Months Of Conservative Treatment Research Articles

Endoscopic Assisted First Rib Resection for Thoracic Outlet Syndromes in Overhead Throwing Athletes

Objectives:Thoracic outlet syndrome (TOS) is a complex of signs and symptoms resulting from compression of the nerves and vessels supplying the upper limb. Repetitive and cumulative stress of the upper extremity in athletes are associated with TOS. Despite of several previous reports, TOS is incompletely understood, difficult to diagnose, and often poorly managed. Especially, etiology and pathology on throwing athletes with TOS have not been still unknown. Recent articles showed that with the help of the endoscope, more safety and less invasive surgery has been achieved. We consider that intraoperative observations will lead to analyses the pathology of TOS in athletes. The purpose of this retrospective study was to investigate characteristic clinical features, objective imaging, intraoperative findings, and surgical outcomes of patients with TOS in overhead throwing athletes.Methods:This study analyzed 158 cases of TOS (47 women and 111 men) who underwent endoscopic assisted first rib partial resection. Patients were divided into 2 group: athletes (89 patients) and non-athletes (69 patients). The diagnosis of TOS was based on clinical features, plane radiographs, ultrasonography, three-dimensional computed tomography angiography, and MRI. Indications for this surgery included failure of more than 6 months of conservative treatment or evidence on artery interruption on 3D angiography or obvious narrowing of interscalene region on ultrasound. Conventional transaxially approach described by Roos with endoscopic assist was underwent for partial resection of the first rib and decompression of neurovascular bundle. Intraoperative findings involved as follows; Interscalene distance (ISD): the distance between the posterior edge of the anterior scalene and the anterior edge of the middle scalene, Neurovascular bundle (NVB) patterns: based on alignment of the nerve, artery, and vein, following three types; parallel type, oblique type, and vertical type. Evaluation was performed through use of the clinical rating system of Roos’s classification, DASH, intraoperative endoscopic findings, plain radiographs, and ultrasonography. The mean follow-up period was 17.4 (from 6.4 to 42.4) months.Results:We found characteristic clinical features in athletes with TOS compared with non-athletes as follows; younger (16.7 years vs 36.3 years), shorter duration of symptoms (7.8 vs 26.0), and better outcomes (excellent or good percentage in Roos score; 91.0 % vs 73.9 %). Intraoperative findings showed no significant differences of ISD and NVB patterns between athletes and non-athletes. On the other hand, anatomical variation including abnormal bundle was found more frequently in athletes compared with non-athletes (Figure 1, Table1). There were no major complications.Conclusions:In conclusion, endoscopic assisted transaxially approach for first rib resection in TOS provided a superior magnified clear visualization and safely sufficient decompression of neurovascular bundle. The current study showed better clinical outcomes in athletes compared with non-athletes. Several factors including younger, shorter duration of symptoms, and anatomical variation would reflect to the result. The orthopaedic surgeon should be aware of the possibility of TOS in an adolescent who plays an overhead throwing sport. Appropriate surgical indication would provide them superior clinical outcomes.

Osteochondral injury of the femoral insertion of the deep medial collateral ligament of the knee-is there asuccessful surgical treatment?

Isolated ruptures of the deep portion of the medial collateral ligament (MCL) without clinical instability can mostly be treated conservatively with good clinical results. A10-year-old girl was initially also treated conservatively. As symptoms of pain and limited range of motion were not resolved after 3months of conservative treatment and although there were no signs of instability, it was decided to proceed with the surgical intervention. A small osteochondral fragment on the femoral insertion of the deep MCL (medial meniscofemoral ligament) was removed and the soft tissue portion of the ligament was reinserted in the anatomical footprint. The patient showed complete resolution of the pain and afull range of motion of the knee joint. At the last follow-up 18months after surgery the patient was completely free of symptoms.

Conservative or surgical treatment of carpal tunnel syndrome based on the severity and patient risk factors.

The carpal tunnel syndrome (CTS) is the most common median nerve compression disease which may result in impaired nerve function. This study was carried out to determine which treatment is more appropriate for moderate or severe CTS patients with or without risk factors. In a cohort prospective study, the patients with moderate CTS received a conservative treatment including night splint for 3months, one methyl prednisolone injection whereas patients with severe CTS underwent surgical release. They were followed for 1year using the bland scale based on the electromyography and nerve conduction velocity studies and five-point global assessment outcome scale. Totally, 68 moderate CTS cases (32 patients with risk factors and 36 without any risk factors) and 32 cases with severe CTS (16 patients with risk factors and 16 without any risk factors) were assess at 6months and 1year following the treatment. Although about 22% of moderate CTS patients with risk factors changed to mild CTS after 6months of conservative treatment, about 75% showed mild CTS or complete remedy following 1year (Pvalue < 0.001). This result was about 30% at 6 months and about 95% at 1year following conservative treatment in patients with moderate CTS without risk factors. None of moderate CTS patients with or without risk factors underwent surgery after 1year of follow-up. Although almost all patients with severe CTS, with and without risk factors, showed complete recovery or changed to mild CTS at 1year postoperatively, the result was statistically significant for cases without risk factors (Pvalue = 0.002). Conservative treatment for moderate CTS would be a good option, and the final result may be seen 1year later; however, its positive effect is quicker and better for moderate CTS cases without risk factors. Surgical release of the carpal tunnel may be the best choice not only for severe CTS cases with risk factors but also for cases without risk factors. For obtaining consistent rapid result, it is recommended to do surgical release for all cases of moderate or severe CTS without considering risk factors, but more clinical researches are needed. II.

Ultrasound-guided platelet-rich plasma injection for the treatment of recalcitrant rotator cuff disease in wheelchair users with spinal cord injury: A pilot study

Context/Objective: Wheelchair users with spinal cord injury (SCI) have a high risk of developing shoulder pain, caused by rotator cuff disease. Platelet-rich plasma (PRP) is a potential treatment after conservative treatments fail and prior to surgical intervention; however, it has not been tested in wheelchair users who have recalcitrant shoulder pain associated with rotator cuff disease. The objective of this pilot project was to test the safety and potential treatment effect of an ultrasound-guided PRP injection for shoulder pain in the aforementioned population. Design: Prospective, quasi-experimental. Setting: Clinical research center. Participants: Six wheelchair users with SCI (3 paraplegia, 3 tetraplegia) who had chronic shoulder pain due to rotator cuff disease (presence of anterior shoulder pain, positive physical examination tests for rotator cuff disease, and tendinopathy demonstrated by ultrasound) and failed at least six months of conservative treatment. Interventions: Ultrasound-guided PRP injection into pathological shoulder tendons, targeting the supraspinatus. Subjects were provided a standardized stretching and strengthening program and were followed for 4, 8, 12, and 24 weeks post-intervention with outcomes collected at each time-point. Outcome Measures: Wheelchair User's Shoulder Pain Index (WUSPI); pain Numerical Rating Scale (NRS); physical and ultrasound examinations for supraspinatus tendinopathy; 5-point patient global impression of change (PGIC). Results: WUSPI (69.9%, P < 0.001), NRS (49.6%, P < 0.01), and physical exam scores (35.7%, P < 0.01) decreased 24 weeks after treatment. Participants reported overall improvement in their status as a result of the treatment. No adverse events were noted, and no changes in ultrasound markers for tendinopathy were observed. Conclusion: A single, ultrasound-guided PRP injection into the supraspinatus tendon, followed by a stretching and strengthening exercise program, was safe and provided improvements in shoulder pain outcome measures in this sample for 24 weeks. Lack of blinding, short-term follow-up, and a suitable control group warrant a larger randomized controlled trial. Trial Registration: NCT01355549

Concurrent Pars Plana Vitrectomy and DSAEK to Manage Pseudophakic Bullous Keratopathy and Intraocular Lens Dislocation: A Case Report

This report describe the anatomical and visual outcomes of concurrent pars planavitrectomy (PPV) and Descemet stripping automated endothelial keratoplasty (DSAEK) for the management of a case with pseudophakic bullous keratopathy (PBK) and intraocular lens (IOL) dislocation following complicated phacoemulsification surgery. A 72-year-old woman was referred to our clinic 7 days after complicated phacoemulsification surgery. Severe corneal edema and IOL dislocation into the vitreous cavity was noticed on examination. After 2 months of conservative treatment, corneal edema remained persistent, so concurrent 23-gauge PPV, DSAEK and iris supported IOL implantation were performed in the single surgical procedure. One year after operation, the cornea was clear, retina was attached and best corrected visual acuity was 20/32. This report showed that concurrent PPV and DSAEK may be safe and effective option for the management of severely complicated Phacoemulsification surgery with PBK and IOL dislocation into the vitreous cavity.

Clinical Outcome of Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia at a Tertiary Care Hospital.

Background: - Trigeminal neuralgia is a disease typically characterized by involuntary attacks of lancinating pain in the distribution of the trigeminal nerve that are activated by non-noxious stimuli. Numerous anticonvulsants, either alone or in combination, remain the first choice in the medical treatment of trigeminal neuralgia.3If the disease becomes non responsive, there are numerous surgical options like micro vascular decompression or minimally invasive percutaneous lesioning of the trigeminal nerve, such as glycerol rhizolysis, Radiofrequency Rhizotomy, and balloon compression. Objective: - To determine efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of early pain relief in a tertiary care hospital. Methods: - 62 patients with refractory trigeminal neuralgia or lancinating, recurrent episodes of pain in the distribution of Ophthalmic (V1) and Mandibular (V3) branches of trigeminal nerve, not responsive to 6 months of conservative treatment were included. Study was completed in one year i.e. from March 2015 to Feb 2016. Result: - In our study population, 62 included patients were had mean age 56.08 ± 7.39 years. 44 patients (71%) were male. Our treatment was effective in 58 patients (93.5%) while there was recurrence among 4 (6.5%) only. Conclusion: - It is concluded that the efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of complete relief of pain with intact sensations in treated branch region is excellent (93.5%).

Clinical evaluation of percutaneous transforaminal endoscopic discectomy (PTED) and paraspinal minitubular microdiscectomy (PMTM) for lumbar disc herniation: study protocol for a randomised controlled trial

IntroductionFor sciatica caused by lumbar disc herniation (LDH), the standard surgical technique is conventional microdiscectomy. In recent years, minimally invasive techniques (eg, percutaneous transforaminal endoscopic discectomy (PTED), paraspinal minitubular microdiscectomy...

TL 18075 - Subtalar arthroscopic debridement for treatment of sinus tarsi syndrome

Introduction: Sinus tarsi syndrome (SST) can be understood as a set of conditions that affect this anatomical region and manifest as common signs and symptoms. When the nonsurgical approach fails, subtalar arthroscopic debridement is a viable alternative with high rates of good outcomes. The objective of this study is to report the outcomes of subtalar arthroscopic debridement in 8 patients with SST refractory to conservative treatment. Methods: This is a retrospective study with 8 patients diagnosed with SST who underwent subtalar arthroscopic debridement of the sinus tarsi from January 2015 to January 2017, after 6 months of conservative treatment. All patients filled out an epidemiological questionnaire and underwent functional evaluation using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation, after an average of 12 months (6-24 months). Results: All patients presented with intense synovitis in the region. Seven patients had remnants of talocalcaneal ligaments, and 6 had remnants of cervical ligaments. The AOFAS score increased by a mean of 30 points (from 51.75 preoperatively to 82.62 at the final evaluation), and the VAS decreased by a mean of 5 points (from 7.37 preoperatively to 2.12 at the final evaluation); these differences were significant, at p=0.043 and p=0.032, respectively. Six patients described the outcome as excellent, and 2 described it as good. No complications were reported. All patients resumed sports activities after 6 months of follow-up. Conclusion: Subtalar arthroscopic debridement is an effective and safe alternative in the treatment of SST refractory to conservative treatment. Further prospective studies are necessary to prove the outcome of this technique.

Impact of CrossFit-Related Spinal Injuries.

Exercise-related injuries (ERIs) are a common cause of nonfatal emergency department and hospital visits. CrossFit is a high-intensity workout regimen whose popularity has grown rapidly. However, ERIs due to CrossFit remained under investigated. All patients who presented to the main hospital at a major academic center complaining of an injury sustained performing CrossFit between June 2010 and June 2016 were identified. Injuries were classified by anatomical location (eg, knee, spine). For patients with spinal injuries, data were collected including age, sex, body mass index (BMI), CrossFit experience level, symptom duration, type of symptoms, type of clinic presentation, cause of injury, objective neurological examination findings, imaging type, number of clinic visits, and treatments prescribed. Four hundred ninety-eight patients with 523 CrossFit-related injuries were identified. Spine injuries were the most common injuries identified, accounting for 20.9%. Among spine injuries, the most common location of injury was the lumbar spine (83.1%). Average symptom duration was 6.4 months ± 15.1, and radicular complaints were the most common symptom (53%). A total of 30 (32%) patients had positive findings on neurologic examination. Six patients (6.7%) required surgical intervention for treatment after failing an average of 9.66 months of conservative treatment. There was no difference in age, sex, BMI, or duration of symptoms of patients requiring surgery with those who did not. CrossFit is a popular, high-intensity style workout with the potential to injure its participants. Spine injuries were the most common type of injury observed and frequently required surgical intervention.

Arthroscopic Distal Scaphoid Resection for Scapho-Trapezium-Trapezoid Arthritis.

Background: The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Methods: Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inclusion criteria were nontraumatic radial-sided wrist pain without improvement after 4 months of conservative treatment and positive radiographic images demonstrating the presence of osteoarthritis. All cases were evaluated preoperatively and postoperatively using visual analog scale, wrist range of motion (ROM), grip strength, and patient's work status (Mayo Wrist Score). Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also administered. The technique consisted of performing a 3- to 4-mm round-shaped scaphoid head resection via arthroscopy while preserving the scaphotrapezial and scaphocapitate ligament insertions. Results: At an average follow-up of 24 months, all the patients were satisfied. The results showed statistically significant improvement in pain at rest (P = .001), under maximal load (P = .0001), and in Mayo Wrist Score (MWS) (P = .0001). Wrist ROM, grip strength, DASH, and PRWHE showed an improvement without reaching statistical significance. The mean preoperative radiolunate (RL) X-ray measurement angle was 17° (-10° to 35°). The postoperative mean value was 25° (0°-45°). In the preoperative radiographic evaluation, 11 cases exceeded the "critical" 15° RL angle. At follow-up, the RL angle increased in 10 cases and remained unchanged in 7 cases. None of these cases became symptomatic. Transitory neurapraxia of the dorsal superficial branch of the radial nerve was observed in 1 case. Damage of the dorsal branch of the radial artery was immediately fixed. Conclusions: Arthroscopic resection of the distal portion of the scaphoid due to scapho-trapezium-trapezoid osteoarthritis demonstrated an effective and safe technique with less complications than open surgery.

Laparoscopic Approach to Inguinal Disruption in Athletes: a Retrospective 13-Year Analysis of 198 Patients in a Single-Surgeon Setting

BackgroundInguinal disruption (ID) is a condition of chronic groin pain affecting mainly athletes. ID cannot be defined as a true hernia. Pathogenesis is multifactorial due to repetitive and excessive forces applied to the inguino-pelvic region. Examination reveals tenderness to palpation of the inguinal region. Differential diagnosis is challenging; imaging is helpful for excluding other pathologies. Surgery is the treatment of choice when conservative treatment fails. Primary aim of the study was to evaluate the time to return to full sport activity after transabdominal preperitoneal patch plasty (TAPP) technique in ID. Secondary aim was to evaluate the postoperative complication rate both in the immediate post-operative time and in 1 year follow-up and to verify the relapse rate after surgery. In this study, we consider time to return to full sport activity as the time needed to return to pre-injury sport activity.ResultsA retrospective study is reported by evaluating 198 cases of ID from a single surgeon experience. All patients failed a previous conservative treatment. All cases were treated with the TAPP approach. Time to return to full sport activity was 4 weeks for 94.4% of patients, with a total of 98.5% of active patients at 9 months. Post-operative inguinal pain was the main complication (9.1%). On 13 years follow-up, we report a recurrence rate of 2.5%.ConclusionsCurrent management algorithm for ID, in professional athletes, supports the role of surgery after at least 2 months of conservative treatment. Recently, the role of surgery has been highlighted for a definitive treatment and a faster full recovery to sport activity, especially for elite professional athletes. In our opinion, laparoscopic surgery is the mainstay for non-responsive ID treatment. We present a long-term retrospective evaluation of a wide cohort of professional athletes diagnosed and treated in a systematic way.

Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series.

The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

Treatment Strategy for Frozen Shoulder.

Frozen shoulder (FS) is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. The pathophysiology of FS is relatively well understood as a pathological process of synovial inflammation followed by capsular fibrosis, but the cause of FS is still unknown. Treatment modalities for FS include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release. Conservative management leads to improvement in most cases. Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management. However, there is no consensus as to the most efficacious treatments for this condition. In this review article, we provide an overview of current treatment methods for FS.

Oxidative stress correction in the treatment of severe keratoconjunctivitis sicca in patients with Sjorgen's syndrome

To evaluate the antioxidative effect of artificial tears in the treatment of keratoconjunctivitis sicca (KCS). The study included 43 patients (60 eyes) with severe KCS: 38 women (50 eyes) and 5 men (10 eyes) aged from 27 to 76 years (in average 52 years). Patients were randomly divided into 2 groups; all patients used therapeutic silicone hydrogel soft contact lens (SCL) and instillations of 0.05% Cyclosporin A (CyA) 2 times a day. Patients of the first group (22 people, 30 eyes) used 0.15% hyaluronic acid. In the second group, patients (21 people, 30 eyes) used a tear substitute with similar surface-active component, but with antioxidant properties. The results of the treatment were evaluated using basic and additional research methods at 1, 3, 6 and 12 months. Corneal epithelialization was achieved after 1 month of conservative treatment in all patients who wore SCLs and were treated with instillations of 0.05% CyA and artificial tears. Then the lenses were removed and the patients were switched to instillations of CyA and artificial tears. Comparative analysis of the results showed that higher functional indicators were achieved in the second group, where patients used Artelac Rebalance drops with antioxidant properties. Improvement of clinical and functional parameters in the treatment of severe forms of KCS was achieved by direct action on both links of pathogenesis with minimal amounts of the drugs and the frequency of their use. Subsequent supportive therapy contributed to stabilization of the results and further increase of the functional parameters.

Surgical outcomes of neurogenic thoracic outlet syndrome based on electrodiagnostic tests and QuickDASH scores

In total, 665 of 680 (97%) patients with neurogenic thoracic outlet syndrome (NTOS) improved with conservative treatment. The remaining (3%) patients (15 of 680 patients) did not benefit after 3 months of conservative treatment and were referred for transaxillary first rib resection. We retrospectively compared the preoperative and postoperative (3 months) electromyelography and Quick Disability of Arm, Shoulder and Hands results of operated NTOS patients. Three of the 15 (20%) patients in the surgical cohort were male, with a median age of 25.3 ± 4.16 years, and the other 12 patients (80%) were female with a median age of 31.9 ± 9.48 years. Two of the 15 patients had a cervical rib, 4 of the 15 patients had an extension of the C7 transverse process, and 14 of the 15 patients had a cervical band. These bone and tissue abnormalities were removed in addition to the first rib resection and division of the subclavius muscle and the anterior scalenus and middle scalenus muscles. QuickDASH scores were 1062 preoperatively and 549 postoperatively. The latency of the median F-wave was significantly prolonged on the affected side compared to the unaffected side preoperatively (p = 0.015). There was no remarkable difference in the latency of ulnar F-waves between sides (p = 0.246). The medial antebrachial cutaneous nerve response values increased significantly postoperatively (p < 0.0001). Significant increases in ulnar sensory nerve action potential values amplitude ratio (p < 0.003) and median nerve motor amplitudes (p < 0.0001) were also found postoperatively.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P62. Application of laparoscopic lumbar discectomy and artificial disc replacement: at least two years of follow-up

BACKGROUND CONTEXT Symptomatic degenerative disc disease is the major cause of low back pain with lumbar segmental instability. Artificial disc replacement (ADR) has increased in popularity as an alternative treatment for lumbar disc herniation. However, the traditional approach to spinal surgery carries the risk of catastrophic bleeding from injury to major vessels, as well as iatrogenic injury to the viscera and associated structures. Therefore, laparoscopic lumbar discectomy and ADR may represent a useful alternative. PURPOSE The current study aimed to assess the safety and efficacy of ADR using a laparoscopic technique for lumbar disc herniation. STUDY DESIGN/SETTING This prospective observational study included 22 patients who were diagnosed with symptomatic degenerative disc disease treated via ADR with a laparoscopic technique. PATIENT SAMPLE Twenty-two patients (8 males and 14 females) who were diagnosed with symptomatic degenerative disc disease were included in this study. Seven cases involved the L4/5 level, and 15 cases involved the L5/S1 level. All patients were ineffective after at least 6 months of conservative treatments; all patients were informed of the surgery before the operation and provided consent. OUTCOME MEASURES Three-dimensional computed tomographic angiography (3D-CTA) of the iliac great blood vessels was completed before the surgery. All surgical procedures were performed under a laparoscope. All patients were followed up. METHODS Twenty-two patients (8 males and 14 females) who were diagnosed with symptomatic degenerative disc disease were included in this study. Seven cases involved the L4/5 level, and 15 cases involved the L5/S1 level. All patients were ineffective after at least 6 months of conservative treatments; all patients were informed of the surgery before the operation and provided consent. Three-dimensional computed tomographic angiography (3D-CTA) of the iliac great blood vessels was completed before the surgery. All surgical procedures were performed under a laparoscope. All patients were followed up. RESULTS All surgeries were successfully completed. The average operation time was 120 minutes (range 110–150 minutes), and the average hemorrhage was 145 mL (range 80–360 mL). All cases underwent X-ray imaging at 3days, 3 months, 6 months, 1 year, and the final postoperative follow-up. The outcome indicated that there was no mobilization, displacement, or subsidence in all patients with the exception of one case with prosthesis migration. The follow-up time was 43.8 months (range 24–64 months). The mean visual analog scale (VAS) and Oswestry scores were decreased postoperatively. The mean improvement rate of the VAS score was 73.5%. CONCLUSIONS Lumbar ADR using a laparoscope represents a novel, minimally invasive treatment for symptomatic degenerative disc disease and severe lumbar discogenic pain.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P134. Application of laparoscopic lumbar discectomy and anterior lumbar interbody fusion: at least six years of follow-up

BACKGROUND CONTEXT Symptomatic degenerative disc disease is the major cause of low back pain with lumbar segmental instability. Anterior discectomy and interbody fusion has increased in popularity as an alternative treatment for lumbar disc herniation. However, the traditional approach to spinal surgery carries the risk of catastrophic bleeding from injury to major vessels, as well as iatrogenic injury to the viscera and associated structures. Therefore, laparoscopic lumbar discectomy and interbody fusion may represent a useful alternative. PURPOSE The current study aimed to assess the mid-term safety and efficacy of lumbar discectomy and anterior lumbar interbody fusion (ALIF) using a laparoscopic technique for lumbar disc herniation. STUDY DESIGN/SETTING This prospective observational study included 32 patients who were diagnosed with symptomatic degenerative disc disease treated via lumbar discectomy and ALIF with a laparoscopic technique. PATIENT SAMPLE Thirty-two patients (12 males and 20 females) who were diagnosed with symptomatic degenerative disc disease were included in this study. Four cases involved the L4/5 level, and 28 cases involved the L5/S1 level. All patients were ineffective after at least 6 months of conservative treatments; all patients were informed of the surgery before the operation and provided consent. OUTCOME MEASURES All patients were followed up for more than 6years, X-ray and CT were reviewed regularly to evaluate the height change of intervertebral space and the fusion of bone graft. The clinical effects of preoperative, postoperative and follow-up were evaluated by VAS score, and the complications of laparoscopic surgery were observed. METHODS Thirty-two patients (12 males and 20 females) who were diagnosed with symptomatic degenerative disc disease were included in this study. Four cases involved the L4/5 level, and 28 cases involved the L5/S1 level. All patients were ineffective after at least 6 months of conservative treatments; all patients were informed of the surgery before the operation and provided consent. Three-dimensional computed tomographic angiography (3D-CTA) of the iliac great blood vessels was completed before the surgery. All surgical procedures were performed under a laparoscope. All patients were followed up for more than 6years, X-ray and CT were reviewed regularly to evaluate the height change of intervertebral space and the fusion of bone graft. The clinical effects of preoperative, postoperative and follow-up were evaluated by VAS score, and the complications of laparoscopic surgery were observed. RESULTS All surgeries were successfully completed. All cases were followed up for more than 6years, the average follow-up time was 9years (range 6–12 years). All cases got bone fusion, the average time was 4.5 months (range 3–12 months). The mean VAS were decreased postoperatively, The VAS score of low back pain for preoperative, postoperative (1 week) and final follow-up was 5.8±1.1, 1.8±0.7, 0.9±0.7, the change were statistically significant (p .05). The outcome indicated that there was no mobilization, displacement or intestinal adhesion in all patients in the mid-term follow-up. CONCLUSIONS Laparoscopic lumbar discectomy and ALIF is an effective treatment for severe degenerative lumbosacral diseases

Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

Avulsion Fractures In Sports

INTRODUCTION:Fractures-detached is an injury in the place where the tendon or the ligament is inserted in the bear, in the plates of growth. Thus, in the offspring, or tendons or proximal ligaments...

Functional Recovery of the Shoulder after Arthroscopic Treatment for Chronic Calcific Tendinitis.

BackgroundWe investigated the resolution of pain and functional recovery of shoulder after arthroscopic removal of calcific deposits in patients with chronic calcific tendinitis.MethodsWe enrolled 39 patients who were treated arthroscopically for chronic calcific tendinitis that had been non-responsive to at least 6 months of conservative treatment. We evaluated clinical outcome in terms of the American Shoulder Elbow Surgeons (ASES), the Constant score, the visual analogue score (VAS) for pain. We used plain radiography to measure the size of the calcific deposits. We also analyzed the clinical outcomes in terms of whether or not a cuff repair was performed or the degree of removal of calcific deposits.ResultsWe found that complete resolution of pain took on average 5.7 months after the arthroscopic treatment. The ASES and the Constant score significantly improved from the 3-month follow-up, however it took 6 months until the scores reached on average 80 points or above. We found that these clinical outcomes at the final follow-up did not significantly differ by whether or not cuff repair was performed. Similarly, we found that the clinical outcomes did not significantly differ by the degree of calcium removal.ConclusionsWe found that arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis. However, our findings show it takes at least 6 months for the clinical improvement to become statistically significant. We also found that concomitant cuff repairs or the degree of removal of calcification does not affect the clinical outcome of the arthroscopic treatment.