Outcome Of Surgical Decompression Research Articles

New horizons in subdural haematoma.

Subdural haematoma (SDH) is a common injury sustained by older people living with frailty and multimorbidity, and typically following falls from a standing height. Anticoagulant and antiplatelet use are commonly indicated in older people with SDH, but few data inform decision-making surrounding these agents in the context of intracranial bleeding. Opposing risks of rebleeding and thrombosis must therefore be weighed judiciously. Decision-making can be complex and requires detailed awareness of the epidemiology to ensure the safest course of action is selected for each patient. Outcomes of surgical decompression in acute SDH are very poor in older people. However, burr hole drainage can be safe and effective in older adults with symptomatic chronic SDH (cSDH). Such patients need careful assessment to ensure symptoms arise from cSDH and not from coexisting medical pathology. Furthermore, the emerging treatment of middle meningeal artery embolisation offers a well-tolerated, minimally invasive intervention which may reduce the risks of rebleeding in older adults. Nonetheless, UK SDH management is heterogenous, and no accepted UK or European guidelines exist at present. Further randomised trial evidence is required to move away from clinical practice based on historic observational data.

487 Clinical Outcomes of Decompressive Spine Surgery for Painless Cervical Myelopathy: An Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC) Registry

INTRODUCTION: Cervical myelopathy (CM) is the occurrence of neurologic dysfunction secondary to any etiology that results in direct cervical spinal cord compression. Although axial neck pain and radicular arm pain are common presenting features in CM, some patients present atypically with myelopathic symptoms in the absence of neck or arm pain. To date, little is known regarding the outcomes of surgical decompression in these patients. METHODS: This is a retrospective study of prospectively collected data from the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. A total of 340 patients undergoing spine surgery for painless CM were analyzed. Surgical and patient reported outcomes, including minimal clinically important difference (MCID) in modified Japanese Orthopedic Association (mJOA) scores and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) scores, were assessed at 90 days, 1 year, and 2 years postoperatively. RESULTS: At 90 days following surgery, a MCID in PROMIS PF and mJOA scores was seen in 42% and 36% of patients, respectively. The proportion of patients with MCID in mJOA scores remained stable at 1- and 2-year follow-up, while the percentage of patients with MCID in PROMIS PF scores decreased to 22% at two years post-operatively. When stratifying by pre-operative CM severity, patient reported outcomes and surgical complications did not significantly vary. Importantly, patient satisfaction remained above 80% at 90 days, 1 year, and 2 years after surgery. CONCLUSIONS: Following surgical intervention, clinically significant improvement was seen in a modest number of patients. The high degree of sustained patient satisfaction suggests that our measured outcomes may not accurately capture the degree of improvement that is important to patients, or it may represent happiness from not experiencing further functional decline.

Nonsurgical Treatment of Neuralgia and Cervicogenic Headache: A Systematic Review and Meta-analysis.

Background:Extracranial compression of peripheral sensory nerves is one of many origins of chronic headaches. Identifying these patients can be difficult, and they are often diagnosed with neuralgia or cervicogenic headache. The recent literature provides the outcomes of surgical decompression in patients with these headaches. This study aimed to give an overview of the current literature on the nonsurgical treatment options and to evaluate the effectiveness of these treatments in patients with neuralgia and cervicogenic headache.Methods:Databases were searched to identify all published clinical studies investigating nonsurgical treatment outcomes in patients with neuralgia or cervicogenic headaches. Studies that reported numerical pain scores, nonnumerical pain scores, headache-free days, or the number of adverse events after nonsurgical treatment were included.Results:A total of 22 articles were included in qualitative analysis. The majority of studies included patients who received injection therapy. Treatment with oral analgesics achieved good results in only 2.5% of the patients. Better outcomes were reported in patients who received local anesthetics injection (79%) and corticosteroid injection (87%). Treatment with botulinum toxin injection yielded the highest percentage of good results (97%; 95% CI, 0.81–1.00). The duration of headache relief after injection therapy varied from 30 minutes to 5 months.Conclusions:The nonsurgical treatment of patients with neuralgia or cervicogenic headache is challenging. Injection therapy in patients with these types of headaches achieved good pain relief but only for a limited time. Surgical decompression may result in long-lasting pain relief and might be a more sustainable treatment option.

Outcomes of Delayed Surgical Interventions (> 72 h After Injury) in Patients with Incomplete Spinal Cord Injury: Observations from a Tertiary Rehabilitation Centre in India

There is no consensus on the timing for early surgery in spinal cord injury (SCI). On Pubmed, we found no primary research article from India evaluating the effects of timing of surgery on outcomes in SCI patients. This single-centre prospective observational study was done to evaluate the outcome of surgical decompression done > 72 h after traumatic incomplete SCI and assess prognosis over 6 and 12 months. Patients, with history of traumatic incomplete SCI of 72 h after the injury) elsewhere were enrolled. A complete and standard neurological examination was done at presentation. Neurological and functional recovery was assessed at 6 and 12 months. Forty-two patients fulfilling the inclusion criteria were followed up of at least 12 months. At baseline, 31 had ASIA B and 11 had ASIA C grade. By 6 months, 4 patients improved by 1 ASIA grade. By 12 months, 14 patients improved by 1 grade and two by 2 grades. Mean motor recovery and overall functional recovery were significant (p = 0.03 and p 72 h after incomplete traumatic SCI, assessed at 2–4 months post injury, may still have encouraging outcomes. Our study may be the first from India to assess the outcome of delayed surgery in incomplete SCI patients but larger prospective studies involving multiple centres are needed for stronger evidence. Inclusion of non-operative cohort would have differentiated the result from spontaneous recovery.

Surgical orbit decompression in patients with endocrine ophtalmopathy (review)

The article presents the definition and the epidemiology of endocrine ophthalmopathy. The main clinical manifestations of endocrine ophthalmopathy and the principles of treatment are described. Particular attention is paid to listing all possible methods of surgical decompression of the orbit, both internal and external. A comparative analysis of the available methods of orbitotomy, their advantages and disadvantages is presented. The main factors of the efficiency of orbit decompression, possible complications and measures for their prevention are analyzed. The paper also highlights the methods of treatment of optical neuropathy and predicting the results of surgical decompression of the orbit.

The results of surgical decompression in the treatment of foot drop due to peroneal nerve entrapment after bariatric surgery.

The loss of the fat pad surrounding the fibular head after rapid and excessive weight loss after bariatric surgery can lead to foot drop symptoms due to peroneal nerve entrapment (PNE). Conservative and surgical approaches have been described for the treatment of this condition, but there is some controversy over the effectiveness of the treatment modalities. We aimed to investigate the causes and frequency of foot drop due to PNE after bariatric surgery and to investigate the effects of peroneal nerve decompression (PND) as a surgical treatment for PNE. Single center, university surgical department. We retrospectively evaluated a series of 2607 patients in terms of neurologic complications after bariatric surgery. Patients' age, sex, co-morbid diseases, vitamin and electrolyte levels, body mass index and postoperative excess weight loss, affected limb, duration of symptoms, and muscle strength scores (according to the Medical Research Council scale) were recorded. A total of 14 (.5%) patients had foot drop symptoms due to PNE. Of these patients, 9 underwent PND. The mean excess weight loss of PND patients at postoperative months 6 and 12 were 68.8 ± 13.5 and 100.9 ± 10.8, respectively. Foot drop symptoms became evident 5 to 11 months after bariatric surgery, affecting only a unilateral lower extremity in all patients. In laboratory analysis, there were no signs of nutritional and vitamin deficiency or insufficiency in any of the PND cases. Muscular strength was Medical Research Council grade 0 in all patients. The median duration of symptoms was 9 days, and the median complete recovery time was 40 days after PND. Patients who had a duration of symptoms for a maximum of 12 days were completely healed 30 days after PND. PND should be the first-choice treatment procedure for acute foot drop due to PNE afterbariatric surgery.

Outcome of surgical decompression in resistant de Quervain tenosynovitis

Introductions: De Quervain tenosynovitis is a common cause of functional impairment. Steroid injection has good result but significant numbers of cases develop resistance requiring surgical decompression. This study assesses the outcome of surgery. 
 Methods: Symptomatic de Quervaint tenosynovitis cases resistant to conservative treatment that underwent surgical decompression and postoperative thumb immobilization using thumb spica splint cast during four and half years were analyzed. They were followed for at least three months for clinical and functional outcome. Patient demography, visual analogue score (VAS) and complications were analyzed descriptively. 
 Results: There were 34 cases of de Quervaint tenosynovitis, mean age 42±16 years, and female 88.2%. Treatment was successful in all cases. The mean VAS score reduced to 0.5 from 6.82, p-value <0.01. Complication occurred in one case. 
 Conclusions: Surgical decompression of de Quervain tenosynovitis was safe and effective in cases resistant to conservative treatment.

167 - Outcomes of Surgical Decompression in Patients with Very Severe Degenerative Cervical Myelopathy

167 - Outcomes of Surgical Decompression in Patients with Very Severe Degenerative Cervical Myelopathy

162 Tobacco Smoking and Outcomes of Surgical Decompression in Patients With Symptomatic Degenerative Cervical Spondylotic Myelopathy

162 Tobacco Smoking and Outcomes of Surgical Decompression in Patients With Symptomatic Degenerative Cervical Spondylotic Myelopathy

Peroneal Nerve Palsy: Evaluation and Management.

Peroneal nerve palsy is the most common entrapment neuropathy of the lower extremity. Numerous etiologies have been identified; however, compression remains the most common cause. Although injury to the nerve may occur anywhere along its course from the sciatic origin to the terminal branches in the foot and ankle, the most common site of compressive pathology is at the level of the fibular head. The most common presentation is acute complete or partial foot drop. Associated numbness in the foot or leg may be present, as well. Neurodiagnostic studies may be helpful for identifying the site of a lesion and determining the appropriate treatment and prognosis. Management varies based on the etiology or site of compression. Many patients benefit from nonsurgical measures, including activity modification, bracing, physical therapy, and medication. Surgical decompression should be considered for refractory cases and those with compressive masses, acute lacerations, or severe conduction changes. Results of surgical decompression are typically favorable. Tendon and nerve transfers can be used in the setting of failed decompression or for patients with a poor prognosis for nerve recovery.

Compressive myelopathy in severe angular kyphosis: a series of ten patients.

Compressive myelopathy in severe angular kyphosis is rare and challenging for surgical treatment. The goal of this retrospective study was to report a series of ten patients with compressive myelopathy in severe angular kyphosis and the results of surgical decompression and correction of kyphosis. Between 2010 and 2014, 10 patients were surgically treated for severe angular kyphosis with a progressive onset or a sudden onset of paraplegia in investigator group. In these ten patients (seven males and three females), the etiologic diagnosis included eight cases of congenital kyphosis and two of neurofibromatosis; the distribution of spine level was from C5 to T11; the duration from onset until surgery ranged from 1 to 120months; follow-up ranged from 12 to 26months (mean 18.5months); the kyphosis angle of the patients ranged from 50° to 180°. Magnetic resonance imaging demonstrated the spinal cord thinning and compression at apex in most of patients. All patients underwent decompressive surgery by single-stage posterior vertebral column resection or both anterior corpectomy fusion and posterior fixation. Neurological status was evaluated using the ASIA impairment classification and the motor score. Postoperatively, all patients had different kyphosis correction rate from 24 to 100%. Nine patients showed neurological improvement; one patient showed no improvement. Among them, one sudden onset ASIA A adolescent paraplegic patient improved to ASIA E within 1year of follow-up. One ASIA C adolescent paraplegic patients deteriorated neurologically to ASIA A after surgery and improved to ASIA D with 12-month follow-up. Compressive myelopathy in severe angular congenital kyphosis is usually occurred high incidence rate at apex of upper thoracic spine (T1-T4). The duration from onset of paraplegia until surgery and the severity of paraplegia before surgery are two key factors for neurological prognosis after surgery.

The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale

Background contextThere have been no previous studies looking at the outcome of surgical decompression (+/−stabilization) for various grades of epidural spinal cord compression (ESCC) due to spinal metastases. PurposeThe aim of this study was to determine the outcome of surgical treatment in patients with ESCC using the Bilsky six-point scale. Study design/SettingThis was a retrospective cohort review of prospectively collected data. Patient sampleA consecutive series of 101 patients managed over the period of 3 years for ESCC due to spinal metastases in a tertiary spine surgery referral unit were included. MethodsData on age, gender, revised Tokuhashi score, preoperative Frankel grade, tumor histology, magnetic resonance imaging scan–based Bilsky cord compression grade, postoperative Frankel grade at last follow-up, complications, and survivorship were collected. Outcome measuresFrankel grading system for function was used to evaluate the patient's preoperative and postoperative neurologic status. Patient survival and postoperative complications were also collected. ResultsAverage patient age was 64.7 years (13–88 years): 62 males and 39 females. Mean follow-up was 7.3 months (3–23.3 months). Most primary tumors were in prostate, breast, renal, lung, and the blood dyscrasias. Within the lower grade of compression (Group 1; Bilsky Grades 0,1a, 1b, and 1c; n=40), 29 patients (72.5%) had no improvement in Frankel grade, seven patients (17.5%) improved, whereas four patients (10%) deteriorated neurologically after surgery. Within the higher compression grade (Group 2; Bilsky Grades 2 and 3; n=61), 37 patients (60%) did not experience neurologic change, 20 (33%) improved, whereas neurology worsened in four patients (7%). When compared with Group 2 patients, Group 1 patients had better preoperative Frankel scores but a greater number of patients in Group 2 improved their Frankel scores significantly postoperatively. The mean revised Tokuhashi score for Groups 1 and 2 was 10 and 9.1, respectively (p=.1). The complication rate for Groups 1 and 2 was 25% and 42.6%, respectively (p=.052). Survival analysis showed no difference between the groups (Group 1: median 376 days [12–1052]; Group 2: median 326 days [12–979]; p=.62). ConclusionsSurgery can achieve improvements in neurology even in higher grades of cord compression. There is a trend toward more complications and worse survival with spinal surgery in patients with higher grades of compression.

Use of the Analgesic, Anti-inflammatory and Neuroprotectant Supplement Palmitoylethanolamide in the Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) is an entrapment neuropathy. Conservative treatment options include anti-inflammatory drugs not always lead to resolution, and although results of surgical decompression are good in selected patients, postoperative fibrosis can lead to recurrence of complaints. However, clinical studies in this field are pilot trials only, both for decompression techniques as well as for conservative interventions, and only few patients were evaluated in each trial. If one would select a treatment based on sufficient clinical studies, data in other compression syndromes should be considered.

Radial tunnel syndrome: results of surgical decompression by a postero-lateral approach.

Our purpose is to describe the results obtained in surgical treatment of a series of patients with symptoms of radial tunnel syndrome. We performed a prospective study on 42 patients (43 limbs) operated for radial tunnel syndrome between 1996 and 2010, using a posterior-external approach. Using the Roles and Maudsley criteria, 21 patients had excellent results (48.8%), 16 good (37.2%) and six fair results (13.9%). Most patients were satisfied with the surgery, reporting symptom relief and improved functionality. Radial tunnel syndrome consists of intermittent compression of the posterior interosseous nerve in the forearm, with pain and functional disability of the forearm, without motor or sensory electromyogram alterations. Because it is often confused with enthesitis of the epicondyle muscle insertions (an entity often occurring simultaneously), differential diagnosis is necessary with treatment-resistant epicondylitis. The most effective treatment is surgical, releasing all possible nerve compression sites.

Outcome of Surgical Decompression in Simple Degenerative Lumbar Canal Stenosis

Introduction: A sensory or motor deficit occurs in about half of patients with symptomatic lumbar canal stenosis. There is no study evaluating neurologically deficient patients with simple degenerative lumbar canal stenosis using validated measures and there are no consensus about outcome predictor of surgical decompression is available in literature. Only one study assessed outcome of patients with neurological deficit but it had not excluded either patients with comorbid conditions that affect outcome or those with lumbar canal stenosis secondary to spondylolisthesis and scoliosis. The aim of this study was to assess overall result and to compare the surgically treated patients of simple degenerative lumbar canal stenosis using validated outcome measures like Oswestry Disability Scale (ODS), Neurogenic Claudication Score (NCS), Visual Analogue Scale (VAS) and Satisfaction, this study also aimed to find outcome predictor of surgical decompression. Methods: This was a retrospective comparative study with homogenous cohorts with control of comorbid conditions that affect outcome. Each cohort ( Those with neurological deficit and without neurological deficit) had 11 patients who had adequate decompression with laminectomy and foraminotomies. Outcome was evaluated using validated ODS, NCS, VAS and Satisfaction in overall and also evaluated by each section of ODS, NCS with appropriate statistical analysis of both cohorts. Results: Neurologically deficient patients had more back pain, tingling, numbness, weakness and heaviness preoperatively. In neurologically deficient patients there was a trend to have poorer outcome, but overall recovery rate was higher than neurologically normal patients. Sensory deficit did not recover. The index surgery may not have effect on sitting and sleeping in both cohorts and may not have effect on lifting in neurologically normal patients and may not have effect on social life in neurological deficient patients. Additionally the index surgery may not have effect in relieving symptoms of numbness, tingling and heaviness and weakness in neurologically normal patients and may not have effect on standing in both cohorts. Recovery according to VAS was higher in neurologically normal patients. Preoperative NCS and preoperative heaviness and weakness severity contributed up to 43 % in ODS recovery rate. Conclusion: Overall there is a trend to have poorer outcome in neurologically deficient patients though recovery rate is better than neurologically normal patients. Recovery in term of VAS is better in neurologically normal patients. Preoperative NCS and preoperative heaviness and weakness severity score predict or contribute up to 43 % in ODS recovery rate. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9512 NOAJ July-December 2013, Vol 3, Issue 2, 2-9

Does Approach Decide the Outcome of Surgical Decompression in Thoracolumbar Burst Fracture?

Does Approach Decide the Outcome of Surgical Decompression in Thoracolumbar Burst Fracture?

Displaced spinopelvic dissociation with sacral cauda equina syndrome: outcome of surgical decompression with a preliminary management algorithm

Displaced spinopelvic dissociation with cauda equina syndrome is still unclear challenging problem with multiple instabilities. This retrospective study tried to evaluate and analyze the results of surgical decompression and lumbopelvic fixation of these injuries. Twenty-eight polytrauma patients with displaced spinopelvic dissociation and cauda equina syndrome were included. Preoperatively, they had thorough clinical, neurological, and radiological evaluation and classification. Operatively, they underwent primary, secondary, or tertiary decompression then spinopelvic fixation. Postoperatively, they were followed up for an average of 26 months. Hannover pelvic scoring system was applied for outcome evaluation. The mean age was 33.7 years; 17 cases were males and 11 were females. According to Roy-Camille, 13 cases had type II and 15 cases had type III injuries; cauda equina syndrome was incomplete in 17 cases and complete in 11 cases. Unilateral L5-S1 facet joint injury was detected in 13 cases; 14 cases had direct decompression (50 %) and 14 cases had indirect decompression (50 %). 19 patients (67.9 %) had excellent and good clinical outcome. Primary decompression had significantly increased the chances for neurological recovery (p = 0.024). Initial fracture kyphosis angles had a significant effect on neurological retrieval (p = 0.016). The mean of Gibbons score improved from 3.1 ± 0.83 preoperatively to 1.5 ± 0.84 at the end of follow-up with a highly significant impact (p = 0.001). Surgical decompression and lumbopelvic segmental fixation can enhance neurological recovery and combat any structural instabilities associated with the displaced spinopelvic dissociation injuries with a hopeful clinical results.

Surgical treatment of spinal intradural carcinoma metastases

Intradural metastases of nonneurogenic origin represent an extremely rare manifestation of systemic cancer. The respective literature is very scarce. We retrospectively evaluated nine patients with intradural metastases treated surgically from March 2006 until today at our department. Four metastases were intramedullary and five intradural extramedullary. Localisation along the spine involved: cervical n = 3, thoracic n = 3, and conus/cauda n = 3. Five patients were female and four male, with a median age of 71 years. Histology showed: breast cancer n = 2, NSCLC (non-small cell lung cancer) n = 2, SCLC (small cell lung cancer) n = 1, colon carcinoma n = 1, malignant skin melanoma n = 1, squamous cell carcinoma of the skin n = 1, and ovarian carcinoma n = 1. Holospinal dissemination in terms of leptomeningeal carcinomatosis according to MRI or positive CSF (cerebrospinal fluid) cytology, respectively, was found in four patients. Gross total resection was achieved in four patients and debulking in five. Results of surgical decompression were: six patients (67%) exhibited immediate improvement of neurological symptoms and/or pain; four of them even improved according to the McCormick Scale score (44%); two patients (22%) were unchanged, and one (11%) exhibited worsening of neurological symptoms after surgery. Median survival time after surgery was 7.3 months. Intradural metastases are associated with limited survival time. Accordingly, the aim of surgery is strictly palliative. The majority of patients benefit with respect to neurological deficit/pain (67%) independent of the extent of resection. Thus, decompressive surgery is recommended to increase the quality of life.

Five-year outcome of surgical decompression of the lumbar spine without fusion. Mannion AF, Denzler R, Dvorak J, Grob D. Eur Spine J 2010;19(11):1883–91. Epub 2010 Jul 31

Five-year outcome of surgical decompression of the lumbar spine without fusion. Mannion AF, Denzler R, Dvorak J, Grob D. Eur Spine J 2010;19(11):1883–91. Epub 2010 Jul 31

Five-year outcome of surgical decompression of the lumbar spine without fusion. Mannion AF, Denzler R, Dvorak J, Grob D. Eur Spine J 2010 Jul 31. [Epub ahead of print

Five-year outcome of surgical decompression of the lumbar spine without fusion. Mannion AF, Denzler R, Dvorak J, Grob D. Eur Spine J 2010 Jul 31. [Epub ahead of print