Surgery In Terms Of Pain Research Articles

Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases

IntroductionMinimally invasive surgery (MIS) techniques have been developed for the surgical treatment of thoracolumbar spinal metastases to reduce the morbidity associated with the operation. The purpose of our study was to compare the mean length of stay, change in pain levels, neurological symptoms, complications and survival after open versus MIS surgery. Material and methodsThis is a single-center retrospective study based on a register of patients treated for vertebral metastases between January 2014 and October 2016. The collection included demographic data, cancer-related data, clinical data, the characteristics of the surgery, the length of stay, assessment of pain and the occurrence of death. These data were compared between open and MIS surgery groups. ResultsOut of 59 patients, 35 were treated with open surgery and 24 were treated with MIS surgery. The two groups were comparable in terms of age, gender and body mass index. Breast, kidney, prostate and lung cancers were the most frequent primary tumors. Prognostic and instability scores were comparable. Short- and medium-term pain assessment showed comparable results. Median survival was 208 days in the open surgery group and 224days in the MIS group (p=0.5299). ConclusionMIS techniques aim to limit the surgical approach and allow a faster introduction of adjuvant treatments than after open surgery. Our study did not find any differences between open and MIS surgery in terms of pain, neurological evolution or survival time in patients treated for thoracolumbar spinal metastases. Level of evidenceIV; retrospective study.

Fibromyalgia and Shoulder Surgery: A Systematic Review and a Critical Appraisal of the Literature.

Fibromyalgia is a common musculoskeletal syndrome characterized by chronic widespread pain and other systemic manifestations, which has demonstrated a contribution to higher postoperative analgesic consumption to other surgeries such as hysterectomies and knee and hip replacements. The aim of this review is to search current literature for studies considering the impact of fibromyalgia on clinical outcomes of patients undergoing shoulder surgery. A systematic literature review was conducted in PubMed/Medline, Embase, and ClinicalTrials.gov in February 2019. Studies were selected based on the following participants, interventions, comparisons, outcomes, and study design criteria: adult patients undergoing surgery for shoulder pain (P); diagnosis of fibromyalgia (I); patients without fibromyalgia (C); outcome of surgery in terms of pain or analgesic or non-steroidal anti-inflammatory drugs consumption (O); case series, retrospective studies, observational studies, open-label studies, randomized clinical trials, systematic reviews and meta-analyses were included (S). Authors found 678 articles, of which four were found eligible. One retrospective study showed that patients with fibromyalgia had worse clinical postoperative outcomes; two retrospective studies reported a higher opioid prescription in patients with fibromyalgia and one prospective observational study found that a higher fibromyalgia survey score correlated with lower quality of recovery scores two days after surgery. The scarce and low-quality evidence available does not allow confirming that fibromyalgia has an impact on postoperative outcomes in shoulder surgery. Future studies specifically focusing on shoulder surgery outcomes may help improvement and personalization of the management of patients with fibromyalgia syndrome (PROSPERO 2019, CRD42019121180).

Surgical Treatment of Venous Malformations of the Knee: Treatment Outcomes for 35 Patients.

The place of open surgery in venous malformations (VMs) of knee joint is still discussed. The aim of this study was to evaluate the benefits of surgery in terms of pain, function, and quality of life. This was a retrospective observational study. Thirty-five consecutive young patients undergoing surgery for VMs of the knee between 2011 and 2014 were included. Data collection was performed using a prospective database by reviewing patient records. Pain, mobility of the joint, residual VMs as seen by magnetic resonance imaging, and quality of life were the main outcome endpoints for this study. Thirty-five patients (22 females and 13 males, with a median age of 15 y, range of 5 to 20 y) were included. Twenty-seven VMs were localized in and around the knee joint, of which 8 were extensive. Indication for surgery was intermittent or permanent pain.Details of the surgical excisions of the VM are as follows: suprapatellar area in 57%, suprapatellar and infrapatellar area in 29%, infrapatellar area in 2%, limited in the femoropatellar area in 12%. Partial resection of a vastus muscle or patellar retinaculum was necessary for 19 patients.The median duration of the surgery was 4 hours (range: 2 to 7 h). The median hospital stay was 5 days; full-time physiotherapy was systematic for 2 to 3 weeks.After 6 months, 74% had no longer pain, the mobility of the joint was normal for 60%. Of the 33 patients who had a magnetic resonance imaging at 6 months, 86% (28 patients) had no residual intra-articular VMs, and 14% had focal residual VMs.At the last follow-up, 77% (27 patients) had no longer pain, 23% experienced intermittent pain with unusual activities, and 91% (32 patients) had normal mobility of the joint. Quality of life was increased significantly due to the pronounced impact on pain. Extensive surgical excision of knee VMs is a safe procedure with good outcomes in terms of pain, function, and quality of life. Level II-retrospective observational monocentric study.

Intramuscular venous malformations of the lower limbs: Results of the surgical treatment of 57 patients

The place of resective surgery to treat intramuscular venous malformations (VM) is still debated because of the risk of functional sequelae. A homogeneous cohort of intramuscular (IM) (MV) of the posterior compartment of leg was studied in order to evaluate this risk. The purpose of the study was to evaluate the benefit of the surgery in terms of pain, function of the member and quality of the life. This was a retrospective, observational, monocentric study.

Surgical treatment of venous malformations of the knee

Background The place of open surgery for treatment of the venous malformations (VMs) of knee joint is still discussed. The aim of this study was to evaluate the benefits of surgery in terms of pain, function, and quality of life.

Short- and long-term effects of smoking on pain and health-related quality of life after non-instrumented lumbar spine surgery

ObjectivesA myriad of negative bodily health effects related to tobacco smoking is known while its detrimental effects on the spine in particular are less defined. The goal of the current study is to compare long-term outcome between smokers and non-smokers after non-instrumented lumbar spine surgery. Patients and methodsProspective observational study on n=172 consecutive patients undergoing non-instrumented spine surgery for lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS) with a follow-up (FU) of 4.5 years. Patients were dichotomized according to their smoking status at the time of surgery. Back pain and health-related quality of life (HRQoL) were assessed using the visual analogue scale (VAS) and the Short-Form (SF)-12. Any subsequent lumbar spine surgeries since the index surgery were registered. Logistic regression analysis was used to estimate the effect size of the relationship between smoking and the responder status to surgery in terms of pain and HRQoL-metrics. ResultsComplete FU data was available for n=29 (55%) smokers and n=75 (63%) non-smokers. At discharge, 1 month, 1 year and 4.5 years, smokers were as likely as non-smokers to achieve a favourable response to surgery in terms of VAS back pain and the SF-12 mental and physical component scale metric. A subgroup analysis on active smokers throughout the entire study interval did not find an inferior responder rate than in never-smokers. A trend for additional lumbar spine surgery performed in 17.2% of the smoking and 8.2% of the non-smoking patients during FU was observed (OR 2.39, 95% CI 0.67–8.57, p=0.179). ConclusionUp to 4.5 years following non-instrumented lumbar spine surgery, there was no difference in the pain or HRQoL-responder status of smokers and non-smokers. Smokers may be more likely to undergo re-do surgery in the long term, but more data is needed to confirm this statistical trend.

Methylprednisolone injection following the surgical extraction of impacted lower third molars: A split-mouth study

Purpose: The purpose of the present study was to compare the effect of intramuscular masseter administration of methylprednisolone using a split-mouth design, as a single 20-mg dose, after removal of impacted lower third molars. Patients and Methods: A non-blind, cross-over, comparative, non-randomized, clinical trial was planned. The sample was composed of 32 patients requiring extraction under local anesthesia of two lower bony impacted mandibular third molars. The difficulty of extraction was similar in all cases. The patients received 20 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound on the right side. The left side received no intramuscular corticoid. Evaluations were made of postoperative pain and swelling. Results: A total of 32 subjects requiring surgical removal of two impacted mandibular third molars under local anesthesia were included in the present study. The patients administered methylprednisolone showed superior results after surgery in terms of pain and facial swelling parameters using self-evaluation, with statistically significant differences versus the control-side (p

Beneficial Influence of Titanium Mesh Cage on Infection Healing and Spinal Reconstruction in Hematogenous Septic Spondylitis

Single institution, single surgeon retrospective review. To investigate if the use of titanium mesh cage on the site of infection could be beneficial for successful outcome of the operative treatment for pyogenic spondylitis. There is a controversy concerning the optimal treatment for pyogenic spondylitis regarding approach, instrumentation and staging. This large series reports on single-stage instrumented open and minimally invasive surgery for septic spondylitis. Twenty-four patients aged 57 +/- 16 years suffering from persistent or complicated septic spondylitis were treated by a total of 25 single stage combined surgeries (first: anterior debridement/partial vertebrectomy plus mesh cage filled with autologous bone graft; second: pedicle screw fixation with open and minimal invasive techniques). The indications for surgery included neurologic compromise, significant vertebral body destruction with kyphosis associated with segmental instability, failure of medical treatment, and/or epidural/ paravertebral abscess formation. Needle biopsy was performed in all patients before surgery. Patients were evaluated before and after surgery in terms of pain and neurologic level, sagittal segmental spinal balance, radiologic fusion and recovery. All but 1 tetraplegic patient with simultaneous cervical and lumbar spondylitis, who died because of massive clot lung embolism 2 months after surgery, were followed for 56 months (range, 31-116 months) The visual analogue scale score improved from 6.5 before surgery to 1.8 after surgery. The segmental kyphotic deformity was corrected at an average of 6 degrees, without cage settling. An insignificant loss of kyphosis correction of an average 0.6 degrees was measured in the thoracolumbar junction only. Blood loss, surgical time, and surgical complications were significant less in the patients who operated with minimal invasive technique. Patients with incomplete neurologic impairment improved after surgery. Physical function (SF-36) averaged 72 1 year after surgery. All operated patients had resolution of infection. There was neither migration of mesh cage nor posterior instrumentation failure at the last follow-up observation. The present study showed that radical debridement of spinal infection and anterior insertion of titanium cage, filled with autogenous bone graft, secured with pedicle screw instrumentation should have had a beneficial influence on the eradication of infection, segmental and global spinal reconstruction and fusion. Supplementary posterior minimal invasive pedicle screw fixation eliminates posterior soft tissue injury and preserves blood supply, and reduces surgical time, blood loss, and surgical complications.

Anterior Surgery With Insertion of Titanium Mesh Cage and Posterior Instrumented Fusion Performed Sequentially on the Same Day Under One Anesthesia for Septic Spondylitis of Thoracolumbar Spine

Retrospective study. To evaluate the outcome on patients with pyogenic spondylitis of the thoracolumbar spine following combined anterior and posterior surgery. Several methods of surgical treatment of pyogenic spondylitis have been reported. These include anterior approach, staged and simultaneous anterior decompression, and posterior stabilization. The use of anterior implants in the presence of an infection presents a challenge for spine surgeons. This study analyzes the clinical and radiologic outcome of surgical intervention on patients with pyogenic spondylitis of the thoracolumbar spine who were treated surgically for intractable pain, instability, and neurologic impairment. Fourteen patients (6 women, 8 men) with thoracolumbar spondylitis were treated with anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia. The age (average, SD) of the patients at the time of surgery was 55 +/- 16 years (range, 29-83 years). Most patients had also systemic diseases as lung tuberculosis, hepatic cirrhosis, diabetes mellitus, or chronic renal failure. Patients were evaluated before and after surgery in terms of pain, neurologic level, sagittal spinal balance, and radiologic fusion. The average duration of the combined surgery was 4.5 hours. All patients were observed up for an average of 45 months (range, 37-116 months). The Visual Analog Scale score (average, range) improved from 7 (range, 4-10) before surgery to 2 (range, 0-5) after surgery. Correction (average, range) of segmental kyphotic deformity was 6 degrees (range, 0 degrees-11 degrees) without loss of correction at the final observation. Neither a postoperative change of the position of mesh cage nor any posterior instrumentation failure was recorded. Patients with incomplete neurologic impairment showed improvement after surgery at an average 1.4 Frankel's grade. There was one complication, an anterior wound abscess culminating in an abdominal hernia. This clinical study showed that patients with thoracolumbar osteomyelitis can successfully undergo anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia. The presence of the mesh cage anteriorly at the site of spondylitis had no negative influence on the course of infection healing, and additionally it stabilized the affected segment maintaining sufficient sagittal profile.