Single-stage Decompression Research Articles

Arthroscopic repair of the supraspinatus tendon with single-stage decompression of the suprascapular nerve at the superscapular notch

The history of shoulder problems dates back to ancient times, and the shoulder joint plays a significant role in various aspects of human life. Throughout history, doctors have been providing assistance to individuals experiencing shoulder pain. In the 20th century, significant advancements were made in shoulder surgery, driven by an improved understanding of joint biomechanics and the recognition of new diagnostic methods. Arthroscopy, a minimally invasive surgical technique, was first used for diagnosing shoulder conditions only about 30 years ago. Since then, it has replaced many open surgical procedures due to its enhanced visualization capabilities and lower invasiveness, leading to reduced injury rates. Suprascapular nerve decompression at the suprascapular notch is an example of a procedure that has benefited from arthroscopy. Dr. Laurent Lafosse's detailed description of arthroscopic manipulation in 2007 has been crucial in advancing this technique.This article aims to shed light on the pathogenesis of suprascapular nerve compression at the suprascapular notch following supraspinatus tendon retraction and examine the potential complications of suprascapular neuropathy. The principal author of this article has successfully performed 20 supraspinatus tendon repair operations with simultaneous decompression of the suprascapular nerve at the suprascapular notch, achieving positive outcomes in the postoperative period.

Meningioma Presenting with Spontaneous Venous Intraparenchymal Hemorrhage

A 65-year-old woman with a known right-sided, dural-based lesion and metastatic pancreatic neuroendocrine tumor presented with multiple days of progressive lethargy and left-sided weakness culminating with obtundation and dilated pupils. Computed tomography demonstrated an acute right convexity subdural hematoma and a frontotemporal intraparenchymal hemorrhage with 1.3 cm of midline shift, uncal herniation, and an increase in size of now a hemorrhagic dural-based lesion. She underwent emergency hemicraniectomy for evacuation of subdural hematoma and resection of hemorrhagic meningioma with excellent postoperative result including improvement in midline shift and gross total resection of lesion. Pathology was consistent with a World Health Organization grade II meningioma with a chordoid component. She underwent adjuvant stereotactic radiosurgery and cranioplasty and made a full neurologic recovery. Identification of hemorrhagic meningioma as the underlying pathology causing multicompartmental hemorrhage is crucial. We recommend single-stage decompression with extraaxial clot evacuation and resection of the meningioma when feasible.

Endoscopic Transcervical Approach for Single-stage Anterior Decompression and Stabilization for Atlantoaxial Dislocation

Background: Anterior and posterior approaches are used for the management of atlantoaxial dislocation (AAD). Anterior decompression is required in some patients in whom the C1–2 dislocation is not properly reduced by the posterior approach. It can be done using transnasal, transoral, or transcervical approaches. The endoscopic transcervical approach can be used for single-stage decompression and stabilization that includes an odontoidectomy and anterior fusion. Objective: To determine the surgical outcomes of endoscopic transcervical approach for single-stage decompression and fixation for atlantoaxial dislocation. Material and Methods: This was a prospective observational study done at a tertiary center specialized for endoscopic neurosurgery during the period from 2015 to 2021. All surgeries were performed under endoscopic control. Data were collected for the extent of decompression, amount of blood loss, operative time, need for conversion to microscopy, and complications. Results: The age ranged from 5 to 68 years, and follow-up from 12 to 84 months (average = 46 months). Preoperatively, 54 patients were in the Ranawat Grade 3b, 43 in the Ranawat Grade 3a, and 5 in Grade 2. A total of 42 patients needed odontoidectomy with median C2 corpectomy. Conversion to a microscopic approach was not required in any case. Of 102 patients, 90 improved to Ranawat Grade 1, 7 patients to Grade 2, and 5 patients to Grade 3a. The blood loss was between 25 and 100 ml (average = 68 ml). Two patients suffered from screw pull-out. One patient had re-dislocation and was managed with redo surgery. There was no mortality. Conclusion: Endoscopic transcervical single-stage decompression and stabilization is a safe and effective technique for AAD.

Single-Stage Decompression for Triple Nerve Entrapment of the Distal Upper Limb

Peripheral nerve injuries have a significant negative impact on daily activities and quality of life. Considering that the compression of more than one peripheral nerve may have an increased negative emotional impact, it is, therefore, important to make a thorough diagnosis and speed up the surgical treatment. We present the case of a 71-year-old male patient with multiple simultaneous compression neuropathies of the distal right arm involving the posterior interosseous, median and ulnar nerves, who sought medical care during the first year of the COVID-19 outbreak.

Clinical Outcome of Single-Stage Decompression and Posterior Stabilization in Thoracolumbar Spinal Tuberculosis

Abstract Background Thoracolumbar spine constitutes the most common site for spinal tuberculosis. Though the treatment of spinal tuberculosis is antitubercular drugs initially, the patient with neurologic weakness warrants definitive surgical procedure of decompression and stabilization. Even though many investigators have reported favorable results with anterior decompression and stabilization surgery, due to the increased morbidity and complications, the posterior-only approach with decompression and stabilization has evolved as the operation of choice in recent time. Methods All patients aged between 18 and 70 years with clinically and radiologically proven symptomatic thoracolumbar spinal tuberculosis who failed with conservative treatment for 4 weeks or developed neurologic weakness between the treatments are included in this study. All patients were offered decompression and posterior stabilization with transpedicular screws and rods after explaining the above procedure. Clinical outcome was measured by modified Frankel grading; AIS (American Spinal Injury Association impairment score) grade impairment score; and pain assessment done with visual analog scale (VAS) pre- and postoperatively and at 3, 6, and 9 months of interval. Results The postoperative pain relief, neurologic improvement as per modified Frankel grade, AIS grade, and improvement in erythrocyte sedimentation rate and C-reactive protein were significant as compared with the preoperative status. The surgical interventions thus prove to have adequate relief to the patient and arresting the disease progression. The surgical outcome has very minimal intra- and postoperative complications. Conclusion Single-stage decompression and posterior stabilization in thoracolumbar spinal tuberculosis is safe, effective, and results in good clinical outcome. The advantages of surgery include thorough debridement, decompression, and achievement of spinal stabilization.

Surgical Treatment of Developmental Spondylolisthesis: Contemporary Series With a Two-Surgeon Team

Study DesignRetrospective case series. ObjectivesTo report operative outcomes of contemporary surgical treatment of spondylolisthesis in the pediatric population. Summary of Background DataSurgical treatment of developmental spondylolisthesis is controversial, with limited data on complication and reoperation rates. MethodsA retrospective study followed pediatric patients with either L5–S1 high-grade spondylolisthesis (HGS) or L5–S1 symptomatic low-grade spondylolisthesis (LGS) for a minimum of two years. All patients underwent a contemporary, single-stage decompression, partial reduction, and posterior instrumented fusion (DRPF) or in situ stabilization by a combined orthopedic and neurosurgeon team at a single institution during 2005–2015. Clinical examination and radiographic data were collected preoperatively and at discharge, 1 year, 2 years, and terminal visit (defined as the last follow-up at >2 years). ResultsThirty-four patients (79% HGS), mean (±standard deviation) age at surgery 13.5 (±3.3) years, were followed for 4.8 (±2.3) years. The patients who underwent DRPF (n = 26) had mean lumbosacral angle increase from 79.8° (±20.8) to 92.5° (±16.1) (p < .001) and mean listhesis reduce from 63.2% (±21.9) to 26.0% (±20.1) (p < .001). Preoperatively, 18 (53%) had neurologic symptoms. At one- and two-year follow-up, new or residual neurologic symptoms were present in four patients (12%) (p < .001). Postoperative symptoms were not significantly related to amount of reduction. Sixteen (47%) underwent reoperation at an average of 24.8 months, 10 for planned prominent instrumentation removal, and 6 for true complications. ConclusionsSurgical reduction and decompression of spondylolisthesis in the pediatric population restores spinopelvic alignment. We found no evidence that a greater amount of reduction was associated with a higher incidence of postoperative complications. However, patients should be advised that prominent instrumentation may require future removal. Although previous reports suggest complication rates and permanent neurologic sequelae in up to 20% after operative treatment of spondylolisthesis, our results suggest that a contemporary approach with a two-surgeon team may provide improved results. Level of EvidenceLevel IV.

Endoscopic single stage trans-oral decompression and anterior C1 lateral mass and C2 pedicle stabilization for atlanto-axial dislocation.

Although most of the cases of atlanto-axial dislocation (AAD) and basilar invasion can be managed by posterior approaches in the recent times, anterior decompression with stabilization is required in selected patients who persist with irreducible AAD even after manipulation of the C1-C2 facet joint under general anesthesia. A single stage endoscopic trans-oral decompression and stabilization can be used in such patients. It has not been described so far to the best of authors' knowledge. This is indicated in irreducible AAD with the mandibular angle lying below the C2-C3 disc space. It is not a proper choice when the mandibular angle is above the C2-C3 disc space, there is involvement of the facet joint by trauma or any other pathologies, and if a posterior compression at the cervicomedullary junction persists. All patients should undergo pre-operative radiographs, computed tomography (CT) scan and magnetic resonance imaging with angiogram of the cranio-vertebral region. Utilizing this technique, an intra-operative satisfactory reduction of the dislocation with C1-C2 stabilization could be achieved in 3 patients, and 7 required an additional odontoid excision. Post- operative plain radiographs should be performed to assess for C1- C2 alignment and fusion at 3 and 12 months after surgery. All 10 patients of our series had an irreducible AAD and two had an additional basilar invasion. All patients improved from the pre-operative Ranawat grade 3A (n = 8) and 3B (n = 2) to post-operative grade 1 (n = 9) and 2 (n = 1) at a 3-12- month follow-up assessment. The average duration of the procedure and blood loss was 145 minutes and 75 ml, respectively. Endoscopic trans-oral single stage decompression and stabilization seems to be an effective and safe alternative in selected patients with AAD and basilar invasion.

Interbody distraction and vertebral body reconstruction with polymethylmethacrylate for the treatment of pathological fractures

OBJECTIVE Treatment of epidural spinal cord compression (ESCC) caused by tumor includes surgical decompression and stabilization followed by postoperative radiation. In the case of severe axial loading impairment, anterior column reconstruction is indicated. The authors describe the use of interbody distraction to restore vertebral body height and correct kyphotic angulation prior to reconstruction with polymethylmethacrylate (PMMA), and report the long-term durability of such reconstruction. METHODS A single institution, prospective series of patients with ESCC undergoing single-stage decompression, anterior column reconstruction, and posterior instrumentation from 2013 to 2016 was retrospectively analyzed. Several demographic, perioperative, and radiographic measurements were collected. Descriptive statistics were compiled, in addition to postoperative changes in anterior height, posterior height, and kyphosis. Paired Student t-tests were performed for each variable. Overall survival was calculated using the techniques described by Kaplan and Meier. RESULTS Twenty-one patients underwent single-stage posterior decompression with interbody distraction and anterior column reconstruction using PMMA. The median age and Karnofsky Performance Scale score were 61 years and 70, respectively. Primary tumors included renal cell (n = 8), lung (n = 4), multiple myeloma (n = 2), prostate (n = 2), and other (n = 5). Eighteen patients underwent a single-level vertebral body reconstruction and 3 underwent multilevel transpedicular corpectomies. The median survival duration was 13.3 months. In the immediate postoperative setting, statistically significant improvement was noted in anterior body height (p = 0.0017, 95% confidence interval [CI] -4.15 to -1.11) and posterior body height (p = 0.0116, 95% CI -3.14 to -0.45) in all patients, and improved kyphosis was observed in those with oblique endplates (p = 0.0002, 95% CI 11.16-20.27). In the median follow-up duration of 13.9 months, the authors observed 3 cases of asymptomatic PMMA subsidence. One patient required reoperation in the form of extension of fusion. CONCLUSIONS In situ interbody distraction allows safe and durable reconstruction with PMMA, restores vertebral height, and corrects kyphotic deformities associated with severe pathological fractures caused by tumor. This is accomplished with minimal manipulation of the thecal sac and avoiding an extensive 360° surgical approach in patients who cannot tolerate extensive surgery.

Thoracolumbar fractures: Three column stabilization through posterior only approach

Abstract Introduction The combination of anterior and posterior approaches when indicated in unstable thoracolumbar fractures provides the most stable reconstruction. However, the use of both approaches on a trauma patient is associated with significant morbidity. We evaluated the clinical outcome, morbidity and feasibility of single stage posterior midline approach for decompression and three column stabilization using expandable cage and pedicle screws. Methods The cases of fifteen patients with severe traumatic thoracolumbar fractures/dislocations that were managed with single-stage decompression, reconstruction and three column stabilization using an expandable cage via an entirely posterior approach were included in this study. Data on age, sex, mechanism of injury neurological status, surgical technique, radiological and clinical outcome were reviewed retrospectively. Observation There was no difference between the preoperative and immediate postoperative neurological status of the patients. The average blood loss was 580 ml and average operating time was 4 h 30 minutes. Adequate decompression, fixation and anterior column correction were achieved in all the patients. After a mean follow up period of 21.4 months, no patient complained of local pain and no significant loss of corrections or hardware failure was observed. Conclusion Our experience proves that single stage posterior approach using pedicle screws and an expandable cage is a safe and biomechanically reliable method for treating thoracolumbar fractures.

Single-stage operation for traumatic thoracolumbar fractures with severe dislocation via a posterior approach alone: a case series

This study reports a technique for treating severe thoracolumbar fractures with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach. The cases of 11 patients with severe traumatic thoracolumbar fractures/dislocations that were managed with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach were included. Data on age, sex, mechanism of injury, associated trauma, neurological status, surgical technique, and clinical outcome were reviewed retrospectively. Of the 11 patients, two presented with primarily coronal displacement and nine with sagittal displacement. Coronal displacement was corrected from 19% preoperatively to 4.0% at the last follow-up evaluation. Sagittal displacement was reduced from 73.0% preoperatively to 3.0% at the last follow-up evaluation. After a mean follow-up period of 20.7 (range 16-30) months, no patient complained of local pain and no significant loss of correction or hardware failure was observed. Our experience proves that the single-stage posterior approach is safe and biomechanically reliable for treating severe thoracolumbar fractures/dislocations. Therefore, the presented technique is an alternative approach for this rare injury.

An anterior expandable titanium cage in Mycobacterium avium vertebral osteomyelitis

Mycobacterial infection is most commonly caused by Mycobacterium tuberculosis. M. avium and M. intracellulare are two other organisms within the Mycobacteria group often classified together as the mycobacterium avium–intracellulare complex (MAC). MAC is of low virulence and usually causes disease in immunocompromised patients such as those with the human immunodeficiency virus. Isolated vertebral osteomyelitis secondary to MAC infection is rare with only 18 previous reports, only one of which required surgical intervention. There is increasing evidence that vertebral body osteomyelitis with other pathogens can be treated with decompression, debridement and reconstruction with titanium vertebral body cages in the setting of active infection. We present a 70-year-old Caucasian male with a pathological fracture of T6 vertebral body and a kyphosis of 60° and MRI findings consistent with granulomatous osteomyelitis. Vertebrectomies of T5 and T6 were performed and an expandable titanium cage was inserted with supplementary lateral fixation using plate and screws. This is the first report of a single-stage decompression and fusion with a titanium vertebral body cage for active MAC vertebral osteomyelitis.

Posterior cervical decompression and fusion for circumferential spondylotic cervical stenosis: Review of 50 consecutive cases

Purpose of Study This study presents a clinical and radiological evaluation of 50 consecutive patients with symptomatic spondylotic cervical myelopathy and circumferential spinal cord compression who were managed with a single stage wide posterior laminectomy and lateral mass instrumented fusion. Methods Used 50 consecutive patients (33 male, 17 female) over a 4 year period presenting with symptomatic cervical myelopathy due to circumferential cervical spondylotic spinal stenosis were evaluated and operated upon by a single surgeon and followed in a prospective fashion. All patients underwent pre- and postoperative clinical, radiological and MRI evaluation. Summary of Findings No deaths occurred and no instrumentation-related neural or vascular injuries were noted. No patient required reoperation for ventral compression and in all cases CSF was visible anterior to the cord on postoperative MRI scanning, with relief of the circumferential compression. Most patients improved by at least 1 Nurick grade. Three patients (6%) had single level screw pullouts which did not affect clinical outcome, and required no intervention. Slight worsening of kyphosis occurred in 4% of cases but as group there was no measured difference in sagittal balance ( P = 0.10). Oswestry Neck Disability Scores improved from 25.7 ± 3.6 to 16.6 ± 7.1 ( P < 0.05). One patient required a foraminotomy/posterior discectomy 12 months postoperatively at an adjacent level. Conclusions This study demonstrates that multisegmental spondylotic circumferential cervical stenosis causing symptomatic myelopathy can be managed by single stage decompression and fusion via a posterior approach with very low morbidity and excellent clinical and radiological outcome. The incidence of adjacent segment disease is lower than for anterior interbody fusions with a 1%/year incidence at follow up to date.

P152. The lateral extracavitary approach for primary single stage decompression arthrodesis and instrumentation of thoracic and lumbar lesions clinical outcomes in 32 consecutive patients at 1 year

P152. The lateral extracavitary approach for primary single stage decompression arthrodesis and instrumentation of thoracic and lumbar lesions clinical outcomes in 32 consecutive patients at 1 year

Synchronous Vertebral Decompression and Posterior Stabilization in the Treatment of Spinal Malignancy

Abstract Thirty-four patients with metastatic tumors of the spinal column exhibiting vertebral collapse and posterior element disease were treated by a single-stage operation combining decompression of the vertebral body with posterior spinal instrumentation. Attention is drawn to the use of computed tomographic scanning in planning the operative approach. The indications for surgery were neurological deficit in 32 patients and pain in 2; 14 patients received preoperative radiotherapy. Of the 21 patients who were nonambulant preoperatively, 67% walked again, 21% regained sphincter control, and 68% had less pain. The surgical mortality was 12%; wound infection and dehiscence occurred in 15%. These results indicate that a single-stage decompression and posterior stabilization may improve neurological function dramatically in patients with malignant cord compression. The operative morbidity and mortality is comparable to that of laminectomy.

Synchronous vertebral decompression and posterior stabilization in the treatment of spinal malignancy.

Thirty-four patients with metastatic tumors of the spinal column exhibiting vertebral collapse and posterior element disease were treated by a single-stage operation combining decompression of the vertebral body with posterior spinal instrumentation. Attention is drawn to the use of computed tomographic scanning in planning the operative approach. The indications for surgery were neurological deficit in 32 patients and pain in 2; 14 patients received preoperative radiotherapy. Of the 21 patients who were nonambulant preoperatively, 67% walked again, 21% regained sphincter control, and 68% had less pain. The surgical mortality was 12%; wound infection and dehiscence occurred in 15%. These results indicate that a single-stage decompression and posterior stabilization may improve neurological function dramatically in patients with malignant cord compression. The operative morbidity and mortality is comparable to that of laminectomy.