Outcome Of Surgical Decompression Research Articles

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

Vertically unstable sacral fractures with neurological insult: outcomes of surgical decompression and reconstruction plate internal fixation

Vertically unstable sacral fractures with neurological insult: outcomes of surgical decompression and reconstruction plate internal fixation

Vertically unstable sacral fractures with neurological insult: outcomes of surgical decompression and reconstruction plate internal fixation

During a 4-year period, 32 patients with type C unstable sacral fractures were treated in our university hospital. All patients had neurological deficits as a result of their sacral fracture. The average age was 31.2 (range 22-54) years and the average Hannover Polytrauma Score (PTS) was 24 (range 19-40) points. Twelve patients had zone I fracture, ten had zone II fracture and ten patients had comminuted fractures involving both zones. All patients underwent surgical decompression and reconstruction plate internal fixation. The average follow up period was 24.4 (range 19-47) months. Twenty-one patients (65.6%) had complete neurological recovery, eight patients (25%) had partial recovery and three patients (9.4%) had no recovery. The relationship between radiological and functional scores was evident but insignificant (P = 0.434). Significantly, the neurological recovery was less favourable in older age groups, pedestrian trauma, vertical shear injuries, comminuted fractures, fifth lumbar root involvement, very low motor power grades and in patients presenting late. Concerning complications, four patients (12.5%) had early infection and five patients (15.6%) had late urological problems and heterotopic ossification. Consequently, we conclude that patients undergoing very early surgical decompression and only reconstruction plate internal fixation can achieve safe early ambulation and better neurological, functional and radiological results.

The 36-Item Short-Form Health Survey Outcome Evaluation for Multiple Lower-Extremity Nerve Decompressions in Diabetic Peripheral Neuropathy

Diabetic neuropathy can be disabling owing to pain and loss of sensibility. Theoretically, surgical restoration of sensation and relief of pain may prevent these complications and improve quality of life. A study was conducted to perform outcome analysis of patients after these surgical procedures using the 36-Item Short-Form Health Survey. The 36-Item Short-Form Health Survey was used to evaluate patients with diabetic neuropathy after nerve decompression surgery. These results were compared with those reported in the literature related to diabetic patients without neuropathy, patients with low-back pain, and an age-matched normative population. The pilot study group included six patients with diabetic neuropathy, three of whom underwent multiple nerve decompression surgery bilaterally. Mean follow-up was 6 months. Single-tailed t tests demonstrated that postoperative patients were not statistically significantly different from the other groups in the domains of Physical Functioning, Bodily Pain, General Health, Vitality, Social Functioning, and Mental Health; in the domains of Role-Physical and Role-Emotional, a statistically significant difference was found, with the postoperative patients scoring lower. Although this study is limited by the lack of preoperative administration of the 36-Item Short-Form Health Survey and by its small sample size, we conclude that the survey can evaluate the results of surgical decompression of lower-extremity peripheral nerves and should be added to the traditional assessments of recovery of sensibility and the visual analog scale for pain.

Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4–8‐years' follow‐up in a prospective, randomized study

Objectives: To compare the prognosis of subacromial impingement (SAI) stage II treated conservatively or with subacromial decompression.Methods: A follow‐up study after 4–8 years in a randomized controlled trial (RCT) with 90 adult cases with SAI treated in a Danish hospital from 1996 to 2000 with graded physiotherapy and exercises or arthroscopic subacromial decompression. Outcomes were proportion of time per year with income transfers (indexed 0–1), including total transfers (marginalization), sick leave and disability pension obtained from the registry at the Ministry of Work. Self‐reported function, working capability, employment status and global improvement were obtained by questionnaire in September 2004. The main outcomes are given as differences in development from baseline.Results: Seventy‐nine (88%) responded to the questionnaire and registry data were obtained from 81. After 1 year the marginalization index increased by 0.45 [95% confidence interval (CI) 0.35–0.56] for surgery and 0.25 (0.16–0.34) for physiotherapy. Cases undergoing surgery also tended to have more sick payments during the first year, but the difference was not significant. Four years after inclusion, changes in indices did not differ between treatment groups. Self‐reported outcomes after 4–8 years did not differ between treatment groups.Conclusion: The results of surgical decompression were equal to those of conservative treatment, and the surgery group had more income transferrals during the first year of follow‐up.

Sex differences in carpal tunnel syndrome: comparison of surgical and non‐surgical populations

Carpal tunnel syndrome (CTS) patients are known to show gender-related differences in severity. The main aim of this cross-sectional study was to determine whether these differences between women and men may be related to age, education or body mass index (BMI) in two populations, one with idiopathic CTS not treated surgically and the other with idiopathic CTS treated by surgical decompression. A secondary aim was to check differences in surgical results between the genders in the surgical population. The non-surgical population consisted of 172 subjects (126 women and 46 men, mean age 55.1 years) whose data were obtained at electrophysiological examination. The surgical population consisted of 219 patients (177 women and 42 men, mean age 55.1 years) whose data were obtained before surgery. Age, education, BMI, duration of symptoms, electrophysiological and clinical severity of CTS (with ordinal scales), and the self-administered Boston Questionnaire (BQ) of symptoms and functional status of hands were considered. There were no differences in age or clinical and electrophysiological severity between women and men in either group, except for distal motor latency of the median nerve that was more delayed and duration of symptoms that was shorter in men than women in non-surgical sample. Men had a higher BMI than women. Women had higher BQ scores in the surgical and non-surgical samples. These differences remained when the results were analysed matching the men with an identical number of women of the same age, education and BMI. In the surgical population, the results of surgical decompression did not modify the gender-related differences in severity. As in many other syndromes and diseases, for a given clinical severity, women with CTS were more sensitive than men in reporting their symptoms. Risk factors of CTS, such as age, education and BMI, were not responsible for these differences. The results of surgical decompression were similar in men and women.

La récupération neurologique après décompression d’une myélopathie cervicale par sténose canalaire

Purpose of the study Progressive myelopathy secondary to stenosis of the spinal canal is generally treated by surgery. Results of surgical decompression are generally good but the pattern of neurological recovery has not been studied. We followed a cohort of patients who underwent cervical cord decompression to study the course of neurological recovery. Material and methods The study cohort included 39 patients (22 men and 17 women), mean age 65.7 years who underwent surgery between 1998 and 2002 for progressive cervical myelopathy. The same surgeon performed all procedures (23 posterior and 16 anterior approaches). The JOA score and MRI findings were noted. The patients were seen at 1, 3, 6, 12, and 18 months then annually (JOA score). The Hirabayashi score was used to assess neurological recovery. Two populations were identified (group 1: preoperative JOA score > 6, group 2: preoperative JOA score ≤ 6). Results The mean preoperative JOA score was 8.3/17, range 1-15. Ten patients had a severe JOA score (< 6). The mean postoperative JOA score was 13.3 (range 3-17) at six months and remained stable during follow-up. Neurological recovery as assessed with the Hirabayashi technique was 52.5% on average at last follow-up. Neurological gain occurred mostly during the first to third month following decompression, remaining stable thereafter. Patients with a severe deficit exhibited the same recovery pattern but stabilized at a lower neurological level. Expressed in JOA points, neurological gain was very similar in the two groups. There was no significant difference between patients who under went anterior or posterior procedures. Discussion and conclusion The pattern of neurological recovery in patients with degenerative cervical disease appears to be rapid during the first six months following surgical decompression. The level of recovery then levels off, irrespective of the severity of the initial deficit. This work demonstrated that more specific evaluation scales than the JOA score should be developed for assessment and follow-up of these patients.

Traumatic tarsal tunnel syndrome: the outcome of surgical decompression

A total of 26 cases of tarsal tunnel syndrome exclusively secondary to injury were treated by surgical decompression. Clinical diagnosis depends upon careful history and examination, with proximal and distal symptoms reproduced by direct compression of the posterior tibial nerve. Extensor hallucis longus weakness is a valuable sign demonstrating insufficiency of the posterior tibial nerve muscles that cannot stabilize the first metatarsal phalangeal joint. Immediate recovery of extensor hallucis longus power, the recovery of sensation and the lack of positive electrodiagnostic investigations suggest that the problem in the nerve is microvascular affecting pain fibres rather than myelinated nerve fibres. If symptoms persist longer than 6 months, we recommend surgical decompression, which, in our series, had a success rate of 80%.

Peroneal tenosynovitis following ankle sprains

Peroneal tenosynovitis has a variety of causes which include inversion injury of the ankle. It is rarely reported and frequently misdiagnosed. We report the operative findings and outcome of surgical decompression in 19 patients who clinically presented following inversion injury with features suggestive of peroneal tenosynovitis. A review of the literature of this pathology is presented.

The surgical treatment of metastatic spinal tumors within the intradural extramedullary compartment.

The authors retrospectively reviewed the surgical outcomes in 10 cases of symptomatic intradural extramedullary spinal metastases of nonneurogenic origin because the collective experience in treating this rare manifestation of systemic cancer is limited. Pain and weakness were the presenting complaints in 70% of the patients and sensory changes were found in all cases. Cytological tests on one specimen of cerebrospinal fluid (CSF) from each of seven patients showed malignant cells in two cases. Gadolinium contrast-enhanced biplanar magnetic resonance (MR) imaging was effective in localizing the lesion and showed evidence of leptomeningeal carcinomatosis in two cases; myelography showed leptomeningeal carcinomatosis in one case and erroneously identified the lesion as intramedullary in the other. Eight of 10 cases had antecedent intracranial metastatic foci with the interval from presentation of the intracranial lesion to appearance of the spinal disease ranging from 3 to 51 months. The majority of the spinal lesions occurred in the thoracolumbar area. The most frequent histological type was adenocarcinoma and the most frequent source was the lung. In all cases laminectomies, intradural exploration, and biopsy or subtotal excision aided by microscopy and ultrasonography were performed. Results of surgical decompression were poor with only 30% of the patients showing improvement, at a 20% risk of perioperative mortality and a 60% risk of morbidity. Plans for surgical intervention in patients with intradural extramedullary metastases from a distant noneurogenic source should be weighed against the high association with intracranial lesions, overall poor prognosis, and modest symptomatic results of decompression. Comprehensive evaluation including multiple specimens of CSF for cytology and contrast-enhanced MR imaging should be undertaken to exclude patients with diffuse leptomeningeal involvement, who should be treated by means other than surgery.

Lumbar spinal stenosis and diabetes. Outcome of surgical decompression

We reviewed 25 diabetic (mean age 68 years) and 25 non-diabetic patients (mean age 71 years) who had undergone decompression for lumbar spinal stenosis at a mean of 3.4 years after operation to determine whether diabetes affected the outcome of surgery. The preoperative symptoms were similar in the two groups except that an abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. Nerve-conduction velocity was slowed in 80% of the diabetic and in 25% of the non-diabetic patients. Peripheral vascular deficiency was diagnosed in 20% of patients with diabetes and in 4% of non-diabetics. The outcome of surgery was similarly successful in the two groups. Mistaken preoperative diagnosis was the cause of failure in three diabetic patients, two with diabetic neuropathy and one with diabetic angiopathy.

A transverse skin incision approach for decompression of pronator teres syndrome

Pronator teres syndrome is a compressive neuropathy of the median nerve in the proximal part of the forearm and distal part of the arm. The outcome of surgical decompression is occasionally unsatisfactory because of a poor scar. We present the use of a transverse skin incision that allows adequate exploration and decompression distally and proximally, beneath the subcutaneous tissue beyond the volar elbow crease.

The shoulder impingement syndrome: The results of surgical decompression

Forty patients (41 operated shoulders) with subacromial impingement resistant to conservative therapy underwent acomioplasty and were evaluated 6 to 142 months after surgery. Patients requiring rotator cuff repair were excluded from the study. With the UCLA scoring system, results were excellent or good in 28 (68%), fair in five (12%), and poor in eight (20%). Thirty-three (80%) were satisfied with their result. There was a trend toward poorer results in women and in the elderly (aged 60 to 69 years). A striking finding was the statistically significant relationship between result rating and duration of symptoms. Ninety-three percent had an excellent or good result, if they had been symptomatic for greater than 3 years, whereas only 56% reached those ratings with symptom duration less than 3 years. The only complication was a superficial infection. Three patients required manipulation after the procedure. Two required subsequent surgery because of continuing pain. This procedure seems safe and reasonably effective. Careful patient selection must be stressed. Results will be better with a longer preoperative duration of symptoms.

Surgical Management of Thoracolumbar Spine Fractures with Incomplete Neurologic Deficits

The results of surgical decompression (SD) in 59 patients with neurologic deficits secondary to thoracic or lumbar fractures were evaluated at a mean of 3.7 years after injury. The purpose was to determine whether SD could be correlated with subsequent neurologic outcome. Follow-up neurologic evaluations showed a greater neurologic improvement in the 20 patients who were treated with anterior spinal SD as compared to the 39 patients who received posterior or lateral SD (88% vs. 64%). The return of normal bowel and bladder control also occurred more frequently in the anteriorly SD group than the posteriorly treated SD group (69% vs. 33%). The inferior results in the posteriorly treated SD group appeared to correlate with a high incidence of bony stenosis as measured on postoperative computed axial tomography.

Cerebellar hemorrhage: diagnosis and treatment. A review of 56 cases.

Two thirds of 56 patients suffering spontaneous cerebellar hemorrhage were responsive on admission. The diagnosis was made solely on clinical bases in the majority of cases. Timing and rate of clinical deterioration were unpredictable in individual cases, especially in the initial hours and days after onset. Fifty percent of patients became comatose by 24 hours and 75% within one week after onset. The results of surgical decompression were strongly influenced by preoperative mental status: 17% mortality for responsive and 75% for unresponsive patients. However, nine patientssurvivedwithout undergoing surgical decompression. Our results suggest that substantial improvement in the overall mortality could be made by immediate craniectomy and evacuation of hematoma in all patients encountered within 48 hours of onset, and in most within a week after onset.

CARPAL-TUNNEL SYNDROME: Results of Surgical Decompression

150 operative decompressions of median nerves in the carpal tunnel have been reviewed. The operation appears less successful than was previously supposed. The best results are obtained in patients who have had symptoms for a short time. This may be because the initial recoverable neuropathy is succeeded by more permanent changes in the nerve.

Metastatic spinal epidural tumors. An analysis of 50 cases.

METASTATIC tumors to the spinal epidural space are not an infrequent finding. They often present as neurosurgical emergencies with rapidly advancing neurological signs. The results of surgical decompression and the prognosis are some-what variable. It is the purpose of this paper to analyze these variables by reviewing 50 cases of metastatic spinal epidural tumors from two large general hospitals in Miami, Fla. These cases represented both staff and private patients of at least ten neurosurgeons and occurred over a four-year period. Only two cases were lost to follow-up. Review of Findings Age and Sex.— In this series there is a predominantly male population and an older age group due to the influence of the Veterans Hospital patients. There were only nine female patients in this study (Table 1). Primary Tumor.— A wide variety of primary tumors were noted in this study. As expected, a large proportion of these