Posterior Release Research Articles

Commentary: Posterior Release, Reduction and Intra-articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation.

Commentary: Posterior Release, Reduction and Intra-articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation.

Preoperative halo-gravity traction combined with one-stage posterior spinal fusion surgery following for severe rigid scoliosis with pulmonary dysfunction: a cohort study

BackgroundTo assess the efficacy of preoperative halo-gravity traction (HGT) in treating severe spinal deformities, evaluating radiological outcomes, pulmonary function, and nutritional status.MethodsThis study retrospectively included 33 patients with severe spinal deformity who were admitted to our department from April 2018 to January 2022. All the patients underwent HGT prior to the posterior spinal fusion corrective surgery, with no patients having undergone anterior or posterior release procedures. The correction of deformity, pulmonary function tests (PFTs), and nutritional status data were collected and analyzed before and after HGT.ResultsA total of 33 patients (9 males, 24 females) were finally included in this study with an average age of 17.79 ± 7.96 (range 12–29) years. Among them, 20 patients were aged ≤ 16 years. The traction weight started from 1.5 kg and raised to 45.2 ± 13.2% of body weight on average progressively, with the average traction duration of 129 ± 63 days. After traction, the main curve was corrected from an average of 120.66 ± 3.89° to 94.88 ± 3.35°, and to 52.33 ± 22.36° (53%) after surgery(P < 0.05). PFTs also showed a significant increase in FVC%, FEV1%, and MEF% after traction [43.46 ± 14.76% vs. 47.33 ± 16.04%, 41.87 ± 13.68% vs. 45.19 ± 15.57%, and 40.44 ± 15.87% vs. 45.24 ± 17.91%, p < 0.05]. Total protein, albumin, and BMI were used as indicators of nutritional status. TP and albumin were significantly improved after traction, from 67.24 ± 5.43 g/L to 70.68 ± 6.98 g/L and 42.40 ± 3.44 g/L 45.72 ± 5.23 g/L, respectively(P < 0.05). No significant difference was found in deformity correction and lung function improvement between patients with traction for more or less than three months (p > 0.05). Two patients developed transient brachial plexus palsy during traction.ConclusionsHalo-gravity traction can partially correct spinal deformity, enhance pulmonary function. And HGT has been shown to facilitate an improved nutritional status in these patients. It could be used as a preoperative adjuvant treatment for severe spinal deformity. However, according to the study, a traction period longer than three months may not be necessary.

Severe Rigid Scoliosis Deformity Correction Using Extended Posterior Release and Instrumentation: A Retrospective Study.

Sever rigid scoliotic deformity (magnitude of the curve >80° and <25% correction on bending film) correction is a great challenge to spine surgeons. Severe scoliosis when untreated or not treated properly, may lead to severe complications due to curve progression. The aim of operative management is to achieve significant correction of sagittal, coronal, and rotational deformity to avoid neurodeficit, maintain sagittal balance, and improve cardiopulmonary function. In this retrospective study, eight patients with severe rigid scoliosis who underwent through single-staged extended posterior release and spinal fusion between March 2022 and November 2023. The surgical procedures were the excision of the posterior ligament and spinous process, laminectomy, excision of ligament flavum, facetectomy, and posterior spinal fusion utilizing pedicle screws, rods, and sub-laminar wires. Patients were evaluated radiologically using posteroanterior and lateral X-rays of the whole spine and computed tomography scans. Demographic data, pre- and post-operative cobbs angle, osteotomized segment, instrumentation segments, blood loss, operation duration, follow-up duration, and complications were recorded. Pre-operative mean cobbs angle was 94.1° (range 83-110°) and post-operative mean cobbs angle was 33.3° (range 28-42°) with 64.6% scoliosis correction. The mean estimated blood loss was 517 mL (range 300-580 mL). The mean operation duration was 272.5 min (210-340 min). Mean spinal fixation fusion segments were 11.1 (range 8-14). No major complications were noted. Our study concluded that extended posterior-only release, facetectomy, and posterior spinal fusion by utilizing pedicle screws and pre-contoured rods significantly corrected severe and rigid scoliosis with a high correction rate and avoid complications of anterior release. Hence, we can achieve remarkable correction in rigid scoliosis using the proper choice of levels, proper implant, and extended posterior release.

Posterior Release, Reduction, and Intra-Articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation.

For irreducible atlantoaxial rotary fixation (AARF), anterior or posterior release was often needed before posterior reduction and fusion. Anterior atlantoaxial joint release has potential complications such as retropharyngeal abscess, persistent hoarseness, and infection. This study aims to assess the efficacy of posterior release, reduction, and intra-articular fusion without resecting the C2 nerve root on irreducible type III AARF. The data of 9 pediatric patients diagnosed with AARF who underwent posterior atlantoaxial release, reduction, and intra-articular fusion without resecting the C2 nerve root were retrospectively reviewed. Japanese Orthopaedic Association scores and Visual Analog Scale for Neck Pain were used to assess outcomes. The preoperative and follow-up assessments of atlantodens interval (ADI) were documented to evaluate the reduction of atlantoaxial joint. The patient demographics, surgery time, blood loss, bone fusion time, follow-up period, and surgery-related complications were meticulously documented. The mean follow-up duration was 35.1 ± 11.5 months. Complete reduction was achieved in 8 patients, while one patient did not achieve complete reduction. The ADI decreased significantly from 8.7 ± 2.2 mm before surgery to 2.1 ± 1.3 mm at the final follow-up. All patients demonstrated successful bone fusion, with an average fusion period of 3.7 ± 1.3 months. The Visual Analog Scale for Neck Pain at the final follow-up exhibited a significant decrease compared with preoperative values (P < .05), while no significant difference was observed in Japanese Orthopaedic Association scores. There were no complications related to surgery. Posterior atlantoaxial release, reduction, and intra-articular fusion with a C2 nerve root preservation technique is effective in the treatment of irreducible type III AARF.

Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion.

Surgical correction of fixed kyphotic deformity or severe sagittal imbalance traditionally involves three column osteotomies, which are associated with high morbidity rates. Anterior column realignment (ACR) has emerged as a minimally invasive alternative for restoring segmental lordosis. This technique involves a lateral approach and release of the anterior longitudinal ligament (ALL), followed by placement of a hyperlordotic interbody cage. In this study, we present a successful case of minimally invasive ACR for the treatment of flatback deformity and adjacent segment disease in a patient with prior L2-S1 fusion. Imaging revealed a flatback deformity, sagittal vertical axis elevation, and spinopelvic disharmony. The patient underwent a multistage procedure involving a lateral retropleural approach for ACR and interbody fusion, followed by open posterior instrumented fusion and vertebroplasties. Postoperatively, the patient experienced significant pain relief and improvement in lumbar lordosis, pelvic tilt, and pelvic incidence-lumbar lordosis mismatch. ACR combined with posterior release allows for manipulation of all three spinal columns, leading to spine reconstruction and improved spinopelvic harmony. We discuss the advantages of ACR, including its minimally invasive nature and potential benefits for patients with sagittal deformities. The presented surgical technique demonstrates the feasibility and efficacy of minimally invasive ACR in addressing flatback deformity and adjacent segment disease.

The Suprascapular Nerve Arthroscopic Anterior and Endoscopic Posterior Release in Elite Volleyball Players

The Suprascapular Nerve Arthroscopic Anterior and Endoscopic Posterior Release in Elite Volleyball Players

A Novel Stepwise Technique for Safe and Effective Transoral Release of Irreducible Atlantoaxial Dislocation: A Retrospective Study of 201 cases.

Retrospective cohort study. To verify the clinical efficacy of a novel Transoral Stepwise Release Technique (TSRT) for treatment of irreducible atlantoaxial dislocations (IAAD). Anterior release for IAAD remains challenging, with 3.2 times higher complication rate than posterior release. However, there are some patients who cannot achieve successful reduction from a posterior approach, and require the higher-risk anterior release. Our work presents a novel anterior release technique that aims to minimize iatrogenic injury and associated complications from an anterior release. IAAD cases who were treated with TSRT were retrospectively studied. Primary outcomes included fusion rate, complications, and neurological function over the course of minimum one-year follow-up. Radiographic differences between preoperative and postoperative imaging were also considered. A preoperative prediction model for the actual release grade was developed using multivariate logistic regression based on demographic factors and the craniovertebral abnormalities identified on preoperative images, evaluating the need for higher-grade TSRT release. We included 201 IAAD cases, with 42% (84/201) demonstrating degeneration of the atlantoaxial joint or anterior-hook-like dens. Reduction was achieved in all cases, with 80% (160/201) of cases only requiring relatively low-grade (grade I) TSRT release. Degeneration of the atlantoaxial joint was significantly associated with the need for higher-grade TSRT release (OR 16.68, CI: 2.91-94.54, P=0.002). The overall complication rate was 4.5% (9/201). Over the course of follow-up, the fusion rate reached 98.5%, and the ASIA and JOA score were significantly improved to 97.28 and 16.25 (P<0.01 and P<0.01), respectively. This study demonstrated that our novel TSRT anterior release technique demonstrated complication rates similar to those published in the literature for posterior release. TSRT can be used as an alternative to posterior release techniques for refractory cases or when a posterior approach is not considered viable.

BRACING COMPLICATIONS IN IDIOPATHIC CONGENITAL TALIPES EQUINOVARUS

Specific brace-fitting complications in idiopathic congenital talipes equinovarus (CTEV) have been rarely described in published series, and usually focus on non-compliance. Our primary aim was to compare the rate of persistent pressure sores in patients fitted with Markell boots and Mitchell boots. Our additional aims were to describe the frequency of other brace fitting complications and identify age trends in these complications. A retrospective analysis of medical files of 247 idiopathic CTEV patients born between 01/01/2010 - 01/01/2021 was performed. Data was collected using a REDCap database.Pressure sores of sufficient severity for clinician to recommend time out of brace occurred in 22.9% of Mitchell boot and 12.6% of Markell boot patients (X2 =6.9, p=0.009). The overall rate of bracing complications was 51.4%. 33.2% of parents admitted to bracing non-compliance and 31.2% of patients required re-casting during the bracing period for relapse. For patients with a minimum follow-up of age 6 years, 44.2% required tibialis anterior tendon transfer. Parents admitting to non-compliance were significantly more likely to have a child who required tibialis anterior tendon transfer (X2=5.71, p=0.017). Overall rate of capsular release (posteromedial release or posterior release) was 2.0%.Neither medium nor longterm results of Ponseti treatment in the Australian and New Zealand clubfoot have been published. Globally, few publications describe specific bracing complications in clubfoot, despite this being a notable challenge for clinicians and families. Recurrent pressure sores is a persistent complication with the Mitchell boots for patients in our center. In our population of Australian clubfoot patients, tibialis anterior tendon transfer for relapse is common, consistent with the upper limit of tibialis anterior tendon transfer rates reported globally.

Open Reduction for Potentially Reducible Atlantoaxial Dislocation Secondary to Transverse Ligament Laxity in Patients with Rheumatoid Arthritis

Atlantoaxial dislocation (AAD) is classified into reducible AAD and irreducible AAD (IRAAD). Anterior or posterior releasing followed by occipitocervical/atlantoaxial fusion is often performed for IRAAD, but is technically demanding. This study aimed to evaluate the results of the posterior open reduction technique without releasing the atlantoaxial joint in the treatment of potentially reducible AAD (PRAAD) caused by transverse ligament laxity in patients with rheumatoid arthritis (RA). Data from 38 RA patients who experienced PRAAD due to transverse ligament laxity were retrospectively reviewed. They all underwent posterior open reduction and fusion without releasing the atlantoaxial joint. Outcomes were evaluated by using atlantodental interval, modified Japanese Orthopedic Association scores, Nurick grade, Neck Disability Index, and visual analog scale score for neck pain. All the patients achieved solid bone fusion at follow-up. The mean atlantodental interval was reduced to 5.6±0.7mm and 2.1±0.5mm after traction and operation, respectively, from a preoperative score of 8.2±0.6mm(P<0.05). Compared with the respective preoperative values, the mean modified Japanese Orthopedic Association score and Nurick grade were significantly increased at the final follow-up (both P<0.05), whereas the Neck Disability Index and visual analog scale score for neck pain were significantly decreased (both P<0.05). AAD with partial reduction after skeletal traction for 48hours should be defined as PRAAD, not IRAAD. Open reduction with a C1-C2 pedicle screw-rod system can be safely and effectively applied in the treatment of PRAAD due to transverse ligament laxity in patients with RA.

Right top pulmonary vein is a venous anomaly of which surgeons should be aware in subcarinal dissection for thoracoscopic esophagectomy: a case report and literature review

BackgroundA right top pulmonary vein (RTPV) that crosses behind the right main or intermediate bronchus is a variation of the superior posterior pulmonary vein in the right upper lobe. Damage or ligation of this abnormal vessel can lead to massive intraoperative bleeding and serious complications, such as congestion of the posterior segment of the right upper lobe and cardiac tamponade. Subcarinal lymph node dissection is mandatory in radical thoracoscopic esophagectomy for esophageal cancer, and the RTPV is an anomalous vessel of which thoracic surgeons should be aware.Case presentationA 70-year-old man underwent thoracoscopic esophagectomy for esophageal cancer (T3N1M0). An anomaly of the superior posterior pulmonary vein in the right lobe was recognized on preoperative computed tomography imaging. With simulation and intraoperative navigation using three-dimensional imaging of the same view as that observed during the operation, radical subcarinal dissection could be performed with preservation of the RTPV.ConclusionIn our review of the relevant literature, the incidence of RTPV ranged from 0.28 to 9.3%, and its mean vascular diameter was 7.0 mm at the maximum and 2.2 ± 0.72 mm at the minimum, with the right superior pulmonary vein being a relatively common inflow site. Our case in which the RTPV ran dorsal to the right main bronchus is very rare. In radical subcarinal dissection of thoracoscopic esophagectomy, it is important to recognize the posterior pericardial plane and release the ventral fixation of these lymph nodes to free space for the back side. This is also true in the case of RTPV, which should be noted to avoid injury. In cases involving an RTPV larger than 4.5 mm, ligation should be avoided, and preoperative recognition of the exact run of this abnormal vessel using three-dimensional imaging can be very useful.

Congenital hypoplasia and aplasia of the quadriceps: Diagnosis and treatment

BackgroundCongenital absence of the quadriceps is an extremely rare condition whose management is not standardised. The objective of this study was to describe the clinical presentation, treatments, and outcomes of a multicentre cohort. HypothesisClassification of the type of abnormality at birth helps to guide management decisions. MethodsFifteen patients (19 knees) were included retrospectively in this multicentre study. Data on joint range-of-motion and management were analysed. We divided the patients into three groups based on whether they had continuous hypoplasia (involving the entire quadriceps), discontinuous hypoplasia (hypoplasia of some of the muscle groups or aplasia of the distal third of the quadriceps), or aplasia (complete absence of the quadriceps with replacement by fat). ResultPhysiotherapy was provided initially to all patients. The main treatment in the 6 patients with continuous hypoplasia was posterior release and biceps femoris lengthening. At last follow-up all 6 patients were able to walk unaided, although 4 of them had persistent knee extension lag. Quadriceps reconstruction and osteotomy to correct knee recurvatum deformity were performed in most of the 11 patients with discontinuous hypoplasia. Among them, 10 were able to walk unaided at last follow-up, and 5 had knee extension lag. The 2 patients with aplasia required knee arthrodesis after multiple surgical procedures. Both were able to walk. DiscussionDepending on the classification of the abnormality at birth, different surgical procedures should be considered. Surgery should only be performed after non-operative treatment. The treatment goal is to obtain a normal mechanical axis of the limb with the knee in extension and no extension lag, in order to enable walking. Level of evidenceIV, retrospective observational study.

The Rotator Cable Does Not Stress Shield the Crescent Area During Shoulder Abduction.

It is accepted by the orthopaedic community that the rotator cable (RCa) acts as a suspension bridge that stress shields the crescent area (CA). The goal of this study was to determine if the RCa does stress shield the CA during shoulder abduction. The principal strain magnitude and direction in the RCa and CA and shoulder abduction force were measured in 20 cadaveric specimens. Ten specimens underwent a release of the anterior cable insertion followed by a posterior release. In the other 10, a release of the posterior cable insertion was followed by an anterior release. Testing was performed for the native, single-release, and full-release conditions. The thicknesses of the RCa and CA were measured. Neither the principal strain magnitude nor the strain direction in either the RCa or the CA changed with single or full RCa release (p ≥ 0.493). There were no changes in abduction force after single or full RCa release (p ≥ 0.180). The RCa and CA thicknesses did not differ from one another at any location (p ≥ 0.195). The RCa does not act as a suspension bridge and does not stress shield the CA. The CA primarily transfers shoulder abduction force to the greater tuberosity. The CA is important in force transmission during shoulder abduction, and efforts should be made to restore its continuity with a repair or reconstruction.

Endoscopic Posterior Ankle Decompression and Release After Total Ankle Arthroplasty

Accurate positioning of the total ankle arthroplasty implant components with the absence of any hindfoot deformity does not preclude the development of bony impingement. In cases of ankle stiffness after total ankle arthroplasty, the usual limitation is in dorsiflexion. If triceps surae contracture is excluded or persistent restriction remains in ankle dorsiflexion after gastrocnemius recession or tendo-Achilles lengthening, posterior ankle capsulectomy, debridement of posterior ankle gutter, and release of the deep posterior deltoid ligament and the posterior talofibular ligament are indicated. In this Technical Note, the technical details of endoscopic posterior ankle decompression and release after total ankle arthroplasty are described.

Dynamic Supination in Congenital Clubfoot: A Modified Delphi Panel Approach to Standardizing Definitions and Indications for Treatment.

Dynamic supination is a well-recognized cause of congenital clubfoot deformity relapse. However, there is no consensus on how to diagnose it and there are varied approaches in its management. This study aims to define dynamic supination and indications for treatment by presenting consensus from an international panel of experts using a modified Delphi panel approach. An international panel of 15 pediatric orthopaedic surgeons with clinical and research expertise in childhood foot disorders participated in a modified Delphi panel on dynamic supination in congenital clubfoot. Panelists voted on 51 statements using a 4-point Likert scale on dynamic supination, clinical indications for treatment, operative techniques, and postoperative casting and bracing. All panelists participated in 2 voting rounds with an interim meeting for discussion. Responses were classified as unanimous consensus (100%), consensus (80% or above), near-consensus (70% to 79%), and indeterminate (69% or less). Consensus was achieved for 34 of 51 statements. Panelists agreed dynamic supination is present when the forefoot is supinated during swing phase of gait with initial contact on the lateral border of the foot. There was also agreement that dynamic supination results from muscle imbalance between the tibialis anterior and the peroneus longus and brevis. There was no consensus on observation of hindfoot varus in dynamic supination, operative indications for posterior release of the ankle joint, or incisional approach for tibialis anterior tendon transfer. Reference to the calcaneopedal unit concept, planes of movement, and phases of gait were deemed important factors for consideration when evaluating dynamic supination. Consensus statements from the Delphi panel can guide diagnosis and treatment of dynamic supination in clubfoot deformity relapse, including clinical decision making regarding preoperative casting, surgical approach, and postoperative immobilization. Near-consensus and indeterminate statements may be used to direct future areas of investigation. Level V.

Posteromedial Accessory Incision for Posterior Capsular Release and Retractor Placement in a Total Ankle Replacement.

The standard approach for performing a total ankle replacement (TAR) is the anterior approach as this offers good direct visualization of the tibiotalar joint. Irrespective of implant system used, most commonly, bone cuts are made in the anterior to posterior direction and may potentially injure the posterior neurovascular structures and tendons running close to the ankle joint. Careful consideration must be taken to ensure these structures are protected. We introduce a new intraoperative technique of protection for the posteromedial soft tissues and neurovascular structures and include the early results of 60 consecutive patients where the described technique was employed. There were no technique-related complications, or evidence of injury to the PTT, FHL, flexor digitorum longus (FDL), or neurovascular bundles.

Simultaneous Anterior and Posterior Release in Lateral Decubitus Position for Rigid Adult Spinal Deformity: A Technical Note and 2 Case Reports

Correction surgery for rigid adult spinal deformity usually involves a complex 360° osteotomy, multiple intraoperative position changes, and staged surgery. Moreover, there is a lack of consensus regarding the surgical strategy for this pathology. We report the technical advantages of a simultaneous anterior and posterior release only in the lateral decubitus position to reduce surgical invasiveness in two case reports. A 76-year-old woman and an 80-year-old woman presented with significant spinal imbalance and segmental fusion in the anterior and posterior columns around the apex of the lumbar spinal curvature. We conducted this procedure for these patients at the first stage of spinal corrective surgery to achieve 360° osteotomy. A long posterior fusion surgery was performed after 1 week. The mean values of the central sacral vertical line, pelvic incidence minus lumbar lordosis, sagittal vertical axis, and pelvic tilt improved substantially postoperatively: central sacral vertical line, from 51.0 to 7.5 mm; pelvic incidence minus lumbar lordosis, from 27.5° to 0.5°, sagittal vertical axis, from 107.6 to 14 mm; pelvic tilt, from 34.0° to 13.0°. The mean surgical time and blood loss in the first- and second-stage operations were 242.1 minutes and 702 mL and 315.5 minutes and 549 mL, respectively, and no perioperative complications occurred. Simultaneous 360° segmental release in the lateral decubitus position without repositioning can make it possible to acquire satisfactory correction and reduce surgical invasiveness compared with the conventional procedure for adult spinal deformity.

Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty

PurposePosterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (FC). However, few studies have focused on the anatomical aspects of the PC. This study aimed to investigate the anatomical site and forms of posterior capsular attachment to the femoral cortex, and to evaluate the efficacy of posterior capsular release for FC by assessing changes in knee extension angles using a navigation system.MethodsAttachment sites of the PC were investigated in 10 cadaveric knees using computed tomography. PS-TKA was performed in six cadaveric knees using a navigation system to evaluate the efficacy of posterior capsular release for FC. Posterior capsular release was performed stepwise at each part of the femoral condyle.ResultsThe gastrocnemius tendon and PC were integrally attached to the femoral cortex at the medial and lateral condyles, whereas the PC at the intercondylar fossa was independently attached directly to the femoral cortex. Moreover, the PC at the intercondylar fossa was attached most distally among each femoral condyle. Posterior capsular release at the intercondylar fossa allowed 11.4° ± 2.8° improvement in knee extension. This angle was further improved by 5.5° ± 1.3°, after subsequent capsular release at the medial and lateral condyles.ConclusionThe forms and sites of posterior capsular attachment differed based on the part of the femoral condyle. Stepwise posterior capsular release was effective for FC in PS-TKA.Level of evidenceIII.

A pragmatic, evidence-based approach to coding for abdominal wall reconstruction

PurposeAmbiguity exists defining abdominal wall reconstruction (AWR) and associated Current Procedural Terminology code usage in the context of ventral hernia repair (VHR), especially with recent adoption of laparoscopic and robotic-assisted AWR techniques. Current guidelines have not accounted for the spectrum of repair complexity and have relied on expert opinion. This study aimed to develop an evidence-based definition and coding algorithm for AWR based on myofascial releases performed.MethodsThree vignettes and associated outcomes were evaluated in adult patients who underwent elecive VHR with mesh between 2013 and 2020 in the Abdominal Core Health Quality Collaborative including: (1) no myofascial release (NR), (2) posterior rectus sheath myofascial release (PRS), and (3) PRS with transversus abdominis release or external oblique release (PRS-TA/EO). The primary outcome measure was operative time based on the following categories (min): 0–59, 60–119, 120–179, 180–239, and 240 + ; secondary outcomes included disease severity measures and 30-day postoperative outcomes.Results15,246 patients were included: 7287(NR), 2425(PRS), and 5534(PRS-TA/EO). Operative time increased based on myofascial releases performed: 180–239 min (p < 0.05): NR(5%), PRS(23%), PRS-TA/EO(28%) and greater than 240 min (p < 0.05): NR (4%), PRS (17%), PRS-TA/EO(44%). A dose–response effect was observed for all secondary outcome measures indicative of three distinct levels of patient complexity and outcomes for each of the three vignettes.ConclusionAWR is defined as VHR including myofascial release. Coding for AWR should reflect the actual effort used to manage these patients. We propose an evidence-based approach to AWR coding that focuses on myofascial release and is inclusive of minimally invasive techniques.

Acoustic features of Hadza clicks

Hadza (Khoesan) has several clicks in its sound inventory [1,2]. There are 4 types of clicks in the language: bilabial, dental, alveolar and lateral [⊙, |, !, ‖] that can be accompanied, by aspirated, glottal and nasal features [⊙∼ , |ʔ, |h, ŋ|, ŋ|ʔ, !ʔ, !h, ŋ!, ŋ!ʔ, ‖, ‖h, ŋ‖h, ŋ‖ʔ]. Our study was made with 9 native speakers (4 women and 5 men) using various instrumental techniques (Acoustic, aerodynamic, EGG and Video). Clicks have two components: an attack and an extinction transient. Bilabial clicks have a noisy release, sometimes whisteled. Aspiration is short for dentals and alveolars, long for laterals. Glottals have a long lag after the burst release. The 4 types of clicks can be produced with the nasal feature. Acoustically, clicks are described with 2 features [grave versus acute] and [abrupt versus noisy] [3]. The [grave] feature has a peak in the FFT spectrum around 1200Hz and the [acute] around 3000 Hz. For some clicks, the cavity posterior to the constriction is excited. Short resonances occur between 1 and 2 kHz following the posterior release, they result from the lowering of the tongue dorsum and from the reduction in the volume of the pharyngeal cavity. [1] K. Miller, Hadza Grammar Notes (Ms Riezlern, 2008). [2] B. Sands, “Phonetics and phonology: Hadza,” in The Khoesan languages, edited by R. Vössen (Routledge, London, 2013). [3] A. Traill, s“The perception of clicks in !xoo,” J. African Lang. Linguist. 15, 161–174 (1994).

V12-08 MODIFIED APICAL DISSECTION AND LATERAL PROSTATIC FASCIA PRESERVATION: PRELIMINARY ANALYSIS OF THE REPRODUCIBILITY OF THE NOVEL TECHNIQUE

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-08 MODIFIED APICAL DISSECTION AND LATERAL PROSTATIC FASCIA PRESERVATION: PRELIMINARY ANALYSIS OF THE REPRODUCIBILITY OF THE NOVEL TECHNIQUE Bernardo Rocco, Luca Sarchi, Simone Assumma, Alessandra Cassani, Elena Morini, Filippo Turri, Cosimo De Carne, Carlo Bellorofonte, Paolo Marcangeli, Claudio Cesana, Giorgio Bozzini, Salvatore Micali, and Maria Chiara Sighinolfi Bernardo RoccoBernardo Rocco More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Simone AssummaSimone Assumma More articles by this author , Alessandra CassaniAlessandra Cassani More articles by this author , Elena MoriniElena Morini More articles by this author , Filippo TurriFilippo Turri More articles by this author , Cosimo De CarneCosimo De Carne More articles by this author , Carlo BellorofonteCarlo Bellorofonte More articles by this author , Paolo MarcangeliPaolo Marcangeli More articles by this author , Claudio CesanaClaudio Cesana More articles by this author , Giorgio BozziniGiorgio Bozzini More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , and Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Novel modified technique (mod-RALP) seems to improve functional outcomes in terms of continence and potency. Whereas these clear advantages, the issue of reproducibility of the technique has not been investigated. Moscovas et al reported their series of 104 patients (first 18 cases as a part of LC process); we aim to analyze the mod-RALP reproducibility with insights on safety and efficacy compared to standard approach. METHODS: A prospective study performed since October 2020, 20 patients with cT2 PCa undergo a mod-RALP (low-intermediate D’Amico risk group). PND was performed according to MSK nomogram, NS strategy according to PRECE tool. A single surgeon performed all procedures (BR). First transperitoneal anterior trocar placement (6 port). After bladder detachment and periprostatic fat excision, anterior bladder neck is opened followed by posterior bladder neck dissection. After seminal vesicle excision, the dissection goes caudally, in the posterior plane. The 0° camera allows blunt dissection toward the apex and lateral aspects of the prostate, avoiding energy use and sharp traumatic incisions. When a NS is planned, after posterior release, a plane medial to the lateral prostatic fascia is developed, leaving the NVBs unseen lateral to the fascial opening at the base. The anterior dissection continues underneath the puboprostatic ligament, preserving apical anatomy. Santorini plexus is controlled by a running barbed suture after the apical dissection and before the urethral division. Endpoints are time from bladder neck incision to urethral section; PSM rate stratified by pT, continence and potency at 30 days. RESULTS: Mod-RALP had no complication. Median time from bladder neck to urethral section was 42 min (DS 9). 16 patients had organ confined disease pT2 with no PSM, (25% had an apical localization of PCa), 1 pT3a, 1 pT3b and 1 pT4. As far as early continence and potency recovery all patients were continent at 30 days (safety pad in 2). All pre-op potent patients (IIEF 5>21) restored an erection sufficient for intercourse with the use of PDE-5i. CONCLUSIONS: From our preliminary experience, mod-RALP is reproducible without compromising oncological safety and operatory time. To our knowledge, this is the first case series testing the transferability of mod-RALP to an independent center. The careful dissection with maximal preservation of the apex enables a recovery of continence in all patients. Despite the single and high-volume surgeon characteristic of our series, the use of the mod-RALP should be furtherly encouraged. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1026-e1026 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernardo Rocco More articles by this author Luca Sarchi More articles by this author Simone Assumma More articles by this author Alessandra Cassani More articles by this author Elena Morini More articles by this author Filippo Turri More articles by this author Cosimo De Carne More articles by this author Carlo Bellorofonte More articles by this author Paolo Marcangeli More articles by this author Claudio Cesana More articles by this author Giorgio Bozzini More articles by this author Salvatore Micali More articles by this author Maria Chiara Sighinolfi More articles by this author Expand All Advertisement Loading ...