Postoperative Visual Analogue Score Research Articles

Extensor muscle-preserving laminectomy in treating multilevel cervical spondylotic myelopathy compared with laminoplasty.

Laminectomy and laminoplasty are popularly used in posterior cervical spine surgery but still have involved complications. We aimed to compare the clinical outcomes of microscope-assisted extensor muscle-preserving laminectomy (MA-EMPL) and open-door laminoplasty (ODLP) in treating multilevel cervical spondylotic myelopathy (MCSM). A prospective study was designed to enroll twenty patients with MCSM underwent MA-EMPL, and recruit twenty-four patients with MCSM received ODLP (control). Radiographic measurements, outcome indicators including Japanese Orthopedic Association (JOA) score and visual analogue score (VAS) were used to evaluate technical effectiveness. Surgical complications were documented to assess technical safety. Postoperative cervical curvature index and range of neck motion (ROM) were not significantly changed except ROM in ODLP group. Postoperative JOA score and VAS in both groups showed improvements at final follow-up. There was no statistical difference in postoperative neurological recovery rates between two groups (67.6%±17.8% vs. 70.15%±19.6%, P=0.632). However, VAS was significantly lower at postoperative 1 month in MA-EMPL group compared with ODLP group (P<0.001). The incidences of C5 palsy were 0 vs. 16.7% between MA-EMPL group and ODLP group. There was no axial symptom occurred in MA-EMPL group while six patients in ODLP group (0 vs. 25%, P=0.049). In addition, the mean blood loss and hospital stay were lesser in MA-EMPL group compared with ODLP group (P<0.001, P=0.002, respectively). MA-EMPL is an effective, safe and minimally invasive method in treatment of MCSM. Compared with ODLP, MA-EMPL has advantage to decrease intraoperative blood loss, hospital stay, postoperative VAS and axial symptom, as well as preserve postoperative ROM.

206. Does ACR result in greater morbidity than LLIF alone when treating adult spinal deformity?

BACKGROUND CONTEXT Anterior column realignment (ACR) can be utilized for correction of adult spinal deformity (ASD), but the additional benefit over lateral lumbar interbody fusion (LLIF) alone is unclear. PURPOSE To evaluate the relative impact of ACR vs LLIF on clinical and radiographic outcomes, as well as complication rates, when surgically treating ASD. STUDY DESIGN/SETTING Prospective multicenter database review. PATIENT SAMPLE A total of 127 patients. OUTCOME MEASURES Oswestry Disability Index (ODI), visual analog score (VAS), SRS-22. METHODS Inclusion criteria were age ≥18 years, and one of the following: coronal cobb>20°, SVA>5cm, PT>20°, PI-LL >10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery, underwent LLIF (LLIF group) or ACR/LLIF (ACR group) and had 1-year minimum follow-up. RESULTS A total of 127 patients met inclusion criteria, 101 underwent LLIF and 26 had ACR. Average age and BMI were 66.3/27.7 and 67.8/27.4 (p=0.654/0.957). The groups had similar rates of prior spine surgery (48.5% vs 57.7%; p=0.403), cMIS (58.7% vs 73.1%; p=0.222), posterior osteotomies (43.6% vs 34.6%; p=0.409), levels instrumented (7.8 vs 8; p=0.895), and interbody fusion levels (3.4 vs 3.6; p=0.478). Preop and postop spinopelvic parameters were similar between groups, except for postop SVA which was higher in the LLIF group (40mm vs 13mm; p = 0.028). One year PI-LL (3.8 vs 5.8; p=0.555), PT (20.6 vs 22.9;p=0.536), and SVA were normalized in both groups. Preoperative and postoperative ODI, VAS, and SRS -22 scores were similar between groups. Complication rates between groups were similar as well (57.4% LLIF vs 57.7% ACR; p=0.98), including neurologic (16.8% vs 15.4%; p=0.859) and vascular (0% for both groups) injuries. CONCLUSIONS Use of ACR via lateral approach for correction of adult spinal deformity results in no increase in neurologic, vascular, or other overall complications rates, when compared to using LLIF alone, but is a more complex procedure and should be performed by highly experienced surgeons. Optimization of spino-pelvic parameters was achieved regardless of the technique employed. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Treatment of Adult Scoliosis Fractional Curve With Minimally Invasive Surgery: Anterior Versus Posterior Approach?

Abstract INTRODUCTION The fractional curve in adult scoliosis often causes radiculopathy and may be managed in varied manners with minimally invasive (MIS) deformity correction. There are inherent risks and benefits to anterior and posterior interbody reconstruction techniques, and the purpose of this study was to evaluate for differences in outcomes or complication rates by fractional curve treatment via MIS anterior vs. posterior interbody fusion METHODS Inclusion criteria were age = 18 yr, and one of the following: coronal cobb &gt; 20°, SVA &gt; 5 cm, PT &gt; 20°, PI-LL &gt; 10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery and had 2-yr minimum follow-up. Patient were divided into two groups: anterior or posterior interbody fusion at the lumbosacral junction (L4-S1). HRQOL measures included Oswestry Disability Index (ODI), visual analog score (VAS). RESULTS A total of 112 patients who underwent MIS adult deformity surgery with minimum 2-yr follow up. A total of 74 patients underwent anterior and 38 patients underwent posterior interbody reconstruction at L4-S1 utilizing MIS technique. Preoperative spinopelvic parameters, radiographic parameters, and VAS were not different, but ODI was higher in the anterior group (53 vs 48, P = .047). Complications and reoperation rates were not different (P = .089, P = .597), but posterior had more infections (15.8% vs 2.7%, P = .01). When subdivided for cMIS only surgery, 38 had anterior and 19 underwent posterior interbody fusions in the fractional curve. Pre- and postoperative VAS leg, ODI, and fractional curve magnitude were not different. In the anterior surgery cohorts, laminectomies at L4-S1 were performed in 22% of hybrid cases and in 8% of cMIS cases. CONCLUSION Treatment of the fractional curve of adult scoliosis appears to be similarly effective in reducing VAS, ODI, and fractional curve magnitude regardless of anterior vs posterior approach. However, posterior interbody reconstruction was associated with higher infection rate than anterior, regardless of application in cMIS or hybrid technique.

Comparison of Magnesium Sulfate and Ketamine with Ropivacaine in Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial.

Background:Supraclavicular brachial plexus block offers good operating conditions with limited postoperative analgesia. Magnesium sulfate (MgSO4) and ketamine block peripheral nociception mediated via N-methyl-D-aspartate receptors.Aims:The aim of this study was to evaluate the effect of MgSO4 and ketamine on the duration of analgesia in brachial block.Settings and Design:This was a prospective, randomized, controlled double-blind study.Materials and Methods:One hundred and five adult patients were randomly divided into three groups: Group I = 27 mL of 0.5% ropivacaine; Group II = 27 mL of 0.5% ropivacaine + 250 mg MgSO4; and Group II = 27 mL of 0.5% ropivacaine + 2 mg.kg−1 ketamine. Normal saline was added to make a total volume of 30 mL. The onset and duration of the sensorimotor blockade, quality and duration of postoperative analgesia, and adverse effects were assessed.Statistical Analysis:Statistical analysis was performed using SPSS, version 17.0 software (SPSS, Inc., Chicago, IL, USA). Chi-square test was used for nonparametric and ANOVA for parametric data. Post hoc Student's paired t-test was applied wherever indicated. The results were expressed as mean and standard deviation or numbers (%). P < 0.05 was considered as statistically significant.Results:The duration of analgesia was significantly longer in Group II (8.78 ± 0.97 h) compared to Group I (6.76 ± 0.92 h; P < 0.001) and Group III (7.1 ± 0.89 h; P < 0.001). Intervention groups had lower postoperative visual analog scores at 8, 12, and 24 h compared to the control group. Sedation, nystagmus, and hallucinations were observed in Group III.Conclusion:The addition of MgSO4 to ropivacaine in supraclavicular brachial plexus block significantly prolongs the duration of analgesia. MgSO4 improves the quality of postoperative analgesia with lesser incidence of side effects when compared to ketamine.

A Comparison Study of Three Posterior Fixation Strategies in Transforaminal Lumbar Interbody Fusion Lumbar for the Treatment of Degenerative Diseases

Background:There are various posterior fixations utilized with transforaminal lumbar interbody fusion (TLIF). Previous studies have focused on the comparison of two fixation techniques.Materials and Methods:Sixty five patients with single-level lumbar disease were included in this retrospective study. Group A was treated by TLIF with bilateral pedicle screw (BPS), Group B treated by TLIF with unilateral pedicle screw (UPS), and Group C treated by TLIF with UPS plus contralateral translaminar facet screw (UPSFS). The operative time, blood loss, Oswestry disability index (ODI), Japanese Orthopaedic Association Scores (JOA), and visual analog scores (VAS) were recorded. Radiographic examination was used to assess fusion rates and incidence of screw failure.Results:The blood loss and operative times were 188.69 ± 37.69 ml and 132.96.5 ± 8.69 min in BPS group, 117.27 ± 27.11 ml and 99.32 ± 12.94 min in UPS group, and 121.50 ± 22.54 ml and 112.55 ± 9.42 min in UPSFS group; UPS and UPSFS were better than BPS (P < 0.05). The mean followup time was 38.2 months. Fusion rates were – BPS group: 95.6%, UPS group: 90%, UPSFS: 95% (P > 0.05). Screw and/or rod failures were found in three groups (BPS group: 1, UPS group: 2 and UPSFS: 1, P > 0.05). The average postoperative VAS, ODI, and JOA scores of BPS, UPS, and UPSFS were improved significantly in each group compared to preoperative scores (P < 0.05); there were no significant differences between any two groups at each followup time point (P > 0.05).Conclusion:UPSFS with TLIF is a viable treatment option that provides satisfactory clinical results; the clinical outcome and the complication rate were comparable to BPS. In addition, the invasive of UPSFS cases was comparable to UPS and better than BPS cases. For UPS, it could be used in suitable patients.

Efficacy of different fixed position of Devine in the treatment of true concealed penis

Objective To investigate the effect of different fixed position of Devine in the treatment of true concealed penis. Methods From March 2014 to February 2016, 40 patients with true concealed penis who underwent Devine operation were selected retrospectively. The patients were divided into two groups according to the postoperative fixation methods, of which the observation group (30 cases) fixed the penis root and the dorsal side of the penis subcutaneously, and the control group (10 cases) fixed the penis root and the penis ventral side subcutaneously. The operation time of the two groups, the rate of bleeding, the time of edema, the length of the exposure of the penis before and after the operation, the postoperative visual analogue score (VAS score), the penile retraction rate and the occurrence of the complications were observed. Results There was no difference in the amount of bleeding between the two groups(P>0.05). The time of operation and the time of edema in the observation group were significantly shorter than those in the control group, and the difference between the two groups was statistically significant(P 0.05). The exposure length of the penis body in the observation group was significantly greater than that of the control group at 12 and 24 weeks after treatment, and the difference was statistically significant(P 0.05). The VAS score of the patients in the observation group was significantly lower than that of the control group. The difference between the two groups was statistically significant(P<0.05). Conclusions When Devine is used to treat the true concealed penis, the operation and edema time of the penis and the dorsal side of the penis can be shortened significantly, the degree of pain in the patients is low, the length of the penis is improved significantly and the penis body is exposed better, and it is worthy of clinical application. Key words: Penis; Urologic Surgical Procedures

CLINICAL EFFECTIVENESS OF LUMBAR EPIDURAL INJECTION FOR SPINAL DISC HERNIATION: A RANDOMISED CONTROL TRIAL.

Purpose: Lumbar epidural is an established procedure, which is commonly used to control pain in cases of disc herniation secondary to lumbar disc disease. We conducted the present study to evaluate the clinical effectiveness of lumbar epidural injection using image intensifier comparing to injection using loss of resistance technique with no fluoroscopy. We also evaluated the outcome of these patients with patients treated conservatively with opioid or other analgesia as a control group. Setting: Epsom General Hospital, an elective part of Epsom &amp; St Helier’s University Hospital spine services. Study Design: Prospective randomized controlled trial. Period: April 2013 and October 2013. Material and Methods: Single center, after seeking appropriate ethical approval in our institution. Group allocation for loss of resistance and II was done by list schedulers independent to the knowledge of trial, operating list become available to research team on the day of procedure. Fifty-five patients were included in each group. A single clinician performed all procedures and the same combination of local anaesthetic and steroid were injected in all patients. Preoperative and postoperative visual analogue score (VAS) and Oswestry Disability Index (ODI) were obtained for each patient. Conclusions: There is a better outcome demonstrated in both injection groups when compared with control. The post-operative scores did not statistically differ significantly between fluoroscopic and loss of resistance groups. The final results of this trial question the efficacy and cost effectiveness of epidural injections using image intensifier and may be used as a reference to change the current practice within several hospitals as cost saving measure. Level of Evidence: 1.

The efficacy of liposomal bupivacaine compared with traditional peri-articular injection for pain control following total knee arthroplasty: an updated meta-analysis of randomized controlled trials

BackgroundThe efficacy of postoperative pain management is an important factor that influences the final outcome of total knee arthroplasty (TKA). Whether liposomal bupivacaine offers better efficacy compared with traditional peri-articular injection after TKA remains inconclusive. We conduct this study to compare the true efficacy of liposomal bupivacaine (LB) with traditional peri-articular injection (TPAI) following TKA.Materials and methodsRandomized controlled trials (RCTs) from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science were searched. Thirteen RCTs involving 1373 patients were finally included in our meta-analysis (LB = 691, TPAI = 682). The continuous and dichotomous outcome were collected in a standard form, and the data were analysed by using Review Manager 5.3 software. Finally, the results were presented in the forest plots.ResultThe pooled data demonstrated that the postoperative visual analogue score (VAS) in the LB group was not significantly different compared with that in the TPAI group at every time period after TKA. The liposomal bupivacaine group had significantly lower consumption of morphine equivalents 24 to 72 h postoperatively and reduced incidence of nausea and vomiting after TKA compared with the TPAI group. Finally, the length of hospital stay in the two groups was not significantly different.ConclusionLiposomal bupivacaine did not yield different results on the visual analogue scale compared with traditional peri-articular injection after total knee arthroplasty. However, liposomal bupivacaine was preferred in terms of lower consumption of morphine equivalents 24–72 h postoperatively and lower incidence of nausea and vomiting after total knee arthroplasty.

A comparative study of microdebrider assisted versus conventional endoscopic sinus surgery for nasal polyposis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal polyps are benign, chronic, inflammatory lesions arising from the mucosa of the nasal sinuses or from the mucosa of the nasal cavity. They are a challenge to treat due to their uncertain etiology and tendency to recur. Therapy involves both medical and surgical treatment. Surgical management includes Endoscopic sinus surgery using conventional instruments or by microdebrider.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted a study on 80 patients with nasal polyposis in whom conservative management failed. They were equally randomised into powered and conventional instruments Endoscopic Sinus Surgery (ESS) groups. The groups were compared for surgical outcomes, intra and postoperative complications and recurrence rates. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Age of patients suffering from bilateral nasal polyposis ranged from 18 to 55 years with maximum number of patients in the group 31 to 40 years. Nasal polyps were more commonly seen in men (53.75%) than women (46.25%). Most common symptom experienced was nasal obstruction (100%), followed by olfactory disturbance in 88.7% and nasal discharge in 76.25%. There was statistically significant difference in operative time, blood loss and postoperative synechiae, with the microdebrider group showing better outcomes. There was no statistically significant difference in the postoperative VAS (visual analogue score) and recurrence rates between the two groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Powered endoscopic sinus surgery offers a better therapeutic approach for patients with nasal polyposis than with conventional instruments. It provides bloodless operative field with better visualisation for a more precise, less traumatic procedure with shorter operative time.&lt;/p&gt;

Is There a Correlation Between Preoperative or Postoperative Vitamin D Levels with Pseudarthrosis, Hardware Failure, and Revisions After Lumbar Spine Fusion?

Vitamin D deficiency is a well-known cause of postoperative complications in patients undergoing orthopedic surgery. Orthopedic complications seen in vitamin D deficiency include nonunion, pseudarthrosis, and hardware failure. We seek to investigate the relationship between vitamin D deficiency and outcomes after lumbar spinal fusions. A retrospective patient chart review was conducted at a single center for all patients who underwent lumbar spinal fusions from January 2015 to September 2017 with preoperative or postoperative vitamin D laboratory values. We recorded demographics, social history, medications, pre-existing medical conditions, bone density (dual-energy x-ray absorptiometry) T-scores, procedural details, 1-year postoperative Visual Analog Score (VAS), documented pseudarthrosis, revisions, and hardware failure. A total of 150 patients were initially included in the cohort for analysis. Overall, preoperative and postoperative vitamin D levels were not significantly associated with a vast majority of the patient characteristics studied, including comorbidities, medications, or surgical diagnoses (P > 0.05). Age at surgery was significantly associated with vitamin D levels; older patients had higher serum levels of vitamin D both preoperatively (P= 0.03) and postoperatively (P= 0.01). Those with a higher average body mass index had lower vitamin D in both groups (P= 0.02). Vitamin D levels were not significantly associated with rates of postoperative pseudarthrosis, revision, or hardware complications (P > 0.05). VAS pain score at 1 year and smoking status preoperatively or postoperatively were not associated with vitamin D levels (P > 0.05). Both preoperative and postoperative vitamin D levels were not significantly associated with an increased or decreased risk of pseudarthrosis, revision surgery, hardware failure, or 1-year VAS pain score after lumbar spine fusion surgery.

Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report

BackgroundCompared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH).MethodsFour patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation.ResultsThe average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative.ConclusionThis is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure.Trial registrationNumbers: ChiCTR1800016383. Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.

Effects of Mobilization Time on Occurrence of New Fractures after Vertebroplasty.

Introduction Osteoporotic vertebral fracture treatment options include vertebroplasty, in which development of new fractures is among the possible complications which may develop during the postoperative period. We aim to evaluate whether or not postoperative mobilization time has effect on occurrence of new fractures. Materials and Methods A total of 126 patients, consisting of 30 (39.7%) males and 96 (60.3%) females, who underwent sedation-assisted vertebroplasty under local anesthesia between January 2014 and June 2017 were retrospectively evaluated. Preoperative and postoperative visual analogue scores (VASs) and mobilization time (hours) were assessed. Day of new fracture occurrence during follow-up was assessed. Results The mean follow-up period was 9 months (7–13 months). The most common fracture segment was the L1 vertebra (15.9%). The preoperative VAS was 8.29 ± 0.95, and the postoperative VAS was 2.33 ± 0.91. The change in VAS was statistically significant (p=0.01, p < 0.05). Of all the patients, 21 (16.66%) had developed new fractures. No statistical difference was observed between mobilization time (hours) and formation of new fractures (p=0.48, p > 0.05). Conclusion We came to the conclusion that mobilization time (hours) was not a risk factor in the development of new fractures. In addition, there is no relationship between mobilization time and localization of new fractures.

Outcomes of Core Decompression with or without Nonvascularized Fibular Grafting in Avascular Necrosis of Femoral Head: Short Term Followup study.

Background:Avascular necrosis (AVN) of the femoral head usually occurs in the third to fifth decade. The treatment options depend on the stage of disease varying from nonoperative treatment to surgical procedure including core decompression (CD) with or without nonvascularized or vascularized fibular graft, muscle pedicle bone grafting, osteotomies, and arthroplasty. Finite life of the total hip arthroplasty (THA) prosthesis limits its use in young adults or in middle aged. In this study, we envisage to evaluate the clinicoradiological outcomes of CD and nonvascularized fibular grafting in early stages of AVN femoral head.Materials and Methods:Our study is longitudinal observational study including 76 hips (46 patients) in the age group of 18–48 years (mean 30.07 years). Ficat and Arlet staging system was used and only early stages, that is, Stage 1 (n = 36 hips) and Stage 2 (n = 40 hips) were included in the study. The cases with traumatic AVN were excluded. All patients in Stage 1 underwent CD (Group 1) and those in Stage 2 underwent CD and fibular grafting (Group 2). Preoperative Harris Hip Score (HHS), visual analog score (VAS), plain radiographs, and magnetic resonance imaging (MRI) were compared with serial postoperative HHS, VAS, plain radiographs, and MRI taken at different intervals.Results:Average period of followup was 53.5 months (44–63 months). Radiological progression was not seen in 55 hips out of 76 hips (72.3%), whereas 21 hips (27.6%) demonstrated signs of progression and collapse. Failure of surgery was defined as progression of the disease, which was 25% (n = 9) in Group 1and 30% (n = 12) Group 2. Median values of HHS at the end of the followup in Group 1 was 77 and in Group 2 was 71.5 compared to the preoperative HHS of 48 and 62 in Group 1 and 2, respectively. Median values of VAS at the end of the followup in Stage 1 was 0 and in Stage 2 was 2 compared to the preoperative VAS of 6 and 8 in Group 1 and Group 2, respectively.Conclusion:CD with or without fibular grafting is effective in preserving the sphericity of the femoral head and to delay the progression of the AVN of femoral head in the early stages, that is, Stage 1 and Stage 2 and aids in the early revascularization of ischemic femoral head and is a useful modality to negate or delay the requirement of THA.

The Safety Profile of Percutaneous Minimally Invasive Sacroiliac Joint Fusion.

Study Design:Literature review.Objectives:Systematic review of the existing literature to determine the safety of minimally invasive (MI) sacroiliac (SI) joint fusion through the determination of the rate of procedural and device-related intraoperative and postoperative complications.Methods:All original studies with reported complication rates were included for analysis. Complications were defined as procedural if secondary to the MI surgery and device related if caused by placement of the implant. Complication rates are reported using descriptive statistics. Random-effects meta-analysis was performed for preoperative and postoperative Visual Analog Score (VAS) pain ratings and Oswestry Disability Index (ODI) scores.Results:Fourteen studies of 720 patients (499 females/221 males) with a mean follow-up of 22 months were included. Ninety-nine patients (13.75%) underwent bilateral SI joint arthrodesis resulting in a total of 819 SI joints fused. There were 91 reported procedural-related complications (11.11%) with the most common adverse event being surgical wound infection/drainage (n = 17). Twenty-five adverse events were attributed to be secondary to placement of the implant (3.05%) with nerve root impingement (n = 13) being the most common. The revision rate was 2.56%. MI SI joint fusion reduced VAS scores from 82.42 (95% confidence interval [CI] 79.34-85.51) to 29.03 (95% CI 25.05-33.01) and ODI scores from 57.44 (95% CI 54.73-60.14) to 29.42 (95% CI 20.62-38.21).Conclusions:MI SI joint fusion is a relatively safe procedure but is not without certain risks. Further work must be done to optimize the procedure’s complication profile. Possible areas of improvement include preoperative patient optimization, operative technique, and use of intraoperative real-time imaging.

Microsurgical Experience with Pedicle-Sparing Transfacet Approach for Thoracic Disk Herniation.

Thoracic disk herniation (TDH) is relatively uncommon. The surgical approach differs from lumbar or cervical disk herniations because serious complications are associated with the posterior approach in TDH. Various different approaches have been tried for the surgical removal of TDH, but most of them are cumbersome surgeries such as thoracotomy or thoracoscopic or anterior approaches with or without instrumentation. The requirement for a simplified, familiar, and less morbid surgery has motivated some new approaches. A pedicle-sparing transfacet approach (PSTA) was first described in 1995, but to date no sufficient clinical series has been presented in the literature to report on its feasibility and applicability along with complication and morbidity rates. Our objective was to assess the feasibility of the PSTA under microscopic visualization in a cumulative clinical series. Twenty-eight consecutive patients with no response to medical/physical treatment with and without motor weakness of their lower extremities underwent the surgery for TDH via the PSTA under microscopic visualization by a senior neurosurgeon. Preoperative and postoperative low extremity muscle strength, sensation, reflex status, and visual analog scores (VAS), Nurick grades, and complications were recorded. Postoperative MRI within 24 hours was performed. The median follow-up period was 33 months. The patients consisted of 16 men and 12 women. The disk levels ranged from T8 to T12-L1. All but one patient received one-level surgery. One patient was operated on two levels. A total of 21 patients had paracentral disk herniations; the other 7 had central disk herniations. Postoperative MRI showed satisfactory removal of disk herniation in all but one patient. There was no infection, wrong level surgery, or incidental durotomy. Median VAS levels significantly improved after the operation from 7.4 to 2.3. The Nuric grades decreased from 2.7 to 1.6 after surgery. The microsurgical PSTA is a safe and feasible technique with a significantly shorter surgeon's learning curve. The approach offers a wide surgical window; moreover, it can by increased by tilting the surgical table allowing satisfactory decompression of TDH. After PSTA, segmental instrumentation is not required.

Evaluation of percutaneous endoscopic lumbar discectomy: a prospective case series

Introduction Lumbar discectomy is one of the most common operations performed worldwide for lumbar-related symptoms. During the latter half of the 19th century, more techniques were developed to remove the herniated disc with minimal invasiveness. The first herniated disc excision using a microscope (microdiscectomy) was performed by Yasargil in 1977. In 1993, Mayer and Brock and then, in 1997, Smith and Foley described endoscopic discectomy techniques. With these minimally invasive techniques, the authors demonstrated decreased soft tissue manipulation, operative time, blood loss, and hospital stay, allowing early recovery. Objective The objective of this study was to evaluate clinical, functional, and surgical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). Patients and methods This study is a clinical prospective case series conducted from December 2016 to May 2018; 15 patients who presented with single-level, posterolateral, L4-5 or L5-S1 LDHs underwent PELD within a mean follow-up period of 10.6 months. The procedure was evaluated by the duration of the procedure, blood loss, time of hospital stay, preoperative and postoperative visual analog score (VAS) of low back pain (LBP) and radicular pain (RP) and patient satisfaction according to modified MacNab's criteria. Results There were 10 male patients and five female patients with the mean age of 35.9 years. The mean amount of intraoperative bleeding was 98.67 ml. The mean operative time was 124 min. The mean postoperative hospital stay was 33.6 h. The mean preoperative VAS of LBP was 6.13 and that of RP was 6.73. Postoperatively, the mean VAS of LBP became 1.6 and that of RP was 1.6. Patient satisfaction score according to modified MacNab's criteria was excellent in 80% and good in 20%. Conclusion PELD appears to be an effective intervention for LDH, as it has a small amount of intraoperative blood loss, short postoperative hospital stay, and good clinical and functional outcomes. It needs more training, as it has a long learning curve.

Thoracoscope and thoracotomy in the treatment of thoracic trauma.

Objective:To compare clinical effects of thoracoscopic surgery and thoracotomy in the treatment of thoracic trauma.Methods:Two hundred and fourteen patients with thoracic trauma were randomly divided into a control group and an observation group, 107 in each group. The control group was treated with conventional thoracotomy, while the observation group was treated with thoracoscopic surgery. The operation-related indications, hospitalization, postoperative complications and inflammatory factor level were observed and compared between the two groups. The study was conducted from April 2016 to February 2018.Results:The duration of operation of the observation group was shorter than that of the control group, the amount of bleeding during operation of the observation group was less than that of the control group, and the postoperative visual analogue score (VAS) of the observation group was lower than that of the control group; the difference were statistically significant (P<0.05). The hospitalization time, time of off-bed activity and time of resuming daily life of the observation group were shorter than those of the control group, and the amount of drainage fluid of the observation group within 24 hours after operation was less than that of the control group; the differences had statistical significance (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The levels of C-reactive protein (CRP), tumor necrosis factor (TNF)-a and interleukin (IL)-6 in both groups after surgery were higher than those before surgery, but the indicators in the observation group were lower than those in the control group (P<0.05).Conclusion:Thoracoscopic surgery can reduce pains of patients, speed up recovery, and reduce incidence of surgical infection in the treatment of thoracic trauma. It is a safe and effective treatment method, which is worth clinical application.

Effect of Single-Dose Dexmedetomidine on Intraoperative Hemodynamics and Postoperative Recovery during Pediatric Adenotonsillectomy.

Background:In children undergoing adenotonsillectomy, smooth recovery from anesthesia without any respiratory compromise and excessive sedation or pain is always desirable. In this placebo-controlled study, we examined the effect of single dose of dexmedetomidine on intraoperative hemodynamics and postoperative recovery profile such as emergence agitation (EA), pain, and sedation in children undergoing adenotonsillectomy.Methods:Sixty American Society of Anesthesiologists I or II children in the age group of 5–10 years, undergoing adenotonsillectomy were randomly assigned to receive dexmedetomidine 1 μg/kg (Group D) or volume-matched saline (placebo) (Group C), 10 min before induction of anesthesia. Intraoperative heart rate (HR) and mean blood pressure (MBP), duration of surgery, time to extubation, EA using Paediatric Anaesthesia Emergence Delirium (PAED) scale, level of sedation in postanesthesia care unit using Ramsay sedation score (RSS), and postoperative visual analog score (VAS) for pain were recorded and compared.Results:Dexmedetomidine group had lower HR and stable MBP, compared to the control group (P < 0.05). Postoperatively, the agitation score (PAED scale score) was statistically lower in Group D compared to Group C (13.84 ± 1.39; median 14 in Group C vs. 9.37 ± 1.33; median 9.5 in Group D; P < 0.001). All patients in Group C had PAED scale score >12, while only 6.67% of patients in Group D had PAED scale score of 12. The patients in Group D had higher RSS (2.62 ± 0.49 in Group D vs. 1.60 ± 0.50, P = 0.004); none of the patients were excessively sedated or had RSS >3. No significant difference was found in VAS score of the groups at all times, except at 0 h (P = 0.002). Time to extubation was significantly longer in the dexmedetomidine group (7.70 ± 1.62 min in Group D vs. 5.23 ± 1.91 min in Group C; P = 0.001).Conclusion:Premedication of dexmedetomidine at the dose of 1 μg/kg in children undergoing adenotonsillectomy resulted in favorable effect on intraoperative hemodynamics, significant decrease in postoperative EA without causing any excessive sedation, desaturation, or any other drug-related adverse events.

Percutaneous Endoscopic Lumbar Discectomy versus Conventional Open Discectomy: A Prospective Randomized Comparative Trial

Introduction: The majority of series considered the conventional open discectomy as the gold standard for the treatment of lumbar disc prolapse. Despite of the popularity of the lumbar endoscopic discectomy nowadays, many neurosurgeons still prefer conventional open discectomy. Purpose: Our study has been designed to compare between percutaneous endoscopic lumbar discectomy and conventional open discectomy; regarding surgical results, complications, clinical and functional outcomes. Patients and Methods: This study is a clinical prospective randomized controlled trial conducted upon 30 patients suffering from prolapsed lumbar disc, from December 2016 to May 2018. Those patients were divided randomly into 2 groups, 15 patients each. One group treated by percutaneous endoscopic interlaminar lumbar discectomy (PELD) and the other group treated by conventional open discectomy (COD). Operative time, wound size, Intraoperative blood loss, Intraoperative complications, postoperative hospital stay, Postoperative complication and the results of visual analogue score (VAS) and modified MacNab’s criteria were assessed. Results: This study included 30 patients (18 males and 12 females). The mean age was about 35 years. Although, there was postoperative improvement of the VAS and MacNab’s criteria in the two groups, there was no statistically significant difference between the preoperative and postoperative VAS of low back pain and radicular pain for the two groups in the follow up period. Conclusion: Both techniques give good results for patients; each technique has some advantages over the other.

Treatment of senile spinal tuberculosis with posterior percutaneous pedicle screw fixation combined with local percutaneous endoscopic debridement

To explore the short-term efficacy of posterior percutaneous screw fixation combined with local percutaneous endoscopic debridement in treating senile spinal tuberculosis. The clinical data of 19 senile patients with spinal tuberculosis underwent surgical treatment from January 2015 to September 2016 were retrospectively analyzed. There were 13 males and 6 females, aged from 60 to 73 years old with an average of (66.2±4.0) years. All patients have been diagnosed with spinal tuberculosis prior to hospitalization with abscess, dead bone formation but no sinus, neurological symptoms, open surgical indications. All patients were treated with posterior percutaneous screw fixation combined with local percutaneous endoscopic debridement, and were given appropriate chemotherapy for 3 weeks preoperatively. Pre-and post-operative visual analogue score (VAS), Oswestry Disability Index (ODI), sagittal Cobb angle of lesion segment, erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) were analyzed. All the 19 patients successfully completed the operation and passed through the perioperative period safely. The operation method was unchanged during the operation. The average operation time was (153.2±14.0) min. Except for 1 patients who had delayed incision healing, other patients healed at I stage within 2 weeks after operation. All patients were followed up for 15 to 26 months with an average of (19.6±3.2) months.VAS, ODI, sagittal Cobb angle of lesion segment, ESR, CRP were decreased from preoperative(5.9±1.1) points, (80.9±4.0)%, (30.8±5.5)°, (79.6±14.4) mm/h, (56.9±9.5) mg/L to(1.8±0.9) points, (66.4±5.4)%, (15.9±2.5)°, (20.4±4.6) mg/L, (32.0±8.1) mm/h at final follow-up(P<0.05). Senile spinal tuberculosis have more complications and poor general body condition. Posterior percutaneous pedicle screw fixation combined with local percutaneous endoscopic debridement in treating the patients can reduce trauma, got satisfactory effect.