Preoperative VAS Research Articles

Bipedicle Advancement Flap for Skin Coverage after Digital Mucous Cyst Excision: A Retrospective Study of 18 Cases.

ObjectivesTo assess the clinical outcomes of using a bipedicle advancement flap to cover the skin defects after digital mucous cyst (DMC) excision.MethodsData for 15 patients (18 fingers) with DMC, admitted to the Department of Orthopaedics and Surgery of the Affiliated Zhongshan Hospital of Dalian University from January 2016 to January 2018, were analyzed retrospectively. This study included 4 men and 11 women, with a mean age of 64 ± 7.8 years (range, 47–77 years). A total of 5 cases involved the thumb, 4 involved the index finger, 5 involved ithe middle finger, and 4 involved the ring finger. Among a total of 18 digital mucous cysts, 7 cases were in the left hand and 11 were in the right hand. Approximately 77.8% of cases had osteophytes. The cysts ranged in size from 0.5–1.0 cm to 0.7–1.2 cm. All patients underwent cyst and osteophyte excision and a bipedicle advancement flap to cover the resultant defect. The same surgical procedure was applied to all patients. Postoperative flap survival, healing, and infection were evaluated. The preoperative and postoperative ranges of motion (ROM) of the distal interphalangeal (DIP) and thumb interphalangeal joints (TIPJ) were recorded. Postoperative patient satisfaction was assessed by the visual analog scale (VAS, 0–10) during follow‐up visits. The Shapiro–Wilk test was used to determine whether the data for the difference between the preoperative and postoperative ROM of the DIP/TIPJ were normally distributed or not. The homogeneity of variance was expressed as mean ± standard deviation. A paired t‐test was used to compare the preoperative and postoperative ROM of the DIP/TIPJ.ResultsThe patients were followed up for 20 ± 6.0 months (range, 12–36 months). All the flaps survived after surgery, and the incisions healed well. The sutures were removed 2 weeks postoperatively. No infections occurred and there was no cyst recurrence at follow up. After systemic physical therapy and functional exercises, the ROM of all the fingers was restored to the preoperative ROM by 1 month after surgery. The scores for patient satisfaction with surgery by means of the VAS were 8.5 ± 1.0 points, 2.8 ± 1.4 points, 2.0 ± 1.6 points, 1.5 ± 1.2 points, and 1.1 ± 1.3 points preoperatively, and 1, 3, 6, and 12 months postoperatively, respectively. The data for the difference between preoperative and postoperative VAS scores were normally distributed. There were significant differences between the preoperative and postoperative VAS scores. The preoperative DIP/TIPJ ROM was 71.7° ± 14.0°, and the postoperative ROM at 1, 3, 6, and 12 months were 69.3° ± 15.3°, 70.4° ± 12.7°, 71.5° ± 15.6°, and 71.8° ± 15.6°, respectively. The data for the difference between preoperative and postoperative ROM of the DIP/TIPJ were normally distributed. No difference was found between the preoperative and postoperative ROM.ConclusionThe bipedicle advancement flap provides a simple and effective technique for covering skin defects following DMC excision.

The effectiveness of cement augmentation in kyphosis correction of dynamically loaded osteoporotic vertebral fractures: A retrospective case series

BackgroundOsteoporotic fracture of vertebrae is the presentation of osteoporosis, in most elderly patients and treatment of these fractures aims in pain relief, correction of kyphosis and management of osteoporosis. The purpose of the study is to evaluate the clinical usefulness of cement augmentation and the ability of cement augmented vertebrae to withstand physiological axial load. Materials and methodsWe did a retrospective analysis of all patients (62 patients and 67 vertebrae) from 2015 to 2019 in whom a stand-alone percutaneous cement augmentation was done for primary osteoporotic vertebral fractures. The kyphotic angle (KA), wedge angle (WA) and anterior vertebral height (AVH) were measured in radiographs taken pre-operatively and post-operatively in slump sitting and supine position. The mobility of the vertebra was determined radiologically by the difference in KA, WA and AVH in two positions (slump sitting and supine) and were compared. Functional outcome was analyzed using VAS scores for back pain. ResultsThe mean age group was 67.66 + 11.49 years, with thoracolumbar region being the most commonly involved. There was a significant improvement in back pain scores post cement augmentation from a pre-operative VAS of 6.91 ± 1.7 to a post-operative VAS score of 1.74 ± 1.1. The kyphotic deformity parameters like KA, WA and AVH also improved post cement augmentation. The difference of KA, WA and AVH between sitting and supine position preoperatively were 4.85 ± 6.87degrees, 2.61 ± 6.35 degrees and 0.26 ± 0.47 cm. The difference of post-operative KA, WA and AVH in two different positions was 1.02 ± 0.76 degrees, 0.05 ± 0.21 degrees and 0.03 ± 0.04 and were statistically significant than pre-operative measurements. ConclusionThe cement augmentation technique in addition to pain relief, it also improves the kyphotic deformity of the fractured vertebrae. The kyphotic deformity correction achieved by the procedure remain sustained even in physiological axial loading of the cement augmented vertebra.

Patient-reported outcome measures in external and endonasal functional septorhinoplasty - A propensity score matching study.

Patient satisfaction after functional-aesthetic SRP (faSRP) is highly influenced by the cosmetic result of the surgical procedure. Studies that directly evaluate aesthetic success after external and endonasal faSRP are scarce. The objective of this prospective propensity score matching study was to compare patient-reported satisfaction regarding aesthetic perception following faSRP using the external and endonasal approach in a single-institution single-surgeon survey. Out of 161 patients operated by the senior author between October 2011 and March 2017, propensity score matching (PSM) computed 54 patients each following external (group 1) or endonasal faSRP (group 2). Patients reported their satisfaction with the aesthetic appearance of the nose on a visual analogue scale (VAS, 0-10) and five Likert scale questions using the Utrecht questionnaire three and twelve months after surgery. The mean preoperative VAS score of 3.46±1.06 improved significantly in all patients after faSRP to 4.54±0.38 (F(1.69;157.04)=634.01, p<0.001). The VAS increase did not show any correlation to the surgical approach (F(1;93)=1.12, p=0.293). The mean aesthetic sum score (5=low burden up to 25=high burden) improved significantly from 13.89±3.78 to 8.46±3.63 after three months (t(95)=14.021, p<0.001) and remained almost unchanged after 12months (8.10±3.76; t(98)=1.450, p=0.150) irrespective of the surgical approach (F(1,544;143,587)=0.126, p=0.829). Both the external and endonasal faSRP allowed for significant improvement in patient's aesthetic self-assessment of similar extent.

Ilizarov technique for severe knee flexion contracture in juvenile rheumatoid arthritis

Severe flexion contracture deformity of the knee joint is often found in patients with rheumatoid arthritis (RA), which severly limiting the walking ability. Total knee arthroplasty (TKA) is a good option, but it is difficult and complicated to perform TKA, especially for juvenile patients with severe flexion deformity. There are limited reports about management of severe knee flexion contracture (KFC) of RA with Ilizarov technique. The aim of this study was to retrospectively analyzed the results of Ilizarov technique for the juvenile rheumatoid arthritis (JRA) patients with severe knee flexion contracture (KFC). From March 2000 to October 2018, nine patients (15 knees) with severe knee flexion contracture (KFC) of JRA who underwent Ilizarov knee joint distraction technique were reviewed retrospectively. There were 4 male (6 knees), 5 female (9 knees) with an average age of 15 years old (12–19years old). However, 6 cases also had equinus deformity, whose foot and ankle joint distraction device were installed simultaneously. The mean preoperative KFC and ROM angle of the knee were 48.8 ​± ​16.7° (mean ​± ​standard deviation) and 41.6 ​± ​15.3°, respectively. Preoperative VAS score (Visual analogue score) and HSS score (hospital for special surgery knee score) were 7.7 ​± ​2.5 and 37.4 ​± ​11.2, respectively. The average time of follow-up was 47.6 ​± ​21.3 months. All the patients achieved full correction of flexion contracture at the end of distraction. At the last follow-up, the mean flexion degree and ROM were 12.1 ​± ​11.7° and 23.5 ​± ​19.3° respectively, which were significantly different compared with preoperative condition. The total duration of ring fixation application was 10–21 weeks, with an average time of 14.3 weeks. The mean VAS and HSS score at the last follow-up were 1.4 ​± ​1.2 and 71.5 ​± ​7.3, which were significantly improvement to the preoperative condition. There were no severe complications during treatment in this study. Pin tract infection occurred in 7 cases during the knee joint distraction and the infection were controlled after slowing down the distraction speed and wrapping with alcohol gauze at the interface between the fixing pin and the skin. Ilizarov method is an effective and safe procedure to treat severe KFC in JRA which can correct deformities, relieve pain and improve the function of weight bearing. Pin tract infection and knee joint stiffness and even fusion are common problems, but correction of deformity of the knee using Ilizarov technique has possible positive outcome for possible further surgery if necessary. Our study shows that Ilizarov knee joint distraction for treatment of severe KFC in JRA is effective and safe. It is concluded that this method offers a new option for juvenile rheumatoid arthritis.

Uniportal thoracic endoscopic decompression using one block resection technique for thoracic ossified ligamentum flavum technical report

IntroductionThere is paucity of literature on application of endoscopic spine surgery in thoracic spine for ossified ligamentum flavum. We aim to evaluate the clinical and radiological outcomes Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression Using One Block Resection Technique (TE-ULBD) for Thoracic Ossified Ligamentum Flavum in our cohort of patients. MethodsRetrospective evaluation performed for all patients who underwent TE-ULBD for thoracic ossified ligamentum flavum. Pre and postoperative parameters of axial cut spinal canal area in upper, middle and lower disc, VAS, ODI and JOA at preoperative, postoperative 1 week, 6 months and final follow up were compared. Results35 levels of TE-ULBD performed in 28 patients. The complication rate of TE-ULBD was 2.8%. In our TE-ULBD cohort there was significant clinical improvement in VAS, ODI and JOA score in postoperative 1 week, 6 months and final score. The mean difference as compared to preoperative VAS in postoperative final follow up 4.80, p < 0.05. The mean difference as compared final follow up (40.8), p < 0.05. The mean as compared to preoperative JOA in final follow up 2.57, p < 0.05. MacNab score showed 11 good and 17 excellent scores in 28 patients. There was significant statistical increase in decompression cross section spinal canal area (SCA) dimension in postoperative compared to preoperative MRI scan with mean increase of 1) upper disc 30.81 mm2, 2) middle disc 34.68 mm2 3) lower disc 26.18 mm2, p < 0.05. ConclusionUniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression Using One Block Resection Technique was able to achieve adequate spinal canal decompression with significantly improved pain, functional status and neurological recovery in our cohort of patients.

Clinical Analysis on the Treatment of Kaschin-Beck Disease of the End-Stage Ankle by Tibiotalocalcaneal Arthrodesis Using Lateral Approach With Platelet-Rich Plasma

Category:Ankle Arthritis; AnkleIntroduction/Purpose:Objective To study the effectiveness of treated Kaschin-Beck Disease of the ankle by tibiotalocalcaneal arthrodesis using lateral approach with autologous platelet-rich plasma.Methods:Retrospective analysis was conducted on the clinical effect of our department on the treatment of 23 patients (25 ankle joints) with severe Kaschin-Beck Disease from May 2014 to May 2016. All patients were treated with tibiotalocalcaneal arthrodesis by using lateral approach of fibula osteotomy with distal fibula cancellous bone combined with autologous platelet rich plasma for bone grafting and internal fixation with full thread cannulated screws or auxiliary lateral plate. Surgical time, blood loss, joint fusion time, delayed wound healing, infection, nonunion of osteotomy surface, chronic pain and other complications were recorded. VAS score and AOFAS ankle and hind foot score were compared before and at the last follow-up.Results:The mean healing time was 14.7 weeks. Postoperative wound healing was delayed in 3 patients. One patient developed superficial infection 1 week after surgery. Bone graft absorption, nonunion of osteotomy surface and loosening of internal fixation were observed in 2 patients. The bone healed at 13 weeks after surgery. 22patients were followed up for an average of 15.7 months. The postoperative AOFAS score was 76 points, and the postoperative VAS score was 2 points with statistically significant differences from the preoperative AOFAS (t=19.13, P<0.01) and VAS (t=17.27, P<0.01). In 21 cases, tibial calcaneal joint fusion was performed in the first stage, and the fusion rate was 87.5%.21 patients received the first stage of bone fusion after surgery, and the fusion rate was 87.5%.Conclusion:Ankle joint and subtalar joint can be well exposed through the lateral approach of fibular osteotomy. The distal fibula autograft with sufficient cancellous bone mass and the combination of autologous platelet rich plasma graft can promote bone healing, and the reliable internal fixation can help achieve satisfactory clinical effect of tibiotalocalcaneal arthrodesis.

Comparison of Outcomes of Cheilectomy with and without Synthetic Hydrogel Interposition (Cartiva®)

Category:Midfoot/Forefoot; OtherIntroduction/Purpose:Cheilectomy and arthrodesis are the primary surgical treatments of hallux rigidus. While cheilectomy preserves limited motion, that motion can be the source of persistent pain that later requires arthrodesis. Cheilectomy with interposition arthroplasty using a synthetic hydrogel implant (Cartiva) has been proposed as an alternative to arthrodesis. Previous studies compared Cartiva to arthrodesis, but Cartiva is really a modification of cheilectomy, meant to improve its results by distracting the bony surfaces of the first MTP joint. This study compared outcomes of cheilectomy with Cartiva to cheilectomy alone.Methods:A retrospective cohort study assessed the results at 1-year minimum follow-up, identifying patients by CPT code for cheilectomy with (28291) and without (28289) Cartiva interposition. There were forty-five patients: 26 in the Cartiva group and 19 in the cheilectomy group. Tabulated data included: age, gender; preoperative, 6-month, and final postoperative total first MTP ranges of motion (ROM); preoperative and final postoperative VAS and SF-36 scores; and reoperation information. Hallux rigidus grade was assessed by Coughlin and Shurnas criteria. First MTP joint space was measured at the medial, midline, and lateral portions of the joint on both AP and lateral radiographs before, immediately following, and at maximum postoperative follow-up (16 month mean). For analysis, medial, midline, and lateral joint measurements were averaged to generate a composite measure of radiographic joint space. Follow-up means were 23 months for all patients, 18 for Cartiva and 28 for cheilectomy.Results:Mean age was 54. Mean preoperative grade was 2.6 for Cartiva and 2.1 for cheilectomy (p=0.037). Mean preoperative ROM was 44°. At 1 year follow-up, ROM was 39° for Cartiva and 47° for cheilectomy (p=0.95). Mean VAS improved from 5.8 to2.0 and 3.0 for Cartiva and cheilectomy, respectively, at final follow-up (p=0.002, p=0.004). Following Cartiva, two week postoperative joint space means increased: AP midline 1.4 to 2.6 mm, AP composite 1.4 to 2.2 mm, and lateral midline 1.3 to 2.7 mm (p<0.001). At final follow-up, joint space measures returned to levels similar to cheilectomy: AP midline 1.3 vs. 1.2 mm, AP composite 1.1 vs. 1.2 mm, and lateral midline 1.6 vs. 1.2 mm (p>0.3). Five patients in each group (22%) underwent revision.Conclusion::Cartiva offers similar intermediate-term ROM preservation and pain relief as cheilectomy in a cohort with higher grade hallux rigidus. Joint distraction gained by synthetic hydrogel interposition subsides with time to levels similar to cheilectomy. Revision surgery for persistent pain is common in both groups.

Outcomes following Subchondroplasty in the First Metatarsal Head

Category:Midfoot/Forefoot; OtherIntroduction/Purpose:Patients with subchondral bone marrow lesions often present with arthritic symptoms causing severe discomfort. Recently, subchondroplasty has been offered to treat such patients who suffer from symptoms of bone marrow edema. Calcium phosphate is percutaneously injected into these edematous regions to stabilize damaged bone and aid in healing. Subchondroplasty has been used successfully in the knee for femoral and tibial plateau injuries. However, its use in foot and ankle orthopaedics is relatively limited. This procedure has shown short-term success in patients with painful edema of the talus, as well as patients with early stage avascular necrosis (AVN) in the second MTP joint and the cuboid. Here, we report outcomes of two patients who developed AVN as a result of subchondroplasty in foot and ankle surgery.Methods:A retrospective review of patients was performed in those patients who underwent subchondroplasty in their first metatarsal heads between January 2017 and April 2017. Exclusion criteria included patients lost to follow up. Following implementation of inclusion and exclusion criteria, two patient charts were reviewed. Patients were treated by a single surgeon at the same institution. Data collected included patient demographics (age, laterality, BMI, ASA class, comorbidities), preoperative and postoperative VAS scores, FAOS scores, and imaging. Patients were followed up in clinic for two years following the procedure. Data was then analyzed via mean, standard deviation, median, and range for continuous variables and counts with percentages for categorical data.Results:In both patients, VAS scores increased, and physical exam showed greater tenderness over the affected region. The corresponding MRIs showed development of avascular necrosis in the region of the first metatarsal joint where the subchondroplasty had occurred. Both patients consequently had to undergo revascularization procedures and required further operations to correct the condition.Conclusion:Ultimately, subchondroplasty over the first metatarsal head failed in our patients. Exposure to calcium phosphate exacerbated their condition, resulting in symptomatic AVN. Although literature for subchondroplasty in foot and ankle orthopaedics is limited, preliminary results are unfavorable for use in the first metatarsal joint. Therefore, more long term data needs to be gathered this area before implementing the procedure more widely in foot and ankle surgeries.

A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus

Category:AnkleIntroduction/Purpose:The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs.Methods:PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score.Results:There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures.Conclusion:The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up.

Return to Play after Arthroscopic Microfracture for Osteochondral Lesions of the Talus in Young Elite Athletes

Category:Ankle; ArthroscopyIntroduction/Purpose:The current scientific evidence for the clinical and sports-related outcomes of the surgical treatment of osteochondral lesions of the talus (OLTs) with arthroscopic microfracture (MF) in elite athletes is scarce. The purpose of curretn study is to evaluate the clinical outcomes and return to sports activity after arthroscopic MF for OLTs in elite athletes.Methods:The files of 41 elite athletes (mean age 19.34 +- 3.76 years) who had undergone arthroscopic MF for OLTs at our institution between January 2011 and September 2015 were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot and visual analog pain (VAS) score, time and rate of ‘return-to-competition’ (RTC, defined as return to an official match for at least one minute after treatment), and rate of ‘return- to-play’ (RTP, defined as participation in at least two entire seasons after treatment) were used to evaluate the outcomes. We compared athletes who were able to RTP (RTP-group) with those who were not (No-RTP group).Results:The mean follow-up was 54.9 +- 13.72 months. All five subscales of preoperative FAOS were significantly improved at the final follow-up. The mean preoperative AOFAS hindfoot score of 74.46 +- 8.10 improved to 91.62 +- 2.99 (P < 0.001) at the final follow-up. The mean preoperative VAS score of 5.44 +- 1.57 improved to 2.66 +- 1.04 (P < 0.001). All patients achieved RTC (100%) at mean time of 5.45 +- 3.18 months, and 74.4% of patients were able to RTP. The RTP-group showed significantly smaller lesions compared to the No-RTP group (71.52 +- 43.29 vs. 107.00 +- 45.28 mm2, P = 0.009). The cut-off OLT size for predicting RTP was 84.0 mm2, with a sensitivity of 90.0% and specificity of 75.9%.Conclusion:All athletes were able to RTC at average of 5.45 months after MF for OLTs, and 74.4% were able to RTP. The only prognostic variable for RTP was lesion size, and its predictive cut-off was 84 mm2.

Excisional Debridement for Chronic Achilles Insertional Tendinosis: Technique and Case Series

Category:Sports; AnkleIntroduction/Purpose:Operative treatment of chronic Achilles insertional tendinosis (AIT) involves tendon debridement, removal of the retrocalcaneal bursitis, and excision of the calcaneal exostosis, often followed by repair of the Achilles tendon and deep tendon transfer. The literature describes a variety of techniques without a single standard of care. The purpose of this study is to describe a novel approach for the treatment of chronic AIT and report clinical outcomes and complications of this technique.Methods:A retrospective review was performed of 57 patients with chronic AIT who were treated with the proposed surgical technique by a single surgeon from January 2015 through January 2019. Patient demographics, pain scores, functional outcome scores, and complications were reviewed. A telephone survey was also utilized to assess patient satisfaction. Following the breakdown of the data, comparisons of the preoperative scores were compared to the postoperative outcomes using Mann- Whitney U testing.Results:Preoperative VAS pain scores and VR-12 Physical scores were significantly improved at two year follow up. Additionally, patients described the outcome of their surgery as, ‘very good.’ Complications were also few and minimal. Three (5.3%) patients experienced superficial skin breakdown requiring return to the operating room and three (5.3%) developed postoperative cellulitis which responded to local care and oral antibiotics. There were no ruptures or record of recurrence of disease or pain.Conclusion:The technique described in this paper utilizes an excisional debridement of the central portion of the Achilles tendon in the shape of an apex superior triangle and therefore, does not require detachment of the tendon from its insertion on the calcaneus (Image 1). Functional outcome scores and pain significantly improved at two years follow up. Postoperative complications were similar to those previously reported with superficial wound breakdown being the most common. In conclusion, the authors encourage the use of this reliable, reproducible, and effective technique for the treatment of patients with chronic AIT.

Recurrent and persistent carpal tunnel syndrome: “Triple-therapy approach”

BackgroundVarious procedures have been described for patients undergoing a revision carpal tunnel release. These can include repeat open decompression with external or internal neurolysis, tenosynovectomy, endoscopic release, various flap techniques, saphenous vein wrapping and use of prosthetic implants. This study reports a case series of 30 consecutive patients who underwent revision carpal tunnel release at single institution from 2012 to 2018. Our surgical plan in all the patients involved a combination of these three techniques (triple therapy approach): neurolysis (external or internal) and tenosynovectomy, collagen matrix conduit wrap (NeuraWrap; Integra LifeSciences or Axoguard Nerve Protector, AxoGen Inc), and hypothenar fat flap. Materials and methodsA total of 30 patient records were identified. The index surgery was performed by a variety of surgeons at varied private institutions as well as the VA hospital. However, all of the revision interventions in this series were performed by the senior author (Z.J.P.). Demographic data (age, sex, hand dominance, comorbidities, alcohol, and smoking history) were collected. Preoperative and postoperative symptoms were recorded for all patients, including: subjective outcomes, need for additional surgery and complications. Mean VAS preoperatively and postoperatively were compared using a paired t-test. All statistical analyses were performed with SPSS 20 (IBM, Chicago, IL). ResultsPatient reported measures of resolution of symptoms and VAS scores documented at 3 months. Of the 30 patients who underwent surgery for persistent or recurrent carpal tunnel syndrome, symptoms resolved completely in 25 patients. 2 patients were lost to follow up. 3 patients showed no improvement. The mean preoperative VAS score was 4.37 and declined to 1.23 after surgery (P < .0001). ConclusionOur study demonstrates that a combination of neurolysis and tenosynovectomy along with a nerve wrap and hypothenar fat flap should be considered in patients presenting with recurrent or persistent carpal tunnel syndrome.

Percutaneous balloon kyphoplasty for the vertebral compression osteoporotic and pathological fracture: one-year retrospective study of 112 patients

Aim The aim of the study was to look for the effectiveness of percutaneous balloon kyphoplasty in the management of vertebral compression osteoporotic and pathological fracture. Methods A retrospective analysis of 112 patients with 198 symptomatic wedge vertebral compression fractures who were treated by percutaneous balloon kyphoplasty was done. Visual Analogue pain (VAP) scale, Oswestry Disability index (ODI) and Short Form (SF-36) were used to look for the outcome. Results Pre-operative median VAS score was (8.0, IQR 2.0) which decreased to (4.0, IQR 3.0) at 12 months. Pre-operative median ODI score was (66, IQR 22) which at 12 months follow up decreased to (28, IQR 31). Short-form 36 showed improvement in all quality of life sub-domains. The physical component summary (PCS) improved from 33.0 ± 5.0 to 37.4 ± 6.1. The Mental component summary (MCS) improved from 17.1 ± 8.6 to 23.5 ± 18.9. The results were statistically significant (p < 0.001). Conclusion Percutaneous balloon kyphoplasty alleviates pain and improves function, disability, and quality of life in osteoporotic and pathological fracture.

P106. Impact of predominant preoperative symptoms on outcomes of CDR

BACKGROUND CONTEXT Cervical pathologies can commonly present with both neck and radicular symptoms. Cervical disc replacement (CDR) is typically indicated in the treatment of radicular symptoms, though it has also been shown to improve neck pain. Its efficacy has yet to be studied between patients presenting with primarily neck, arm, or equivalent neck and arm pain. PURPOSE To assess whether predominant preoperative symptom has an impact on outcomes of CDR. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE A total of 107 patients who had undergone CDR by three surgeons at a single academic institution. OUTCOME MEASURES PROMs (NDI, neck/arm VAS, SF-12 PCS/MCS) were collected prospectively as standard of care preoperatively and at each follow-up (2wk, 6wk, 12wk, and 6mo). METHODS Based on predominant symptom, patients were divided into three groups: NECK (VAS Neck>VAS Arm,n=41), ARM (VAS Arm>VAS Neck,n=28), and NA (VAS Neck=VAS Arm,n=38). Differences in postoperative PROMs and change in PROMs from the preoperative time-point were compared using t-tests. RESULTS Compared to the ARM cohort (4.61±2.82), NECK (6.73±2.48; p=0.005) and NA (6.69±2.85;p=0.007) patients had significantly worse preoperative neck VAS scores, which is not unexpected as groups were created based on preoperative VAS. Although all three groups demonstrated significant improvement in neck VAS by 2wks, which was maintained until 6mo, NECK patients had significantly worse neck VAS than ARM patients at 2 weeks (p=0.020), 12 weeks (p=0.002), and 6 months (p=0.003), with no differences in the amount of improvement among the three groups at any time point. Compared to the NECK cohort (3.28±2.85), ARM (7.45±2.02; p CONCLUSIONS All three cohorts demonstrated significant improvement in NDI and neck VAS with no differences in the degree of improvement. All groups demonstrated improvement in arm VAS, with greater and earlier improvement seen in ARM and NA compared to NECK. All groups demonstrated improvements in PCS and MCS scores, with greater and earlier PCS improvement seen in ARM and earlier MCS improvement seen in NA. Overall, all groups showed improvement following CDR; however, the improvement in ARM and NA is greater and seen earlier compared to NECK. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

115. Preoperative factors associated with outpatient lumbar decompression surgery

115. Preoperative factors associated with outpatient lumbar decompression surgery

Tendoscopic management of posterior tibial tendinitis

Objective: The aim of this study was to present a case series of patients undergoing posterior tibial tendoscopy, assess their clinical outcome, and describe surgical findings and treatment complications. Methods: This is a clinical, retrospective, observational study of 11 consecutive cases of tenosynovitis of the posterior tibial tendon. All 11 patients underwent tendoscopy of the posterior tibial tendon. All procedures were performed by the same surgeon in 2 different hospitals. Minimum follow-up was 2 years. Results: All patients had their preoperative and postoperative AOFAS and VAS scores assessed. Both scores had an important improvement at 12 months that persisted at 24 months. Moreover, 72.72% of the patients were very satisfied with the procedure, and no patient reported to be dissatisfied. Additionally, 90.91% of the patients had no postoperative complications. The present results are consistent with those previously reported in the literature. Conclusion: Endoscopic or tendoscopic repair of the posterior tibial tendon is a simple and reproducible procedure that provides good functional and cosmetic outcomes with a low complication rate. It is important to increase the number of patients in this series in order to expand our conclusions. Level of Evidence IV; Therapeutic Studies; Case Series.

Outcome analysis of lumbar endoscopic unilateral laminotomy for bilateral decompression in patients with degenerative lumbar central canal stenosis

Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has been reported as an alternative treatment for degenerative lumbar central canal stenosis (DLCS). To investigate the outcomes of LE-ULBD for different types of DLCS, including simple DLCS, DLCS with degenerative spondylolisthesis (DSL), and DLCS with degenerative scoliosis (DSC). Prospective cohort study. One-hundred sixteen patients with DLCS who underwent LE-ULBD at a spine center from April 2015 to June 2017 were enrolled in this study. Operative time, postoperative duration of hospitalization, and clinical outcomes (Oswestry disability index [ODI], visual analog scale [VAS], and modified Macnab outcome scale), and adverse events. A comparative analysis was performed evaluating medical records, radiological studies, and patient reported outcomes including ODI score, VAS scores and modified Macnab outcome scales in patients who underwent LE-ULBD. Data were prospectively collected at preoperative, postoperative 3-, 6-, 12-, 24-month to assess clinical and radiological outcomes and complications. The study analyzed 106 patients (45 men and 61 women, with a mean age of 69.5 years); 40 (37.8%) had simple DLCS, 41 (38.7%) had DLCS with DSL, and 25 (23.5%) had DLCS with DSC. The mean follow-up period was 33.3 months. The mean preoperative and postoperative follow-up ODI score and VAS scores for leg and back pain showed significant improvement in all time points. No significant difference was found among different pathologies in terms of VAS scores for back and leg pain, ODI scores and modified Macnab outcome scales at all follow-up periods. LE-ULBD is a feasible treatment method for DLCS. It did not result in worse outcomes in cases with DLCS with DSL or DLCS with DSC as compared with cases with simple DLCS.

CT-Guided Percutaneous Trigeminal Tractotomy-Nucleotomy for Intractable Craniofacial Pain

Object: In this report, we aimed to analyze the outcome results of our patients who underwent percutaneous trigeminal tractotomy (TR) and nucleotomy (NC) procedures, which are defined as destructive procedures targeting the descending trigeminal tractus and nucleus caudalis of the spinal trigeminal nucleus, respectively, for intractable craniofacial pain. Methods: The medical records of a total of 12 patients who underwent a total of 14 computed tomography (CT)-guided TR-NC procedures at our clinics between 2005 and 2017 were retrospectively reviewed. Results: A significant increase in patients’ performance status (p = 0.015) as well as a significant decrease in the VAS score (p < 0.001) were achieved. Grade I pain relief (VAS = 0, no pain) was established in 66.7% of the patients, whereas grade II pain relief was observed in the remaining patients. Two of the patients suffered from recurrent pain after the initial procedure. Both patients underwent a second trigeminal TR-NC procedure, and grade I pain relief was re-established. The mean VAS score at 3-month follow-up was 1.4 ± 1.1, whereas this score at 6-month follow-up was 2 ± 1.3. The trigeminal TR-NC procedure resulted in a significant decrease in patients’ VAS scores at 3- and 6-month follow-up visits compared with preoperative VAS scores (p < 0.001). Transient ataxia was noted in only one patient (8.3%) early after the procedure. Conclusions: The results presented in the current study support the efficacy of the percutaneous CT-guided trigeminal TR-NC procedure in the management of intractable facial pain in selected patients. The use of CT guidance allows direct visualization of the target area, thereby enhancing the safety and success of the procedure.

The Outcomes of Patients With Neck Pain Following ACDF

Retrospective cohort study. The goal of the present study was to determine whether neck pain responds differently to anterior cervical discectomy and fusion (ACDF) between patients with cervical radiculopathy and/or cervical myelopathy. Many patients who undergo ACDF because of radiculopathy/myelopathy also complain of neck pain. However, no studies have compared the response of significant neck pain to ACDF. Patients undergoing one to three-level primary ACDF for radiculopathy and/or myelopathy with significant (Visual Analogue Scale [VAS] ≥ 3) neck pain and a minimum of 1-year follow-up were included. Based on preoperative symptoms patients were split into groups for analysis: radiculopathy (R group), myelopathy (M group), or both (MR group). Groups were compared for differences in Health Related Quality of Life outcomes: Physical Component Score-12, Mental Component Score (MCS)-12, Neck Disability Index, VAS neck, and VAS arm pain. Two hundred thirty-five patients met inclusion criteria. There were 117 patients in the R group, 53 in the M group, and 65 in the MR group. Preoperative VAS neck pain was found to be significantly higher in the R group versus M group (6.5 vs. 5.5; P = 0.046). Postoperatively, all cohorts experienced significant (P < 0.001) reduction in VAS neck pain, (ΔVAS neck; R group: -2.9, M: -2.5, MR: -2.5) with no significant differences between groups. However, myelopathic patients showed greater improvement in absolute MCS-12 scores (P = 0.011), RR (P = 0.006), and % minimum clinically important difference (P = 0.013) when compared with radiculopathy patients. This greater improvement remained following regression analysis (P = 0.025). Patients with substantial preoperative neck pain experienced significant reduction in their neck pain, disability, and physical function following ACDF, whether treated for radiculopathy or myelopathy. However, in this study, only myelopathy patients had significant improvements in their mental function as represented by MCS improvements. 3.

Clinical outcomes of sacroplasty for metastatic sacral tumours: a systematic review and meta-analysis.

A systematic review and meta-analysis. The purpose of this study was to evaluate the clinical outcome and safety of sacroplasty for patients with secondary metastatic lesions to the sacrum. Several databases, including the Cochrane library, PubMed and EMBASE, were systematically searched to identify potentially eligible articles in English language. All the above databases were searched until December 2019. The search strategy was based on the combination of the following keywords: sacroplasty AND secondary tumours OR metastasis OR metastases. The reference list of the selected literature was also reviewed and a standard PRISMA template utilised. From a total of 102 articles initially identified, a final seven studies were identified as meeting the inclusion criteria. A total of 107 patients from these studies were included. The follow-up ranged from immediate post-operatively to 30.5months. The mean preoperative VAS was 8.38 (range 6.9-9.3), which improved significantly to 3.01 (range 1.12-4.7) post-operatively (p < 0.001). The most frequent complication reported was cement leakage, which occurred in 26 patients (25.4%), but without any neurological or other adverse sequelae. Sacroplasty in the management of secondary sacral tumours is a safe procedure that can achieve a significant reduction in pain, as quantified by VAS scores, and low complication rate.