Postoperative Neuropraxia Research Articles

Femoral head to lower lumbar neural foramen distance as a novel radiographic parameter to predict postoperative stretch neuropraxia.

Lumbosacral fractional curves in adult spinal deformity (ASD) patients often have sharp coronal curves resulting in significant pain and imbalance. Postoperative stretch neuropraxia after fractional curve correction can lead to discomfort and unsatisfactory outcomes. The goal of this study was to use radiographic measures to increase understanding of the relationship between postoperative stretch neuropraxia and fractional curve correction. In 62 ASD patients treated from 2015 to 2018, radiographic review was performed, including measurement of the distance between the lower lumbar neural foramen (L4 and L5) in the concavity and convexity of the lumbosacral fractional curve and the ipsilateral femoral heads (FHs; L4-FH and L5-FH) in pre- and postoperative anteroposterior spine radiographs. The largest absolute preoperative to postoperative change in distance between the lower lumbar neural foramen and the ipsilateral FH (ΔL4/L5-FH) was used for analysis. Chi-square analyses, independent and paired t-tests, and logistic regression were performed to study the relationship between L4/L5-FH and stretch neuropraxia for categorical and continuous variables, respectively. Of the 62 patients, 13 (21.0%) had postoperative stretch neuropraxia. Patients without postoperative stretch neuropraxia had an average ΔL4-FH distance of 16.2 mm compared to patients with stretch neuropraxia, who had an average ΔL4-FH distance of 31.5 mm (p < 0.01). Patients without postoperative neuropraxia had an average ΔL5-FH distance of 11.1 mm compared to those with stretch neuropraxia, who had an average ΔL5-FH distance of 23.0 mm (p < 0.01). Chi-square analysis showed that patients had a 4.78-fold risk of developing stretch neuropraxia with ΔL4-FH > 20 mm (95% CI 1.3-17.3) and a 5.17-fold risk of developing stretch neuropraxia with ΔL5-FH > 15 mm (95% CI 1.4-18.7). Logistic regression analysis indicated that the odds of developing stretch neuropraxia were 15:1 with a ΔL4-FH > 20 mm (95% CI 3-78) and 21:1 with a ΔL5-FH > 15 mm (95% CI 4-113). The novel ΔL4/L5-FH distances are strongly associated with postoperative stretch neuropraxia in ASD patients. A ΔL4-FH > 20 mm and ΔL5-FH > 15 mm significantly increase the odds for patients to develop postoperative stretch neuropraxia.

Low mental health scores are associated with worse patient-reported outcomes and difficulty with return to work and sport after distal biceps repair.

BackgroundMost patients have successful outcomes with minimal limitations after distal biceps repair, but a minority continues experiencing functional constraints. We hypothesize that low scores on a validated mental health measure correlate with worse patient-reported outcomes and increased difficulty with return to work and sport.MethodsWe conducted a retrospective review of a consecutive series of patients who underwent distal biceps repair with a single-incision cortical button technique and immediate mobilization. Patient-reported outcome data were available at 1 year or later for 33 (85%) patients. The primary outcomes were American Shoulder and Elbow Surgeons-Elbow (ASES-E) score, Single Assessment Numeric Evaluation score, Visual Analog Scale for pain, Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), and Veterans RAND 12 (VR-12) quality-of-life assessment.ResultsAll patients were male, with a median age of 49 years (range, 28-65). None had reruptures, and 1 (3%) had superficial wound dehiscence that healed without further surgery. Eleven (33%) had postoperative neuropraxia, 6 of which resolved completely. At latest follow-up, the median Visual Analog Scale was 0 (range, 0-5; mean, 1), and median ASES-E functional score was 36 (range, 24-36; mean, 34). Median Single Assessment Numeric Evaluation score was 92 (range, 41-100). The median QuickDASH was 5 (range, 0-50; mean, 11). More than half of the patients with VR-12 mental component score (MCS) < 50 (5 of 9, 56%) reported difficulty with work activities, compared with 4% (1 of 24) of patients with an MCS ≥ 50 (P = .001). Most patients (8 of 9, 89%) with an MCS < 50 also reported difficulty with return to sporting activities, compared with only 8% (2 of 24) of patients with MCS ≥ 50 (P < .0001). Patients with an MCS < 50 (n = 9) had significantly worse ASES-E functional scores (median, 34; range, 27-36) and QuickDASH scores (median 23, range 0-43), compared with those with an MCS ≥ 50 (ASES-E: median, 36; range, 24-36; P = .033; QuickDASH: median, 2; range, 0-50; P = .026). Most patients (17 of 24, 71%) with MCS ≥ 50 had a perfect score of 36 on the ASES-E functional outcome score, compared with only 22% (2 of 9) among patients with MCS < 50.ConclusionPatients who undergo distal biceps repair show excellent functional patient-reported outcomes at 1-year and later follow-up. Lower scores on the VR-12 MCS are associated with worse patient-reported outcome scores and difficulty with return to work and sporting activities.

Aneurysmal bone cyst of head of fibula with transient postoperative neuropraxia of common peroneal nerve

The pain over the knee region is a common complaint noted in routine practice and may require proper investigations to diagnose the etiology. Pain over the proximal fibular area is uncommon more so with no history of injury or overuse. Benign neoplastic lesion of fibula head is rarely encountered on radiographs, and further investigations are directed to exclude the differentials. Excision biopsy of smaller, uncomplicated lesion is a treatment of choice that not only is curative but is important to collect biopsy specimen to confirm the diagnosis. Common peroneal nerve (CPN) in the vicinity of upper fibula poses a challenge in surgical approaches to this region and requires careful identification and handling to avoid any damage. Despite best efforts, neuropraxia of CPN may be noted in few cases. Proper preoperative documentation, counseling, and assurance are crucial to manage this complication. Proper bracing and physiotherapy is encouraged while spontaneous recovery is expected. We report a case of aneurysmal bone cyst of fibular head managed by excisional biopsy that led to the aforementioned complication and full recovery in the follow-up.

Current therapeutic strategies for erectile function recovery after radical prostatectomy – literature review and meta-analysis

Current therapeutic strategies for erectile function recovery after radical prostatectomy – literature review and meta-analysis

Clinical study on the management of extra-articular distal humerus fracture treated with extra-articular distal humeral locking compression plate

Background: Extra-articular distal humerus fracture treatment is a controversial topic. One group of surgeons favor non-operative treatment with plaster cast immobilization and functional bracing, while the other favors operative fixation. Concern of radial nerve injury, mal aligned fracture ends and stiffness of the shoulder and elbow following non-operative treatment are the major reasons to opt for an operative fixation. Distal humerus fractures surgeries remain one of the most challenging orthopaedic surgeries. These fractures have a complex anatomy, occurs in osteoporotic bone and are commonly multi-fragmented. The Extra-articular Distal Humeral Locking Compression Plate is a useful treatment option for managing extra-articular distal humerus fractures. Due to the greater screw hole density of the plate distally and using 3.5-mm screws instead of 4.5 mm allows adequate number of screws to be placed to hold the small distal fragment. Materials and Methods: A prospective clinical study was carried out for a total of 20 cases of extra-articular distal humeral fractures between 18 years and 65 years attending OPD and Emergency Department of Orthopaedics, Silchar Medical College and Hospital who meet inclusion and exclusion criteria from 1st June 2017 to 31st May 2018. All the cases were operated with EADHP. The time for union, range of motion at elbow and complications were recorded in followup. The elbow function was assessed using the Mayo Elbow Performance Score (MEPS) and pain by Visual Analogue Score (VAS). Results: There were 20 patients (13 males and 7 females) with an average age of 38.85 years. 10 cases were 12B1; 3 cases were 12A1; 2 cases each were 12A2, 12B2 & 12C1 and 1 case was 12C2. The mean time of radiological union was 14.25 weeks. The average duration of follow-up was 9.25 months with a range of 6-12 months. The average range of motion in the study at the 6 months analysis was 0.500 – 125.50. The mean Mayo Elbow Performance Score at the end of 6 months was 95.5, and ranged from 80 to 100. The average visual analogue score was 0.745 cm at the end of 6 months and ranged from 0 to 4cm. All the fractures showed union except one. There was one incidence of plate failure which was reoperated and it got united after 20 weeks of the revision surgery. There were 4(20%) patients who had complications. Two patients had post-operative neuropraxia, one patient had plate failure and in one patient there was loss of 100 extension. Conclusion: Extra-articular Distal Humeral Locking Compression Plate fixation of distal humerus fractures using the paratricepital approach provides stable fracture fixation with adequate exposure of the radial nerve and 90% of posterior humeral shaft surface.

Postprostatectomy Erectile Dysfunction: A Review.

In the current era of the early diagnosis of prostate cancer (PCa) and the development of minimally invasive surgical techniques, erectile dysfunction (ED) represents an important issue, with up to 68% of patients who undergo radical prostatectomy (RP) complaining of postoperative erectile function (EF) impairment. In this context, it is crucial to comprehensively consider all factors possibly associated with the prevention of post-RP ED throughout the entire clinical management of PCa patients. A careful assessment of both oncological and functional baseline characteristics should be carried out for each patient preoperatively. Baseline EF, together with age and the overall burden of comorbidities, has been strongly associated with the chance of post-RP EF recovery. With this goal in mind, internationally validated psychometric instruments are preferable for ensuring proper baseline EF evaluations, and questionnaires should be administered at the proper time before surgery. Careful preoperative counselling is also required, both to respect the patient's wishes and to avoid false expectations regarding eventual recovery of baseline EF. The advent of robotic surgery has led to improvements in the knowledge of prostate surgical anatomy, as reflected by the formal redefinition of nerve-sparing techniques. Overall, comparative studies have shown significantly better EF outcomes for robotic RP than for open techniques, although data from prospective trials have not always been consistent. Preclinical data and several prospective randomized trials have demonstrated the value of treating patients with oral phosphodiesterase 5 inhibitors (PDE5is) after surgery, with the concomitant potential benefit of early re-oxygenation of the erectile tissue, which appears to be crucial for avoiding the eventual penile structural changes that are associated with postoperative neuropraxia and ultimately result in severe ED. For patients who do not properly respond to PDE5is, proper counselling regarding intracavernous treatment should be considered, along with the further possibility of surgical treatment for ED involving the implantation of a penile prosthesis.

Reprint of: Do intra-operative changes to recurrent laryngeal nerve electromyography during thyroid surgery predict post-operative neuropraxia?

Background: Injury to the recurrent laryngeal nerve (RLN) is an important risk of thyroid surgery. Intra-operative nerve monitoring has been proposed as a method of predicting RLN neuropraxia. Since December 2012 we have used the Nerve Integrity Monitor (NIM-Response 3.0 System, Medtroinc Xomed, Jacksonville, Florida) for intraoperative RLN monitoring. This system provides automatic periodic (APS) simulation of the vagus nerve at 6 second intervals. Do intra-operative changes to recurrent laryngeal nerve electromyography during thyroid surgery predict post-operative neuropraxia?European Journal of Surgical OncologyVol. 40PreviewBackground: Injury to the recurrent laryngeal nerve (RLN) is an important risk of thyroid surgery. Intra-operative nerve monitoring has been proposed as a method of predicting RLN neuropraxia. Since December 2012 we have used the Nerve Integrity Monitor (NIM-Response 3.0 System, Medtroinc Xomed, Jacksonville, Florida) for intraoperative RLN monitoring. This system provides automatic periodic (APS) simulation of the vagus nerve at 6 second intervals. Full-Text PDF

Do intra-operative changes to recurrent laryngeal nerve electromyography during thyroid surgery predict post-operative neuropraxia?

Do intra-operative changes to recurrent laryngeal nerve electromyography during thyroid surgery predict post-operative neuropraxia?

Ultrasound‐guided peripheral nerve blocks: What are the benefits?

Use of ultrasound by anaesthesiologists performing regional blocks is rapidly gaining popularity. The aims of this review were to summarize and update accumulating evidence on ultrasound-guided nerve blocks, with an emphasis on the clinical relevance of the results and to critically appraise changing standards in regional anaesthesia. A search of MEDLINE and EMBASE (1966 to 31 December 2007) was conducted using the following free terms: 'ultrasound and regional anesthesia', 'ultrasound and peripheral block' and 'ultrasound and nerve and block'. These were combined with the MESH terms 'nerve block' and 'ultrasonography'. The following limits were applied: studies with abstracts, only in humans, published in core clinical journals. Trial type: meta-analysis, randomized-controlled trial and clinical trial. When peripheral nerves are adequately imaged by ultrasound, the concomitant use of nerve stimulation offers no further advantage. However, several studies reported problems with obtaining satisfactory images in some patients. Ultrasound guidance significantly shortened the block performance time and/or reduced the number of needle passes to reach the target in all comparative studies. The occurrence of paraesthesia during block performance was also reduced, but not the incidence of short-lasting post-operative neuropraxia. The frequency of accidental vascular punctures may be lower, but the data are contradictory. Block onset time was significantly shortened. Block duration was longer in children, but not in adults. Ultrasound also allowed dose reduction of the local anaesthetic (LA). Ultrasound guidance shortens the block performance time, reduces the number of needle passes and shortens the block onset time. Blocks may be performed using lower LA doses.

Cranial/cervical nerve dysfunction after carotid endarterectomy.

The purpose of this article is to review the results of patients who had cranial and cervical nerve dysfunction after undergoing carotid endarterectomy. The prospective study reviewed 183 consecutive carotid endarterectomies. Preoperative and postoperative cranial nerve assessments were accomplished on all patients. Neurologic evaluation included direct fiberoptic laryngoscopy. Patients found to be neurologically intact had no further follow-up. Patients with postoperative neuropraxia were entered into regular long-term follow-up to assess delayed recovery. Twenty-six (14.2%) nerve injuries were identified in 21 patients. There were 14 recurrent laryngeal, 8 hypoglossal, 2 marginal mandibular, and 2 greater auricular nerve dysfunctions. Two patients were lost to follow-up. Eighteen (9.8%) nerve injuries were transient, whereas two (1.1%) were permanent. Four patients are currently undergoing extended follow-up to assess delayed recovery. Two patients with recurrent laryngeal nerve dysfunction were found to have prolonged full recovery intervals: 20 months and 50 months, respectively. The incidence of focal neuropraxia after carotid endarterectomy is presented. Most injuries are transient. However, permanent injuries can lead to significant disability. Extended follow-up will identify the small subset of patients with delayed complete nerve recovery.