Preoperative Visual Analogue Score Research Articles

PL-TOSP, the Novel Entry Point in Transforaminal Endoscopic Spine Surgery: Radiological Analysis with Prospective Surgical Evaluation and Review of Literature of Various Skin Entry Points

Abstract Purpose Aim of this study was to analyze variation in angulation of trajectories of various skin entry points in transforaminal endoscopic spine surgery with change in the physical parameters, namely, weight, abdominal girth, and body mass index and to validate our hypothesis that posterolateral (PL)-tip of spinous process (TOSP) entry has minimal variation in the angle of trajectory as compared with currently available skin entry points. The study included an analysis of the functional outcomes of these patients who underwent transforaminal endoscopy using the novel PL-TOSP technique, assessing improvements in pain and disability. Overview Entry point in transforaminal endoscopic lumbar discectomy (TELD) was taken as a rough distance of 10 to 12 cm from midline as proposed by Kambin whereas Yeung and Tsou advised entry point as distance between the center of the disc space and the posterior skin line measured on lateral. But entry points cannot be static as they tend to change according to changes in physical parameters. Materials and Methods This study comprises of radiological analysis and a prospective evaluation of these patients operated on using the PL-TOSP entry point. Radiological analytic study was performed on 50 symptomatic preoperative patients who underwent transforaminal endoscopy using the novel PL-TOSP entry point. A lumbar spine magnetic resonance imaging (MRI) field of vision (MRI-FOV) was performed for the patients including the abdominal perimeter. Weight, height, and abdominal girth of the patients were noted prior to MRI. Angulation of trajectory made by four standard entry points used in TELD, namely, 45–45, PL, TOSP), dorsum of facet joint, and our proposed entry point PL-TOSP (which is a midpoint between PL and TOSP entry), were calculated using MRI-FOV at L45 and L5S1 level. For the functional outcome analysis of these 50 patients, preoperative Visual Analogue Score (VAS) for lower limb pain and Oswestry Disability Index (ODI) were recorded. Postoperative VAS and ODI scores were reassessed at 2, 6, and 12 weeks. Statistical analysis was conducted to evaluate the significance of changes in VAS scores and ODI preoperative versus postoperative. A p-value of < 0.05 was considered statistically significant. Results Angle of trajectory with the horizontal for all five entry points varies with physical parameters. PL-TOSP entry point has the least variation with change in physical parameters as compared with other entry points. The range of angle for PL-TOSP entry was 21 to 29 degrees. In our study, there was improvement in postoperative VAS and ODI scoring systems which was statistically significant (p-value < 0.05). This suggests reliability of our proposed entry point with consistent postoperative improvement. Conclusion The novel PL-TOSP entry point for transforaminal endoscopy demonstrates superior stability in trajectory angle despite variations in physical parameters, and is associated with significant improvements in functional outcomes and pain reduction for patients with lower limb radiculopathy. Angulation of PL-TOSP trajectory with horizontal also corresponds to current generation of endoscopes (25 or 30 degrees).

Arthrodesis for Eaton-Littler stage III degenerative trapeziometacarpal arthritis: a retrospective comparative study of fixation methods

Purpose: This study compared clinical outcomes depending on the fixation modality in patients who underwent arthrodesis surgery for Eaton-Littler stage III trapeziometacarpal (TM) joint arthritis between 2009 and 2022. Methods: In total, 39 patients with 44 hands (five patients had surgery on both hands) were selected. Depending on the operative fixation instruments, patients were divided into two groups: group 1, surgery with 25-gauge interosseous wiring and Kirschner wire or headless screw fixation; group 2, surgery with only multiple headless screws for fixation. Bone union was achieved at 62 days after surgery in group 1 and 75 days in group 2 (p=0.165). Results: The preoperative mean visual analogue scores improved during the postoperative outpatient follow-up period in both groups (group 1, from 4.0 preoperatively to 1.0 at the final follow-up; group 2, from 5.0 preoperatively to 2.0 at the final follow-up). Mean grip strength and pinch strength increased after surgery. One patient (4.8%) experienced nonunion in group 1, whereas nonunion occurred in four patients (17.4%) in group 2. This difference was not statistically significant. Four patients in group 1 and no patients in group 2 underwent fixation instrument removal after sound union. Conclusion: Adequate stability can be achieved during arthrodesis by combining interosseous wiring and other implants or multiple headless compression screws, resulting in successful outcomes for patients with Eaton-Littler stage III degenerative TM arthritis.

Clinical efficacy and influencing factors of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a 10-year follow-up study

BackgroundTo date, few reports have evaluated the long-term outcome of percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) and the factors influencing the long-term outcome of this procedure are uncertain.MethodsA total of 91 patients underwent PKP for thoracolumbar OVCFs from June 2012 to December 2012. Pain Visual Analogue Scores (VAS) and Oswestry Disability Index (ODI) were recorded preoperatively and after 10-year follow-up. Factors that may affect surgical outcome, such as gender, age, height, weight, hypertension, diabetes, cause of injury, fracture segment, length of hospitalization, history of previous spinal surgery, preoperative bone mineral density (BMD), preoperative VAS and ODI scores, length of surgery, bone cement dosage, postoperative standardized anti-osteoporosis treatment, and other new vertebral fractures, were analyzed by multiple linear regression with VAS and ODI scores at the last follow-up. The correlation factors affecting the efficacy were analyzed.ResultsThe preoperative and final follow-up pain VAS was 7.9 ± 1.1 and 2.2 ± 1.1. ODI scores were 30.4 ± 4.2 and 10.7 ± 2.6. The difference was statistically significant (P < 0.05). Most of the patients were females aged 65–75 years who suffered low-energy injuries, with most of the fracture segments in the thoracolumbar region (T11-L2). At the final follow-up visit, 12 cases (13.19%) developed other new vertebral fractures, and 33 cases (36.26%) continued to adhere to anti-osteoporosis treatment after discharge. Multiple linear regression analysis showed that there was a statistical difference between gender and VAS score at the last follow-up (P < 0.05), and between age, cause of injury and postoperative standardized anti-osteoporosis treatment and ODI at the last follow-up (P < 0.05). There were no statistically significant differences between the other factors and the final follow-up VAS and ODI scores (P > 0.05).ConclusionThe long-term outcome after PKP is satisfactory. Age, gender, cause of injury, and standardized postoperative anti-osteoporosis treatment may be factors affecting the long-term outcome.

Surgical Treatment of Concha Bullosa: A Comparison of the Short-term Results of Crushing and Lateral Laminectomy with and without Mucosal Preservation.

Pneumatized middle turbinate (Concha bullosa) is one of the commonest intranasal anatomical variants. Surgery is the effective method to control symptomatic concha bullosa, however, still no clear definition for the best surgical technique. The aim of our study to assess and compare the short-term outcomes of crushing and lateral laminectomy with and without mucosal preservation in the surgical treatment of symptomatic concha bullosa. Thirty patients who underwent concha bullosa surgery (a total of 42 conchae surgeries) were included in this prospective randomized study. Patients were allocated consecutively and equally into 3 groups: Group A (lateral laminectomy without mucosal preservation, n = 10), Group B (lateral laminectomy with mucosal preservation, n = 10) and Group C (Crushing, n = 10). Patients underwent the preoperative and postoperative visual analogue score (VAS) for nasal obstruction and headache, sinonasal outcome test-22 (SNOT-22) and olfactory detection test. All patients were arranged to postoperative reevaluation for 3 months. All groups showed strong significant improvement in VAS results, SNOT-22 and smell test between preoperative and postoperative scores (P < 0.001). There was a significant difference between the three groups only upon comparing lateral laminectomy groups with crushing group. No significant differences were detected between group A and B regarding all the evaluated variables. According to our results, lateral laminectomy was more advantageous than crushing in surgical management of concha bullosa. Moreover, lateral laminectomy without mucosal preservation was as effective as lateral laminectomy with mucosal preservation and there is no detectable difference between both techniques.

Prospective 5-year follow-up of L5-S1 versus L4-5 midline decompression and interspinous-interlaminar fixation as a stand-alone treatment for spinal stenosis compared with laminectomies.

Spinal stenosis treatment includes laminectomies with or without fusion or with interspinous distraction with or without fixation. Lack of published data on interspinous fixation devices (IFD) at L5-S1 is less considered as an option due to the smaller anatomical S1 spinous process and the higher stresses from the immobile sacrum. Our objective was to evaluate the outcomes of an IFD used as a stand-alone treatment for spinal stenosis at L5-S1 and L4-5 compared to historical data on open laminectomies. Prospective comparative cohort study (Level 2) looking at collected preoperatively and postoperatively Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) data, complications, and revision rates on 100 consecutive patients with spinal stenosis treated with midline decompression and InSpan (InSpan LLC, Malden, MA, USA) IFD, at L5-S1 and L4-5, up to five-year follow-up. All patients were treated by a single surgeon in an academic private practice. Historical published outcome data for open laminectomies were compared. Among the 100 patients, 45 underwent surgery at L5-S1 with a mean VAS pain score that decreased by 75% and ODI improved by 63% (P<0.001). Fifty-five patients had surgery at L4-5 with mean VAS and ODI scores improved by 80% and 66% (P<0.001) respectively. Preoperative and postoperative ODI and preoperative VAS scores were similar at L5-S1 and L4-5, however, postoperative VAS scores were significantly less for L4-5 versus L5-S1 (P<0.01). All surgeries were completed in less than one hour. There was a total of one L4-5 revision (1.8%) and two L5-S1 revisions (4.4%). Comparable laminectomy data showed decrease in VAS and ODI scores by 51% and 62% (P<0.05). The reoperation rate for laminectomies at five to ten years varied up to 24%. Spinal stenosis patients treated with midline decompression and InSpan IFD, used as a stand-alone treatment for interspinous-interlaminar fixation, at L4-5 and L5-S1, showed improved outcome scores and low complication and revision rates at five years and were comparable to historical open laminectomy data. InSpan is a successful substitute for laminectomies in selected patients and was performed in less than 60 minutes. We recommend choosing the appropriately sized implant to achieve adequate distraction decompression to avoid recurrent symptoms.

Analysis of the clinical effect of percutaneous pedicle screw fixation combined with transpedicular bone grafting in the treatment of thoracolumbar fracture

To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures. From Janury 2021 to June 2022, 40 patients with thoracolumbar fracture were divided into the experimental group and the control group. There were 26 patients in the experimental group, including 21 males and 5 females with an aberage age of (47.3±12.3) years old, who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting. In the control group, 14 patients received percutaneous pedicle screw fixation only. including 7 makes and 7 females with an average age of (50.2±11.2) years old. The operative time, intraoperative blood loss, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score (VAS), MacNab scores, loosening or broken of the implants. were compared and analyzed. There was no significant difference in operation time, intraoperative blood loss, VAS and anterior height ratio of injured vertebrae between the two groups. Compared with the preoperative results, VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05). For Cobb angle of injured vertebra, there was no significant difference between the two groups before surgery (P=0.766). While at 1 week, 3 months and 12 months after surgery, there were statistically differences between the two groups (P values were 0.042, 0.007 and 0.039, respectively). The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery (P<0.001). One year after surgery, the excellent and good rate of Macnab scores was 96.15% in the experimental group and 92.86% in the control group, and there was no statistical differences between the two groups (P=0.648). There was one patient in the control group suffering superficial wound infection on the third day, which was cured by dressing change and anti-infection treatment. There were no postoperative screw loosening and broken in both groups. The two surgical methods have the advantages of less trauma, less pain and quicker recovery, which can restore the height of the injured vertebra, reconstruct the spinal sequence and reduce the fracture of the vertebral body. Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery, thus reducing the possibility of complications such as kyphosis, screw loosening and broken.

Pulsed radiofrequency in the management of lumbar radicular pain: initial experience

BackgroundLumbar radicular pain (LRP) is one of the most encountered complaints in neurosurgical practice that pose a challenge in its management as adequate pain control, which is not always achieved.ObjectiveThe aim of this study was to evaluate the role of pulsed radiofrequency as a minimally invasive tool in the management of lumbar radicular pain of lumbar discogenic origin.MethodsThis is a prospective study that included 20 patients with lumbar radicular pain with radiological evidence of lumbar disc prolapse, who have been subjected to pulsed radiofrequency.ResultsThe mean preoperative visual analogue score was 71 ± 14.38 dropped to a mean of 43.5 ± 21.47 at six-month follow-up. Seventy percentage of the study population had a satisfactory outcome, which did not correlate with the age, sex, or body mass index of the patients.ConclusionsPulsed radiofrequency is a safe and useful tool that may be used in the management of lumbar radicular pain.

Patient Reported Outcomes with the Use of Fibular Nail Fixation, Retrospective Review of 41 Cases

Category: Trauma; Ankle Introduction/Purpose: Traditionally, open reduction and internal fixation of unstable lateral malleolus fractures with plate and screw constructs has been considered the gold standard treatment. More recently, the use of an intramedullary fibula nail has gained popularity as an alternative treatment method using a mini open incision to obtain anatomic reduction. The minimally invasive nature of this technique and the no profile load bearing/sharing implant is reported with very low complication rates and a much lower incidence of implant irritation and removal. We report our surgical and patient reported outcomes for a cohort of single surgeon consecutive fibula nails with proximal and distal locking fixation. Methods: We retrospectively reviewed prospectively collected data on 41 patients that were implanted with the Fibulock® Fibula Nail (Arthrex, Naples, Florida, USA). All nails were implanted by a single surgeon. Intraoperative reduction quality was recorded, and patients were followed post operatively with radiographs that were assessed for maintenance of reduction, healing, and complications. Patient reported outcome questionnaires (PROMs) were collected preoperatively and at 3, 6, 12, and 24 months postoperatively. The Foot and Ankle Ability Measure (FAAM) assessed the patient’s functional status in terms of activities of daily living and sports. The Visual Analogue Score (VAS) was also collected. Results: All 41 patients had one- to two- year follow-up (14.68 months ± 5.92). Demographics are listed on table 1. Forty of the patients were reduced via mini open incision and one was reduced closed. There were no conversions to a plate, no intraoperative complications, and no cases of loss of reduction postoperatively. No patient required revision surgeries, no cases of delayed union or nonunion, and zero superficial or deep postoperative infections. Statistical analysis revealed a significant difference between preoperative and postoperative FAAM scores overall (+67.52, p &lt; 0.001), within activities of daily living (+68.07, p &lt; 0.001), and sport (+65.95, p &lt; 0.001). Also, there was a significant difference between preoperative VAS and postoperative VAS (+4.73, p &lt; 0.001). Conclusion: Our results support existing literature that fixation of fibula fractures with an intramedullary nail with proximal and distal locking capabilities is an alternative option to a plate and screw construct, with a very low incidence of hardware related complications requiring removal, and favorable patient reported outcomes.

Effect of knee arthroscopic debridement combined with peripatellar denervation on restoration of knee function in patients with knee osteoarthritis

BackgroundThis research examines knee osteoarthritis (OA), a prevalent orthopedic disease marked by cartilage degeneration and chronic synovitis, leading to pain, restricted mobility, and eventual loss of knee function. Notably, patellofemoral osteoarthritis constitutes a significant proportion of knee OA cases. Our study aims to assess the impact of knee arthroscopic debridement coupled with peripatellar denervation on restoring knee function in OA patients and analyze the risk factors affecting treatment outcomes. By doing so, we hope to contribute to the informed selection of clinical treatment plans, addressing a disease that, if untreated, significantly impairs patients’ quality of life.MethodsA total of 211 patients with knee osteoarthritis treated in our hospital from June 2020 to June 2022 were analyzed retrospectively. Among them, 116 patients received arthroscopic knee debridement treatment alone as the control group, and 95 in the observation group were combined with denervation treatment based on the control group. The clinical efficacy of the two groups of patients after treatment was evaluated, and patients’ pain was counted using the pain visual analogue score (VAS) method. The knee range of motion (ROM) was used to count the mobility of the patients and to compare the operative time, intraoperative perfusion volume, and length of stay between the two groups. According to the effectiveness after treatment, patients were divided into the improvement group (effective + markedly effective) and the non-improvement group, and the risk factors affecting the clinical efficacy of patients after treatment were analyzed by logistic regression.ResultsThe total treatment efficiency of patients in the control group was lower than that of those in the observation group (P < 0.05). There was no difference in intraoperative perfusion volume and length of stay between patients in both groups (P > 0.05). However, the operative time was shorter in the control group compared with that in the observation group (P < 0.001). The post-treatment VAS scores of patients in the observation group were lower than those in the control group, while the ROM scores were higher than those of the control group (P < 0.001). Age, BMI, and preoperative VAS score were found to be independent risk factors for patient outcome by logistic regression analysis (P < 0.05).Conclusionknee arthroscopic debridement combined with peripatellar denervation has a significant improvement in the restoration of knee function in patients with knee osteoarthritis and reduces their level of pain.

Management of Scaphoid Pseudoarthrosis Surgery With Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Axillary Block Anesthesia: Comparison of Patient Satisfaction

Objectives: We aimed to compare clinical and functional results of treatment of scaphoid pseudoarthrosis between patients undergoing wide-awake local anesthesia no tourniquet (WALANT) versus axillary block anesthesia. Methods: The patients diagnosed with scaphoid non-union who underwent pseudoarthoris surgery were divided into WALANT group ( n = 12) and axial block group ( n = 11). Visual analog scores (VAS) were measured by calling the patients via phone on postoperative days 1, 2, 3, and 7. The VASs were also measured on the 14th day during patient check-ups. At the end of 12 months, Michigan Hand Questionnaire was used to assess clinical recovery. Bone union rate and surgery time were also investigated. Radiological and clinical examinations were compared between the groups. Results: Eleven patients (91.7%) in the WALANT group and 10 patients (90.9%) in the axillary block group achieved bone union ( P = .94). Although there was no significant difference in preoperative VAS score between the groups, the WALANT group had significantly lower VAS score of the first 3 days postoperatively. However, there was no significant difference in VAS score between the groups on the seventh and 14th day postoperatively. There was no significant difference between the groups regarding Michigan score, time to surgery, time to union and operation time. Conclusion: The scaphoid pseudoarthrosis surgery can be done safely with WALANT technique which has significant lower VAS score on the first 3 days postoperatively.

FUNCTIONAL OUTCOME OF VERTEBROPLASTY IN OSTEOPOROTIC VERTEBRAL FRACTURES – A PROSPECTIVE STUDY

Aim: The aim of this study is to evaluate the efcacy of vertebroplasty for treatment of painful osteoporotic vertebral fractures on clinical grounds. Materials &amp; Methods: 20 patients with osteoporotic compression fractures treated by vertebroplasty were enrolled in this study. In all patients, Pre operative Visual analog score for back ache, Oswestry disability score were noted for the purpose of comparison of post operative functional outcome. In our study, average follow up was done for 12 months with maximum follow up wa Observation &amp; Results: s for 16 months and minimum follow up was for 3 months. Statistics comparing preop VAS score versus VAS score, pre op ODS vs post op ODS at immediate, one month, three months, six months and twelve months were done from which we interpreted that p value &lt;0.005 in all postoperative period, so it was a signicant comparison. Statistically, there was signicant pain relief and functional outcome in immediate post operative period which was maintained at the end of 12 months also. We conclude that the Vertebroplasty Conclusion: are promising innovations with the benet of quick improvement in mobility, markedly decreases pain-related doctor visits, stature in the management of osteoporotic compression fracture

Full Endoscopic Transpedicular Technique in the Treatment of High Grade Down Migrated Herniated Disc: An Evaluation of Clinical Outcomes at 12 Months Follow-Up

High-grade migrated lumbar disc herniation (LDH) such as up-migrated and down-migrated discs are challenging pathologies to treat. High-grade migrated discs are usually sequestered and situated adjacent to the medial pedicle wall. This can be easily addressed if the pedicle is used as an access route. The authors present a retrospective case series of high-grade migrated LDH treated using a full endoscopic transforaminal approach. This is a retrospective case series. The clinical outcomes in the patients were evaluated according to improvement in the symptoms as suggested by improvement in Visual Analog Score (VAS) and Oswestry Disability Index (ODI) scores in the immediate postoperative period and at the final follow-up. The radiological outcomes were evaluated using postoperative magnetic resonance imaging and computed tomography scans. After the data were collected and tabulated, descriptive statistics were used for continuous variables. The t test was used to determine the significance of changes in the VAS and ODI scores. Statistical significance was set at P<0.05. Five patients underwent discectomy using the transpedicular technique, and the mean preoperative VAS scores for the back and leg were 7.2±0.83 and 8.4±0.54, respectively. The mean VAS scores at the final follow-up for the back was 0.2±0.4 and 0 for the leg (P < 0.05). The mean preoperative ODI score was 72±8.3, which improved to 6±4.69 at the final follow-up (P < 0.05). All patients had a hospital stay of 1day. The full endoscopic transpedicular approach is a good option for treating highly migrated LDH. Surgical planning, including pedicle morphometry and the angle of the approach, should be undertaken preoperatively for the best results.

Efficacy, Safety, and Reliability of the Single Anterior Approach for Subaxial Cervical Spine Dislocation.

Background Though there is ongoing controversy regarding the best treatment option for cervical spine dislocation (CSD), anterior cervical surgery with direct decompression is becoming widely accepted. However, managing all cases of subaxial CSD entirely by a single anterior approach is rarely seen in the published literature. Methods The study comprised patients with subaxial CSD who underwent surgical stabilization utilizing a single anterior approach. Most of the CSD was reduced and anterior cervical discectomy and fusion (ACDF) were performed. Anterior cervical corpectomy and fusion (ACCF) were done in unreduced dislocations. The patient's neurological condition, radiological findings, and functional outcomes were assessed. SPSS version 25.0 (IBM Corp., Armonk, NY) was used for statistical analysis. Results The total number of operated cases was 64, with an average of 42 months of follow-up. The mean age was 34.50±11.92 years. The most prevalent level of injury was C5/C6 (57.7%). Reduction was achieved in 92.2% of cases; only 7.8% of patients needed corpectomy. The typical operative time was 84.25±9.55 minutes, with an average blood loss of 112.12±25.27 ml. All cases except complete spinal cord injury (CSI) were improved neurologically (87.63%). The mean Neck Disability Index (NDI) was 11.14±11.43, and the pre-operative mean visual analog score (VAS) was finally improved to 2.05±0.98 (P<0.05). In all cases, fusion was achieved. The most common complication was transient dysphagia (23.4%). After surgery, no patient developed or aggravated a neurological impairment. Implant failure was not observed at the final follow-up except for two cases where screws were pulled out partially. Conclusion Based on the results of this study, a single anterior approach is a safe and effective procedure for subaxial CSD treatment with favorable radiological, neurological, and functional outcomes.

Scaphocapitate Fusion with lunatum excision in advanced Kienböck disease: 5.3-year mean follow-up

Objective: This study evaluated the clinical and radiological outcomes of scaphocapitate fusion (SCF) performed after lunate excision in patients with advanced Stage III Kienbock's disease. Materials and method: Eleven patients diagnosed with Stage 3 Kienbock's disease who underwent SCF following lunate excision retrospectively evaluated in this study. The scores of arm, shoulder and hand disability (DASH) and Visual Analogue Scores (VAS) recorded preoperatively were also recorded at the final follow-ups after surgery. Wrist ROM (flexion, extension, radial, ulnar) was measured using a goniometer in the operated and contralateral wrists. Grip, tip pinch, key pinch forces and palmar grip were measured using a Jamar dynamometer and pinch gauge (Model SH 5005, South Korea). Results: The study included a total of eleven patients including six female and five male patients. The mean follow-up period was 63.45 months (range 24-86). According to the functional evaluation, the mean preoperative and postoperative Visual Analog Scores (VAS) were 8.45 (range 7-10) and 1.18 (range 0-3), respectively. The mean disabilities of the arm, shoulder and hand (DASH) score was reduced from 52.27 (range 36.40-70) to 16.51 (4.5-47.7) between the preoperative and postoperative periods. According to the evaluation of joint range of motion, the mean range of flexion was 72.9%, the mean range of extension was 84.9%, the mean radial deviation range was 57.35% and the mean ulnar deviation range was 82.46% in the operated hands compared to the contralateral wrist. While wrist flexion and extension ranges exhibited a statistically significant increase, radial deviation exhibited a statistically significant decrease compared to the preoperative period (p&lt;0.05). Conclusion: SCF after lunate excision is a successful surgical method that provides pain relief and increases joint range of motion by maintaining acceptable range of motion in the medium-long term.

Distal tibial tubercle-high tibial osteotomy with assistance of modifiable spreader in the treatment of varus knee osteoarthritis: A retrospective observational study

As one of the knee preservation surgical approaches, good clinical outcomes of high tibial osteotomy were reported. Aims of this study were to analyze the clinical outcome and pre- and postoperative radiographical parameter and knee functional score between distal tibial tubercle high tibial osteotomy (DTTHTO) and open wedge- high tibial osteotomy (OWHTO) in patients with varus knee osteoarthritis after more than 1 year following-up. A total of 194 consecutive patients in our joint center from March 2016 to October 2021 were enrolled, according to the surgical method, patients were divided into DDTHTO and OWHTO groups. Radiographic parameters of Kellgren-Lawrence grading, hip-knee-ankle angle, weight bearing line ratio and medial tibial plateau angle, knee functional score of American knee society (AKS) score, western Ontario and McMaster universities arthritis index (WOMAC) score, visual analogue score (VAS) were introduced to evaluate clinical outcome for patients who received DDTHTO and OWHTO. There were 103 knees and 89 knees in the OWHTO and DTTHTO group, respectively. Mean weight bearing line ratio for OWHTO and DTTHTO were 25.1 ± 11.7 and 25.2 ± 12.0% respectively, medial tibial plateau angle and hip-knee-ankle angle angle demonstrated that all patients in the present study inherited a varus angle ranges from 3.4° to 9.5°. Preoperative AKS, WOMAC and VAS were 68.4 ± 5.7 versus 69.0 ± 5.9, 109.3 ± 15.0 versus 107.7 ± 14.0 and 6.8 ± 1.0 versus 6.9 ± 0.8, and there was no significant difference between 2 groups (P > .05). Mean postoperative AKS and WOMAC score for patients in both OWHTO and DTTHTO group were significantly improved, moreover, postoperative VAS of DTTHTO patients was lower than that in OWHTO group (P < .05). When comparing the operation time, intraoperative blood loss and bone union time, DHHTO group shows a superiority in these variables over patients in OWHTO (121 ± 29.6 vs 145.7 ± 35.2 minutes, 115.0 ± 20.8 vs 103.3 ± 17.3 mL, 13.7 ± 4.1 vs 12.0 ± 2.8 weeks; P < .005) and incidence of complication was lower for DTTHTO group. DTTHTO in patients with varus knee osteoarthritis has good clinical outcomes, and it can achieve a better postoperative alignment. Operation time and surgical trauma were also less in patients who underwent DTTHTO.

Preoperative anxiety on postoperative pain in craniotomy patients

Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent craniotomy and investigate the effects on the development of postoperative acute-chronic pain. Materials and Methods: In this prospective, observational study, STAI-I (State-Trait Anxiety Inventory) and STAI-II were used to measure preoperative anxiety levels in a total of 104 patients who underwent craniotomy, and a visual analog score (VAS) was used to determine pain. Demographic data of the patients, ASA (American Society of Anesthesiologists) scores, comorbidities, preoperative and postoperative VAS scores, cause of preoperative anxiety, type, and duration of operation were recorded. Results: The mean values of STAI tests showed that 31.3% of our patients had mild preoperative anxiety, 58.7% had moderate and 10% had severe preoperative anxiety. In the STAI tests we performed before the operation, the mean values were 44 ± 11.2 for STAI-I and 44.5 ± 9.4 for STAI-II. The causes of preoperative anxiety in patients were determined as surgical operation (35.6%), anesthesia applications (17.3%), insufficient information (11.5%), and the possibility of postoperative pain (3.8%). It was observed that 60.6% of our patients had pain in the preoperative period, 51.9% of patients had acute pain in postoperative the 0th minute, 69.2% in 30th minute, 54.8% in 1st hour, 44.2% in 2nd hour, 34.6% in 24th hour, 22.1% in 48th hour, and 51% of patients had chronic pain in postoperative 6th month. We found a significant relationship between STAI-I and VAS scores at the 48th hour and, between STAI-II and VAS scores at the 2nd, 24th hour, and 6th month (p&amp;lt;0.05). Conclusion: It was observed that craniotomy patients mostly had moderate anxiety and moderate to severe pain before the operation, and moderate-severe acute and chronic pain developed after the operation. A significant correlation was found between preoperative anxiety and postoperative pain.

Dorsal Scapholunate Ligament Reconstruction by Using Palmaris Longus Tendon Graft in Chronic Static Scapholunate Dissociations: Does It Yield Favorable Radiographic and Functional Results?

Background Scapholunate (SL) instability is the most common dissociative carpal instability, and the most frequent cause of wrist osteoarthritis (OA), termed as scapholunate advanced collapse (SLAC). The aim of this study was to present the mid-term clinical and radiographic results of dorsal SL ligament reconstruction by utilizing free palmaris longus tendon graft in patients with symptomatic, chronic, static SL dissociation; while assessing the safety and efficacy of this technique, Materials and Methods In total, 42 patients with a mean age of 44.1 (range 26-53) and mean follow-up duration of 69.4 months (range 60-72) with a diagnosis of chronic, static, and reducible SL instabilities with no chondral damage were enrolled. They all underwent dorsal SL ligament reconstruction with the exam same technique. Results At the last follow-up, patients' mean preoperative SL gap improved from 4.7 (range 4-6) to 2.1 (range 2-3), as did SLA from 84 degrees (range 67-101 degrees) to 66 degrees (range 49-72 degrees)( p <0.001 for both). Preoperative mean VAS (visual analog score), DASH (Disabilities of the Arm, Shoulder and Hand), Mayo wrist scores and SF-36 scores showed significant improvements in the last follow-up visit ( p <0.001, for all). No major complications were acquired in either of the patients. Conclusion Dorsal SL ligament reconstruction by using free PL tendon graft was detected to provide successful restoration of the normal carpal alignment together with SL joint stability. This procedure, by significantly reducing pain and improving grip strength was detected to yield significantly improved clinical and functional outcomes, together with high patient satisfaction indicated by improved health-related quality of life (HRQOL) scores. Level of Evidence IV.

The Use of Amniotic Membrane for Peripheral Nerve Injury in Lower Extremity Surgical Procedures

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Patients undergoing nerve decompression surgery often report persistent symptoms. Some have suggested that wrapping the affected nerve with amniotic membrane may improve outcomes if the nerve is wrapped with amniotic membrane at the time of surgery, possibly related to anti-inflammatory, antifibrotic, or pro-regenerative effects. There is little in the foot and ankle literature to support such approaches. The aim of this preliminary study was to assess the initial safety of amniotic membrane use outcomes in foot and ankle surgery during nerve decompression procedures as an initial study in anticipation of a randomized, prospective trial. Methods: We retrospectively reviewed outcomes among 22 patients, &gt;=18 years old, who had undergone amniotic membrane neurorrhaphy for lower extremity nerves including sural, saphenous, superficial peroneal, common peroneal, deep peroneal, digital (Morton's neuroma), Baxter's and posterior tibial nerve. Patients may have had multiple nerves wrapped and have had other procedures done. All patients had failed conservative treatments including cortisone injections, orthotics, nonsteroidal anti- inflammatory drugs, and physical therapy. Patients' demographics, postoperative complications, patient reported outcome measures (PROMs), and preoperative/postoperative Visual Analog Scores (VAS) for pain was collected. Data were reported in a descriptive manner. Results: Twenty-two patients, 16 females and 6 males averaging 51 years of age were assessed. Only one patient of the twenty- two reported a higher postoperative VAS compared to the preoperative VAS. There were no post-operative infections or reactions to the amniotic membrane. No patient required repeat surgery. The average pre- and post-operative VAS were 6.36 and 2.77, respectively. The average PROMs Pain Interference and Pain Intensity (Short Form 4a and 3a, respectively) were 42.02 and 35.94, respectively, that were within the normal range. Conclusion: The use of amniotic membrane wrap in lower extremity nerve decompression procedures was shown to be safe regarding post-operative short-term complications in this series of patients. However, in order to prove the usefulness of this technique for pain and function improvement, further studies with larger populations, particularly randomized clinical trials with long term follow up are necessary.

Does the application of expandable cages in TLIF provide improved clinical and radiological results compared to static cages? A meta-analysis.

PurposeThis study aimed to provide a direct meta-analysis of the evidence comparing outcomes between expandable cages and static cages in patients with transforaminal lumbar interbody fusion (TLIF).MethodsA search of relevant materials from databases was performed from inception to March 7, 2022. Clinical and radiological outcomes were included.ResultsTen studies (1,440 patients) were included. The anterior disc height and foraminal height for expandable cages were substantially higher than those for static cages at the final follow-up (P < 0.0001; P = 0.05). In comparison with static cages, although not statistically significant, expandable cages showed beneficial results, including an increase in posterior disc height and segmental lordosis. There were no statistically significant differences in segmental lordosis, lumbar lordosis, pelvic parameters, cage subsidence, or fusion rates (P > 0.05). Oswestry disability index scores for expandable cages were substantially lower than those for static cages at the final follow-up (P = 0.0007). Interestingly, although the preoperative visual analog scores for back and leg pain were significantly higher in the expandable group than in the static group (P < 0.0001; P = 0.008), there was no significant difference between the static and expandable groups during the final follow-up (P = 0.51; P = 0.85).ConclusionsExpandable cages are associated with improved functional outcomes and restored postoperative disc and foraminal heights in patients with TLIF. In addition, no statistically significant differences were observed in segmental lordosis, lumbar lordosis, pelvic parameters, cage subsidence, or fusion rate.

Outcome of Multilevel Anterior Cervical Discectomy and Fusion without plating

Background &amp; objectives: The safety and efficacy profile of stand-alone polyetheretherketone cages has been questioned in the management of patients with more than one cervical disc disease. In this article, we evaluated the idea of safety of multilevel anterior cervical discectomy and fusion, without using a plate and the achieved pain relief. Methods: In this study, retrospectively we reviewed 30 patients diagnosed with multilevel cervical disc disease (total 69 segments) due to degenerative changes, disc herniation, and/or osteophyte formation. They complained of axial neck pain and/or radiculopathy not responding to non-surgical measures. All the included subjects treated for more than one-disc disease using stand-alone polyetheretherketone. With minimum 2-years of regular, clinical and radiological follow up. We have assessed the patient for criterions defined for cage subsidence and protrusion, as well as pain assessment pre and postoperatively using the visual analog score. Results: we assessed 22 patients (73.3%) for two level pathology and 8 patients (26.7%) with three level diseases. Mean age was 48.2±8.9 years. Female to male ratio was (1.1:1). The most common segment involved was C5-6 segment in 83.3%. The pre-operative visual Analogue Score for axial neck pain 6.3±3.05 and radiculopathy 6.8±2.2 was decreased post-operatively to 2±1.3 points respectively. Subsidence and protrusion assessed by measurement of serial X rays and one patient 3.3% developed subsidence in 2 adjacent levels which is statistically not significant. No incidence of cage protrusion was detected. Conclusions: Multilevel anterior cervical discectomy and fusion without plating provide good fusion, low subsidence rate, stability provided by the cage with excellent pain improvement.