scholarly journals P.133 Minimally invasive MetrX microdiskectomy for lumbar disc herniation: review of long-term outcomes

2019 ◽  
Vol 46 (s1) ◽  
pp. S47
Author(s):  
MN Kindrachuk ◽  
A Persad ◽  
E Noyes ◽  
AS Wu ◽  
DR Fourney
Keyword(s):  
Minimally Invasive ◽  
Statistical Significance ◽  
Cauda Equina ◽  
Open Technique ◽  
Long Term Outcomes ◽  
Vas Score ◽  
Long Term Follow Up ◽  
The Mean

Background: Lumbar microdiskectomy is amongst the most common neurosurgical techniques. In Saskatoon, minimally invasive microdiskectomy using the MetrX tubular retractor system has become a routinely performed procedure. While the outcomes of microdiskectomy are known to be similar to open technique, long term outcomes have not been reported. Methods: We performed a retrospective study of 160 minimally invasive microdiskectomies. We excluded subjects with cauda equina syndrome, redo surgery, fusions, and multi-level decompressions. We used one-way ANOVA to compare VAS, ODI, SF36, and EQ5D scores at pre-operative, 6-week postoperative, and long-term timepoints. Results: The mean pre-operative back pain VAS score was 6.23+/−2.63, 6-week post-operative follow-up VAS was 3.21+/−2.49, and long-term follow-up VAS was 2.56+/−2.45. The mean preoperative leg pain VAS score was 7.66+/−1.99, 6-week follow-up VAS was 3.56+/−2.79, final follow-up VAS was 2.20+/−2.57. The mean preoperative ODI score was 60.41+/−13.97; falling to 32.54+/−20.57 at 6-week follow up, and further to 24.50+/−20.97 at long term follow up. The mean baseline EQ5D quality of life score was 46.4+/−18.1, 68.9+/−20.2 at 6-week follow up and 69.3+/−20.3 at final review. Data reached statistical significance. Conclusions: We report good outcomes for minimally invasive microdiskectomy that are as durable as published results using open technique.

scholarly journals The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials

2012 ◽  
Vol 16 (5) ◽  
pp. 452-462 ◽  
Author(s):  
Hormuzdiyar H. Dasenbrock ◽  
Stephen P. Juraschek ◽  
Lonni R. Schultz ◽  
Timothy F. Witham ◽  
Daniel M. Sciubba ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Meta Analysis ◽  
Leg Pain ◽  
Current Evidence ◽  
Randomized Controlled ◽  
Vas Score ◽  
Long Term Follow Up ◽  
The Mean

Object Advocates of minimally invasive discectomy (MID) have promoted this operation as an alternative to open discectomy (OD), arguing that there may be less injury to the paraspinal muscles, decreased postoperative pain, and a faster recovery time. However, a recently published large randomized controlled trial (RCT) comparing these approaches reported inferior relief of leg pain in patients undergoing MID. The authors conducted a meta-analysis to evaluate complications and improvement in leg pain in patients with radiculopathy enrolled in RCTs comparing OD to MID. Methods The authors performed a literature search using Medline and EMBASE of studies indexed between January 1990 and January 2011. Predetermined RCT eligibility included the usage of tubular retractors during MID, a minimum follow-up duration of 1 year, and quantification of pain with the visual analog scale (VAS). Trials that only evaluated patients with recurrent disc herniation were excluded. Data on operative parameters, complications, and VAS scores of leg pain were extracted by 2 investigators. A meta-analysis was performed assuming random effects to determine the difference in mean change for continuous outcomes and the risk ratio for binary outcomes. Results Six trials comprising 837 patients (of whom 388 were randomized to MID and 449 were randomized to OD) were included. The mean operative time was 49 minutes during MID and 44 minutes during OD; this difference was not statistically significant. Incidental durotomies occurred significantly more frequently during MID (5.67% compared with 2.90% for OD; RR 2.05, 95% CI 1.05–3.98). Intraoperative complications (incidental durotomies and nerve root injuries) were also significantly more common in patients undergoing MID (RR 2.01, 95% CI 1.07–3.77). The mean preoperative VAS score for leg pain was 6.9 in patients randomized to MID and 7.2 in those randomized to OD. With long-term follow-up (1–2 years postoperatively), the mean VAS score improved to 1.6 in both the MID and OD cohorts. There was no significant difference in relief of leg pain between the 2 approaches with either short-term follow-up (2–3 months postoperatively, 0.81 points on the VAS, 95% CI −4.71 to 6.32) or long-term follow-up (2.64 on the VAS, 95% CI −2.15 to 7.43). Reoperation for recurrent herniation was more common in patients randomized to the MID group (8.50% compared with 5.35% in patients randomized to the OD group), but this difference was not statistically significant (RR 1.56, 95% CI 0.92–2.66). Total complications did not differ significantly between the operations (RR 1.50, 95% CI 0.97–2.33). Conclusions The current evidence suggests that both OD and MID lead to a substantial and equivalent long-term improvement in leg pain. Adequate decompression, regardless of the operative approach used, may be the primary determinant of pain relief—the major complaint of many patients with radiculopathy. Incidental durotomies occurred significantly more frequently during MID, but total complications did not differ between the techniques.

scholarly journals Long-Term Outcomes of Scaphoid Malunion

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Blake P. Gillette ◽  
Peter C. Amadio ◽  
Sanjeev Kakar
Keyword(s):  
Nonoperative Management ◽  
Corrective Osteotomy ◽  
Nonoperative Treatment ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Surgical Evaluation ◽  
Long Term Follow Up ◽  
The Mean

Background: The optimal treatment of patients with a scaphoid malunion remains controversial. The long-term outcomes of operative and nonoperative management have not been established. Methods: We conducted a retrospective review of the outcomes of all scaphoid malunions treated at single institution over a 30-year period. This included patients who underwent corrective osteotomy, salvage procedures (ie, dorsal cheilectomy, radial styloidectomy, and scaphoidectomy with midcarpal fusion), and those who refused operative intervention. The Mayo Wrist Score was determined at the time of surgical evaluation. Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder and Hand (QuickDASH) surveys were sent to all patients for long-term follow-up. Results: Seventeen patients had follow-up at a mean 21.4 years (range, 12-30 years). The mean initial lateral intrascaphoid angle was 58°. Of the 17 patients, 11 proceeded with surgery and 6 opted for nonoperative management. A corrective osteotomy was performed in 4 patients. Of the remaining 7 surgical patients, 5 patients underwent procedures such as cheilectomy and radial styloidectomy, whereas 2 patients had a scaphoidectomy with midcarpal fusion. The final mean PRWE and QuickDASH scores for corrective osteotomy, salvage procedures, and nonoperative treatment were 23 and 6, 18 and 10, and 33 and 22, respectively. Conclusion: Long-term outcomes were similar between operative and nonoperative management.

Long-term visual, anterior and posterior corneal changes after crosslinking for progressive keratoconus

2021 ◽  
pp. 112067212110528
Author(s):  
Abdelrahman Salman ◽  
Ali Ali ◽  
Shaaban Rafea ◽  
Rana Omran ◽  
Buraa Kubaisi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Statistical Significance ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Long Term Outcomes ◽  
Corrected Distance Visual Acuity ◽  
Hyperopic Shift ◽  
The Mean

Aim To evaluate the long-term outcomes of corneal cross-linking (CXL) in patients with progressive keratoconus. Method In this retrospective non-comparative study, forty-five eyes of 31 patients with progressive keratoconus were treated with 30 min “epi-off” corneal cross-linking. The visual, refractive, topographic and tomographic outcomes were evaluated preoperatively and at least 10 years after cross-linking. Results Ten years post-corneal cross-linking, the mean anterior maximum keratometry decreased (−2.10 ± 3.25 D, P = 0.0001). Conversely, the posterior maximum keratometry increased (6.38 ± 9.79 D, P = 0.065). Both uncorrected and corrected distance visual acuity improved (LogMAR −0.08 ± 0.30) and (LogMAR −0.05 ± 0.21), respectively (P > 0.05, both). A statistically significant hyperopic shift was observed postoperatively (0.70 ± 1.31 D, P = 0.0009). The anterior topographic cylinder values revealed no change (−0.17 ± 1.31 D, P = 0.3), whereas the mean posterior cylinder values decreased (absolute value increased) significantly compared to baseline from −1.31 ± 0.97 D to −1.82 ± 1.78 D, (P < 0.05). The minimum corneal thickness values decreased significantly (−35.11 ± 48.63 µm, P = 0.0001). Four eyes (8.8%) showed more than 1 D increase in the anterior maximum keratometry. Conclusion This protocol and duration of Epi-off corneal cross-linking was found to be effective in halting keratoconus progression over the follow up period (10 years). Anterior corneal flattening and a hyperopic shift were observed. A statistically significant increase in the posterior corneal cylinder was observed. Although, not reaching statistical significance, the logMAR uncorrected and corrected visual acuity were improved.

Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up

2017 ◽  
Vol 43 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Ngoc B. Ha ◽  
Joideep Phadnis ◽  
Simon B. M. MacLean ◽  
Gregory I. Bain
Keyword(s):  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Distal Pole ◽  
Long Term Follow Up ◽  
Radioscapholunate Fusion ◽  
The Mean

The purpose of this study was to assess the long-term outcomes of radioscapholunate fusion, with and without distal pole of scaphoid excision and excision of the triquetrum. These compromised three operative groups. Seventeen patients were identified with a minimum of 10 years follow-up, with a mean of 15 years (range 10–19). Fifteen of the 17 patients were satisfied with their outcome. Two were converted to total wrist fusion. The mean outcomes scores were; pain visual analogue scale score 2.1/10, Quick Disabilities of the Arm, Shoulder, and Hand 29 and Modified Mayo Wrist score 60. Patients with excision of the triquetrum had a mean radial–ulnar arc increase of 10° compared with the other two groups, but this was not statistically significant. The mean space for the scaphocapitate joint was 1.7 mm and lunocapitate joint was 1.3 mm at latest follow-up. Close adherence to the indications and surgical technique provided a sustainable good clinical outcome. Patients who obtained a good result at 2 years were likely to achieve a good long-term outcome. Level of evidence: IV

scholarly journals Transsphenoidal Surgery for Cushing Disease

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 70-81 ◽  
Author(s):  
Ivan Ciric ◽  
Jin-Cheng Zhao ◽  
Hongyan Du ◽  
James W. Findling ◽  
Mark E. Molitch ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Statistical Significance ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Cushing Disease ◽  
Transsphenoidal Microsurgery ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND This is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery. OBJECTIVE To evaluate factors influencing immediate postoperative results and long-term outcomes. METHODS Data regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and long-term results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency. RESULTS IPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 μg/dL (range, &lt;0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P &gt; .001) and with 4.1 times greater odds of IPBR (P = .07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P = .004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean follow-up in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P = .08). CONCLUSION In microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 μg/dL may be associated with higher incidence of recurrences.

scholarly journals P663 Long-term follow up in IBD: 10-year observational study of a UK IBD cohort

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S588-S588
Author(s):  
S T Radhakrishnan ◽  
A Vasireddy ◽  
K I Gallagher ◽  
L C Hicks ◽  
S T Powles ◽  
...  
Keyword(s):  
Observational Study ◽  
Statistical Significance ◽  
Z Score ◽  
Long Term Outcomes ◽  
Phenotypic Data ◽  
Long Term Follow Up ◽  
Inflammatory Bowel ◽  
The Uk

Abstract Background Crohn’s Disease (CD) and ulcerative colitis (UC) are the two main sub-types of Inflammatory Bowel disease (IBD), which affect 300–500 per 100,000 people within Europe, with an increasing incidence. Long-term outcomes have been reported cohorts of Korean and Scandinavian populations, but long-term UK data are limited. Methods Data were prospectively collected from an IBD cohort over a 10-year period. 90 patients were included (47 CD, 36 UC, 7 IBD-unclassified). Phenotypic data (Montreal classification), medication and management decisions were documented. Statistical significance was determined by the Z-score for 2 population proportions. Results Over 10 years, the number of operations for CD significantly increased from 8 to 19 patients (p=0.03) but not significantly in UC from 1 to 4 (p=0.09). Perianal involvement in CD also increased from 15.5% to 27.7% at 10 years, but this change was non-significant (p=0.14). Within the UC cohort, a trend for aminosalicylate use was seen, increasing from 53% to 64% (p=0.34), whilst thiopurine use decreased from 44% to 28% (p=0.12). 6/36 patients with UC and 10/47 patients with CD failed thiopurine use due to intolerance or severe side-effects. Biologic use in both UC and CD significantly increased from 10 to 22 patients (p=0.013) over 10 years. Conclusion This is the first long-term observational study in IBD patients within the UK. The data show that even with an increase in biologic availability and prescribing, the overall lifetime risk of surgical management in CD does increase with time, mirroring recent publications. Studies with an increased number of IBD patients under long-term follow up are ongoing.

scholarly journals Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy

2022 ◽  
Vol 11 ◽  
Author(s):  
Gilda Cennamo ◽  
Daniela Montorio ◽  
Luca D’ Andrea ◽  
Antonio Farella ◽  
Elide Matano ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Uveal Melanoma ◽  
Tumor Control ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
The Mean ◽  
Lost To Follow Up ◽  
Plaque Brachytherapy

Uveal melanoma is the most common primary intraocular malignancy. The aim of this retrospective study was to report the results after ruthenium-106 (Ru-106) plaque brachytherapy for uveal melanoma in terms of tumor control, visual acuity, radiation-related complications, tumor recurrence, metastases, and patients’ survival rate during 4 years’ follow-up. A total of 355 eyes from 355 patients have been treated with Ru-106 plaque brachytherapy for uveal melanoma between February 2011 and March 2020. Five patients were lost to follow-up, and then 350 eyes of 350 patients (mean age 58 ± 11 years) were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination including echography and spectral domain–optical coherence tomography. The mean follow-up was 4 years (3 months to 9 years). After treatment, the mean tumor thickness was reduced to 1.75 ± 0.21 mm. Radiation complications were found in 63% of patients: 38% showed radiation maculopathy, 11% had optic neuropathy, and 14% developed cataracts. Cancer-free survival was 99%, 97%, and 85%, respectively, at 5, 7, and 9 years. Ru-106 plaque brachytherapy represents a reliable treatment of uveal melanoma. This technique is valid and safe with a low rate of ocular complications during a long-term follow-up.

scholarly journals Long-Term Follow-Up of Intrastromal Corneal Ring Segments in Paracentral Keratoconus with Coincident Corneal Keratometric, Comatic, and Refractive Axes: Stability of the Procedure

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Luis Fernández-Vega Cueto ◽  
Carlos Lisa ◽  
David Madrid-Costa ◽  
Jesús Merayo-Lloves ◽  
José F. Alfonso
Keyword(s):  
Postoperative Period ◽  
Refractive Errors ◽  
Spherical Equivalent ◽  
Long Term Outcomes ◽  
Group I ◽  
Intrastromal Corneal Ring ◽  
Long Term Follow Up ◽  
The Mean

Purpose. To assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRS) in paracentral keratoconic eyes. Methods. 58 eyes with paracentral keratoconus with coincident refractive, keratometric, and comatic axes were evaluated. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and refractive errors were recorded before and at all follow-up visits. The postoperative follow-up was 5 years. Patients were divided into two groups: group I (30 years old or younger) and group II (more than 30 years old). Results. The mean UDVA (logMAR) rose from a preoperative 0.83 ± 0.31 to a five-year postoperative 0.42 ± 0.33 (P<0.0001). The mean CDVA varied from 0.16 ± 0.17 to 0.11 ± 0.18 (P=0.0003). Both the UDVA and CDVA were stable over the postoperative period in both groups (P>0.05). The spherical equivalent and the refractive cylinder declined steeply after ICRS implantation in both groups (P<0.001), and were stable over the postoperative period (P>0.05). The keratometric values were also stable over the postoperative follow-up. Conclusion. Ferrara-type ICRS implantation in keratoconus that meets the characteristics of the sample under study reduces the refractive error at the same time as it improves postoperative UDVA and CDVA six months after surgery and that these results remain stable over five years of follow-up.

Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

2020 ◽  
Vol 133 (3) ◽  
pp. 830-838 ◽  
Author(s):  
Andrea Franzini ◽  
Giuseppe Messina ◽  
Vincenzo Levi ◽  
Antonio D’Ammando ◽  
Roberto Cordella ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Lower Limb ◽  
Internal Capsule ◽  
Posterior Limb ◽  
Vas Score ◽  
The Mean ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

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