Preoperative Score Research Articles

Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: Secondary analysis of data from a randomised controlled trial

BackgroundThe aims were to assess whether a specific subgroup(s) of patients had a clinically significant benefit in their knee specific outcome or health-related quality of life (HRQoL) when undergoing robotic total knee arthroplasty (rTKA) when compared to manually performed TKA (mTKA). MethodsOne hundred patients were randomised to either rTKA or mTKA, 50 to each group, of which 46 and 41 were available for functional review at 6-months, respectively. Subgroup analysis was undertaken for sex, age (<67-years versus ≥ 67-years), preoperative WOMAC score (<40 versus ≥ 40) and EQ-5D utility (<0.604 versus ≥ 0.604). ResultsMale patients undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (mean difference (MD) 16.3, p = 0.011) at 2-months, function (MD 12.6, p = 0.032) and total score (MD 12.7, p = 0.030), and OKS (MD 6.0, p = 0.030) at 6-months. Patients < 67-years old undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 10.3, p = 0.039) at 2-months, and function (MD 12.9, p = 0.040) and total (MD 13.1, p = 0.038) scores at 6-months. Patients with a preoperative WOMAC total score of < 40 points undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 14.6, p = 0.044) at 6-months. Patients with a preoperative EQ-5D utility of <0.604 undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 15.5, p = 0.011) at 2-months. ConclusionPatients of male sex, younger age, worse preoperative knee specific function and HRQoL had a clinically significantly better early functional outcome with rTKA when compared to mTKA.

Preoperative factors associated with patient satisfaction after modified kinematically aligned total knee arthroplasty in varus knees

PurposeKinematically aligned-total knee arthroplasty (KA-TKA) has recently attracted significant interest because it delivers better clinical outcomes than mechanically aligned (MA)-TKA. However, the optimal preoperative factors that maximize the effectiveness of KA-TKA remain controversial. Therefore, we aimed to determine the preoperative factors that are appropriate for and might benefit from modified KA-TKA, based on patient-reported outcome measures (PROMs). MethodsThe relationships between postoperative satisfaction and other variables in 84 patients with varus-type osteoarthritis of the knee who underwent primary modified KA-TKAs were investigated using stepwise multiple regression analysis. Patients were assigned to groups that were satisfied or dissatisfied with their outcomes after KA-TKA according to the 2011 Knee Society Scores. The cutoff for preoperative advanced activities scores (AASs) for excellent satisfaction were determined by analyzing receiver operating characteristic (ROC) curves. The variables correlated with excellent satisfaction were identified using logistic regression models. ResultsA preoperative variable relevant to patient satisfaction was AAS (β ​= ​0.465). The results of the ROC curve analysis revealed eight optimal cut-offs for preoperative AASs that predicted excellent satisfaction, with a sensitivity and specificity of 0.700 and 0.625, respectively. Logistic regression analysis revealed that AASs significantly contributed to excellent patient satisfaction (odds ratio, 1.181; p ​= ​0.001). ConclusionsIndividuals who were highly active preoperatively were good candidates for KA-TKA. This modified kinematically aligned surgical technique can satisfy the demands of highly active patients.

Signal intensity of repaired posterior roots after transtibial pullout repair for medial meniscus posterior root tears in stable knees: Magnetic resonance imaging evaluations at 3 years postoperatively

BackgroundOnly a few studies have assessed signal intensity after pullout repair for medial meniscus posterior root (MMPR) tears (MMPRTs) based on mid-term magnetic resonance imaging (MRI) evaluations. Therefore, this study aimed to assess the quantitative signal intensity of repaired posterior roots over time, up to 3 years postoperatively, and the related factors. MethodsThis study included 36 patients who underwent pullout repair for MMPRTs and MRI examinations using the same MRI system. The signal intensity of the repaired posterior roots was quantitatively evaluated using the signal-to-noise quotient (SNQ). Medial meniscus extrusion (MME), the SNQ for MMPR, and clinical scores were assessed over 3 years postoperatively. ResultsMME progressed over time until 3 years postoperatively, and its progression during this period was 1.61 ± 1.44 mm. The SNQ for MMPR decreased over time until 3 years postoperatively, and the change in the SNQ from 3 months to 3 years postoperatively (ΔSNQ) was 2.69 ± 1.69. All clinical scores significantly improved (p < 0.001). ΔSNQ was significantly correlated with body weight (correlation coefficient = -0.424, p = 0.010) and body mass index (correlation coefficient = -0.330, p = 0.050). However, ΔSNQ was not significantly correlated with preoperative or postoperative clinical scores. ConclusionAfter pullout repair for MMPRTs, MME progressed to 3 years postoperatively. However, the signal intensity of the repaired posterior roots decreased, and clinical scores improved over time until 3 years postoperatively. Patient weight and body mass index were significantly correlated with the reduced signal intensity of the repaired posterior roots, suggesting that weight assessment in patients with MMPRTs is crucial.Level of evidence: IV.

Preoperative Risk Score for Mortality Within 3 Years of Visceral Segment Fenestrated Endovascular Aortic Repair

Preoperative Risk Score for Mortality Within 3 Years of Visceral Segment Fenestrated Endovascular Aortic Repair

Effect of Weighted Blanket Versus Traditional Practices on Anxiety and Pain in Patients Undergoing Elective Surgery: A Multicenter Randomized Controlled Trial.

Perioperative anxiety is common in surgical patients and linked to poor outcomes. This multicenter randomized controlled trial assessed the effect of the use of a warm weighted blanket on presurgical anxiety and pain, as well as postsurgical restlessness, nausea, and vomiting. Levels of anxiety and pain were measured in adult patients using a 100-point visual analog scale before elective surgery. Patients received either a warm weighted blanket (n=74) or a traditional sheet or nonweighted blanket (n=74). Patients in the intervention group had significantly lower preoperative anxiety scores (mean [SD]=26.28 [25.75]) compared to the control group (mean [SD]=38.73 [30.55], P=.008). However, the intervention had no significant effect on presurgical pain or postsurgical nausea, vomiting, or restlessness. These results suggest that weighted blankets reduce preoperative anxiety in adult patients.

Efficacy and safety of ultrasound-guided pulsed radiofrequency in the treatment of the ophthalmic branch of postherpetic trigeminal neuralgia

ObjectiveTo investigate the efficacy and safety of ultrasound-guided pulsed radiofrequency (PRF) targeting the supraorbital nerve for treating the ophthalmic branch of postherpetic trigeminal neuralgia.MethodsA retrospective cohort study was conducted involving patients who presented at the Department of Pain, Affiliated Hospital of Southwest Medical University from January 2015 to January 2022. The patients were diagnosed with the first branch of postherpetic trigeminal neuralgia. In total, 63 patients were included based on the inclusion and exclusion criteria. The patients were divided into the following two groups based on the treatment method used: the nerve block (NB) group (n = 32) and the PRF + NB group (radiofrequency group, n = 31). The visual analog scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) score, and pregabalin dose were compared between the two groups before treatment, 1 week after the procedure, and 1, 3, and 6 months post-procedure, and the complications, such as local infection, local hematoma, and decreased visual acuity, were monitored post-treatment.ResultsNo significant difference was found in terms of pretreatment age, sex, course of disease, preoperative VAS score, preoperative PSQI score, and preoperative pregabalin dose between the two groups (P &amp;gt; 0.05). The postoperative VAS score, PSQI score, and pregabalin dose were significantly decreased in both groups. Furthermore, significant differences were found between the two groups at each preoperative and postoperative time point (P &amp;lt; 0.05). The VAS score was lower in the radiofrequency group than in the NB group at 1, 3, and 6 months, and the difference was statistically significant (P &amp;lt; 0.05). The PSQI score was lower in the radiofrequency group than in the NB group at 1 week, 1, 3, and 6 months post-procedure, and the difference was statistically significant (P &amp;lt; 0.05). The dose of pregabalin was lower in the radiofrequency group than in the NB group at 1 week, 1, 3, and 6 months post-procedure, and the difference was statistically significant at 3 and 6 months (P &amp;lt; 0.05). After 6 months of treatment, the excellent rate of VAS score in the radiofrequency group was 70.96%, and the overall effective rate was 90.32%, which was higher than that in the NB group. The difference in the efficacy was statistically significant (P &amp;lt; 0.05).ConclusionPRF targeting the supraorbital nerve can effectively control the pain in the first branch of the trigeminal nerve after herpes, enhance sleep quality, and reduce the dose of pregabalin. Thus, this study shows that PRF is safe under ultrasound guidance and is worthy of clinical application.

Clinical efficacy and complications of MIS-TLIF and TLIF in the treatment of upper lumbar disc herniation: a comparative study

BackgroundThe optimal treatment modality for upper lumbar disc herniation remains unclear. Herein, we compared the clinical efficacy and application value of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and transforaminal lumbar interbody fusion (TLIF) for upper lumbar disc herniation. We aimed to provide new evidence to guide surgical decisions for treating this condition.MethodsWe retrospectively analyzed the clinical data of 81 patients with upper lumbar disc herniation admitted between January 2017 and July 2018, including 41 and 40 patients who underwent MIS-TLIF and TLIF, respectively. Demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared. We performed consecutive comparisons of visual analog scale (VAS) scores of the lumbar and leg regions, Oswestry disability index (ODI), Japanese Orthopaedic Association scores (JOA), and MacNab scores at the final follow-up, to assess clinical outcomes 5 years postoperatively.ResultsVAS scores of the back and legs were significantly lower in the MIS-TLIF than the TLIF group at 3 months and 1 year postoperatively (P < 0.05). Intraoperative bleeding and postoperative hospitalization time were significantly lower, and the time to return to work/normal life was shorter in the MIS-TLIF than in the TLIF group (P < 0.05). The differences in JOA scores and ODI scores between the two groups at 3 months, 1 year, and 3 years postoperatively were statistically significant (P < 0.05).ConclusionThe early clinical efficacy of MIS-TLIF was superior to that of TLIF, but no differences were found in mid-term clinical efficacy. Further, MIS-TLIF has the advantages of fewer medical injuries, shorter hospitalization times, and faster postoperative functional recovery.

The Comparison of the Results of Microfracture and Mosaicplasty in Talus Osteochondral Lesions.

This study aims to compare the mid-term functional outcomes of microfracture and mosaicplasty techniques in talus osteochondral lesions. This study consists of 47 patients with talus osteochondral lesions who underwent arthroscopic surgery. These patients were divided into two groups: microfracture (28 patients) and mosaicplasty (19 patients). The American Orthopedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate ankle function, and the Visual Analog Scale (VAS) score was used for pain assessment. The mean follow-up period was 26 months (range 10-36 months). It was determined that the mean preoperative AOFAS score of individuals in the mosaicplasty group was 38.84±2.83, and the postoperative AOFAS score was 78.79±3.91. A statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the mosaicplasty group (*t=33.756; p<0.001). The effect size for this difference observed in the mosaicplasty group was determined to be r=0.992 (large). Similarly, a statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the microfracture group (*t=28.152; p<0.001). The effect size for this difference observed in the microfracture group was determined to be r=0.983 (large). We believe that both treatment methods have similar positive effects on pain and ankle function. However, larger controlled studies with longer follow-up periods are needed to reach a definitive conclusion.

Effects of Chinese traditional five-element music intervention on postoperative delirium and sleep quality in elderly patients after non-cardiac surgery: a randomized controlled trial

BackgroundPostoperative delirium (POD) is a common neurologic disorder among elderly patients after non-cardiac surgery, which leads to various negative outcomes. Sleep disorder is considered an important cause of POD. The objective of this study was to investigate whether the Chinese traditional five-element music intervention could reduce POD by improving sleep quality in elderly patients undergoing non-cardiac surgery.MethodsA total of 132 patients aged 65 to 90 years who underwent non-cardiac surgery were randomized to two groups: the intervention (n = 60) and the control group (n = 63). Patients in the intervention group were subjected to the Chinese traditional five-element music intervention during the perioperative, while patients in the control group had no music intervention. POD was evaluated using the Confusion Assessment Method (CAM) in the first 5 days after surgery. The Richards‒Campbell Sleep Questionnaire (RCSQ) was used to assess subjective sleep quality. The levels of nocturnal melatonin and cortisol in saliva were measured on the preoperative and the first 2 postoperative days.ResultsThe incidence of POD within 5 days was 27.0% in the control group and 11.7% in the intervention group. Preoperative PSQI and MMSE scores were associated with POD. The RCSQ scores on the first postoperative day were significantly decreased in the two groups compared to the preoperative day. Compared to the control group, the RCSQ scores showed a significant improvement in the intervention group on the first postoperative day. Compared to the control group, the level of saliva melatonin in the intervention group showed a significant increase on the first postoperative day. However, there was no statistical difference in cortisol levels between the two groups.ConclusionsChinese traditional five-element music intervention decreased the incidence of POD in elderly patients who underwent noncardiac surgery via improving sleep quality, which may be associated with increased levels of melatonin.

Predicting who has delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage using machine learning approach: a multicenter, retrospective cohort study.

Early prediction of delayed cerebral ischemia (DCI) is critical to improving the prognosis of aneurysmal subarachnoid hemorrhage (aSAH). Machine learning (ML) algorithms can learn from intricate information unbiasedly and facilitate the early identification of clinical outcomes. This study aimed to construct and compare the ability of different ML models to predict DCI after aSAH. Then, we identified and analyzed the essential risk of DCI occurrence by preoperative clinical scores and postoperative laboratory test results. This was a multicenter, retrospective cohort study. A total of 1039 post-operation patients with aSAH were finally included from three hospitals in China. The training group contained 919 patients, and the test group comprised 120 patients. We used five popular machine-learning algorithms to construct the models. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and f1 score were used to evaluate and compare the five models. Finally, we performed a Shapley Additive exPlanations analysis for the model with the best performance and significance analysis for each feature. A total of 239 patients with aSAH (23.003%) developed DCI after the operation. Our results showed that in the test cohort, Random Forest (RF) had an AUC of 0.79, which was better than other models. The five most important features for predicting DCI in the RF model were the admitted modified Rankin Scale, D-Dimer, intracranial parenchymal hematoma, neutrophil/lymphocyte ratio, and Fisher score. Interestingly, clamping or embolization for the aneurysm treatment was the fourth button-down risk factor in the ML model. In this multicenter study, we compared five ML methods, among which RF performed the best in DCI prediction. In addition, the essential risks were identified to help clinicians monitor the patients at high risk for DCI more precisely and facilitate timely intervention.

Clinical effect of the modified pharyngeal flap of bilateral muscular rings in the treatment of moderate and severe velopharyngeal insufficiency

To introduce the modified pharyngeal flap of bilateral muscular rings(BMR), and to discuss the clinical effect of this operation in the correction of moderate and severe velopharyngeal insufficiency. The clinical data of 18 patients who underwent BMR surgery in the Department of Craniofacial Plastic and Aesthetic Surgery, School of Stomatology, The Fourth Military Medical University from May 2019 to July 2021 were retrospectively analyzed. There were 10 males and 8 females, with a median age of 8.5 years (aged from 5 to 34 years). The patients were diagnosed preoperatively with moderate to severe velopharyngeal insufficiency (velopharyngeal closure ratio<0.7). The results of nasopharyngoscopy and speech assessment were compared and analyzed before operation and at the follow-up 6 months after the operation to evaluate the changes in velopharyngeal function and speech. Eighteen patients underwent BMR, 4 patients had snoring (the symptom disappeared after a few weeks in 3 cases), and 2 patients had local erosion of the wound, which delayed healing. Postoperative nasopharyngoscopy showed that all patients achieved comparatively complete velopharyngeal closure, some patients got enhanced lateral pharyngeal wall motility, and all patients got active motility of posterior pharyngeal wall flap. The postoperative speech assessment was significantly improved compared with that before the operation. The preoperative median score was 9 (range 7-12), and the postoperative median score was 2 (range 0-4). The statistical analysis was performed by paired non-parametric Wilcoxon signed rank test, and the difference was statistically significant (P<0.001). BMR is a reliable method for the treatment of moderate and severe velopharyngeal insufficiency. This technique can achieve functional contraction of the full circumference of the ventilator while preserving the obstructive effect of the posterior pharyngeal wall flap, which is helpful to balance nasal ventilation and velopharyngeal closure and improve the velopharyngeal function of patients.

Analysis of weight loss, metabolism, and anti-reflux effect of sleeve gastrectomy combined with fundoplication as treatment of obesity complicated by gastroesophageal reflux disease

Objective: To explore the weight-loss, metabolism, and anti-reflux effect of laparoscopic sleeve gastrectomy combined with fundoplication (SGFD) as treatment of obesity complicated by gastroesophageal reflux disease (GERD) with the aim of identifying the best treatment for such patients. Methods: This was a retrospective cohort study. Relevant clinical data of 140 patients with obesity (body mass index≥30 kg/m2) complicated by GERD (confirmed by preoperative GerdQ score, gastroscope, upper gastrointestinal radiography, 24-hour pH monitoring of esophagus, and high-resolution esophageal manometry) who had undergone bariatric surgery in the Minimally Invasive Surgery, Hernia and Abdominal Surgery Department of the People's Hospital of Xinjiang Uygur Autonomous Region from January 2019 to February 2023 were collected. The participants were allocated to the following groups according to surgical procedure performed: sleeve gastrectomy group (SG group, 92 cases) versus SGFD (SGFD group, 48 cases). SGFD, a new type of anti-reflux weight loss surgery that achieves both anti-reflux and weight loss effects by a procedure involving "cutting first and then folding", was developed by our team. In this study, our main aim was to compare and analyze differences in outcomes between the SG and SGFD groups in terms of weight loss and improvements in metabolism and reflux 3 and 6 months postoperatively. Results: The 140 patients comprised 50 men and 90 women of average age 36.0±9.6 years and preoperative body mass index (BMI) (38.5±6.5) kg/m2. The average preoperative GERD score was 10.2±1.6. There were no significant differences in baseline characteristics between the SGFD and SG groups (all P>0.05). There were also no significant differences in postoperative hospital stay, intraoperative blood loss, or postoperative complications between the two groups (all P>0.05). However, the operation time was longer in the SGFD than SG group (137.5±10.5 minutes vs. 105.3±12.6 minutes, t=-15.131, P<0.001). Compared with preoperative values, fasting blood glucose, cholesterol, body mass, BMI, and GERD score were all lower 3 months postoperatively (all P<0.05). Six months postoperatively, triglyceride, uric acid, and DeMeester score were lower in the SGFD than SG group; however, the lower esophageal sphincter resting pressure was higher in the SGFD group (all P<0.05). There were no significant differences in weight loss indexes (body mass, BMI, percentage of excess body mass loss) or metabolic indexes (fasting blood glucose, triglyceride, cholesterol, and uric acid concentrations) between the SG and SGFD groups 3 and 6 months postoperatively (all P>0.05). However, anti-reflux indexes (GerdQ score, DeMeester score, and lower esophageal sphincter resting pressure) were all significantly better in the SGFD than SG group 6 months postoperatively (all P<0.05). Conclusion: Obese patients with GERD get good weight loss, metabolism improvement and anti-reflux effect after SGFD. SGFD is a safe and feasible surgical method, and its anti-reflux effect is better than SG at the 6th month after operation, so it is feasible.

Fluorescein-guided surgery in high-grade gliomas: focusing on the eloquent and deep-seated areas

PurposeThe vital function of eloquent and deep brain areas necessitates precise treatment for tumors located in these regions. Fluorescein-guided surgery (FGS) has been widely used for high-grade gliomas (HGGs) resection. Nevertheless, the safety and efficacy of utilizing this technique for resecting brain tumors located in eloquent and deep-seated areas remain uncertain. This study aims to assess the safety and extent of resection of HGGs in these challenging tumors with fluorescein and explore its impact on patient survival.MethodsA retrospective analysis was conducted on the clinical and radiological data of 67 consecutive patients with eloquent or deep-seated HGGs who underwent surgery between January 2020 and June 2023. Lacroix functional location grade was used to determine the eloquence of the tumors. The comparison between the fluorescence-guided surgery group (FGS, n = 32) and the conventional white-light microscopic surgery group (non-FGS, n = 35) included assessments of extent of resection (EOR), rates of gross total resection (GTR, 100%) and near-total resection (NTR, 99 to 98%), postoperative Neurologic Assessment in Neuro-Oncology (NANO) scores, overall survival (OS), and progression-free survival (PFS), to evaluate the safety and efficacy of fluorescein-guided technology in tumor resection at these specific locations.ResultsBaseline of demographics, lesion location, and pathology showed no significant difference between the two groups. GTR of the FGS group was higher than the non-FGS group (84.4% vs. 60.0%, OR 3.60, 95% CI 1.18–10.28, p < 0.05). The FGS group also showed higher GTR + NTR (EOR ≥ 98%) than the non-FGS group (93.8% vs. 65.7%, OR 7.83, 95% CI 1.86–36.85, p < 0.01). 87.0% of eloquent tumors (Lacroix grade III) in the FGS group achieved GTR + NTR, compared to 52.2% of control group (OR 6.11, 95% CI 1.50–22.78, p < 0.05). For deep-seated tumors, the rate of GTR + NTR in the two groups were 91.7% and 53.3%, respectively (OR 9.62, 95% CI 1.05–116.50, p < 0.05). No significant difference of the preoperative NANO score of the two groups was found. The postoperative NANO score of the FGS group was significantly lower than the non-FGS group (2.56 ± 1.29 vs. 3.43 ± 1.63, p < 0.05). Median OS of the FGS group was 4.2 months longer than the non-FGS group despite no statistical difference (18.2 months vs. 14.0 months, HR 0.63, 95% CI 0.36–1.11, p = 0.112), while PSF was found significantly longer in FGS patients than those of the non-FGS group (11.2 months vs. 7.7 months, HR 0.59, 95% CI 0.35–0.99, p < 0.05).ConclusionSodium fluorescein-guided surgery for high-grade gliomas in eloquent and deep-seated brain regions enables more extensive resection while preserving neurologic function and improve patient survival.

Effects of Elective Revision After Breast Reconstruction On Patient-Reported Outcomes.

There has been increasing emphasis on patient-reported satisfaction as a measure of surgical outcomes. While previous research has investigated factors influencing patient satisfaction following breast reconstruction, there are few studies on how patient satisfaction is impacted by revision procedures. The purpose of this study was to investigate whether elective revisions following breast reconstruction are significantly associated with changes in patient-reported outcomes and quality of life. A retrospective review was conducted of patients who underwent immediate autologous or alloplastic breast reconstruction at a single institution from 2015-2021. Patients were included if they had completed BREAST-Q pre-operatively, post-initial reconstruction, and post-revision procedures. Patients were excluded if they received adjuvant radiation or if they had previously undergone breast reconstruction procedures. The primary outcome measures were BREAST-Q domains. Demographic, clinical, and surgical variables were also analyzed. Of the 123 patients included for analysis, 61 underwent autologous breast reconstruction and 62 underwent alloplastic reconstruction. Mean age was 49.31 ± 11.58 years and BMI was 29.55 ± 5.63 kg/m2. 48 patients underwent no revision procedures and 75 patients underwent at least one revision. Between these two groups, there were no differences in age, BMI, complication rates, socioeconomic status, or pre-operative BREAST-Q scores. Patients reported significantly higher satisfaction with outcome after their first revision compared to after initial reconstruction alone (p=0.04). Autologous reconstruction patients who had at least one revision had significantly higher Satisfaction with Outcome (p=0.02) and Satisfaction with Surgeon (p=0.05) in the 2-year follow-up period compared to patients who had no revisions. Revision procedures following autologous breast reconstruction are associated with higher patient satisfaction with outcome. Further research should explore specific factors influencing patient decision-making regarding whether to undergo revisions.

Recurrence of sleep apnea in children after intracapsular coblation tonsillectomy: A comprehensive exploration of tonsil regrowth

ObjectivesSleep apnea is a prevalent issue in children, associated with significant morbidities such as cardiovascular and neurocognitive disorders. There is increasing interest in intra-capsular tonsillectomy by coblation (ICTC) as a method to address obstructive sleep apnea (OSA) in children. However, the literature remains controversial regarding the most effective intra-capsular tonsillectomy (ICT) technique with the least morbidity. Our current research extends a previous study that established the effectiveness and safety of ICTC, demonstrating rapid post-surgical recovery with minimal analgesic needs. This new investigation specifically focuses on long-term follow-up. Our aim is to assess tonsil regrowth and the risk of recurrence of OSA symptoms at a mean follow-up of 6.1 years post-surgery. By presenting the results of this extended study, our goal is to gain a better understanding of the long-term effectiveness of this surgical intervention in treating OSA in children. Thus, considering the initial benefits, we will also explore potential long-term implications. Materials and methodsThis research follows up on children from our previous study who underwent ICTC, with or without adenoidectomy, for OSA resulting from tonsillar hypertrophy at a tertiary-level university hospital between March 2016 and March 2018. They were followed up for an average of 6.1 years postoperatively. Symptom recurrence is assessed by comparing preoperative OSA-18 questionnaire results with those obtained at the 6.1-year mark. Tonsil regrowth is evaluated by comparing preoperative Brodsky scores with those obtained at 6.1 years. ResultsThe mean total score of OSA-18 significantly decreased from 79.41 (SD = 14.95) before ICTC to 25.47 (SD = 8.92) at 6.1 years postoperatively (p < 0.001, mean difference = 53.94, 95 % CI [50.32, 57.56]). Similarly, the mean Brodsky score dropped from 2.95 (SD = 0.51) before ICTC to 1.04 (SD = 0.24) 6.1 years postoperatively (p < 0.001, mean difference = 1.92, 95 % CI [1.80, 2.04]). The overall regrowth rate was 2.35 % (n = 2), with a revision surgery rate of 1.18 % (n = 1). ConclusionICTC exhibits minimal risk of tonsil regrowth and maintains long-term efficacy in preventing the recurrence of OSA symptoms. Therefore, it justifies broader utilization in addressing OSA symptoms arising from tonsillar hypertrophy in children.

Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusions Using a Titanium Cage with a Biomimetic Surface.

We analyzed clinical and radiographic outcomes in patients undergoing anterior lumbar interbody fusions (ALIFs) using a new biomimetic titanium fusion cage (Titan nanoLOCK interbody, Medtronic, Minneapolis, Minnesota, United States). This specialized cage employs precise nanotechnology to stimulate inherent biochemical and cellular osteogenic reactions to the implant, aiming to amplify the rate of fusion. To our knowledge, this is the only study to assess early clinical and radiographic results in ALIFs. We conducted a retrospective review of data for patients who underwent single or multilevel ALIF using this implant between October 2016 and April 2021. Indications for treatment were spondylolisthesis, postlaminectomy syndrome, or spinal deformity. Clinical and radiographic outcome data for these patients were collected and assessed. A total of 84 patients were included. The mean clinical follow-up was 36.6 ± 14 months. At 6 months, solid fusion was seen in 97.6% of patients. At 12 months, solid fusion was seen in 98.8% of patients. Significant improvements were seen in patient-reported outcome measures (PROMs; visual analog scale and Oswestry Disability Index) at 6 and 12 months compared with the preoperative scores (p < 0.001). One patient required reoperation for broken pedicle screws 2 days after the ALIF. None of the patients required readmission within 90 days of surgery. No patients experienced an infection. ALIF using a new titanium interbody fusion implant with a biomimetic surface technology demonstrated high fusion rates (97.6%) as early as 6 months. There was significant improvement in PROMs at 6 and 12 months.

CO2 laser in benign vocal fold lesions: an observational study

BackgroundTo evaluate the clinical and functional outcome of patients having benign vocal fold lesions who were treated with carbon dioxide laser.MethodsFor this Study a total of 41 Patients who had hoarseness of voice and satisfied the inclusion criteria were included. A detailed medical history and a thorough ENT examination was performed. Voice evaluation was done using (G)rade, (R)oughness, (B)reathiness, (A)sthenia….weakness (S)train (GRBAS), voice handicap index (VHI), and maximum phonation time scores.ResultsAll 41 patients reported hoarseness of voice as their primary complaint, and most of them developed their symptoms gradually. The following causes seem to have contributed to the presence of hoarseness of voice: LPR in 8 patients, smoking in 25 patients, voice abuse in 14 patients, and irritation exposure in 6 patients. The most frequent lesion in 25 (60.97 percent) of the subjects was a vocal polyp. This study showed majority of patients 35 (85.4%) had posterior phonatory gap and six (14.6%) had anterior gap preoperatively. All patients had incomplete glottic closure preoperatively, whereas glottic closure was complete at first follow-up postoperatively. The mean preoperative GRBAS score in study subjects was 10.972 with an SD (standard deviation) of 2.1724 and a median of 10.000. The mean postoperative GRBAS score at six months was 0.268 with an SD of 0.4486, median 0.000, Z score − 5.618, and p value < 0.001 which is statistically significant.ConclusionPrecision, hemostasis, and minimal postoperative edema are benefits of using carbon dioxide laser. This research therefore supports the idea that benign vocal fold lesions might be successfully treated with the super-pulsed microspot carbon dioxide laser, which offers good voice outcomes.

Demographic, pain, and quality of life factors in unilateral and bilateral total knee arthroplasty

BackgroundThe Alberta Bone and Joint Health Institute (ABJHI) has a comprehensive registry capturing clinical, demographic, and patient-reported outcome measures on all knee arthroplasties performed in the province of Alberta, Canada. This large database provides an opportunity to study the outcomes of total knee arthroplasties (TKA) in patients who underwent unilateral or bilateral procedures. MethodsPain and quality of life outcomes of 29,157 TKAs performed in 23,033 patients for knee osteoarthritis performed in Alberta, Canada from January 2013 to February 2020 were examined. This study: (1) investigates whether having both knees replaced results in better pain and quality of life outcomes than replacing only one knee (using multivariate analysis of variance) and (2) identifies if pain and quality of life outcomes impact the likelihood of needing surgery in the contralateral knee after a first TKA (using univariate and multivariate Cox proportional hazards models). Patient-reported outcomes were measured using questionnaires: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to assess knee pain, and the EuroQol-5D-5L (EQ-5D) to assess quality of life. ResultsPatients who had surgery on both knees had approximately 5% better WOMAC (pain) and EQ-5D (quality of life) questionnaire scores 12 months post-surgery than those who had surgery on only one knee. Additionally, for every 1-point higher pre-operative WOMAC pain score (i.e., less pain) there was a 1% decreased likelihood of undergoing a contralateral TKA compared to a 46% decreased likelihood per 1-point improvement in quality of life. Dementia, back pain, and hospital readmission were associated with a 68%, 17%, and 44% decreased likelihood of contralateral TKA respectively. By contrast, patients with obesity were 36% more likely to undergo bilateral TKA (p &lt; 0.05). ConclusionsPreoperative knee pain and quality of life play a statistically significant role in determining which patients undergo bilateral TKA. Additionally, bilateral TKA resulted in better patient-reported outcomes compared to unilateral TKA. Though clinical significance cannot be drawn from the low response rates for the patient-reported outcomes, these findings provide a basis for future research on patient-reported outcomes within the Canadian healthcare system.

Safety and feasibility of mini-open Wiltse approach in posterolateral lumbar stabilization and fusion: intra- and post-operative evaluation

BackgroundExpected operative challenges in minimally invasive spine surgeries as a result of restricted surgical field, unfamiliarity with surgical approaches and fear of complications are behind the preference of using traditional "open" spine surgery.ObjectivesTo evaluate the safety and feasibility of mini-open Wiltse approach in comparison with the conventional midline approach for posterolateral lumbar stabilization and fusion.Patients and methodsA retrospective comparative study conducted on 49 patients with low grade single level lumbar spondylolithesis who were surgically treated in our Department between May 2020 and May 2022. Patients who were surgically treated with traditional midline approach were included in group (A) and patients in whom the mini-open Wiltse approach was used, were assigned to group (B). The two groups were compared regarding various intra and postoperative parameters.ResultsGroup (A) included 27 patients (55.1%) operated upon with the classic midline approach and 22 patients (44.9%) were surgically treated using the Wiltse approach (group B). The mean patients' age (50.43 ± 5.538) years and L4-5 was the most commonly affected level (71.4%). The intra-operative parameters (operation time, blood loss and fluoroscopy time) showed significant lower results (P < 0.001) among patients of group (B). No cases in the group (B) required blood transfusion versus 5 cases in group (A) (P = 0.033). Postoperatively, the Oswestry Disability Index (ODI) and Visual analogue scale (VAS) scores were significantly improved in each group in comparison to the preoperative scores (P < 0.001). However, after 3 months the ODI score in group (B) was superior to that in group (A) (P = 0.045) and postoperative VAS score in group (B) was significantly improved compared to that in group (A) at discharge (P = 0.016), and also after 1 and 3 months (P < 0.001). Patients operated with Wiltse approach had a shorter duration of hospital stay but the difference was not statistically significant (P = 0.090).ConclusionsBecause of minimal trauma to the muscles and soft tissues, the mini-open Wiltse approach can be faster, safer and requires less recovery time as opposed to the classic midline approach.

The Comparison between Spinal Facet Joint Toothed Plate and Traditional Pedicle Screw-rod on Reduction of Thoracolumbar Fracture.

Thoracolumbar fractures are one of the most common fractures in clinical practice. Surgical intervention is recommended to restore spinal alignment or decompress the nerves when there are unstable fractures or neurological injuries. However, after excessive forward thrust force restoration, facet joint dislocation often occurs between the upper vertebra and the fractured vertebra, which usually leads to unsatisfactory reduction outcomes. Herein, we propose a novel spinal facet joint toothed plate to assist in fracture reduction. The purpose of this study is to evaluate the effectiveness of the new spinal facet joint toothed plate in preventing facet joint dislocation, and its advantages compared to traditional pedicle screw-rod decompression. A total of 26 patients in the toothed plate group and 93 patients in the traditional group who experienced thoracolumbar fracture with reduction were retrospectively included. Relevant patients' information and clinical parameters were collected. Furthermore, visual analogue scores (VAS) scores and Oswestry disability index (ODI) scores were also collected. Moreover, imaging parameters were calculated based on radiographs. Correlated data were analyzed by χ2 test and t test. All patients in this study had no postoperative complications. Postoperative VAS scores and ODI scores (p < 0.001) were statistically significant (p < 0.001) in both groups compared with preoperative scores and further decreased (p < 0.001) at final follow-up. In addition, the postoperative vertebral margin ratio (VMR) (p < 0.001) and vertebral angle of the injured vertebrae (p < 0.001) were significantly improved compared with the preoperative period. There were no significant differences in postoperative VAS scores and ODI scores between the two groups. However, toothed plate reduction significantly improved the VMR (p < 0.05) and vertebral angle (p < 0.05) compared with conventional reduction. Ultimately, the total screw accuracy was 98.72% (sum of levels 0 and I), with 100% screw accuracy in the segment related to the tooth plate in the tooth plate group. The dislocation rate was higher in the conventional group (6.45%) than in the new serrated plate repositioning group (0.00%). The facet toothed plate assisted reduction method prevents facet joint dislocation and improves fracture reduction compared to traditional reduction technique, hence it could be considered as a novel surgical strategy for thoracolumbar fracture reduction.