Previous Decompression Research Articles

A new management strategy in reopening laminectomies for cases with spinal canal stenosis

Background While a laminectomy is often mandated for spinal canal stenosis, foraminal stenosis may account for pain and functional limitations instead of central canal issues. Targeted treatment directed at this specific region may enhance patient outcomes. Methods Retrospective observational study of a total of 30 patients with previous decompression laminectomies for lumbar spinal canal stenosis were operated upon for foraminotomies from November 2012 to November 2018. The surgeries were clinically done, and EMG-confirmed nerve root compressions were treated with exact decompression techniques according to the anatomy and pathology in each case. Additionally, a systematic review followed PRISMA guidelines was conducted, utilizing Scopus and PubMed databases to identify studies on reoperation rates after decompression with or without fusion in lumbar spinal stenosis. Results The results were fearsome post-operatively, trying significant improvement in pain, functional status, and walking distance. Pain reduction was achieved in 80% of patients by an increase in the Carnovsky rating scale with evidence of improved pain reduction and walking endurance; this points to minimal resulting complications of one complete case of foot drop and three infective cases managed conservatively. It was shown in the systematic review that fusion surgeries lowered the rates of reoperations at the index level but increased those for adjacent segment reoperations, while decompression alone had higher index-level reoperation rates due to recurrent stenosis. Conclusion Most of the emphasis on foraminal stenosis, rather than traditional laminectomies, significantly reduces postoperative pain and improves functional outcomes. This strategy brings a promising alternative to the management of recurrent symptoms in patients with lumbar spinal canal stenosis.

Redefining Oswestry Disability Index success criteria to assess the effect of consecutive surgeries on lumbar spinal stenosis

BACKGROUNDRegister studies have shown that chances of success after surgery for lumbar spinal stenosis (LSS) decrease with increasing numbers of previous operations. However, these studies presumed that success criteria remain constant with each consecutive spinal surgery. PURPOSEWe aimed to redefine success criteria specific for each consecutive surgery. Also, we assessed if fusion could be an effective procedure for LSS patients with previous decompression(s). STUDY DESIGNWe retrospectively analyzed prospectively collected patient-reported outcome measures (PROMs) from surgically treated LSS patients enrolled in The NORspine Register. PATIENT SAMPLEPatients operated for lumbar spinal stenosis. OUTCOME MEASURESPROMs: Oswestry Disability Index (ODI) percentage (%) change and Global Perceived Effect (GPE). METHODSWe categorized the LSS cohort by number of previous spine surgeries (none to ≥3). ROC analyses gave the most accurate cut-offs for ODI% change that corresponded to success, anchored by GPE, i.e., “much improved” and “completely recovered”. Areas under the ROC curves (AUCs) indicated how well ODI discriminated between success and nonsuccess for each consecutive surgery: good (0.8–0.89) and excellent (0.9–0.99). We then calculated proportions of successfully treated patients by number of consecutive surgeries. We also analyzed whether fusion succeeded in patients with previous lumbar decompression(s). RESULTSAt 12 months, 8,919 (75%) responded; 6,961 (78%) had no previous LSS surgery, 1,338 (15%) had one, 417 (5%) had 2, and 203 (2%) had ≥3 previous surgeries. Preoperative ODI (95% CI) was 38.7 (38.2–39.1) for no previous surgery versus 49.4 (46.9–51.9) for patients with ≥3 previous surgeries. The postoperative ODIs (95% CI) were 21.9 (21.4–22.4) and 37.9 (34.9–40.8) for patients with no and ≥3 previous surgeries, respectively.For patients with no previous surgeries, ODI% change of 37.6% most accurately defined success (AUC [95% CI]=0.909 [0.903–0.916]), and 57.1% reported success. For patients with ≥3 previous surgeries, success was an ODI% change of 25.0% (AUC [95%CI]=0.930 [0.890–0.971]), and 46.3% reported success.Finally, 350 patients received fusion after previous decompression(s). ODI% change of 34.6% defined success (AUC [95% CI]=0.920 [0.890–0.949]). The proportion of successfully treated fusion patients was 47.7%, compared to 54.3% for the entire cohort. CONCLUSIONSWe redefined ODI success criteria for patients with consecutive lumbar spinal stenosis surgeries. Our register study found the detrimental effect of consecutive surgeries on success rates to be less pessimistic than previously reported; fusion may be an effective option for LSS patients with previous decompression.

Graves' orbitopathy as the cause of diplopia in old age-Differences between young and old

Endocrine orbitopathy (EO) is an autoimmune disease mostly associated with a disease of the thyroid gland, which leads to inflammation, adipogenesis and fibrosis. The severity of EO can vary greatly between individuals, which makes it difficult to exactly predict the natural course of the disease; however, this is important to be able to individually adapt the treatment. The aim of this study was to compare the clinical features, course, treatment and prognosis for patients with EO under 50 years old with older patients. The results of the study with a focus on motility are presented in this special issue. The hospital records of a randomly selected sample of 1000 patients from the EO databank in Essen (GODE), which includes 4260 patients, were analyzed. The patients were divided into two groups: group 1 ≤50 years and group 2 >50 years. Only patients with complete data sets were included in the statistical analyses. Younger patients (n = 484) presented significantly more frequently with milder EO (53% vs. 33%, p < 0.0001), whereas older patients (n = 448) more frequently suffered from moderate or severe forms (44% vs. 64%, p < 0.0001). Older patients showed more severe strabismus, motility and clinical activity scores (5.9 vs. 2.3 prism diopters, PD/310° vs. 330°, both p < 0.0001, CAS 2.1 vs. 1.7, p = 0.001). Proptosis and the occurrence of optic nerve compression showed no significant differences between the groups (3% each). Multiple logistic regression showed that the necessity for a second eye muscle surgery was most strongly associated with a previous decompression (OR = 0.12, 95 % CI 0.1-0.2, p < 0.0001), followed by orbital irradiation and age. In summary, younger patients with EO presented with milder clinical features, such as a lower rate of restrictive motility disorders and weaker expression of signs of inflammation. Therefore, older patients needed steroids, irradiation, eyelid and eye muscle surgery more frequently; however, the risk of dysthyroid optic neuropathy and the necessity of a second eye surgery were not or only slightly associated with age.

Peroneal Nerve Decompression in Patients with Multiple Hereditary Exostoses: Indications, Complications, and Recurrence.

To our knowledge, there have been no studies examining peroneal nerve decompression and proximal fibular osteochondroma excision exclusively in patients with multiple hereditary exostoses (MHE). The purpose of this study was to evaluate the indications, complications, and recurrence associated with nerve decompression and proximal fibular osteochondroma excision in patients with MHE. The records on patients with MHE undergoing peroneal nerve decompression from 2009 to 2023 were retrospectively reviewed. Indications, clinical status, surgical technique, recurrence, and complications were recorded and were analyzed using the Fisher exact test, logistic regression, and the Kaplan-Meier method. There were 126 limbs identified in patients with MHE who underwent peroneal nerve decompression. The most common indications were pain over the proximal fibula, tibialis anterior and/or extensor hallucis longus weakness, and dysesthesias and/or neuropathic pain. Seven cases experienced postoperative foot drop as a complication of the decompression and osteochondroma excision. Logistic regression found significant relationships between complications and excision of anterior osteochondromas (odds ratio [OR], 5.21; p = 0.0062), proximal fibular excision (OR, 14.73; p = 0.0051), and previous decompression (OR, 5.77; p = 0.0124). The recurrence rate was 13.8%, and all recurrences occurred in patients who were skeletally immature at the index procedure. The probability of skeletally immature patients not experiencing recurrence was 88% at 3 years postoperatively and 73% at 6 years postoperatively. Indications for peroneal nerve decompression included neurologic symptoms and pain. The odds of a complication increased with excision of anterior osteochondromas and previous decompression. Recurrence of symptoms following decompression and osteochondroma excision was found exclusively in skeletally immature patients. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Laser and radio frequency technologists in the treatment of degenerative polysegmental pathologies of the spine in elderly people

The article discusses outcomes after treating 88 elderly patients with degenerative pathologies of the spine, 42 of whom had previous decompression- stabilizing surgical interventions. Clinical manifestations of the disease were characterized by prolonged pain syndrome, lumboishialgia caused by degenerative-dystrophic changes in the arch-process joints and progressive degeneration of the intervertebral discs. Surgical intervention in 65 patients included puncture laser ablation of the medial branch of the spinal nerve in the facet joint. In 23 patients, ablation of the medial branch of the spinal nerve was performed at two (n = 8) and three (n = 15) levels using four-channel radio frequency generator COSMAN G4.Excellent and good results after surgery were found in 58 (65.9%) patients. The researchers assessed intermediate results within 3 years in 55 patients, and 37 (42.01%) of them had a stable positive state. Minimally invasive laser and radiofrequency technologies in the treatment of degenerative polysegmental pathologies of the spine in elderly and old people is justifi ed, and it is an important component of their rehabilitation

Exoscope for revision of right lateral femoral cutaneous nerve decompression.

The exoscope serves as a valuable addition or alternative to traditional microscope systems in surgery, offering 3D visualization and magnification with enhanced maneuverability. In lateral femoral cutaneous nerve decompression for meralgia paresthetica, the exoscope is effective in identifying strictures of neural compression and minimizing iatrogenic nerve damage that may lead to improved pain management outcomes for patients. In this report, the specific case presented showcases how the exoscope aided in surgical decompression of the lateral femoral cutaneous nerve of a patient with refractory meralgia paresthetica with remote previous decompression and resultant scarring. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23162.

Postoperative residual vertical deviation affects quality of life in Asian patients with thyroid-associated ophthalmopathy (Graves ophthalmopathy).

To evaluate the treatment effect of strabismus surgery for Graves ophthalmopathy in an ethnic Chinese population. A prospective clinical study. Thirty-one patients with Graves ophthalmopathy who had undergone strabismus surgery at National Taiwan University Hospital between 2012 and 2013 were consecutively recruited. The subjective outcome was evaluated using the Graves' Ophthalmopathy Quality-of-Life (GO-QoL) questionnaire, and the ocular deviation was measured preoperatively and postoperatively by use of a prism cover test. The GO-QoL scores for visual functioning and appearance improved significantly after surgery (preoperative scores 32.6 ± 19.9 and 43.8 ± 26.4, postoperative scores 55.2 ± 24.4 and 54.1 ± 27.6, respectively; P < .05). Motor success was achieved in 61.3% of the patients, and their postoperative visual scores were higher (61.5 ± 22.5) than the scores of those who experienced motor failure (45.3 ± 26.8, P = .048). The postoperative visual function scores showed a negative correlation with the residual vertical deviation (R2 = 0.546, P = .040). A higher increase in GO-QoL visual scores and a lower residual vertical deviation in downgaze were achieved among patients without previous decompression surgery. Our surgical methods resulted in a motor success rate of 76.5% for the correction of vertical deviation. GO-QoL scores and ocular deviation improved significantly after strabismus surgery. Precise correction of vertical deviation was of greater importance than horizontal deviation for visual function scores. Our surgical methods were effective for the correction of vertical deviation in Graves ophthalmopathy.

Analysis of Results After Surgical Application of Bone Marrow Aspirate Stem Cell Concentrate in the Treatment of Avascular Necrosis of the Femoral Head.

Introduction: Avascular necrosis or osteonecrosis of the femoral head is defined as a pathological process that results in a critical reduction in the blood supply to the hip head with increased intraosseous pressure. Avascular necrosis is a multifactorial disease. The treatment used so far consists of transosseous decompression of the femoral head and is the most commonly used method in the early stages of osteonecrosis. Aim: The aim of this study was to evaluate the results after application of bone marrow stem cells obtained from the pelvic ridge, which was applied to the necrotic zone after previous decompression. Material and methods. The study is of prospective character and included 30 patients with first, second, and third degrees of AVN according to the Ficat classification, determined with X-ray. The range of motion in the hip was examined preoperatively by using a goniometer, a radiological evaluation of the degree of AVN was performed, according to the Ficat classification, and the VAS scale and the Harris Hip Score were examined preoperatively and postoperatively. Results: The average value for the Harris Hip Score (HHS) preoperatively was: for Ficat I -66.32±5.1, for Ficat II - 49.19±3.4 and for Ficat III - 33.71±2.1. At the 3-month postoperative follow-up, the average HHS values were: 87.92±4.3 for Ficat I, 78.64±6.6 for Ficat II and 76.48±2.6 for Ficat III. The same values for HHS were obtained in the control examinations at the 6th and 12th month postoperatively, indicating the fact that good bone regeneration was achieved and the progression of the condition was prevented. A decrease in the HHS value was observed at the control examination at 1 year after the surgical treatment, in 3 patients according to the Ficat classification of grade III, in whom a total hip replacement surgery was performed. Conclusion: The use of stem cells in the treatment of avascular necrosis of the femoral head has achieved good functional results and reduced pain in operated patients. Radiographically, good bone regeneration was achieved and the progression of necrosis to a higher degree was prevented.

Indirect Decompression Using Oblique Lumbar Interbody Fusion Revision Surgery Following Previous Posterior Decompression: Comparison of Clinical and Radiologic Outcomes Between Direct and Indirect Decompression Revision Surgery.

ObjectiveThis study compared the radiological and clinical outcomes with transforaminal lumbar interbody fusion (TLIF) to evaluate the effect of indirect decompression through oblique lumbar interbody fusion (OLIF) as revision surgery. MethodsWe enrolled patients who underwent single-level fusion with revision surgery at the same level as the previous decompression level. We retrospectively reviewed 25 patients who underwent OLIF from 2017 to 2018 and 25 who received TLIF from 2014 to 2018. Radiologic and clinical outcomes were evaluated by cross-sectional area (CSA) of the spinal canal, thickness and area of ligamentum flavum (LF), subsidence, disc height, fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). ResultsCompared with OLIF, the thickness and area of the LF after surgery were significantly less in TLIF, and the resulting CSA extension was also significantly higher. However, both groups showed improvement in ODI and VAS after surgery, and there was no difference between the groups. Complications related to the posterior approach in TLIF were 4 cases, and in OLIF, there were 2 cases that underwent additional posterior decompression surgery and 6 cases of transient paresthesia. ConclusionSince complications associated with the posterior approach can be avoided, OLIF is a safer and useful minimally invasive surgery. Therefore, appropriate indications are applied, OLIF is a good alternative to TLIF when revision surgery is considered.

Patient and operative factors associated with unanticipated intensive care admission and outcomes following posterior fossa decompressions in children: A retrospective study.

IntroductionPosterior fossa decompression for Chiari I Malformation is a common pediatric neurosurgical procedure. We sought to identify the impact of anesthesia‐related intraoperative complications on unanticipated admission to the intensive care unit and outcomes following posterior fossa decompression.MethodsMedical records of all patients <18 years who underwent surgery for Chiari I malformation between 1/1/09 and 1/31/21 at the Ann & Robert H. Lurie Children's Hospital of Chicago were included. Records were reviewed for patient characteristics, anesthesia‐related intraoperative complications, postoperative complications, and surgical outcomes. The primary outcome was the incidence of unanticipated admission to the intensive care unit, and the primary variable of interest was an anesthesia‐related intraoperative complication. Patient, surgical characteristics, and year of surgery were also compared between patients with and without an unanticipated admission to the intensive care unit, and a multi‐variable adjusted estimate of odds of unanticipated admission to the intensive care unit admission following an anesthesia‐related intraoperative complication was performed. Secondary outcomes included anesthesia factors associated with an anesthesia‐related intraoperative event, and postoperative complications and surgical outcomes between patients admitted to the intensive care unit and those who were not.ResultsTwo hundred ninety‐six patients with Chiari I Malformation were identified. Clinical characteristics associated with an unanticipated admission to the intensive care unit were younger age, American Society of Anesthesiologist (ASA) physical status >2 and an anesthesia‐related intraoperative complication. 29 anesthesia‐related intraoperative complications were observed in 25 patients (8.4%). Two of 25 patients (8%) with an anesthesia‐related intraoperative complication compared with 3 of 271 (1%) patients without anesthesia‐related intraoperative complication had an unanticipated admission to the intensive care unit, odds ratio 7.8 (95% CI 1.2–48.8, p = .010). When adjusted for age, sex, ASA physical status, presenting symptoms, concomitant syringomyelia, previous decompression surgery and year of surgery, the odds ratio for an unanticipated admission to the intensive care unit following an anesthesia‐related intraoperative complication was 5.9 (95% CI 0.51–59.6, p = .149). There were no differences in surgical outcomes between patients with or without an unanticipated admission to the intensive care unit.ConclusionOur study demonstrates that although anesthesia‐related intraoperative complications during posterior fossa decompression are infrequent, they are associated with an increased risk of an unanticipated admission to the intensive care unit.

Extreme cases in percutaneous transforaminal endoscopic surgery: case series and brief review of the literature

Purpose Percutaneous transforaminal endoscopic decompression (PTED) is a minimally invasive method of surgical treatment of miscellaneous spinal conditions. We describe our experience with PTED in extreme cases of foraminal stenosis (FS) in adult degenerative scoliosis (ADS), recurrent foraminal stenosis (RFS) after previous open decompression surgery and adjacent segment disease (ASD) after previous lumbar fusion. Methods Twenty-one (21) patients with FS encountered in the clinical framework of ADS (n = 6), previous open decompression surgery (n = 8) and ASD (n = 7) were prospectively reviewed. Patients were preoperatively assessed via clinical and radiologic evaluation. All patients underwent PTED in 2018–2019. Postoperative evaluation was conducted with clinical examination and evaluation of Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria in predetermined chronic intervals in a 1–2 years follow-up. Results All patients were successfully managed with PTED. Operated levels were L3–L4 (19.0%), L4–L5 (52.4%) and L5–S1 (28.6%). No major perioperative complications were recorded. VAS and ODI scores were demonstrated to exhibit a clinically and statistically significant (p < 0.05) amelioration in all patients’ categories directly postoperatively, which was preserved until the end of follow-up. Overall outcomes according to modified MacNab criteria were excellent in 12 patients (57.1%), good in 6 (28.6%) and fair in 3 (14.3%) patients. Conclusions PTED is safe and effective in extreme cases of FS encountered in patients with ADS, previous posterior open decompression surgery and ASD after previous spinal fusion.

Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

Retrospective case series. To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution's skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

Decompression and enucleation of a large dentigerous cyst in the mandible angle – a case report

Dentigerous cyst is the most prevalent lesion of odontogenic origin, commonly radiographically diagnosed, between the second and fourth decades of life, with a predilection for the male sex. The treatment of choice is enucleation; however, decompression is indicated for cysts that reach large proportions. The most frequent complications are expansion and resorption of the bone cortex, facial asymmetry, root resorption of adjacent teeth, migration or delay of dental eruption and compression of the lower alveolar nerve canal. Objective: To report a clinical case of a dentigerous cyst adjacent to an impacted mandibular third molar, treated with decompression and enucleation. Case report: A 39-year-old male, attended the Stomatology service with a history of a radiographic finding in the mandible. At the radiopraghic evaluation, it was possible to observe a radiolucent unilocular cystic tumor lesion, well delimited by a radiopaque, asymptomatic, intraosseous image in the region of the mandible right angle, extending from the left first pre molar to the left third molar, with the later included in a mesioangular position. The patient underwent a previous cystic decompression process, followed up regularly for 6 months, and referred for endodontic treatment of the left first and second molars to prepare for surgical enucleation and removal of the third molar. After removal, the material was sent to anatomopathological analysis, and the results confirmed the diagnosis of dentigerous cyst. The patient is being followed up without postoperative comorbidities. Conclusion: The chosen treatment allowed the maintenance of the teeth involved in the lesion, and mainly, the minimization of the enucleation procedure by previous decompression.

IHDT++: improving HDT for SPARQL triple pattern resolution

RDF self-indexes compress the RDF collection and provide efficient access to the data without a previous decompression (via the so-called SPARQL triple patterns). HDT is one of the reference solutions in this scenario, with several applications to lower the barrier of both publication and consumption of Big Semantic Data. However, the simple design of HDT takes a compromise position between compression effectiveness and retrieval speed. In particular, it supports scan and subject-based queries, but it requires additional indexes to resolve predicate and object-based SPARQL triple patterns. A recent variant, HDT++, improves HDT compression ratios, but it does not retain the original HDT retrieval capabilities. In this article, we extend HDT++ with additional indexes to support full SPARQL triple pattern resolution with a lower memory footprint than the original indexed HDT (called HDT-FoQ). Our evaluation shows that the resultant structure, iHDT++ , requires 70 - 85% of the original HDT-FoQ space (and up to 48 - 72% for an HDT Community variant). In addition, iHDT++ shows significant performance improvements (up to one level of magnitude) for most triple pattern queries, being competitive with state-of-the-art RDF self-indexes.

Recurrence-free survival and prognostic factors of odontogenic keratocyst: a single-center retrospective cohort.

The aim of the present study was to evaluate the 5-year recurrence-free survival and prognostic factors of odontogenic keratocyst (OKC) from a single-center retrospective cohort in the northeastern region of Brazil. Forty cases of OKC comprised the study population. In the cohort analyzed, 18 (45%) cases were recurrent OKCs and 22 (55%) were non-recurrent OKCs. Recurrence-free survival was defined as the period from the release of the histopathological report to the occurrence of relapse or last visit to the service. Comparison of the clinicopathological variables between primary and recurrent OKC lesions revealed no differences in the frequency of epithelial thickness, presence of satellite cysts and cystic spaces, presence of an inflammatory infiltrate, locularity, and lesion borders. The frequency of symptoms was practically the same even after recurrence. Satellite cysts were more frequent in the group of recurrent lesions (n = 9, p = 0.002) and the presence of an inflammatory infiltrate was also significantly associated with recurrent lesions (n = 15, p = 0.006). Previous decompression or marsupialization was associated with recurrence of the lesion (p = 0.010). In conclusion, the most significant prognostic factors were previous decompression or marsupialization, as well as, morphological parameters associated with the recurrence cases were the presence of an inflammatory infiltrate and satellites cysts. The risk of recurrence is low but continues due to the particularities of epithelial proliferation in OKC.

A Prospective, Randomized, Double-blind, Placebo-controlled Study of Orbital Radiotherapy for Graves’ Ophthalmopathy

Although widely used for more than 85 years, the efficacy of radiotherapy for Graves' ophthalmopathy (GO) has not been established convincingly. To evaluate the efficacy of radiotherapy for GO. Prospective, randomized, internally controlled, double-blind clinical trial in a tertiary care academic medical center. The patients were ethnically diverse males and females over age 30 seen in a referral practice. The patients had moderate, symptomatic Graves' ophthalmopathy (mean clinical activity score, 6.2) but no optic neuropathy, diabetes, recent steroid treatment, previous decompression, or muscle surgery. Forty-two of 53 consecutive patients were enrolled after giving informed consent and fulfilling study entry criteria. Eleven eligible patients declined to participate because of inconvenience, desire for alternative therapy, or concern about radiation. One randomly selected orbit was treated with 20 Gy of external beam therapy; sham therapy was given to the other side. Six months later, the therapies were reversed. Every 3 months for 1 year, we measured the volume of extraocular muscle and fat, proptosis, range of extraocular muscle motion, area of diplopia fields, and lid fissure width. Effective treatment for GO will modify one or more of these parameters. No clinically or statistically significant difference between the treated and untreated orbit was observed in any of the main outcome measures at 6 months. At 12 months, muscle volume and proptosis improved slightly more in the orbit that was treated first. In this group of patients, representative of those for whom radiotherapy is frequently recommended, we were unable to demonstrate any beneficial therapeutic effect. The slight improvement noted in both orbits at 12 months may be the result of natural remission or of radiotherapy, but the changes are of marginal clinical significance.

Analysis of the Factors Affecting Lumbar Segmental Lordosis After Lateral Lumbar Interbody Fusion.

Retrospective study. To elucidate factors that determine segmental lordosis after lateral retroperitoneal lumbar interbody fusion (LLIF) with percutaneous pedicle screw fixation. LLIF has been widely used in degenerative lumbar spine surgery. However, the detailed mechanisms that determine segmental lordosis are still unknown. A total of 69 patients who underwent LLIF with posterior pedicle screw fixation without posterior osteotomy were analyzed. Computed tomography was performed before and within 2 weeks after surgery, and segmental lordotic angle (SLA) after surgery (Post-SLA) was predicted using multiple regression analysis. Explanatory factors considered in this study included SLA before surgery (Pre-SLA), disc height before surgery (DiscH), cage position (CageP; distance between the center of the cage and the center of the disc, where a positive value indicates an anterior cage position), cage angle (CageA), cage height (CageH), CageH-DiscH (amount of lift up), previous decompression surgery, and level fused. A total of 102 levels were analyzed. Multiple regression analysis revealed that the Post-SLA can be predicted with three independent variables, CageP, Pre-SLA, and CageH-DiscH and the adjusted R was 0.70. In cases when the cage was located anteriorly (CageP > 3 mm), Post-SLA was greater with larger CageH, larger CageA, and larger Pre-SLA. When the cage was located in the middle (3 mm ≤CageP ≤-1 mm), Post-SLA was greater with larger CageP, larger Pre-SLA, and without previous decompression surgery. If the cage was located posteriorly (CageP < -1 mm), Post-SLA was greater with smaller CageH-DiscH and greater Pre-SLA. To gain maximum segmental lordosis in LLIF, the cage should be located anteriorly. Furthermore, if the cage can be located anteriorly, a thicker cage with proper angle cage will gain segmental lordosis. If the cage is located posteriorly, a thin cage should be selected. 3.

Conservative treatment options of odontogenic tumors: cases series with 1-8 years follow up

Background: The surgical treatment is the first option, which varies according to the type of cyst and tumor. The marsupialization or previous decompression, as was mentioned in the treatment of odontogenic cysts, may also be used to reduce the lesion and subsequent enucleation and/or resection. However, due to the proliferative activity of some tumors, the use of complementary measures to reduce tumor cell remnants at the post-surgical site is recommended. The electrocautery, cryotherapy with nitrogen, Carnoy's solution and ostectomy with drills; are complementary procedures recommended by some authors.

Berbagai Faktor yang Berpengaruh Terhadap Kualitas Hidup Penyelam Tradisional Penderita Penyakit Dekompresi

Background: Decompression sickness is thought to have an effect on health-related quality of life (HRQL), however, not yet known factors that affect the quality of life on traditional divers with decompression sickness.Methods: This research was a mix methods research with case-control study design which strengthened by FGD. The participants were 66 volunteers, consist of 33 cases dan 33 controls. The data obtained from the study were analyzed using bivariate and multivariate analysis.Results: Variables that had been proven to affect poor quality of life were history of hypertension comorbid (p = 0.010; OR = 65.476; 95% CI = 2.735 – 1,568), diving depth ≥ 30 meters (p = 0.014; OR = 38.410; 95% CI = 2.114 – 698.028), history of loss of consciousness during diving (p = 0.009; OR = 12.456, 95% CI = 1.884 – 82.363), diving duration ≥ 2 hours (p = 0.021; OR = 9.860; 95% CI = 1.410 – 68.943), suffering from anemia (p = 0.024; OR = 8.837; 95% CI = 1.332 – 58.632), frequency of decompression sickness history &gt; 1 time (p = 0.020; OR = 8.834; 95% CI = 1.404 – 55.584).Conclusion: Factors that had been proven to affect poor quality of life on traditional diver with decompression sickness were the history of hypertension comorbid, diving depth ≥ 30 meters, history of loss of consciousness during diving, diving duration ≥ 2 hours, suffering from anemia, the frequency of previous decompression sickness &gt; 1 time.

Improvement of Back and Leg Pain after Lumbar Spinal Decompression without Fusion.

To evaluate whether decompression in lumbar spinal stenosis without fusion leads to sufficient improvement of back pain and leg pain and whether re-decompression alone is sufficient for recurrent lumbar spinal stenosis for patients without signs of instability. A successive series of 102 patients with lumbar spinal stenosis (with and without previous lumbar surgery) were treated with decompression alone during a 3-year period. Data on pre- and postoperative back pain and leg pain (numerical rating scale [NRS] scale) were retrospectively collected from questionnaires with a return rate of 65% (n = 66). The complete cohort as well as patients with first-time surgery and re-decompression were analyzed separately. Patients were dichotomized to short-term follow-up (< 100 weeks) and long-term follow-up (> 100 weeks) postsurgery. Overall, both back pain (NRS 4.59 postoperative versus 7.89 preoperative; p < 0.0001) and leg pain (NRS 4.09 versus 6.75; p < 0.0001) improved postoperatively. The short-term follow-up subgroup (50%, n = 33) showed a significant reduction in back pain (NRS 4.0 versus 6.88; p < 0.0001) and leg pain (NRS 2.49 versus 6.91: p < 0.0001). Similar results could be observed for the long-term follow-up subgroup (50%, n = 33) with significantly less back pain (NRS 3.94 versus 7.0; p < 0.0001) and leg pain (visual analog scale 3.14 versus 5.39; p < 0.002) postoperatively. Patients with previous decompression surgery benefit significantly regarding back pain (NRS 4.82 versus 7.65; p < 0.0024), especially in the long-term follow-up subgroup (NRS 4.75 versus 7.67; p < 0.0148). There was also a clear trend in favor of leg pain in patients with previous surgery; however, it was not significant. Decompression of lumbar spinal stenosis without fusion led to a significant and similar reduction of back pain and leg pain in a short-term and a long-term follow-up group. Patients without previous surgery benefited significantly better, whereas patients with previous decompression benefited regarding back pain, especially for long-term follow-up with a clear trend in favor of leg pain.