Mean Preoperative Visual Analog Scale Research Articles

Functional outcomes of a Lima modular shoulder replacement

BackgroundThe use of metal backed glenoid (MBG) components over polyethylene (PE) for total shoulder arthroplasty (TSA) remains controversial. While their advantages and disadvantages are documented, few studies exist demonstrating their efficacy in TSA and conversion rates to a reverse total shoulder arthroplasty (RSA). This study aims to evaluate acute postoperative complications, shoulder pain, functional outcomes, and conversion rates to RSA in patients who underwent TSA using a modular MBG component. MethodsA retrospective review of individuals undergoing TSA between October 2014 and March 2019 was performed. Inclusion and exclusion criteria were defined. Baseline surgical characteristics were collected and outcomes were assessed preoperatively and postoperatively using the visual analog scale and American Shoulder and Elbow Surgeons score at preoperative, 1 year, 2 year, and final follow-up. Revision rates were documented. Summary statistics were performed using a two-tailed Student’s t-test. ResultsThe study’s final cohort consisted of 91 patients, with a mean age of 66.5 ± 8.1 years, an average body mass index of 32.8 ± 6.9 kg/m2, and 53.8% being male. Majority of patients underwent a TSA on the right side (64.9%), with an average operative duration of 105 minutes and EBL of 148.8 mL. The mean follow-up time was 38.8 months. Thirteen patients (14.3%) went onto conversion to an RSA. Among these individuals, 30.8% (n = 4) was due to a traumatic rotator cuff tear (RCT), 23.1% (n = 3) due to excessive PE wear, and 46.2% (n = 6) due to nontraumatic RCT. The average time to revision for all patients was 27.7 ± 24.8 months. Mean time to revision was 17.5 ± 9.8 months for trauma patients, 51.0 ± 3.5 for patients with signs of excessive PE wear, and 22.9 ± 31.3 months for nontrauma patients. Mean preoperative visual analog scale scores were 6.8 ± 2.3 and American Shoulder and Elbow Surgeons scores were 28.5 ± 15.6. Both significantly improved at 1-year, 2-year, 3-year postoperative timepoints as well as the final postoperative timepoint (P < .001). ConclusionPatients undergoing TSA using a MBG component reported no acute postoperative complications and improved shoulder function. A small proportion of patients were converted to RSA for signs of a RCT and excessive component wear. This study may suggest that the MBG design demonstrates a failure rate equivalent to cemented PE component systems; thereby, does not expose patients to subsequent higher rates of revision procedures.

Functional Anterior Knee Pain and Return to Sport Following Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction

Background: Bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction is a frequently used technique but has been associated with a high incidence of postoperative anterior knee pain. However, previous studies have not evaluated if this anterior knee pain is functionally limiting for patients. This study introduces the concept of functional anterior knee pain, or kneecap pain that limits patients' ability to return to their prior level of activity or sport. Methods: We reviewed BPTB ACL reconstructions from April 2013 to May 2017. Patients included in the analysis had a minimum of 1 year of clinical follow-up and 3 years of survey follow-up. Statistical analyses were performed using paired t tests and binomial test. Results: Sixty-seven patients met the inclusion criteria. Compared to the mean preoperative visual analog scale (VAS) pain score of 6.1, patients reported statistically significant reductions in VAS scores at 1 year and 3 years postoperatively to 0.9 and 1.8, respectively (P<0.01). The incidence (28.4%) of anterior knee pain was highest at the 3-month time point. This incidence decreased to 6.0% at 1 year and 7.5% at 3 years postoperatively. At 3 years postoperatively, 94% (63/67) of the patients in this study were not limited by functional anterior knee pain and returned to preoperative levels of activity and sport. Conclusion: To our knowledge, this investigation is the first to define and quantify the relationship between postoperative anterior knee pain and resultant functional limitations. This study shows that ACL reconstruction with BPTB autograft was not significantly associated with functional anterior knee pain in our population and that the incidence of postoperative anterior knee pain following BPTB ACL reconstruction may be less than previously reported.

Advantages of Revision Transforaminal Full-Endoscopic Spine Surgery in Patients who have Previously Undergone Posterior Spine Surgery.

Revision lumbar spine surgery via a posterior approach is more challenging than primary surgery because of epidural or perineural scar tissue. It demands more extensive removal of the posterior structures to confirm intact bony landmarks and could cause iatrogenic instability; therefore, fusion surgery is often added. However, adjacent segment disease after fusion surgery could be a problem, and further exposure of the posterior muscles could result in multiple operated back syndrome. To address these problems, we now perform transforaminal full-endoscopic spine surgery (TF-FES) as revision surgery in patients who have previously undergone posterior lumbar surgery. There have been several reports on the advantages of TF-FES, which include feasibility of local anesthesia, minimal invasiveness to posterior structures, and less scar tissue with fewer adhesions. In this study, we aim to assess the clinical outcomes of revision TF-FES and its advantages. We evaluated 48 consecutive patients with a history of posterior lumbar spine surgery who underwent revision TF-FES (at 60 levels) under local anesthesia. Intraoperative blood loss, operating time, and complication rate were evaluated. Postoperative outcomes were assessed using the modified Macnab criteria and visual analog scale (VAS) scores for leg pain, back pain, and leg numbness. We also compared the outcome of revision FES with that of primary FES. Mean operating time was 70.5 ± 14.4 (52-106) minutes. Blood loss was unmeasurable. The clinical outcomes were rated as excellent at 16 levels (26.7%), good at 28 (46.7%), fair at 10 (16.7%), and poor at 6 (10.0%). The mean preoperative VAS score was 6.0 ± 2.6 for back pain, 6.8 ± 2.4 for leg pain, and 6.3 ± 2.8 for leg numbness. At the final follow-up, the mean postoperative VAS scores for leg pain, back pain, and leg numbness were 4.3 ± 2.5, 3.8 ± 2.6, and 4.6 ± 3.2, respectively. VAS scores for all three parameters were significantly improved (p < 0.05). There was no significant difference in operating time, intraoperative blood loss, or the complication rate between revision FES and primary FES. Clinical outcomes of revision TF-FES in patients with a history of posterior lumbar spine surgery were acceptable (excellent and good in 73.4% of cases). TF-FES can preserve the posterior structures and avoid scar tissue and adhesions. Therefore, TF-FES could be an effective procedure for patients who have previously undergone posterior lumbar spine surgery.

Awake transforaminal endoscopic lumbar facet cyst resection: technical note and case series.

The aim of this study was to describe a minimally invasive transforaminal surgical technique for treating awake patients presenting with lumbar radiculopathy and compressive facet cysts. Awake transforaminal endoscopic decompression surgery was performed in 645 patients over a 6-year period from 2014 to 2020. Transforaminal endoscopic decompression surgery utilizing a high-speed endoscopic drill was performed in 25 patients who had lumbar facet cysts. All surgeries were performed as outpatient procedures in awake patients. Nine of the 25 patients had previously undergone laminectomies at the treated level. A retrospective chart review of patient-reported outcome measures is presented. At the 2-year follow-up, the mean (± standard deviation) preoperative visual analog scale leg score and Oswestry Disability Index improved from 7.6 ± 1.3 to 2.3 ± 1.4 and 39.7% ± 8.1% to 13.0% ± 7.4%, respectively. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. A minimally invasive awake procedure is presented for the treatment of lumbar facet cysts in patients with lumbar radiculopathy. Approximately one-third of the treated patients (9 of 25) had postlaminectomy facet cysts.

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.

Osteochondral lesions of the talus (OLT) are common following ankle trauma. Operative treatment is often required, with osteochondral autografting frequently performed for large or cystic lesions, or following failed primary surgery. The aim of this systematic review was to evaluate the current evidence for osteochondral autograft transfer system (OATS) in the management of OLT. A systematic search of the PubMed, EMBASE, Scopus, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Study quality was assessed using the modified Coleman Methodology Score (CMS). Meta-analysis was carried out using RevMan, version 5.4 (The Cochrane Collaboration, 2020). A total of 23 studies were included. The mean modified CMS was 48.1±7.47. Fourteen studies reported preoperative and postoperative Visual Analog Scale (VAS) and American Orthopaedic Foot & Ankle Score (AOFAS). The aggregate mean preoperative and postoperative VAS scoreacross 14 studies was 6.47±1.35 and 1.98±1.18, respectively. Meta-analysis of seven studies on 210 patients found that OATS resulted in a significant reduction in VAS score compared to baseline (Mean Difference {MD} -4.22, 95% Confidence Interval {CI} -4.54 to -3.90, P < 0.0001). The aggregate mean preoperative and postoperative AOFAS scores across 14 studies were 56.41±8.52 and 87.14±4.8, respectively. Based on eight studies on 224 patients, OATS resulted in a significant improvement in AOFAS score compared to baseline (MD 29.70, 95% CI 25.68 to 33.73, P = < 0.0001). Donor site pain occurred in 9% of cases. Current evidence from low-quality studies suggests that OATS is a safe and effective treatment option for OLT, though it is associated with a risk of donor site morbidity.

Hallux Valgus Multiplanar Correction Surgery Through a Minimally Invasive Technique: Our First 100 Patients Experience

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Recently, minimally invasive surgery for hallux valgus correction has regained popularity. The minimally invasive Chevron and Akin (MICA), has been proved to be as satisfactory for patients as conventional open techniques. However, due to its design, it is difficult to correct the coronal plane malalignment, which could lead to the recurrence of the deformity. Instead, a Bösch-type osteotomy allows multiplanar correction, and with an upgrade in its fixation we can create a stable third- generation percutaneous osteotomy. We report our first 100 patients results using the minimally invasive Bösch and Akin osteotomy (MIBA). Methods: This was a prospective case series of our first 100 patients (137 feet) undergoing MIBA procedure. Outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), the AOFAS Forefoot Score, and the visual analog scale (VAS) for pain assessment. There was also a significant improvement in all radiographic parameters (p &lt; 0.05). Mean HVA decreased from 30.5° to 7.8°, mean IMA decreased from 13° to 4.5°, and the mean DMAA decreased from 13.8° to 4.0° (p&lt;0.05). All complications and emitted radiation dosage were reported as well. Results: At 12 months MOXFQ and AOFAS improved from 57.3 to 0.73 (p=0.00) and 45.2 to 99.2 (p=0.00), respectively. The mean preoperative VAS was 4.6, and improved during the first week to 1.3 (p&lt;0.05). There was also a significant improvement in all radiographic parameters. We had three significant and 13 minor complications. Conclusion: The MIBA procedure is a safe and effective option to achieve a multiplanar hallux valgus correction.

Glomus Tumour of Hand--A Commonly Misdiagnosed Pathology: A Case Series.

Glomus tumours are benign neoplasms arising from the glomus body, a network of specialized neuromyoarterial structures containing arteriovenous anastomosis and regulating temperature. It is often misdiagnosed as paronychia, arthritis, traumatic sequelae, and many other conditions including psychiatric misdiagnosis. A typical triad of paroxysmal pain, point tenderness, and cold intolerance characterize it. Surgical excision is the treatment of choice, either by transungual or lateral approaches. We carried out a retrospective study of cases operated in our department in the last 4 years. Patients are evaluated based on either clinical parameters (Love test, Hildreth test, and cold insensitivity) or radiological parameters (X-ray and magnetic resonance imaging). Parameters such as age, gender, tumour side, presenting complaints, duration of symptoms, diagnostic modality, follow-up duration, recurrence, and postoperative nail deformity were analysed. Visual analogue scale (VAS) score was the primary statistical parameter, and the change in VAS score following surgery was analysed with paired t test. Mean preoperative VAS was 7.75 ± 0.5; in a total of four patients, and following surgery, VAS was reduced to a mean of 1 ± 1.5. Paired t test on the change of VAS score following surgery showed a significant difference in the VAS score (P = 0.002838). The average age was 39.25. The male-to-female ratio was 1:3, and the mean follow-up was 16 months (range 2-48 months). The mean duration of symptoms was 5.75 years (range 2-10 years). Two cases were in the right-hand side, and two cases were on the left-hand side; the thumb was most commonly involved with 50% (n = 2) incidence. Glomus tumours are often misdiagnosed and are intervened with different treatment options before being surgically intervened. With complete surgical excision, recurrence is nil but postoperative nail growth requires nearly 10 months. Level IV.

AOFAS and Karlsson-Peterson scales in evaluating patients treated with modified Broström-Gould and suture tape augmentation for ankle instability: a performance analysis

Objective: The objective of this study was to evaluate the performance of the American Orthopedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson scales in patients with lateral ankle instability treated with modified Bröstrom-Gould (MBG) plasty and suture tape augmentation. Methods: This retrospective, bicentric, cohort study involved consecutive patients with lateral ankle instability treated with MBG plasty and suture tape augmentation. The Visual Analog Scale (VAS), AOFAS scale, and Karlsson-Peterson scale were used in pre-/postoperative assessments. Results: Fifty-five patients who underwent MBG plasty and suture tape augmentation were included. Mean preoperative and postoperative VAS scores were 7.1 ± 1.4 and 1.3 ± 1.6 (p&lt;0.001), respectively. Mean AOFAS scores were 61.3 ± 21.1 and 95.4 ± 8.4, respectively (p&lt;0.001). Mean Karlsson-Peterson scale scores were 46.8 ± v14.3 and 95.2 ± v7.9 (p&lt;0.001), respectively. Conclusions: The Karlsson-Peterson scale showed a better performance than the AOFAS scale in the clinical and functional evaluation of patients with ankle instability treated with MBG plasty and suture tape augmentation. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

What’s New in Hip Replacement

What’s New in Hip Replacement

Patient Outcomes After Minimally Invasive Excision of Lumbar Synovial Cysts, With and Without a Spondylolisthesis, in an Ambulatory Care Center Setting.

Lumbar synovial cysts are thought to signal facet joint degeneration and possible instability, leading some surgeons to routinely add a fusion to the decompressive procedure. These recommendations were formulated before the minimally invasive surgery (MIS) era. Here we describe our outcomes in surgical treatment of lumbar synovial cysts using MIS techniques. The charts of 117 patients who underwent MIS resection of a synovial cyst were retrospectively reviewed. All surgeries were carried out in an ambulatory surgery center (ASC). The preoperative and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) were collected prospectively. Surgical variables and complications were also reviewed. The subset of 48 patients followed for over 1 year was analyzed, and the outcome of patients with and without a spondylolisthesis was compared. A total of 117 patients underwent MIS decompression of a synovial cyst. Postoperative follow-up ranged from 3 to 12 months. There were no perioperative complications or 30-day readmissions. Preoperative mean VAS and ODI were 6.2 and 46.7. The postoperative VAS and ODI declined by 3.0 and 22.0 over a mean of 125 days. There were 48 patients with a mean follow-up of 15 months, where the VAS and ODI declined by 2.8 and 22.5, respectively. In this subset, the 23 patients with a spondylolisthesis (all grade 1), were compared to the 25 patients without. The spondylolisthesis group VAS and ODI, preoperatively and postoperatively, declined by 3.3 and 26.1, respectively, while the nonspondylolisthesis group declined by 2.6 and 19.2. These results for each group in this study surpass the standard for a minimal clinically important difference. Patients with lumbar synovial cysts may safely undergo MIS decompression in an ASC setting, with a low risk of perioperative complications. The reduction in pain and disability is meaningful in the short term and sustained over the next 15 months. The presence of a grade 1 spondylolisthesis did not adversely impact patient outcomes over this time period. For patients undergoing MIS resection of a lumbar synovial cyst, with either the presence or absence of a grade 1 spondylolisthesis, the mandatory inclusion of a concomitant spinal fusion is brought into question. This work is among the largest series of synovial cysts published in which the MIS technique is applied. It demonstrates the efficacy of the procedure, along with its safety and appropriateness for performance in an ambulatory care setting. Moreover, it describes the outcomes using the patient-reported outcome measures VAS and ODI. Finally, the long-term outcomes of patients with and without spondylolisthesis are compared, further supporting the position that when performing a decompression of a synovial cyst with an associated grade 1 spondylolisthesis, a concomitant fusion may not always be necessary.

Arthrodesis for Carpometacarpal Joint Arthritis: A Systematic Review.

This study reviews the patient demographics, functional outcomes, and complications of trapeziometacarpal arthrodesis as a treatment for arthritis of the first carpometacarpal joint. A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Google Scholar. Articles located by the search were independently assessed by title, abstract, or full article review for inclusion or exclusion. Demographic, outcome, and complication data from included articles were extracted, compiled, and analyzed. Frequency-weighted means and proportions were generated. In total, 21 articles met inclusion and exclusion criteria accounting for 802 patients and 914 thumbs. Average age at time of surgery was 55.4 years, and mean follow-up time was 72.7 months. Arthrodesis techniques include Kirschner-wire fixation (51.3%), plate fixation (24.6%), screw fixation (9.8%), tension band technique (7.1%), staple fixation (7.0%), and none (<0.1%). Mean preoperative Disabilities of the Arm, Shoulder and Hand score was 58 and 25.4 postoperatively (∆ = -32.6 points). Mean preoperative visual analogue scale score was 6.8 and 1.9 postoperatively (∆ = -4.9 points). Mean preoperative grip strength was 15.7 kg, and 23.0 kg postoperatively (∆ = +7.3 kg). In all, 48.7% of thumbs had complications, 15.1% of which were major, while 33.6% were minor. The most common major complication was symptomatic hardware (8.6%) requiring return to the operating room, and the most common minor complications were peritrapezial arthritis (8.5%) and nonunion (8.4%). Arthrodesis for arthritis of the trapeziometacarpal joint is associated with good functional outcomes and low to moderate patient-reported disability and pain scores, but a high complication rate. IV.

Reconstruction of the coracoclavicular ligament with palmaris longus tendon and Mersilene tape for acromioclavicular dislocations

BackgroundAcromioclavicular (AC) joint dislocation is common among shoulder injuries, and various surgical methods have been introduced for effective ligament reconstruction. Reconstruction of the coracoclavicular (CC) ligament in the anatomical position using autologous tendons is a recent surgical trend. This study is to report clinical and radiologic results of reconstruction of the CC ligament using an autologous palmaris longus tendon interweaved with Mersilene tape (PLMT) with a minimum 2-year follow-up.MethodsThis retrospective study analyzed 76 patients (mean age, 43.4 ± 11.2 years) with AC joint dislocation treated by reconstruction of the CC ligament with PLMT, from March 2004 to February 2017. The mean follow-up period was 28 ± 6.7 months (range, 24–66 months). The Visual Analog Scale (VAS) for pain assessment, American Shoulder and Elbow Surgeons rating scale (ASES), and Constant Score (CS) were used to evaluate clinical outcomes at the preoperative and the final follow-ups. CC and AC distances were measured using anteroposterior (AP) X-ray preoperatively and at the final follow-up for radiologic outcomes. Complications were also assessed.ResultsThe mean preoperative VAS for pain, ASES, CS were 5.7 ± 0.7, 77.1 ± 6.2, and 61.5 ± 5.2, respectively. These scores at the final follow-up improved to 2.1 ± 0.5, 90.9 ± 4.3, and 94 ± 7.0, respectively (p = 0.043, p < 0.001, p < 0.001). The mean preoperative CC and AC distances were 16.49 ± 3.73 mm and 13.84 ± 3.98 mm, respectively. The final follow-up CC and AC distances were 9.29 ± 2.72 mm and 5.30 ± 2.09 mm, respectively (p < 0.001, p < 0.001). Although a slight re-widening of the CC distance occurred in 10 patients (13.1%), most patients regained full range of motion of the affected shoulder at the final follow-up.ConclusionThe CC ligament reconstruction with PLMT for the treatment of AC joint dislocation showed good clinical and radiological results. This technique could be a good alternative treatment for AC dislocations.

Long-term follow-up of motor cortex stimulation on central poststroke pain in thalamic and extrathalamic stroke.

To investigate the long-term effects of motor cortex stimulation (MCS) on central poststroke pain (CPSP) in patients with thalamic and extrathalamic stroke. We retrospectively analyzed 21 cases of CPSP patients who were treated with MCS. Pain intensity was evaluated using the visual analog scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) before the operation and at follow-up assessments. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). The average follow-up time was 65.43 ± 26.12 months. In the thalamus stroke group (n=11), the mean preoperative VAS score was 8.18 ± 0.75 and the final mean follow-up VAS score was 4.0 ± 2.14. The mean total NPSI score at the last follow-up (20.45 ± 12.7) was significantly reduced relative to the pre-MCS score (30.27 ± 8.97, p < 0.001). Similarly, the mean PSQI value at the last follow-up (12.63 ± 1.91) was significantly reduced compared with the pre-MCS value (16.55 ± 1.97, p < 0.001). In the extrathalamic stroke group (n=11), the mean preoperative VAS score was 8.2 ± 0.79 and the final mean follow-up VAS score was 6.6 ± 2.12. The mean total NPSI score before MCS was not statistically different from that at the last follow-up. There were no statistical differences in sleep quality before versus after surgery. Motor cortex stimulation has higher long-term efficacy in CPSP patients with stroke confined to the thalamus than in CPSP patients with stroke involving extrathalamic structures.

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder.

In cases of large osteochondral lesions of the talus (OLTs), fresh structural or bulk osteochondral allograft transplantation has yielded favorable outcomes in several retrospective and few prospective case series. The purpose of this study was to prospectively evaluate patients who received fresh structural allograft transplantation of the talar shoulder. A prospective evaluation of patients who received a fresh structural allograft of an OLT was performed. Preoperative imaging included magnetic resonance imaging (MRI) and/or computed tomography (CT) with plain radiographs. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 36-Item Short-Form Health Survey (SF-36), visual analog scale (VAS) for pain, and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative imaging were evaluated for allograft assimilation, evidence of arthritic changes, or functional range of motion abnormalities. Thirty-one patients with a mean age of 41.4 years (±14.1, range 18-69) underwent structural fresh osteochondral allograft transplantation to the talar shoulder and were included in this study. The mean follow-up was 56.2 months (±36.1, range 24-142). The majority of patients were female (n=17, 54.8%), reported some history of prior ankle trauma (n=21, 67.7%), and underwent prior ankle surgery (n=23, 74.2%). The mean lesion size on CT scan was 1879 mm3 (n = 27) compared to the mean lesion size of 3877 mm3 (n = 21) on MRI. There was a significant improvement in the mean preoperative VAS score (P < .0001), SF-36 score (P < .0005), SMFA bother index (P < .0015), and the SMFA function index (P < .0001) at final follow-up. A total of 15 (48.4%) patients underwent an additional surgery following their osteochondral allograft transplant, most commonly arthroscopic debridement or removal of hardware, performed at an average of 25.2 (±13.0) from their index procedure. There was one failure that required a total ankle replacement. The overall graft survival rate was 96.8%. Fresh, structural allograft transplantation resulted in significant improvement in patient-reported postoperative pain and function in patients suffering from OLTs. The graft survival rate was 96.8% at a mean of 56.2 months follow-up, with half of patients requiring a second procedure. Level IV, prospective case series.

Ultrasonographic Measurement of Median Nerve Cross-Sectional Area in Evaluating Carpal Tunnel Release Outcomes

Earlier research has explored carpal tunnel release (CTR) surgery outcomes using electrodiagnostic tests (EDX). However, evaluation of the median nerve before and after CTR by ultrasound (US) is understudied. This study aimed to establish the outcomes of CTR by EDX and US, and examine the correlation between the clinical improvement and US after CTR. The sample consisted of 172 wrists that underwent CTR. Pain was assessed using the visual analog scale (VAS). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), including the symptom severity and function subscales, was applied before and 3 months after CTR. The proximal and distal cross-sectional areas (CSAs) of the median nerve were measured using US, and EDX was performed before and 3 months after CTR. Patients had mean preoperative and postoperative VAS scores of 7.7 ± 1.2 and 1.7 ± 1.2, respectively. The mean preoperative and postoperative proximal CSA measurements were 16.4 ± 4.5 mm2 and 12.1 ± 3.9 mm2, respectively. The mean preoperative and postoperative distal CSA measurements were 13.6 ± 3.7 mm2 and 11.0 ± 3.1 mm2, respectively. A significant improvement was observed in VAS, BCTQ, and EDX 3 months after CTR. A weak, positive correlation was observed between the improvement in the BCTQ symptom severity and function subscales and CSAs following CTR. The results of this study demonstrate that preoperative median nerve CSA values may be used in evaluating CTR outcomes. Therapeutic IV.

Cave-in decompression technique in percutaneous endoscopic transforaminal discectomy for ossification occupation in lumbar spinal canal: A retrospective analysis of 23 cases

ObjectivePercutaneous endoscopic transforaminal discectomy (PETD) for the treatment of ossification occupation of the lumbar spinal canal is technically demanding. The purpose of this study was to describe an endoscopic cave-in decompression technique in PETD for ossification occupation of the lumbar spinal canal and to report the clinical results. MethodsFrom May 2018 to June 2020, 23 consecutive cases, diagnosed in our institution as ventral ossification in the lumbar spinal canal and treated with PETD, were evaluated. The endoscopic cave-in decompression technique was performed. We analyzed the clinical outcomes on a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Perioperative data and complications rate were also recorded. ResultsMean follow-up was 15.7±2.8months. Mean preoperative VAS score for low-back pain was 5.65±1.43, and decreased to 0.57±0.5 at final follow-up. Mean preoperative VAS score for leg pain was 5.48±1.38, and decreased to 0.56±0.5 at final follow-up. Mean preoperative ODI score decreased from 33.04±5.28 preoperatively to 8.7±2.54 at last follow-up. One patient experienced transient postoperative hypoesthesia, and one developed a mild transient decline in muscle strength; both recovered progressively. Postoperative CT and MRI showed that the ossification was effectively removed and the nerve root and dural mater was completely decompressed in all cases. ConclusionThe endoscopic cave-in decompression technique in PETD is a safe and effective treatment method for selected patients with ossification occupation of the lumbar spinal canal.

Postoperative Paraspinal Muscles Assessment After Endoscopic Stenosis Lumbar Decompression: Magnetic Resonance Imaging Study.

Conventional open lumbar decompression is a widely accepted procedure for degenerative lumbar disease. However, it is associated with morbidity due to damage to the paraspinal muscles and posterior ligamentous complex. Endoscopic spine surgery (ESS) is considered the least invasive type of spine surgery in modern times and was developed to minimize the iatrogenic injury to the paraspinal muscles. Many studies are reported to estimate the paraspinal muscle damage after an open or minimal invasive spine surgery by radiological methods (magnetic resonance imaging [MRI] and computed tomography], biochemistry (creatinine phosphokinase level), or electrophysiology (electoneuromyography). The objectives of this study were to assess paraspinal muscles changes after lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) based on preoperative and 6-month postoperative MRIs. We studied 159 consecutive patients with lumbar degenerative disease who underwent LE-ULBD at a spine specialty hospital from 2018 to 2019. The current study was a single-center, single-surgeon, retrospective case study. Changes of paraspinal muscles after LE-ULBD measured on lumbar MRI. Postoperative paraspinal muscles changes are evaluated on a picture archiving and communication system by measuring the cross-sectional area (CSA) of multifidus and erector spinae muscles along with the fatty infiltration of muscle on Kjaer's scale at the level of surgery on the ipsilateral and contralateral sides on T1W image. Correlations between imaging and visual analog scale (VAS) score for back, Oswestry Disability Index (ODI), and MacNab's criteria were examined in the preoperative and postoperative periods. Of the 159 patients included, 120 underwent a single level procedure and 39 a multilevel procedure. For single-level LE-ULBD group, mean (SD) preoperative, postoperative, and final follow-up VAS score (7.83 [1.37], 3.15 [0.67] and 2.19 [0.88]; P < 0.001) and ODI (74.09 [7.18], 27.88 [4.40], and 23.88 [4.56]; P < 0.001) improved significantly. Based on MacNab's criteria, the clinical result was excellent in 37 patients, good in 78 patients, and fair in 5 patients. For the multilevel LE-ULBD group, the mean (SD) preoperative, postoperative, and final follow-up VAS score (7.84 [1.38], 3.50 [0.60],and 2.44 [0.79]; P < 0.001) and ODI (74.1 [7.72], 31.30 [4.46], and 24.90 [4.75]; P < 0.001) also improved significantly . Based on MacNab's criteria, the clinical result was excellent in 6 patients, good in 31 patients, and fair in 2 patients.The functional CSA of paraspinal muscles for both groups showed no significant difference in the 6-month follow-up MRI. The fatty infiltration of paraspinal muscles significantly improved from 0.77 to 0.59 (P < 0.05) for the single level LE-ULBD group but not for the multilevel LE-ULBD group (P = 0.320). The mean dural sac CSA increased significantly for both groups (P < 0.001). Adequate neural decompression can be achieved with the preservation of paraspinal muscles after an ESS. Preservation of the paraspinal muscles along with the posterior ligamentous complex improves the stability of motion segment in the postoperative period, which ultimately results in better patient outcomes in related to postoperative pain and rehabilitation.Key.

Clinical results of free vascularized fibula graft in the management of precollapse osteonecrosis of the femoral head: A retrospective clinical study.

This study aimed to evaluate clinical results, femoral head survival, and the need for total hip arthroplasty (THA) in patients with precollapse osteonecrosis of the femoral head (OFH) (Steinberg stage II and III) treated by free vascularized fibula graft (FVFG) application. We retrospectively reviewed 54 hips of 47 patients (39 males, eight females; mean age 36 ± 14 years) who underwent FVFG due to OFH, with at least two years of follow-up. The patient data, including Harris Hip Score (HHS), Visual Analogue Scale (VAS), and conversion to THA, were documented. The right hip of 26 patients and the left hip of 28 patients were involved. Bilateral FVFG surgery was performed on seven patients due to bilateral OFH. The mean follow-up time was 5.5 (range 2-14) years. Survival of the femoral head was observed in 39 hips (72.2%), while the femoral head collapse was observed in 15 femoral heads (27.8%). The mean preoperative HHS increased from 46.5 (range=12-85) to 86.5 (range=33-100) postoperatively (P < 0.001). The mean preoperative VAS score improved from 8.2 (range=2-10) to 1.3 (range=0-10) postoperatively (P < 0.001). THA was performed on seven hips at a mean follow-up time of 1.8 years (range=0.7-3.3). There was no significant difference in the collapse rate between unilateral or bilateral OFH (P=0.175). A higher survival rate was observed in the Steinberg stage II femoral head patients compared to the stage III femoral head (P=0.021). This study has shown that FVFG surgery can be a good option for managing patients with Steinberg stage II and III precollapse OFH to prevent femoral head collapse and joint function. Level IV, Therapeutic Study.

Safety and Feasibility of DTRAX Cervical Cages in the Atlantoaxial Joint for C1/2 Stabilization.

Pathological changes in the atlantoaxial joint often lead to instability, pain, and neurological deterioration. One treatment option is the surgical stabilization of the atlantoaxial joint. In other areas of the spine, fusion rates have been improved by the introduction of an interbody cage. Our aim was to use cervical interbody spacers, originally designed to augment fusion across subaxial posterior cervical facets, to optimize the conditions for atlantoaxial fusion. To evaluate the safety and efficacy of implanting cervical cages in the atlantoaxial joint for C1/2 stabilization. Our retrospective study evaluated patients who had undergone C1/2 cervical fusions by the Harms/Goel technique. This technique was modified by implanting a titanium cervical interbody spacer into the joint space. Mean overall pain, as measured by a 0 to 10 visual analog scale (VAS) and neurological outcomes were measured preoperatively and postoperatively. In addition, radiological outcomes were collected using follow-up imaging. Nine patients were included in this case series. The mean preoperative VAS for overall pain was 5.0 ± 4.0, which changed to a mean VAS of 2.0 ± 3.0 after an average follow-up period of 41.4 ± 20.4 (P = .043). All patients showed a bony fusion in our case series. None of the radiological imaging during follow-up showed screw loosening, hardware breakage, implant migration, or nonunion. The implantation of cervical titanium cages into the atlantoaxial joint in combination with posterior fixation appears to be a safe and effective method for achieving C1/2 fusion.

Minimally invasive pedicle screw fixation, including the fractured vertebra, combined with percutaneous vertebroplasty for treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals: A prospective clinical study.

To evaluate the feasibility, efficacy, and safety of minimally invasive pedicle screw (MIPS) fixation, including the fractured vertebra, combined with percutaneous vertebroplasty (PVP) for the treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals.Between January 2016 and August 2019, a total of 30 patients, with a mean age of 69.4 years (range, 58–75 years), who experienced thoracic or lumbar fracture without neurological deficits, underwent the MIPS procedure combined with PVP. Preoperative and postoperative pain were assessed using a visual analog scale and Oswestry Disability Index. Cobb angles and anterior column height were measured on lateral radiographs before surgery and at 3 days, 1, 3, and 6 months, and 1 and 2 years at final follow-up after surgery.All patients underwent surgery successfully, with a mean follow-up of 18.2 ± 5.7 months (range, 12–45 months). Mean preoperative visual analog scale score decreased from 7.3 ± 2.2 to 1.4 ± 0.3 at the final follow-up (P < .05). Mean preoperative Oswestry Disability Index decreased from 84.2 ± 10.3 to 18.8 ± 7.5 (P < .05) at the final follow-up. The Kyphosis angle of operative segment was improved from preoperative (21.38 ± 1.68)° to (4.01 ± 1.38)° 3 days postoperatively and (5.02 ± 1.09)° at final follow-up (P < .05). The anterior vertebral height was improved from preoperative (49.86 ± 6.50)% to (94.01 ± 1.79)% 3 days postoperatively and (91.80 ± 1.88)% at final follow-up (P < .05). No significant changes in vertebral body height restoration were observed during 2 years of follow-up after surgery. In addition, there were no instrumentation failures or complications in any of the patients.MIPS, including the fractured vertebra, combined with PVP, was a reliable and safe procedure, with satisfactory clinical and radiological results for the treatment of thoracolumbar osteoporotic compression fracture in patients without neurological deficits.