Surgery For Stenosis Research Articles

Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review

In recent years, unilateral biportal endoscopic spinal surgery has been used for the treatment of lumbar spinal stenosis with good results. Some investigators counted the total incidence of complications in unilateral biportal endoscopic surgery for lumbar spinal stenosis, but none have analyzed the incidence of specific complications. The present study further counted the incidence of specific complications and gave the possible causes of the complications. English databases including PubMed were searched to collect relevant literature on unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis. The inquiry period is from January 1, 2015, to July 1, 2022. The literature was screened, information extracted, and risk of bias evaluated by the researchers, followed by Meta analysis using R4.2.1 and RStudio statistical software. In total, we included 14 studies involving 707 patients. The included studies were retrospective case series, The results of the single-arm rate meta-analysis showed that the total complication rate of unilateral biportal endoscopic surgery treatment of lumbar spinal stenosis was 8.1% (95% confidence interval [CI] [0.060; 0.103]); of which, the highest incidence of dural tear was 4.5% (95% CI [0.030; 0.064]), the incidence of symptomatic postoperative spinal epidural hematoma was approximately 1.1% (95% CI [0.001; 0.027]), the incidence of incomplete decompression was 2.0% (95% CI [0.007; 0.038]), the incidence of transient palsy was 2.6% (95% CI [0.005; 0.057]). The incidence of total complications of unilateral biportal endoscopic surgery for lumbar spinal stenosis was 8.1%, dural tear remained a major complication with an incidence of 4.5%, incomplete decompression was 2.0%, transient palsy was 2.6%, and, unexpectedly, symptomatic postoperative spinal epidural hematoma was only 1.1%.

Preliminary results of biportal endoscopic lumbar interbody fusion, decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability

Objectives: To evaluate the preliminary clinical outcomes of biportal endoscopic lumbar interbody fusion (BE-LIF), decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability. Methods: The data of 9 patients with single-level lumbar spinal stenosis who underwent BE-LIF, decompression and pedicle screw insertion assisted with biportal endoscopy in Xinjiang Production and Construction Corps Hospital from March 1st 2022 to April 30th 2022 were analyzed retrospectively. The visual analogue scales (VAS) for pain in back and legs, and the Oswestry disability index (ODI) of all the patients were collected before operation, on the third day after operation and at the last follow-up. Moreover, the operation time, intra-operation blood loss, radiation shots for pedicle screw insertion, post-operation drainage and ambulation time were recorded. The screw position was checked with CT after the operation. Results: All the patients were female with a mean age of (70.3±8.4) years (ranged 56-84 years); the patients were followed-up for 12-16 weeks. All 9 patients had good clinical results. The VAS scores for back pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(2.9±0.6), (1.8±0.4) vs (6.4±1.1) points, both P<0.05]. The VAS scores for leg pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(1.9±0.3), (1.4±0.5) vs (7.3±1.6) points, P<0.05]. The ODI scores at last follow-up was significantly lower than that before the operation ((24.0%±6.5% vs 55.7%±12.8%, P<0.05). The intra-operative blood loss was (177±103) ml, the drainage amounts post-operation was (122±56) ml, the operation time was (207.8±32.7)min, the ambulation time was (2.3±0.5) days. The total radiation shots for pedicle screw insertion were 20-42 times, the average radiation shots per screw was (6.9±1.5) times. No severe complications or adverse events occurred. No nerve root injury or dural tear occurred in the operation, and no revision surgery needed. Conclusions: The pedicle screw insertion assisted with biportal endoscopic technique can decrease the radiation exposure with good feasibility and safety during the BE-LIF. The BE-LIF combined with the pedicle screw insertion assisted with biportal endoscopy is an effective and safe surgery for lumbar spinal stenosis with good early results.

Early surgery or conservative management for asymptomatic severe aortic stenosis: Meta-analysis of RECOVERY and AVATAR.

The standard practice for management for asymptomatic severe aortic stenosis with a normal left ventricular systolic function is conservative management with a few exceptions. This practice is challenged by two recent randomized controlled trials (RCT). All the prior data is observational. We performed a meta-analysis of these 2 RCTs to determine if early surgical aortic valve replacement in this patient population is beneficial compared with the standard conservative therapy.

Predictors for failure after surgery for lumbar spinal stenosis: a prospective observational study

Background/contextSome patients do not improve after surgery for lumbar spinal stenosis (LSS), and surgical treatment implies a risk for complications and deterioration. Patient selection is of paramount importance to improve the overall clinical results and identifying predictive factors for failure is central in this work. PurposeWe aimed to explore predictive factors for failure and worsening after surgery for LSS. Study design /settingRetrospective observational study on prospectively collected data from a national spine registry with a 12-month follow-up. Patient sampleWe analyzed 11,873 patients operated for LSS between 2007 and 2017 in Norway, included in the Norwegian registry for spine surgery (NORspine). Twelve months after surgery, 8919 (75.1%) had responded. Outcome measuresOswestry Disability Index (ODI) 12 months after surgery. MethodsPredictors were assessed with uni- and multivariate logistic regression, using backward conditional stepwise selection and a significance level of 0.01. Failure (ODI>31) and worsening (ODI>39) were used as dependent variables. ResultsMean (95%CI) age was 66.6 (66.4–66.9) years, and 52.1% were females. The mean (95%CI) preoperative ODI score was 39.8 (39.4–40.1). All patients had decompression, and 1494 (12.6%) had an additional fusion procedure. Twelve months after surgery, the mean (95%CI) ODI score was 23.9 (23.5–24.2), and 2950 patients (33.2%) were classified as failures and 1921 (21.6%) as worse. The strongest predictors for failure were duration of back pain > 12 months (OR [95%CI]=2.24 [1.93–2.60]; p<.001), former spinal surgery (OR [95%CI]=2.21 [1.94–2.52]; p<.001) and age>70 years (OR (95%CI)=1.97 (1.69–2.30); p<.001). Socioeconomic variables increased the odds of failure (ORs between 1.36 and 1.62). The strongest predictors for worsening were former spinal surgery (OR [95%CI]=2.04 [1.77–2.36]; p<.001), duration of back pain >12 months (OR [95%CI]=1.83 [1.45–2.32]; p<.001) and age >70 years (OR [95%CI]=1.79 [1.49–2.14]; p<.001). Socioeconomic variables increased the odds of worsening (ORs between 1.33–1.67). ConclusionsAfter surgery for LSS, 33% of the patients reported failure, and 22% reported worsening as assessed by ODI. Preoperative duration of back pain for longer than 12 months, former spinal surgery, and age above 70 years were the strongest predictors for increased odds of failure and worsening after surgery.

Lumbar stenosis due to wild-type transthyretin amyloid-induced thickening of the ligamentum flavum: a separate etiology from degeneration of intervertebral discs?

Wild-type transthyretin amyloid (ATTRwt) is deposited in the ligamentum flavum (LF) of a subset of patients with spinal stenosis who undergo decompressive surgery, although its role in the pathophysiology of spinal stenosis is unknown. It has been theorized that degeneration of intervertebral discs causes increased mechanical stress and inflammatory/degenerative cascades and ultimately leads to LF fibrosis. If ATTRwt deposits contribute to LF thickening and spinal stenosis through a different pathway, then patients with ATTRwt may have less severe disc degeneration than those without it. In this study, the authors compared the severity of disc degeneration between patients with lumbar stenosis with and without amyloid in their LF to test whether ATTRwt is a unique contributor to LF thickening and spinal stenosis. Of 324 consecutive patients between 2018 and 2019 who underwent decompression surgery for spinal stenosis and had LF samples sent for pathological analysis, 31 harboring ATTRwt were compared with 88 controls. Patient medical records were retrospectively reviewed for demographic and surgical information. Disc degeneration was assessed on preoperative T2-weighted MR images with the modified Pfirrmann grading system at every lumbar disc level. Baseline characteristics were similar between the groups, except for a statistically significant increase in age in the ATTRwt group. The crude unadjusted comparisons between the groups trended toward a less severe disc degeneration in the ATTRwt group, although this difference was not statistically significant. A multivariable linear mixed-effects model was created to adjust for the effects of age and to isolate the influence of ATTRwt, the presence of an operation at the level, and the specific disc level (between L1 and S1). This model revealed that ATTRwt, the presence of an operation, and the specific level each had significant effects on modified Pfirrmann scores. Less severe disc degeneration was noted in patients with degenerative spinal stenosis harboring ATTRwt compared with those without amyloid. This finding suggests that ATTRwt deposition may play a separate role in LF thickening from that played by disc degeneration. Future studies should aim to elucidate this potentially novel pathophysiological pathway, which may uncover an exciting potential for the development of amyloid-targeted therapies that may help slow the development of spinal stenosis.

Microscopic Unilateral Approach for Bilateral Decompression of Lumbar Spinal Stenosis.

This is a study based on single-surgeon data on spinal stenosis surgery via microscopic approach. The aim is to evaluate the effectiveness of the unilateral approach to bilateral decompression and the usage of Taylor retractors and brain spatula in patients with spinal stenosis. This is a retrospective study on bilateral decompression for lumbar spinal stenosis using a microscopic unilateral approach by a single surgeon, between April 2015 and March 2018. In total, 50 patients were operated due to single level lumbar spinal stenosis. All patients were evaluated by preoperative and postoperative plain radiographs and magnetic resonance (MR) images. Walking distance (WD), visual analog scale (VAS) for pain and Odom's criteria were evaluated for follow-up. One level of the lumbar spine was surgically decompressed in all patients. The median age of patients was 64.6 (51- 82). Of the patients, 72% (36) were women, and 28% (14) were men. Most patients had refractory low back pain (96%) after conservative treatment. The stenotic levels of the cases were as follows: L3-4, 23(46%); L4-5, 24(48%); and L5-S1, 3 (6%). VAS scores decreased in all patients after surgery. According to Odom's criteria, an excellent or good score was found in 43 patients at the 12th follow-up examination. WDs increased up to 1000 meters for 41 patients. The microscopic unilateral approach to bilateral decompression is an effective method for decompression in spinal stenosis. Via this approach, surgical trauma is reduced and surgically induced instability is avoided as much as possible.

Effect of aspirin in preventing deep vein thrombosis (DVT) after lumbar canal spinal stenosis surgeries: a double-blind parallel randomized clinical trial

Background: Deep vein thrombosis (DVT) is a great postoperative challenge in all orthopaedic surgeries. To the authors’ knowledge, this study is the first to evaluate the efficacy of aspirin administration in the prevention of DVT in patients undergoing lumbar spinal surgery. Methods: In this double-blind parallel randomized clinical trial, a total of 126 candidates (age 40 yr and older) were admitted between June 2021 to December 2021. Patients were randomly assigned to the intervention chemoprophylaxis group (41 patients receiving 325 mg aspirin) and controls. The DVT occurrence was recorded by clinical features (Well’s criteria), Doppler lower limbs ultrasound, and D-dimer levels in all participants at baseline (24 hr before the time of surgery) and 2, 6, and 12 wk after surgery in postoperative visits. Results: The mean age of the participants was 63.72±6.87 yr. Baseline demographic values were similar in both groups (P&gt;0.05). The mean follow-up duration was 6.11±2.33 mo. No cases of DVT or abnormal findings on Doppler ultrasound were observed in either group. The mean duration of hospitalization or intensive care unit (ICU) admission was similar between the two groups. Mean baseline D-dimer levels were significantly higher in the intervention group compared with the controls (P=0.047), while it was similar in both groups 3 mo after the operation (P=0.13). Conclusions: In the current study, no case of DVT was observed in either study group. These data do not support the use of aspirin as an anticoagulant for DVT prophylaxis following regular lumbar spinal surgeries. Level of Evidence: Level II.

The Effect of Cervical and Lumbar Decompression Surgery for Spinal Stenosis on Erectile Dysfunction.

Observational study. To evaluate the prevalence of erectile dysfunction and evaluate the effects of decompressive surgery on erectile dysfunction in cervical spinal stenosis and lumbar canal stenosis patients. This observational, prospective analysis enrolled patients aged 18-80 with cervical spinal stenosis and/or lumbar canal stenosis that underwent respective decompressive surgery. The IIEF-5 questionnaire was administered preoperatively, and at 6- and 12-months postoperatively to assess erectile dysfunction severity. The EPIC database was queried to determine any postoperative complications and document prominent erectile dysfunction risk factors. Of 79 patients included in the analysis, 42 (53.2%) completed the IIEF-5 at 6months, and 62 (78.5%) completed it at 12months. Eighteen had cervical stenosis only, 54 had lumbar stenosis only, and 7 had both. 72% (18/25) of cervical stenosis patients and 83.6% (51/61) of lumbar stenosis patients had erectile dysfunction preoperatively according to IIEF-5 responses. The average preoperative IIEF-5 score indicated significant presence of erectile dysfunction for both the cervical and lumbar stenosis groups. No significant differences were identified in IIEF-5 score deltas from pre- to both postoperative periods. The presence of erectile dysfunction in both the cervical and lumbar stenosis groups was not significantly associated with the presence of any documented risk factors. Our results suggest no significant improvement in overall erectile function postoperatively for patients with preoperative erectile dysfunction. This is important to address during patient counseling for decompression surgery candidates with cervical spinal stenosis and/or lumbar canal stenosis to manage expectations.

Postlaminectomy instability–is fusion essential in degenerative lumbar stenosis surgery?

Aim: To examine the incidence of postlaminectomy instability in cases of lumbar spinal stenosis who underwent facet-preserving laminectomy and decompression with the classical laminectomy technique, together with comorbid diseases, and to determine whether fusion is needed. Material and Method: The patients who were operated by the same surgeon in the same hospital between 2017 and 2019 and followed up in terms of instability in the postoperative 1st and 6th months were evaluated retrospectively with their clinical findings, comorbid diseases and radiological images. White and Panjabi's instability criteria were used. It was analyzed with SPSS 23.00 statistical package program. Data were analyzed by descriptive statistics (number, percentage distribution, mean and standard deviation), t-test and ANOVA. Results: A total of 53 patients, 22 male (41.5%) and 31 female (58.5%) were included in the study. Age, surgical precedures and comorbid diseases were investigated. None of the patients, but 2 patients with osteoporosis with or without diabets, had postlaminectomy instability. Conclusion: It has been shown in our study that decompressive and facet-preserving surgery performed at 2 levels or less using only the classical laminectomy technique does not cause instability in patients without osteoporosis alone or with diabetes, especially in the first 6 months, and can be safely applied to patients. Osteoporosis alone or in association with diabetes mellitus suggests increased postoperative instability.

Efficacy of the five-item modified frailty index for predicting a poor prognosis in patients undergoing posterior lumbar interbody fusion surgery for lumbar spinal stenosis

Objective: This study aimed to determine whether preoperative frailty assessed using the five-item modified frailty index (mFI-5) in patients undergoing posterior lumbar interbody fusion for lumbar spinal stenosis can predict poor patient outcomes.Methods: We retrospectively included 192 patients aged 18 years or older who were diagnosed with lumbar spinal stenosis and underwent posterior lumbar interbody fusion at a single hospital between March 2009 and February 2021. We calculated mFI-5 scores for these patients based on the following five comorbidities: (1) hypertension requiring medication, (2) diabetes mellitus, (3) history of chronic obstructive pulmonary disease or pneumonia, (4) history of congestive heart failure in the 30 days before surgery, and (5) partially or totally dependent functional health status at the time of surgery. The patients were categorized into three groups according to their mFI-5 scores, and these groups were analyzed. A P&lt;0.05 was considered statistically significant in all analyses.Results: Length of hospital stay (LOS) was significantly associated with mFI-5 score (β=0.196, P=0.008), age (β=0.112, P=0.159), and surgical level (β=0.238, P&lt;0.001). In patients with fusion at one or two levels, mFI-5 score showed the greatest association with LOS (β=0.188, P=0.016), followed by sex (β=0.137, P=0.065) and the number of fused segments (β=0.137, P=0.065).Conclusion: Frailty may not be an independent predictor, but it has significant predictive power for LOS in patients undergoing posterior lumbar interbody fusion for lumbar spinal stenosis, especially in patients undergoing fusion at one or two levels.

Patient-level payment patterns prior to single level lumbar decompression are associated with resource utilization, postoperative payments, and adverse events

Understanding patient-specific trends in costs and healthcare resource utilization (HCRU) surrounding lumbar spine surgery is critically needed to better inform surgical decision making and the development of targeted interventions. 1) Identify subgroups of patients following distinct patterns in direct healthcare payments pre- and postoperatively, 2) determine whether these patterns are associated with patient and surgical factors, and 3) examine whether preoperative payment patterns are related to postoperative payments, healthcare resource utilization (HCRU), and adverse events. Retrospective analysis of an administrative claims database (IBM Marketscan Research Databases 2007-2015). Adults undergoing primary single-level decompression surgery for lumbar stenosis (n=12,394). Direct healthcare payments, HCRU payments (15 categories), 90-day complications and all-cause readmission, 2-year reoperation METHODS: Group-based trajectory modeling is an application of finite mixture modeling that is able to identify meaningful subgroups within a population that follow distinct developmental trajectories over time. We used this technique to identify subgroups of patients following distinct profiles in preoperative direct healthcare payments. A separate analysis was performed to identify distinct profiles in payments postoperatively. Patient and surgical factors associated with these payment profiles were assessed with multinomial logistic regression, and associations with adverse events were assessed with risk-adjusted multivariable logistic regression. We identified 4 preoperative patient payment subgroups following distinct profiles in payments: Pre-Low (5.8% of patients), Pre-Early-Rising (4.8%), Pre-Medium (26.1%), and Pre-High (63.3%). Postoperatively, 3 patient subgroups were identified: Post-Low (8.9%), Post-Medium (29.6%), and Post-High (61.4%). Patients following the higher-cost pre- and postoperative payment profiles were older, more likely female, and had a greater physical and mental comorbidity burden. With each successively higher preoperative payment profile, patients were increasingly likely to have high postoperative payments, use more HCRU (particularly high-cost services such as inpatient admissions, ER, and SNF/IRF care), and experience postoperative adverse events. Following risk adjustment for patient and surgical factors, patients following the Pre-High payment profile had 209.5 (95% CI: 144.2, 309.7; p<.001) fold greater odds for following the Post-High payment profile, 1.8 (1.3, 2.5; p=.003) fold greater odds for 90-day complications, and 1.7 (1.2, 2.6; p=.035) fold greater odds for 2-year reoperation relative to patients following the Pre-Low payment profile. There are identifiable subgroups of patients who follow distinct profiles in direct healthcare payments surrounding lumbar decompression surgery. These payment profiles are related to patient age, sex, and physical and mental comorbidities. Notably, preoperative payment profiles may provide prognostic value, as they are associated with postoperative costs, HCRU, and adverse events. III.

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients.

A retrospective study. The purpose of this study is to identify the incidences, causes, and risk factors of 30-day unplanned reoperation of posterior surgery for thoracic spinal stenosis (TSS) based on 1948 patients in a single center. Unplanned reoperation is suggested to be a useful quality indicator for spine surgery. However, the incidences, causes, and risk factors of 30-day unplanned reoperation in patients who underwent posterior spinal surgery for TSS have not been well-established. We retrospectively analyzed the clinical data of patients who underwent posterior spinal surgery for TSS from January 2011 to December 2021. Statistical methods including univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors. A total of 1948 patients who underwent posterior spinal surgery for TSS in our institution were reviewed, and 77 (3.95%) required unplanned reoperations within 30 days because of epidural hematoma (1.64%), wound-related complications (1.02%), inadequate decompression (0.41%), and implant malposition or failure (0.36%), neurological deficit (0.26%), and other causes (0.26%). After univariate analysis, seven clinical factors were associated with unplanned reoperation ( P <0.05). Multivariate logistic regression analysis showed that upper thoracic spine surgery ( P =0.010), thoracic kyphosis ≥45° ( P =0.039), and intraoperative dural injury ( P =0.047) were independent risk factors for 30-day unplanned reoperation of posterior surgery for TSS. The incidence of 30-day unplanned reoperations after posterior surgical treatment for TSS was 3.95%. The most common causes were epidural hematoma, wound-related complications, inadequate decompression, and implant malposition or failure. Upper thoracic spine surgery, thoracic kyphosis ≥45°, and intraoperative dural injury led to an increased risk of unplanned reoperation within 30 days after posterior spinal surgery for TSS. 4.

Successful concomitant minimally invasive surgery for aortic valve stenosis and right lung cancer via right mini-thoracotomy : A case report

BackgroundThe case of aortic valve stenosis complicated with lung cancer have compelled cardiovascular surgeons to make challenging. We report the first successful short-term outcomes of one-stage minimally invasive aortic valve replacement and video-assisted thoracoscopic surgery lobectomy through right mini-thoracotomy in a patient with synchronous bicuspid severe aortic valve stenosis which was unsuitable for transcatheter aortic valve implantation and right lung cancer.Case presentationA 76-year-old man with severe aortic valve stenosis was diagnosed with lung cancer of the right upper lobe with stage IA2. Considering the potential risk of tumor metastasis, a one-stage surgical therapy for right lung cancer and type 0 bicuspid aortic valve stenosis was required; however, transcatheter aortic valve implantation was unsuitable due to a bicuspid aortic valve with severe calcification. Therefore, concomitant minimally invasive aortic valve replacement and lobectomy via right mini-thoracotomy were performed. The postoperative course was uneventful.ConclusionConcomitant aortic valve replacement and right lobectomy via right mini-thoracotomy may reduce surgical invasiveness, leading to early recovery. This surgical strategy is a useful option, particularly for patients with aortic valve stenosis complicated with right lung cancer.

Optimal timing of referral for nerve transfer surgery for postoperative C5 palsy.

Cervical nerve 5 palsy can occur following surgery for cervical spine pathology. The prognosis of C5 palsy is generally favorable, and most patients recover useful function. However, some patients do not recover useful strength. Nerve transfers are a potential effective treatment of postoperative severe C5 palsy. This study aimed to further delineate the natural history of recovery from postoperative C5 palsy, determine whether lack of recovery at specific time points predicts poor recovery prognosis, and thereby determine a reasonable time point for referral to a complex peripheral nerve specialist. The authors conducted a retrospective review of 72 patients who underwent surgery for cervical spondylosis and stenosis complicated by C5 palsy. Medical Research Council (MRC) motor strength grades were recorded preoperatively; immediately postoperatively; at discharge; and at 2 weeks, 3 months, 6 months, and 12 months postoperatively. Univariate and multivariate logistic regression models were used to identify demographic and clinical risk factors associated with recovery of useful strength after severe C5 palsy. The mean patient age was 62.5 years, and 36.1% of patients were female. Thirty patients (41.7%) experienced severe C5 palsy with less than antigravity strength (MRC grade 2 or less) at discharge. Twenty-one (70%) of these patients recovered useful strength (MRC grade 3 or greater) at 12 months postoperatively, and 9 patients (30%) did not recover useful strength at 12 months. Of those patients with persistent severe C5 palsy at 3 months postoperatively, 50% recovered useful strength at 12 months. Of those patients with persistent severe C5 palsy at 6 months postoperatively, 25% recovered useful strength at 12 months. No patient with MRC grade 0 or 1 strength at 6 months postoperatively recovered useful strength. A history of diabetes was associated with the occurrence of severe C5 palsy. On multivariate analysis, female sex was associated with recovery of useful strength. Most patients with severe C5 palsy recover useful strength in their C5 myotome within 12 months of onset. However, at 3 months postoperatively, patients with persistent severe C5 palsy had only a 50% chance of recovering useful strength by 12 months. Lack of recovery of useful strength at 3 months postoperatively is a reasonable time point for referral to a complex peripheral nerve center to establish care and to determine candidacy for nerve transfer surgery if severe C5 palsy persists.

Usefulness of preoperative Short Form-36 Mental Component Score as a prognostic factor in patients who underwent decompression surgery for degenerative lumbar spinal stenosis.

Physical factors such as frequency of low back pain, sensory abnormalities in the lower extremities, smoking history before surgery, and preoperative mental health status as predictors of operative outcomes have been growing as areas of interest in the field of degenerative lumbar spinal stenosis (DLSS). This study aimed to investigate the correlation between the preoperative Short Form-36 Mental Component Score (SF-36 MCS) and long-term prognosis after decompression surgery for DLSS. In total, 198 patients were enrolled in this study. The Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) were used to evaluate spinal functional outcomes. The SF-36 questionnaire was used and analyzed by classifying it into physical component score (PCS) and mental component score (MCS). The SF-36 MCS was divided into role limitations caused by emotional problems, social functioning, vitality, and emotional well-being. In the correlation between preoperative MCS and ODI improvement, the r value was −0.595 (P < .05) at 12 months postoperatively. ODI improvement at 12 months after decompression surgery showed a statistically significant and strong negative correlation with preoperative MCS. In the correlation between preoperative MCS and RMDQ improvement, the r value was −0.544 (P < .05) at 12 months postoperatively. Therefore, RMDQ improvement 12 months after decompression surgery showed a strong negative correlation with preoperative MCS. Regarding the correlation between preoperative MCS and SF-36 PCS improvement, the r values were 0.321 (P < .05) at 6 months postoperatively and 0.343 (P < .05) at 12 months postoperatively. Therefore, SF-36 PCS improvement at 6 and 12 months after decompression surgery showed a strong positive correlation with preoperative SF-36 MCS scores. Preoperative SF-36 MCS is a factor that can predict the prognosis of patients who underwent decompression surgery for lumbar spinal stenosis for at least 1 year postoperatively.

Efficacy and Safety of Microscopic Bilateral Decompression with Unilateral Laminectomy in Geriatric Lumbar Spinal Stenosis Surgery

Efficacy and Safety of Microscopic Bilateral Decompression with Unilateral Laminectomy in Geriatric Lumbar Spinal Stenosis Surgery

Effect of Simultaneous Multiplane Surgery on Cardiopulmonary Function in Patients with Moderate to Severe Obstructive Sleep Apnea-Hypopnea Syndrome and Its Curative Effect.

Objective To investigate the changes in cardiopulmonary function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by one-stage multiplane surgery. Methods 70 patients with moderate and severe OSAHS underwent nasal in our hospital from July 2017 to February 2021, palatopharyngeal, and/or tongue operations simultaneously and were followed up for 6 months. The Epworth Sleeping Scale (ESS) scores of patients before and after surgery were compared to observe the surgical efficacy, and the changes in the cardiopulmonary function of patients before and after surgery were detected. The static and dynamic indexes of cardiopulmonary function, respiratory disturbance index (AHI), and blood oxygen saturation (SaO2) were compared before and after the operation. Results After surgery, all patients' indexes of static lung function were improved compared with that before surgery. After surgery, the percentage of maximal oxygen uptake peak to the predicted value, percentage of oxygen pulse to the predicted value, the ratio of oxygen uptake power, anaerobic threshold, and maximum ventilatory capacity per minute/maximum exercise volume were increased compared with that before surgery, and AHI and SaO2 were improved compared with that before surgery. Conclusion This study suggests that it is feasible for patients with OSAHS who are unable to tolerate or unwilling to undergo noninvasive assisted ventilation to undergo simultaneous surgery for multiplane stenosis. It can reduce clinical symptoms and improve cardiopulmonary function.

Phagophobia in A 6-Year-Old Child : Case Report

Introduction: Photophobia or swallowing phobia is a rarely studied clinical entity. Classified as a specific phobia by the DSM-V. Through our clinical case, we highlight the diagnosis difficulty of this clinical entity and the interest of early therapeutic management appropriate to the age of the child. Clinical observation: A 6-year-old female patient was hospitalized in pediatric surgery for esophageal caustic stenosis that required esophageal replacement. Thereafter, the persistence of swallowing disorders was observed while the organic etiological assessment was negative. Manifestations of phobic anxiety were identified starting the first psychiatric consultation. These manifestations were found to be linked to the memory of traumatic events that the patient experienced during the gastro esophageal fibro copy. The diagnosis of phobic disorder was retained and the treatment was essentially based on behavioral therapy. The evolution was globally favorable. Discussion: Photophobia, or swallowing phobia, is an uncommon phobic disorder listed in the 11th edition of the International Classification of Mental Disorders and the DSM-5. The important question before diagnosing this disorder is to determine its psychogenic basis. In most cases, the onset of the disorder follows a swallowing accident, which leads to swallowing phobia, which in turn is considered a particular form of post-traumatic stress disorder. It can also be associated with separation anxiety in children as in our case. Conclusion: Swallowing phobia is considered a specific, non-developmental phobia. Swallowing phobia and other childhood anxiety disorders are closely correlated. Cognitive behavioural therapies have shown favourable responses in most cases.

Obstruction on the Left Can Be Hard to Make Right

In this issue of The Annals of Thoracic Surgery, the nicely prepared article by Fatima and colleagues1 describes a retrospective review of patients aged less than 21 years who had surgery for hypertrophic cardiomyopathy (HCM) or subaortic stenosis (SAS) at Mayo Clinic over the last 6 decades. They found that patients with HCM were older and more symptomatic than patients with SAS. Thirty-day mortality was slightly higher in the HCM group, but survival was similar through the first 10 years. However, during the second decade, patients with HCM had worse survival.

Neonates undergoing pyloric stenosis repair are at increased risk of difficult airway management: secondary analysis of the NEonate and Children audiT of Anaesthesia pRactice IN Europe

BackgroundHypertrophic pyloric stenosis in otherwise healthy neonates frequently requires urgent surgical procedure but anaesthesia care may result in respiratory complications, such as hypoxaemia, pulmonary aspiration of gastric contents, and postoperative apnoea. The primary aim was to study whether or not the incidence of difficult airway management and of hypoxaemia in neonates undergoing pyloric stenosis repair was higher than that in neonates undergoing other surgeries. MethodsData on neonates and infants undergoing anaesthesia and surgery for pyloric stenosis were extracted from the NEonate and Children audiT of Anesthesia pRactice In Europe (NECTARINE) database, for secondary analysis. ResultsWe identified 310 infants who had anaesthesia for surgery for pyloric stenosis. Difficult airway management (more than two attempts at laryngoscopy) was higher in children with pyloric stenosis when compared with the entire NECTARINE cohort (7.9% [95% confidence interval {CI}, 5.22–11.53] vs 4.4% [95% CI, 1.99–6.58]; relative risk [RR]=1.81 [95% CI, 1.21–2.69]; P=0.004), whereas transient hypoxaemia with oxygen saturation <90% was comparable between the two cohorts. Postoperative complications occurred in 16 children (5.6%) within the 30-day follow-up. No mortality was reported at 30 and 90 days. ConclusionsChildren undergoing surgery for pyloric stenosis had a higher incidence of difficult intubation compared with the entire NECTARINE cohort. Clinical trial registrationNCT 02350348.