Selective Decompression Research Articles

Time Course of Asymptomatic Stenosis in Multiple Lumbar Spinal Stenosis-Five-Year Results of Selective Decompression of Symptomatic Levels.

Background: In the diagnosis of lumbar spinal stenosis (LSS), finding stenosis with magnetic resonance imaging (MRI) does not always correlate with symptoms such as sciatica or intermittent claudication. We perform decompression surgery only for cases where the levels diagnosed from neurological findings are symptomatic, even if multiple stenoses are observed on MRI. The objective of this study was to examine the time course of asymptomatic stenosis in patients with LSS after they underwent decompression surgery for symptomatic stenosis. Materials and Methods: The participants in this study comprised 137 LSS patients who underwent single-level L4-5 decompression surgery from 2003 to 2013. The dural sac cross-sectional area at the L3-4 disc level was calculated based on preoperative MRI. A cross-sectional area less than 50 mm2 was defined as stenosis. The patients were grouped, according to additional spinal stenosis at the L3-4 level, into a double group (16 cases) with L3-4 stenosis, and a single group (121 cases) without L3-4 stenosis. Incidences of new-onset symptoms originating from L3-4 and additional L3-4-level surgery were examined. Results: Five years after surgery, 98 cases (72%) completed follow-up. During follow-up, 2 of 12 patients in the double group (16.7%) and 9 of 86 patients in the single group (10.5%) presented with new-onset symptoms originating from L3-4, showing no significant difference between groups. Additional L3-4 surgery was performed for one patient (8.3%) in the double group and three patients (3.5%) in the single group; again, no significant difference was shown. Conclusion: Patients with asymptomatic L3-4 stenosis on preoperative MRI were not prone to develop new symptoms or need additional L3-4-level surgery within 5 years after surgery when compared to patients without preoperative L3-4 stenosis. These results indicate that prophylactic decompression for asymptomatic levels is unnecessary.

Operative V2 decompression for traumatic vertebrobasilar insufficiency: illustrative case.

Blunt vertebral artery injuries after cervical trauma due to the close anatomical relationship of the vertebral artery to the cervical spine may have fatal consequences because of posterior circulation ischemia and vertebrobasilar insufficiency. While the standard of care remains medical treatment by anticoagulation or antiplatelet therapy, surgical decompression of the vertebral artery is rarely indicated. The authors present a case of selective decompression of a traumatically constricted vertebral artery within the transverse foramen of C2 presenting with vertebrobasilar insufficiency due to bilateral aplasia of the posterior communicating arteries and contralateral hypoplasia of the vertebral artery. Because of their close relationship to the cervical spine, the vertebral arteries are at risk for blunt injury, which may present asymptomatically or with symptoms of posterior circulation ischemia or vertebrobasilar insufficiency either immediately or after a latency phase. The anatomical variability of (1) the vertebral arteries, (2) collateral brainstem perfusion, and (3) the individual injury pattern demands individualized treatment strategies. If endovascular treatment of hemodynamically relevant stenosis of the V2 segment of the vertebral artery poses too high a risk for vessel injury, decompression of the transverse foramen can be performed safely and without risk to the biomechanical stability of the cervical spine.

Long-Term Outcomes after Selective Microendoscopic Laminotomy for Multilevel Lumbar Spinal Stenosis with and without Remaining Radiographic Stenosis: A 10-Year Follow-Up Study.

Long-term clinical outcomes of microendoscopic laminotomy (MEL) for patients with multilevel radiographic lumbar spinal canal stenosis (LSS) have not been widely explored. The clinical significance and natural progression of additional untreated levels (e.g., remaining radiographic (RR)-LSS not addressed by selective MEL) remain unknown. This retrospective study aimed to investigate the long-term clinical outcomes of selective MEL in LSS patients and compare outcomes between patients with and without remaining RR-LSS to determine the efficacy of this procedure. Forty-nine patients at a single center underwent posterior spinal microendoscopic decompression surgery for neurogenic claudication or radicular leg pain in moderate-to-severe spinal stenosis. The patients were categorized into the RR-LSS-positive and RR-LSS-negative cohorts based on unaddressed levels of stenosis. Pre-operative and 10-year follow-up evaluations, including the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score for low back pain and leg pain, Oswestry Disability Index (ODI), and satisfaction, were compared between the groups. Additionally, the need for reoperation was determined. MEL significantly improved JOA scores, lumbar VAS, and ODI over the 10-year postoperative period. Pre-operative characteristics and postoperative outcomes were not significantly different between the cohorts. Overall, 18.4% (9/49) of patients required reoperation during the follow-up period. The reoperation rate in the RR-LSS-positive (13.8%; 4/29) group was similar to that in the RR-LL-negative (15.0%; 3/20) group. MEL is effective for lumbar stenosis, with improved clinical outcomes up to 10 years following surgery. Selective MEL, addressing only symptomatic levels in multilevel stenosis, with residual remaining lumbar stenosis, is similarly effective without increased reoperation rates. Surgeons may consider more limited selective decompression in patients with multilevel stenosis, avoiding the risk and invasiveness of extensive procedures. Level III.

RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

BackgroundThe objective of this study was to evaluate the feasibility, safety, efficacy, and indications of percutaneous pedicle screw fixation (PPSF) combined with selective transforaminal endoscopic decompression (TED) in the treatment of thoracolumbar burst fracture (TBLF).MethodsFrom August 2015 to October 2018, a total of 41 patients with single-segment TLBF (28 men and 13 women) were enrolled in this study. X-ray and computed tomography were obtained before surgery, 1 week after surgery, and 1 year after surgery to evaluate spinal recovery. In addition, we used the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association score (JOA), and the Frankel classification of neurological deficits to evaluate the effectiveness of the treatments.ResultsThe average follow-up time was 22.02 ± 8.28 months. The postoperative Cobb angle, vertebral body compression ratio, vertebral wedge angle, mid-sagittal canal diameter compression ratio, and Frankel grade were significantly improved. There were also significant improvements in the VAS (7.61 ± 1.41 vs. 1.17 ± 0.80, P < 0.001), ODI (89.82 ± 7.44 vs. 15.71 ± 13.50, P < 0.001), and JOA (6.90 ± 2.91 vs. 24.90 ± 3.03, P < 0.001).ConclusionsOur results showed that PPSF combined with selective TED in the treatment of TLBF had excellent efficacy, high safety, less secondary injury than other treatments, and a wide range of indications and that it could accurately distinguish patients who did not need spinal canal decompression after posterior fixation. PPSF combined with selective TED is therefore a good choice for the treatment of TLBF.

Retraction Note: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s13018-020-02167-7.

Functional Outcome of Early, Selective Surgical Nerve Decompression in Leprous Neuropathy.

Background: Leprous neuropathy is a significant, yet preventable, cause of disability worldwide. Decompressive surgery and oral steroids have been used along with Multi Drug Therapy (MDT) for treating leprous neuropathy with varied success as reported in literature. Methods: We prospectively studied 16 peripheral nerves in 10 patients with leprous neuropathy of less than a year duration and not responding to steroid therapy in 3 weeks. The patients were divided into 2 groups: Group-A (decompressive nerve surgery was done within 12 weeks of onset of neurological deficit), and Group-B (nerve decompression was performed after 12 weeks from onset of neurological deficit). Post-operatively patients were assessed for regression of deformity, sensory, motor, vasomotor recovery and neuropathic pain. Results: Median age of patients was 32 years (range; 18 years to 46 years). Mean motor score and mean grip strength was significantly better for group A patients at 2 years follow-up (p < 0.05). Mean sensory score improved significantly in both the groups (p < 0.05). Similarly, mean VAS score for neuropathic pain improved significantly in both the groups (p < 0.05). Recovery of autonomic function was observed in 3 nerves in group A and 1 in group B. Conclusions: The cases who underwent nerve decompression surgery within 12 weeks had better functional outcomes, especially in terms of motor recovery, than those who were operated after that. Studies involving larger number of patients are required to draw firm conclusions.

THORACIC SPINE CANAL STENOSIS WITH CAUDA EQUINE SYNDROME: CASE REPORT

Background: Cases of thoracic stenosis with cauda equina syndrome are rare. The thoracal canal is relatively narrow compared with cervical and lumbar, so the less pressure on the lower thoracal region is the thoracic vertebral height 11 which is the initial release of the cauda equine nerve root can cause complaints of cauda equina syndrome.Case: A 50-year-old male presented pain in both legs for 3 years, accompanied by weakness in the legs, numbness in the buttocks, and erectile dysfunction. Thoracal MRI examination shows severe spinal stenosis at 11th-12th thoracal vertebra with ligamentum flavum hypertrophy. Second patient, a 70-year-old man complained of weak legs since 1 week, accompanied by low back pain, numbness in the buttocks, and difficulty defecating. Thoracal MRI examination shows severe spinal stenosis in the 10th-11th thoracal vertebra. Both patients immediately underwent selective decompression surgery, laminotomy, and flavectomy at thoracal level showed satisfactory results based on improvement in clinical symptoms.Discussion: Leg weakness, hypoesthesia in the buttocks and pubic area, erectile dysfunction is the cauda equina syndrome. The exit of the first cauda equine nerve can be placed at 11th thoracic vertebra, so the presence of stenosis at that level and bellow can cause symptoms of the cauda equina syndrome. MRI examination is needed to ensure that there is severe spinal stenosis at the level of the thoracal-lumbar spine, according to the level of neurological disorders. The surgery of decompression is immediately carried out in the case of cauda equina syndrome because it is an emergency state.Conclusion. In cases with complaints of the cauda equina syndrome, thoracic stenosis can be the cause due to stenosis of the lower thoracic region which is the initial root of the cauda equina nerve. Confirm accurate diagnosis is with MRI.

Curve progression in de novo degenerative lumbar scoliosis combined with degenerative segment disease after short-segment fusion.

To validate the reliability of Berjano and Lamartina classification system of surgical planning in cases of de novo degenerative lumbar scoliosis (DNDLS) combined with degenerative segment disease and identify factors contributing to curve progression. Fifty-four cases of type I or II DNDLS were retrospectively reviewed. Health-related quality of life (HRQOL) was assessed using visual analogue scale (VAS) scores for the back and leg, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Radiographic parameters were obtained from X-rays. Improvements in HRQOL were confirmed by a paired t test. Changes in radiographic parameters were confirmed by paired t test and Wilcoxon signed-rank test. Clinical relevance between spinopelvic parameters and Cobb angle progression was analyzed by Spearman correlation coefficient. The mean follow-up period was 36.8 ± 14.8months. The scores taken preoperatively versus at the last follow-up were as follows: mean VAS back score, 4.5 ± 2.4 versus 1.8 ± 1.5 (p < 0.01); and mean VAS leg score, 5.2 ± 2.5 versus 1.7 ± 2.1 (p < 0.01). The ODI score improved from 25.3 ± 8.9% to 10.1 ± 5.4% (p < 0.01), whereas the mean JOA score improved from 14.3 ± 4.9 to 21.0 ± 3.7 (p < 0.01). The mean Cobb angle decreased from 17.1° ± 7.4° to 9.4° ± 4.5° postoperatively but worsened to 14.1° ± 6.4° at the last follow-up with a mean progression of 2.1° per year. Cobb angle correction was lost at a mean 2.1° ± 3.3° per year with correlation to T1 pelvic angle and sagittal vertical axis preoperatively. Selective decompression and short-segment fusion were effective for treating type I and II cases DNDLS. The Cobb angle increased relative to preoperative sagittal spine alignment. These slides can be retrieved under Electronic Supplementary Material.

Posterior instrumentation without fusion but with selective decompression in early active cases of Pott’s spine with or without neurological deficit

Posterior instrumentation without fusion but with selective decompression in early active cases of Pott’s spine with or without neurological deficit

Selective versus multi-segmental decompression and fusion for multi-segment lumbar spinal stenosis with single-segment degenerative spondylolisthesis

BackgroundLumbar spinal stenosis, often accompanied by degenerative spondylolisthesis, is one of the most common conditions in the elderly. Decompression and fusion is a well-accepted treatment for single-segment lumbar spinal stenosis with degenerative spondylolisthesis; however, the treatment for multi-segment lumbar spinal stenosis with single-segment degenerative spondylolisthesis (MLSS) remains controversial. The objective of this study is to compare the effectiveness of selective decompression and fusion to multi-segmental decompression and fusion for MLSS.MethodsA total of 42 patients suffering from MLSS who underwent surgery between June 2012 and January 2015 were included in this analysis. Of the 42 patients with minimum 3-year follow-up, 22 underwent selective decompression and fusion, and 20 patients underwent multi-segmental decompression and fusion. Age, gender, symptom duration, operative time, blood loss, the number of decompressed segment and fused segment, and complication were compared between the two groups. The visual analog scale (VAS), Oswestry Disability Index (ODI) and Short Form 36 (SF-36) were used to assess efficacy.ResultsOperative time, blood loss, and the number of fused segment in multi-segmental decompression and fusion group were greater than those in selective decompression and fusion group (P < 0.01). The VAS, ODI, and SF-36 scores at 1-year follow-up and 3-year follow-up were significantly improved compared with those preoperatively in both groups (P < 0.01) but were not significantly different between the two groups at each time point (P > 0.05). There was no iatrogenic spinal instability in the decompressed segments in selective decompression and fusion group, while three patients developed postoperative instability at the adjacent segments above the fused segments in multi-segmental decompression and fusion group at 3-year follow-up.ConclusionsSelective decompression and fusion is a safe and effective method for the treatment of MLSS, with the advantages of shorter operative time, less blood loss, and more preservation of spinal motion segments when compared with multi-segmental decompression and fusion.

Flexor muscle disconnection combined with myocutaneous flap for pressure ulcer in patients of ankylosing posture

Objective To investigate the efficacy of flexor muscle disconnection combined with myocutaneous flap in the treatment of pressure ulcer in patients of ankylosing posture. Methods A retrospective case series study was conducted to analyze 15 patients with pressure ulcer at different body parts due to ankylosing posture after paraplegia admitted to the First Affiliated Hospital of Jinan University from January 2012 to July 2017. There were 10 males and five females, aged 40-78 years, with an average age of 68 years. The pressure ulcer ranged from 3 cm×3 cm to 15 cm×11 cm. The pressure ulcers were distributed at sacrococcygeal region in eight patients, macro-rotator in four, and ischial nodules in three. According to the size and position of pressure ulcer, different musculocutaneous flaps were selected, and high selective decompression of hip flexion and knee flexion was performed to ensure the tension free suture of the wound. After the operation, the negative pressure closed drainage (VSD) was given to maintain a proper posture for wound healing. The stitches were removed after the wound healed. The wound healing, pressure ulcer recurrence, flap texture, flap color, and donor site were observed, and patient satisfaction were also surveyed. Results All patients were followed up for 12-36 months, average 24 months. The pressure ulcer was healed in 12 patients after the first repair operation. In two nonunion cases, the unrelieved knee flexion and knee muscles led to high muscular tension and stiff joint, causing strong resistance during limb movement and strong flexor reflex. Two patients were healed after twice operation. In one patient, the incision was torn by the excessive flexion tension due to improper body position caused by the passive movement of the limb after operation, and the wound was healed after twice operation. All muscle flaps covered the wound and survived well, and the wounds were completely closed and healed with good shape, texture as well as elastic recovery. After the suture was removed 18 days after surgery, the patients were discharged satisfactorily. The patients received conventional pressure ulcer care, and no new pressure ulcer was reported during the follow-up. The flap donor site was healed well after autologous skin repair. Conclusion For pressure ulcer in patients of ankylosing posture, flexor muscle disconnection combined with myocutaneous flap has notable effects in reducing tension and can accelerate wound healing and improve healing rate. Key words: Pressure ulcer; Surgical flaps; Reconstructive surgical procedures; Closed negative pressure drainage

Bow Hunter Syndrome Treated Via an Anterior Approach and Selective Decompression Only

Bow Hunter Syndrome Treated Via an Anterior Approach and Selective Decompression Only

Coronary Renal Shunt with Splenectomy (CRSS) for Selective Variceal Decompression

Distal splenorenal shunt and coronary caval shunt are commonly used for selective decompression of esophagogastric varices, but they may not solve severe hypersplenism and their application may be hampered by the presence of splenic venous thrombosis or a left gastric vein (LGV) situated deeply behind the pancreas. On the other hand, some patients have an LGV entering the splenic vein (SV). We tried to work out a new selective shunt for this group of patients. Sixteen patients with severe hypersplenism and esophagogastric varices received coronary renal shunt using the SV following splenectomy. After splenectomy, the proximal portion of the SV and the LGV was isolated from the pancreas. The isolated SV was divided at a point 3-5cm left to its junction with the LGV. The proximal orifice was anastomosed to the left renal vein, and the distal orifice was ligated. A clip was applied to the SV for occlusion between the portal vein and LGV. The right gastric and gastroepiploic vessels were divided to block backflow from the portal vein and to reduce the arterial inflow of the varices. No operative mortality or procedure-related complications occurred. Postoperative computed tomography and endoscopy showed that all the shunts were patent and that the varices had been obliterated or markedly alleviated. In the 6-36months' follow-up period, no recurrent variceal hemorrhage or encephalopathy occurred. Coronary renal shunt combined with splenectomy can achieve the goal of selective decompression of esophagogastric varices. It would become an alternative means of selective variceal decompression for patients whose LGV enters the SV.

Biportal Endoscopic Spine Surgery for Various Foraminal Lesions at the Lumbosacral Lesion.

The stenosing foramen of L5–S1 by several degenerative diseases is one of the challenging areas on surgical approaching because of the deeper depth and steep slope in the lumbosacral junction. The floating view using unilateral biportal endoscopic spine surgery rather than docking into the Kambin’s zone can make the foraminal structures seen panoramically and permit dynamic handling of various instruments without destroying the facet joint and causing iatrogenic instability. Fine discrimination of structural margins in helps of the higher magnification and gentle manipulation of neural structures just as in open spine surgery could be guaranteed using floating technique from the target structures. Selective decompression with preserving innocent structures including facet joints could relieve foraminal lesions at the L5–S1 and decrease the necessity of fusion surgery caused by wider decompression and iatrogenic instability.

Results and Prospects of Portosystemic Shunting in Patients with Liver Cirrhosis

Aim. To perform a comparative analysis of the results of portosystemic shunting with other competitive methods in patients with liver cirrhosis. Materials and Methods. During the period from 1976 to 2015 in the department of portal hypertension and pancreatoduodenal zone surgery conventional portosystemic shunting (PSSh) was performed in 925 patients with portal hypertension (PH). Liver cirrhosis and extrahepatic obstruction caused portal hypertension in 867 (94.3%) and 58 (5.7%) patients respectively. Results. Three study groups were analyzed: the first group – PSSh implementation phase for the period from 1976 to 1992; the second group – stage of partial shunts implementation (1992–1998); the third group – current stage with the introduction of portocaval drainage restrictions by the original method and the implementation of the TIPS technique (1998–2015). Main complication was fatal liver failure which accounted for over 70% of cases. For the last follow-up on background of prophylactic hepatopetal flow-preserving bypass immediate postoperative mortality rate decreased to 2.7% in case of central bypass and to 3.9% in the selective decompression. Conclusion. Traditional selective or partial central portosystemic shunting should be considered as an actual alternative in patients with functional classes A and B if the immediate prospect for liver transplantation is absent.

Percutaneous endoscopic cervical discectomy: a technical review.

The treatment of cervical disc herniations has evolved in the last 2 decades. While the anterior cervical discectomy and fusion continues being the gold standard for the treatment of radicular pain triggered by cervical disc herniation, other surgical approaches have been developed. Percutaneous endoscopic cervical discectomy has demonstrated the ability to decompress the exiting nerve root and dural sac correctly and encouraging clinical outcomes has been reported in the literature. One of the most important advantages offered by the endoscopic technique is the capability to resolve the patient's symptoms without the need for interbody fusion. Also, a specific and selective decompression under continuous visualization with minimal surgery-related trauma can be achieved. There are two percutaneous endoscopic cervical discectomy approaches: anterior and posterior. The decision to perform each other depends on pathology site. However, the endoscopic technique requires previous surgical training, a steep learning curve, and proper patient selection. The development of new hardware such as endoscopes with better optics, lighting systems, and endoscopic surgical tools have allowed using endoscopic techniques in more complex cases. The objective of this review is the technical description of the anterior and posterior percutaneous endoscopic cervical discectomy.

Compressed Voxel-Based Mapping Using Unsupervised Learning

In order to deal with the scaling problem of volumetric map representations we propose spatially local methods for high-ratio compression of 3D maps, represented as truncated signed distance fields. We show that these compressed maps can be used as meaningful descriptors for selective decompression in scenarios relevant to robotic applications. As compression methods, we compare using PCA-derived low-dimensional bases to non-linear auto-encoder networks and novel mixed architectures that combine both. Selecting two application-oriented performance metrics, we evaluate the impact of different compression rates on reconstruction fidelity as well as to the task of map-aided ego-motion estimation. It is demonstrated that lossily compressed distance fields used as cost functions for ego-motion estimation, can outperform their uncompressed counterparts in challenging scenarios from standard RGB-D data-sets.

The Effectiveness and Safety of Selective Lumbar Decompression in Diagnostic Doubt Patients: A Retrospective Control Study

Background: Our previous study demonstrated that selective nerve root block (SNRB) can influence decision-making in lumbar surgery by guiding the selection of nerve roots targeted for decompression in diagnostic doubt patients (DDPs). However, further studies were needed to determine whether this selective decompression (SD) procedure would result in similar clinical outcomes and reduce the perioperative parameters and postoperative complications as compared to the non-selective decompression (NSD) procedure. Objective: The specific goal of this study is to compare clinical outcomes, perioperative parameters, and complications between SD and NSD procedures in DDPs. Study Design: A retrospective control study. Setting: Gaozhou People’s Hospital. Methods: From January 2009 to January 2011, 57 lumbar surgery patients with diagnostic doubt were retrospectively reviewed. Basic patient parameters, as well as perioperative and postoperative data were compared between the selective and non-selective decompression groups. Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and JOA recovery rates. Results: Both groups showed significant improvement in VAS, ODI, and JOA scores between preoperative and postoperative measurements. The differences in VAS and ODI scores between groups were not significant at 3 and 60 months postoperatively (both P &gt; 0.05). In addition, there was no significant difference in JOA recovery rate (P = 0.659) and survival rate (P = 0.586) during the 60 months following surgery. However, distinctly superior perioperative parameters (operation time and hospital stay, blood loss and drainage volume, laminectomy numbers, and fusion segment numbers) were observed in the SD group (P &lt; 0.001 for each score). Moreover, the SD-treated group experienced significantly fewer adverse events postoperatively (P = 0.036). Limitations: The limitations of this study lie in the size of the study and selection of patients and in the fact that it was not feasible to include all cases of diagnostic doubt. Conclusions: On the basis of the 5-year follow-up data, we suggest that the SD procedure guided by SNRB is an effective and safe method for the surgical treatment of DDPs. This procedure produces superior perioperative parameters when compared with the conventional NSD procedure, but has a comparable clinical outcome. Moreover, the benefits of SD surgery include fewer perioperative and postoperative complications. Key words: Lumbar spinal surgery, diagnostic doubt, selective nerve root block (SNRB), selective decompression (SD)

Transcorporeal Selective Decompression without Fusion for Midline-located Cervical Disc Pathology

Transcorporeal Selective Decompression without Fusion for Midline-located Cervical Disc Pathology

Effect of selective decompression of portal vein by distal splenorenal shunt combined with splenopancreatic disconnection on glucose and amino acid metabolism in patients with cirrhosis

Effect of selective decompression of portal vein by distal splenorenal shunt combined with splenopancreatic disconnection on glucose and amino acid metabolism in patients with cirrhosis