tests were considered significant. The 90-day mortality rate was 0.08% (all males) and 3.95% of the patients experienced one or the other complications. The majority of patients reported excellent-to-poor scores at 90-day follow-up VAS (8.85 ± 1.02 vs. 2.65 ± 1.15; p < 0.0001) and KSS scores (42.96 ± 5.90 vs. 80.52 ± 4.15; p < 0.0001). The early readmission rate was 0.96%. Infection was being the primary reason. Age > 70years; Deyo-Charlson co-morbidity score ≥ 4, ASA grade-III, Diabetes Mellitus, BMI > 35, Cardiac Issues and Male gender were significant predictors of early morbidity and mortality. Female, Deyo-Charlson comorbidity score ≥ 4, ASA grade-III, BMI > 35, Age > 75years and poor preoperative scores were significantly associated with poor functional outcome. The present study explicates the relative importance of predictors on morbidity, mortality and functional outcome. Efforts to minimize morbidity and mortality should concentrate more on elderly male patients, and those with high Deyo-Charlson comorbidity score, BMI and ASA grade.

Long term outcome and fusion rate of transdiscal fixation for L5-S1 high grade spondylolisthesis

ObjectiveHigh grade spondylolisthesis (HGS) is a quite rare entity and many techniques are available to address this condition. In 1994 Abdu et al. proposed a transdiscal fixation approach that achieved a good clinical outcome. We analyse outcome and fusion achieved in patients treated by transdiscal fixation after 1-year follow-up. MethodsWe reviewed patients operated through transdiscal fixation since 2014 with a follow-up of at least 1 year, and compared preoperative and postoperative clinical measures (ODI, VAS and EQ-5D) and postoperative complications. Also, we analyzed the degree of fusion on CT scan with Lenke and Birdwell criteria. ResultsTwelve patients were included in the study with a mean follow-up of 49.4 months (range 12.8–84.1 months). Three cases presented a Meyerding grade IV spondylolisthesis and 9 cases grade III. At 1-year follow-up mean postoperative ODI, VAS and EQ5D scores improved (ODI 13.2 (range 0–30) vs 49.83 (range 15–71.1); p = .005). Equally this improvement was seen in the last follow-up (ODI 9.28 (range 0–35) vs 49.83 (range 15–71.1); p = .005). CT scan showed fusion grade A in 5 patients (41.6%), another 5 as grade B (41.6%) in Lenke classification. According to the Birdwell criteria 4 patients were classified as grade I (33.3%), 7 patients grade II (58.3%). None showed complications postoperatively or radiolucency in follow-up. ConclusionsTransdiscal fixation shows a good clinical outcome that is maintained throughout a long time period and provides a reliable and suitable fusion.

İnternal Üretrotomide İntraüretral Lidocaine ile Sedoanaljezi Kombinasyonunun Etkinliği

Aim: In this study, our aim was to compare the effectiveness of combined intraurethral lidocaine and intravenous sedoanalgesia with intraurethral lidocaine alone in patients with undergoing optical internal urethrotomy(OIU) for primary anterior urethral strictures. &#x0D; Materials and methods: A total of 76 patients who underwent OIU with anterior urethral stricture 2-3 cm long were analysed. Patients were divided into two groups. There were 36 patients in group 1 received only intraurethral lidocaine gel (12.5 g,% 2 ) and there were 40 patients in group 2 operated under intraurethral lidocaine gel anesthesia with intravenous sedoanalgesia (1 mg/kg Propofol and 1µg/kg Fentanyl). Anatomic location, length and etiology of the urethral stricture, procedure time, patients’ follow-up and postoperative VAS scores were compared in two groups. &#x0D; Results: There was no significant differences between the two groups in the length of the urethral stricture,age and in the follow-up time. Most of the patients in two groups had iatrogenic as the cause of urethral stricture and the stricture was most commonly located in the bulbar urethra. The mean procedure time and VAS score in group 1 were significantly higher than group 2 (p

Favorable prognosis with nonsurgical management of type III acute odontoid fractures: a consecutive series of 212 patients

BACKGROUND CONTEXTThe recommended primary treatment for type III odontoid fractures (OFx) is external immobilization, except for patients having major displacement of the odontoid fragment. The bony fusion rate of type III OFx has been reported to be >85%. High compliance to treatment recommendations is favorable only if the treatment leads to a good outcome. PURPOSEThe primary aim of this study was to determine the long-term outcome after conservative and surgical treatment of type III OFx and to reaffirm that primary external immobilization is the best treatment for most type III fractures. STUDY DESIGN/SETTINGRetrospective study based on a prospective database. PATIENT SAMPLETwo hundred twelve consecutive patients with type III OFx treated at Oslo University Hospital over an 8-year period (2009–2017). OUTCOME MEASURESLong-term rates of bony fusion, crossover from primary conservative treatment to surgical fixation, new onset spinal cord injury (SCI), severe persistent neck pain (visual analogue scale - VAS), and persistent disability measured with Neck Disability index (NDI). METHODSThe present study was based on data extracted from our quality control database for acute cervical spine fractures from a general population. During the years 2018 to 2019 long-term follow-up of alive patients was performed (median follow-up time was 38.0 months; range 3.0–108.0 months). The follow-up included neurological examination, radiological examination and scoring of bony fusion status, crossover from primary conservative treatment to surgical fixation, new onset SCI, neck pain, and Neck Disability Index (NDI score). RESULTSIn this consecutive series of 212 patients with type III acute OFx, median patient age was 72 years, 56% had severe preinjury comorbidities (ASA score ≥3) and 22% lived dependently. Severe comorbidities and dependent living were significantly associated with increasing age (p<.001). The trauma mechanism was fall injury in 82%. The median age of patients injured by falls was significantly higher than in patients with a nonfall injury (p<.001). At the time of diagnosis, 4% had an OFx related SCI. Primary treatment was external immobilization alone in 95.3% and open surgical fixation in 4.7%. Patients treated with primary external immobilization alone presented with significantly less translation of the odontoid fragment (p<.001) and less angulation of the odontoid fragment (p=.025) than patients treated with primary surgery. Subsequent crossover to surgical fixation was performed in 5.4%. At long-term follow-up, 95.7% of patients had bony fusion of the OFx, 80.5% had minimal/no neck pain, and none developed new onset SCI. There was no significant difference in long-term follow-up VAS (p=.444) or NDI (p=.562) between the primary external immobilization group and the primary surgical group. CONCLUSIONThis study reaffirms that nonsurgical treatment remains the preferable option in the majority of patients with type III OFx.

Degenerative lumbar scoliosis patients with proximal junctional kyphosis have lower muscularity, fatty degeneration at the lumbar area.

To assess the lumbar muscle conditions on the incidence of proximal junctional kyphosis (PJK) after long-level correction and instrumentation surgery for degenerative lumbar scoliosis (DLS) patients with a minimum 2-year follow-up. Eighty-four DLS patients undergoing long instrumented fusion surgery (≥ 5 vertebrae) were retrospectively studied. According to the occurrence of PJK at the final follow-up, patients were divided into the PJK group and the Non-PJK group. Patient characteristics, surgical variables and radiographic parameters were analyzed statistically. The lumbar muscularity (cross-sectional area of muscle-disc ratio × 100) and fatty degeneration (signal intensity of muscle-subcutaneous fat ratio × 100) were evaluated on magnetic resonance imaging . The prevalence of PJK was 20.24%. Gender, age at surgery, body mass index, uppermost instrumented vertebrae level, fusions extending to the sacrum, and levels fused were not significantly different between the groups. Lower bone mineral density, smaller functional cross-sectional area (FCSA) of paraspinal extensor muscles (PSE), higher lean muscle-fat index and total muscle-fat index of PSE, greater preoperative thoracolumbar kyphosis (TLK), smaller preoperative sacral slope (SS), larger preoperative sagittal vertical axis were identified in PJK group. Logistic regression analysis showed that osteoporosis, preoperative TLK > 15°, SS > 24°, FCSA of PSE > 138.75, and total muscle-fat index of PSE > 4.08 were independently associated with PJK. The final follow-up VAS score for back pain was higher, and SRS-22 subcategories of pain, function, self-image, and total score were significantly lower in the PJK group. Osteoporosis, lower lumbar muscularity and higher fatty degeneration, preoperative greater TLK and smaller SS were found to be strongly associated with the presence of PJK in DLS.

Outcome analysis of lumbar endoscopic unilateral laminotomy for bilateral decompression in patients with degenerative lumbar central canal stenosis

Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has been reported as an alternative treatment for degenerative lumbar central canal stenosis (DLCS). To investigate the outcomes of LE-ULBD for different types of DLCS, including simple DLCS, DLCS with degenerative spondylolisthesis (DSL), and DLCS with degenerative scoliosis (DSC). Prospective cohort study. One-hundred sixteen patients with DLCS who underwent LE-ULBD at a spine center from April 2015 to June 2017 were enrolled in this study. Operative time, postoperative duration of hospitalization, and clinical outcomes (Oswestry disability index [ODI], visual analog scale [VAS], and modified Macnab outcome scale), and adverse events. A comparative analysis was performed evaluating medical records, radiological studies, and patient reported outcomes including ODI score, VAS scores and modified Macnab outcome scales in patients who underwent LE-ULBD. Data were prospectively collected at preoperative, postoperative 3-, 6-, 12-, 24-month to assess clinical and radiological outcomes and complications. The study analyzed 106 patients (45 men and 61 women, with a mean age of 69.5 years); 40 (37.8%) had simple DLCS, 41 (38.7%) had DLCS with DSL, and 25 (23.5%) had DLCS with DSC. The mean follow-up period was 33.3 months. The mean preoperative and postoperative follow-up ODI score and VAS scores for leg and back pain showed significant improvement in all time points. No significant difference was found among different pathologies in terms of VAS scores for back and leg pain, ODI scores and modified Macnab outcome scales at all follow-up periods. LE-ULBD is a feasible treatment method for DLCS. It did not result in worse outcomes in cases with DLCS with DSL or DLCS with DSC as compared with cases with simple DLCS.

Cochlear Implantation for Treatment of Tinnitus in Single-sided Deafness: A Systematic Review and Meta-analysis

Quantify the benefit of cochlear implantation (CI) for tinnitus relief among individuals with single-sided deafness (SSD). PubMed, Scopus, and Cochrane databases were searched through July 10, 2019. Search strategies used a combination of subject headings (e.g., MeSH in PubMed) and keywords for the following three concepts: single-sided deafness, cochlear implantation, and tinnitus. English articles that reported the preintervention (baseline) tinnitus-related patient-reported outcome measures (e.g., Tinnitus Handicap Inventory [THI] and Visual Analog Scale [VAS] for loudness) in patients with SSD that underwent CI were included. Number of patients, mean age, etiology of hearing loss, duration of deafness, baseline and follow-up THI and VAS scores. A total of 17 studies met inclusion criteria encompassing 247 patients with SSD receiving a cochlear implant (mean age 50.2 yr, range 23-71). For THI, CI resulted in a mean difference of -35.4 points [95% CI -55.8 to -15.0, p < 0.001]. VAS decreased by -4.6 points [CI -6.0 to -3.3, p < 0.001]. A weighted proportion of 14.9% [CI 6.4-26.1] of patients experienced complete resolution of tinnitus, while 74.5% [CI 63.1-84.5] experienced partial improvement; 7.6% [CI 4.1-12.6] of patients had no change in severity, and 3.0% [CI 1.0-6.7] experienced worsening of their tinnitus. On both THI and VAS, patients reported significant reduction in their scores, representing an overall improvement in tinnitus severity while wearing the cochlear implant. Most patients with SSD will experience partial improvement or complete resolution of tinnitus with a cochlear implant.

Surgical Management of Thoracolumbar Spondylodiscitis in End-Stage Renal Disease.

In recent times due to the advancement of haemodialysis techniques, there is increase in the life span of the patients with end-stage renal disease, which tends to increase the risk of complications of bacteraemia due to skin penetration for blood access and leading to propensity for more skeletal and spinal complications. Hence, early diagnosis of spine infection and early initiation of appropriate therapy are important in ensuring successful treatment and preventing further morbidity. The study included 22 males and 12 females who were known case of end-stage renal disease undergoing haemodialysis therapy and diagnosed with spondylodiscitis based on the clinical and radiological signs. The included patients required surgical stabilization based on the instability, neurological status, and epidural abscess, and non-responsive to medical line of treatment. To measure the degree of pain, Visual Analog Scale was used and British Medical Research Council grading system was used for motor evaluation. Radiography was undertaken one immediately and later at 1, 3, 9, and 12months and at yearly interval thereafter. Fusion assessment was done by features of consolidation of graft and absence of loosening of implants in both anteroposterior and lateral views will be an indirect evidence of fusion in short-term follow-up. Average age of the patients was 62years (range 40-75years). Twenty-two patients were male (64.7%) and twelve (35.3%) were female. Sixteen patients had diabetes mellitus and fifteen patients had chronic glomerulonephritis with various underlying causes. All patients presented with back pain with a duration range from 3 to 8weeks. 13 patients gave a history of on/off fever which was mild grade and 3 patients with high-grade fever. Eighteen patients presented with neurological deficits. The most common organism isolated was Methicillin-Resistant Staphylococcus Aureus (MRSA). At the final follow-up, radiographs revealed a good interbody fusion in 30 of the 34 cases, with 3 cases showed delayed fusion. The mean hemoglobin (Hb) level was 8.8g/dl and elevated total leucocyte level with mean of 14,425; mean C-reactive protein (CRP) level was 55.6mg/dl and erythrocyte sedimentation rate (ESR) was 47.5. All patients showed improvement in back pain. Preoperatively, the VAS had a mean of 8.5; post-operatively on day 2, the mean VAS was 3.2, and on 1month follow-up mean VAS was 2.4. In end-stage renal disease patients presenting with back pain, the diagnosis and treatment of spondylodiscitis becomes difficult. Where fever may not be a presenting feature even in cases with severe destructive osteomyelitis, and at times presenting as latent infection. Hence, spinal infection should be suspected as a possible cause of back pain in patients presenting with ESRD, even if they are presenting without fever and MRI study should be performed for the early diagnosis. Surgical intervention with debridement and posterior instrumentation should be considered as a modality of treatment in all cases of spondylodiscitis, with improved clinical outcome in terms of functionality, disability, and rehabilitation and acceptable complication rates in the perioperative period which can be adjusted to the individual cases.

Five-year clinical outcomes with endoscopic transforaminal foraminoplasty for symptomatic degenerative conditions of the lumbar spine: a comparative study of inside-out versus outside-in techniques.

Foraminal stenosis is a condition that is underappreciated by traditionally trained surgeons because the entire foraminal zone is not adequately visualized with the translaminar approach unless extensive removal of the facet is performed to expose the extraforaminal zone. Its direct endoscopic visualization is feasible with the inside-out and outside-in endoscopic transforaminal technique. The authors analyzed the differences in long-term 5-year clinical outcomes of endoscopic transforaminal foraminoplasty for symptoms from lumbar foraminal stenosis to better establish clinical indications for each technique. Long-term 5-year MacNab outcomes, VAS scores, complications, and unintended aftercare were analyzed in a series of 176 patients consisting of 86 inside-out (group 1) and 90 outside-in (group 2) patients treated for sciatica-type back and leg pain due to lumbar foraminal stenosis. At minimum 5-year follow-up, excellent results according to the MacNab criteria were obtained in 93 (52.8%) patients, good in 63 (35.8%), fair in 17 (9.7%), and poor in 3 (1.7%), respectively. The mean preoperative VAS was 6.87±1.96. The mean postoperative VAS was 3.15±1.59 and 2.98±1.75 at last follow-up, respectively. Both postoperative VAS and final follow-up VAS were statistically reduced at a significance level of P<0001. There were no major approach-, surgical- or anesthesia-related complications in this series. The vast majority of patients (112/176; 63.6% of the study population) did not require any additional interventional or surgical treatment following the index transforaminal endoscopic decompression. Postoperative dysesthesia due to irritation of the dorsal root ganglion (DRG) as a consequence of operation next to the DRG occurred in 17 patients (9.7%) and was the most common benign postoperative sequelae. There was a higher reoperation rate in the outside-in group (35.6%) than in the inside-out group (8.1%). The secondary fusion rate was also higher with the outside-in (8.9%) than with the inside-out technique (2.3%). Ultimately, the long-term clinical outcomes with the endoscopic transforaminal decompression procedure were favorable regardless of whether the inside-out or outside-in technique was used. These numbers were generated by two experienced endoscopic surgeons with thousands of case experience. Patients with symptomatic foraminal stenosis may be treated successfully with either the inside-out or the outside-in selective endoscopic discectomy (SED™) method while maintaining favorable long-term outcomes with a 3.2× decreased need for secondary fusion at 5-year follow-up when compared to recently reported reoperation rates for traditional decompression/fusion. Long-term clinical outcomes with the inside-out technique were presumably better because of the ability to visualize and decompress underneath the dural sac, the ventral facet and the axilla known as the hidden zone of MacNab.