scholarly journals Simultaneous Cervical and Lumbar Spine Surgery: Retrospective Analysis of 45 Cases

2019 ◽  
Vol 08 (01) ◽  
pp. 047-052 ◽  
Author(s):  
Amit Aiwale ◽  
Pankajkumar Patel ◽  
Syed Paspala ◽  
T. Murthy
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Cost Effective ◽  
Lumbar Spine Surgery ◽  
Neurogenic Claudication ◽  
Cervical Canal ◽  
Canal Stenosis ◽  
Significant Difference ◽  
The Mean

Abstract Background The term ‘tandem spinal stenosis’ (TSS) was first introduced by Dagi et al to describe concurrent symptomatic cervical and lumbar spinal stenosis. A typical clinical picture includes intermittent neurogenic claudication, myelopathy, and polyradiculopathy in both the upper and lower extremities. The incidence of TSS ranges from 0.12 to 28%. Methods We studied patients who presented with tandem canal stenosis and operated cervicolumbar decompression with or without fusion procedures by two separate neurosurgical teams simultaneously from June 2015 to 2017 with follow-up period of minimum 6 months. Results We had 30 (66.66%) male and 15 (33.33%) female patients who underwent simultaneous cervical and lumbar spine surgeries. The average age was 57.8 years (male) and 53.9 years (female). Cervical canal stenosis was graded as per magnetic resonance imaging (MRI) morphological grades of stenosis by Kang et al and lumbar grading, was done as per Schizas et al grading system. The mean duration of complaints in cervical and lumbar compression was 29.54 ± 44.99 months and 30.55 ± 38.11 months, respectively. The mean preoperative Japanese Orthopaedic Association (JOA) score of was 10.46 ± 1.39, whereas the postoperative mean JOA score was 11.93 ± 1.28, and mean preoperative (38.59 ± 16.52) and postoperative (29.22 ± 9.38) Oswestry Disability Index (ODI) scores showed a statistically significant difference (p = 0.0001). Conclusion Patients with TSS are elderly and have associated comorbidities, still simultaneous cervical and lumbar surgery is feasible with the good outcome if you have two neurosurgical teams operating simultaneously and having good other super specialty teams’ support. It can be timesaving and cost effective for patients. Also, it avoids patients from undergoing exposure to two separate surgical and anesthetic stress.

scholarly journals Anterior Controllable Antedisplacement and Fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS): a retrospective study of 45 cases

2019 ◽  
Author(s):  
Xi Luo ◽  
Kaiqiang Sun ◽  
Jingchuan Sun ◽  
Shunmin Wang ◽  
Yuan Wang ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Operation Time ◽  
Significant Difference ◽  
Csf Leakage ◽  
One Year ◽  
Neck Disability ◽  
Multilevel Cervical Spondylotic Myelopathy

Abstract Background To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), and compare ACAF with hybrid decompression fixation (HDF). Methods A retrospective analysis of 85 cases with MCSMSS was carried out. 45 patients were treated with ACAF, while 40 patients were treated with HDF. The operation time, intraoperative bleeding volume, postoperative complications, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, Computed Tomography (CT) transverse measurement, cervical curvature and Kang's grade were compared between two groups. Results The patients were followed up for 12 to 17 months. Compared with HDF, ACAF group achieved better decompression according to CT measurement and Kang’s grade (P < 0.05), and recovered to a greater cervical Cobb’s angle (P < 0.05). However, JOA score and NDI index showed no significant difference one year after surgery (P＞0.05). Additionally, ACAF presented longer operation time and greater intraoperative blood loss (P < 0.05). As to complications, ACAF developed less incidences of cerebrospinal fluid examination (CSF) leakage, neurologic deterioration, epidural hematoma and C5 palsy by comparing with HDF. Conclusions ACAF is an effective method for the treatment of MCSMSS. Compared with HDF, ACAF has the advantages of significant decompression, increasing cervical curvature, and reducing the incidences of complications.

Results of degenerative spondylolisthesis treated with posterior decompression alone via a new surgical approach

2001 ◽  
Vol 95 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Tomoaki Kinoshita ◽  
Isao Ohki ◽  
Kenneth R. Roth ◽  
Kageharu Amano ◽  
Hideshige Moriya
Keyword(s):  
Japanese Orthopaedic Association ◽  
Degenerative Spondylolisthesis ◽  
Spinal Instability ◽  
Content Type ◽  
Significant Difference ◽  
Potential Alternative ◽  
The Mean ◽  
New Surgical Technique ◽  
Fine Print

Object. The purpose of this study was to assess radiologically demonstrated results and clinical outcomes in patients with degenerative spondylolisthesis who underwent posterior decompressive surgery via a new (unilateral) approach. This approach allows surgeons to perform central and bilateral decompression while only stripping the muscles unilaterally, thus preserving the posterior osteoligamentous complexes. Methods. The authors evaluated 51 consecutive patients in whom surgery was performed between 1987 and 1996. The mean follow-up period was 4.7 years. There was no statistically significant difference between the pre- and postoperative measurements in percentage of vertebral slippage. Postoperative dynamic angulation statistically decreased compared with its preoperative value (p < 0.05). Improvement of an average of 67% was shown on the Japanese Orthopaedic Association scale, and in 78% of these patients, good to excellent results were demonstrated. Secondary fusion was required in only three patients (5.9%). Conclusions. This new surgical technique offers a potential alternative for the treatment of degenerative spondylolisthesis in a minimally invasive manner, avoiding the risk of causing or aggravating postoperative spinal instability.

Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

2012 ◽  
Vol 16 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masatoshi Sumi ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Shuichi Kaneyama ◽  
Takako Kanatani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Mr Imaging ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Rank Test ◽  
Imaging Findings ◽  
Significant Difference ◽  
The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

scholarly journals Vitamin E in the treatment of primary dysmenorrhoea

2018 ◽  
Vol 7 (6) ◽  
pp. 2257
Author(s):  
Vilvapriya S. ◽  
Vinodhini S.
Keyword(s):  
Vitamin E ◽  
Cost Effective ◽  
Pain Severity ◽  
Medical College ◽  
Primary Dysmenorrhoea ◽  
Relieve Pain ◽  
Significant Difference ◽  
Before And After ◽  
Pain Duration ◽  
The Mean

Background: The objective of this study is to determine the efficacy of Vitamin E in the treatment of primary dysmenorrhoea compared to the placebo.Methods: Sixty women, aged 17-25 years old who suffered from primary dysmenorrhoea, among 1000 Women attending the gynec OPD in Kilpauk Medical College. 30 women were given 200 units of vitamin E (each tablet twice daily) and 30 were given a placebo tablets (each tablet twice daily). The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain and duration of pain before and after the treatment was studied. Treatment in both groups was carried out in three consecutive menstrual periods.Results: As to the findings, the mean age of the participants was 22.6 years. There was a significant difference between the pre- and post-treatment periods in terms of pain severity (P=0.72 and P=0.002, respectively) and pain duration (P=0.514 and P=0.027, respectively) in Vitamin E group. There was a significant difference observed between the Vitamin E group and placebo group regarding the mean of pain severity and duration (P=0.002 and p=0.027 respectively).Conclusions: Vitamin E helps to relieve pain in primary dysmenorrhoea. As this is a relatively easier method for control of pain with lesser amount of side effects and as it is cost effective, it can be considered as a universal drug in the treatment of primary dysmenorrhoea.

scholarly journals Variations in 30-day readmissions and length of stay among spine surgeons: a national study of elective spine surgery among US Medicare beneficiaries

2018 ◽  
Vol 29 (3) ◽  
pp. 286-291 ◽  
Author(s):  
Siddhartha Singh ◽  
Rodney Sparapani ◽  
Marjorie C. Wang
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Spine Surgery ◽  
Practice Patterns ◽  
Lumbar Spine Surgery ◽  
Medicare Beneficiaries ◽  
Readmission Rates ◽  
Underlying Assumption ◽  
The Mean ◽  
Hospital Characteristics

OBJECTIVEPay-for-performance programs are targeting hospital readmissions. These programs have an underlying assumption that readmissions are due to provider practice patterns that can be modified by a reduction in reimbursement. However, there are limited data to support the role of providers in influencing readmissions. To study this, the authors examined variations in readmission rates by spine surgeon within 30 days among Medicare beneficiaries undergoing elective lumbar spine surgery for degenerative conditions.METHODSThe authors applied validated ICD-9-CM algorithms to 2003–2007 Medicare data to select beneficiaries undergoing elective inpatient lumbar spine surgery for degenerative conditions. Mixed models, adjusting for patient demographics, comorbidities, and surgery type, were used to estimate risk of 30-day readmission by the surgeon. Length of stay (LOS) was also studied using these same models.RESULTSA total of 39,884 beneficiaries were operated on by 3987 spine surgeons. The mean readmission rate was 7.2%. The mean LOS was 3.1 days. After adjusting for patient characteristics and surgery type, 1 surgeon had readmission rates significantly below the mean, and only 5 surgeons had readmission rates significantly above the mean. In contrast, for LOS, the patients of 288 surgeons (7.2%) had LOS significantly lower than the mean, and the patients of 397 surgeons (10.0%) had LOS significantly above the mean. These findings were robust to adjustments for surgeon characteristics and clustering by hospital. Similarly, hospital characteristics were not significantly associated with readmission rates, but LOS was associated with hospital for-profit status and size.CONCLUSIONSThe authors found almost no variations in readmission rates by surgeon. These findings suggest that surgeon practice patterns do not affect the risk of readmission. Likewise, no significant variation in readmission rates by hospital characteristics were found. Strategies to reduce readmissions would be better targeted at factors other than providers.

scholarly journals Expression of matrix metalloproteinases 2 and 9 and TGF-b in ligamentum flavum hypertrophy

2014 ◽  
Vol 13 (3) ◽  
pp. 206-209
Author(s):  
Marcelo Ferraz de Campos ◽  
Cintia Pereira de Oliveira ◽  
Maria Aparecida da Silva Pinhal ◽  
Luciano Miller Reis Rodrigues
Keyword(s):  
Matrix Metalloproteinases ◽  
Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Statistical Significance ◽  
Herniated Disc ◽  
Older Individuals ◽  
Younger Patients ◽  
Canal Stenosis ◽  
Significant Difference ◽  
Hematoxylin Eosin

OBJECTIVE: To evaluate the expression of matrix metalloproteinases and TGFb in patients with spinal stenosis and in younger patients who have herniated disc. METHODS: 19 samples of LA were analyzed, nine of them with lumbar canal stenosis and 10 with disc herniation. Of the total, five patients were aged between 15 and 40 years, 10 were between 40 and 65 years and four had more than 65 years. Representative areas of LF were chosen based on the staining of tissues with hematoxylin-eosin. The 3µm-thick sections embedded in paraffin and fixed in formalin were deparaffinized and rehydrated. All ligaments were incubated overnight at 4 °C with primary antibodies. RESULTS: An increase of TGFb was verified in older individuals, although without statistical significance. CONCLUSION: Metalloproteinases showed no significant difference between both groups with respect to age and type of abnormality of the spine.

scholarly journals Cost Effectiveness Analysis of Candesartan Therapy in Comparison to Candesartan-Amlodipine Therapy on Hypertensive Outpatients

2019 ◽  
Vol 7 (22) ◽  
pp. 3837-3840
Author(s):  
Faridah Baroroh ◽  
Andriana Sari ◽  
Noviana Masruroh
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Significant Difference ◽  
Hypertension Therapy ◽  
The Mean ◽  
The Cost

BACKGROUND: he achievement of optimal hypertension therapy requires cost-effective medicine. The treatment of hypertensive patients needs for long-term medication have made medical costs a prime issue in health economics. AIM: This study aims to determine the cost effectiveness of candesartan therapy compared to candesartan-amlodipine therapy on hypertensive outpatients. METHODS: This is a prospective cohort study that compares candesartan therapy to candesartan-amlodipine therapy at a public hospital from payers’ perspective. The outcome is the percentage of targeted blood pressure decrease after three months of therapy. The cost effectiveness analysis uses the Incremental Cost Effectiveness Ratio (ICER) based on the ratio of cost difference to the outcome in both therapy groups. RESULTS: As many as 111 patients participated in this research, comprising 40 candesartan therapy patients and 71 patients with the combination of candesartan-amlodipine. Of the participants, 63.96% were female, 57.66% were aged 60 or older, and 56.32% had diabetes mellitus as the most common complication. Results show that the average direct medical cost per patient for a therapy of three months with candesartan was IDR 1,050,536 ± 730,007 and IDR 760,040 ± 614,290 for a candesartan-amlodipine therapy. The mean decline of systolic and diastolic blood pressure under candesartan therapy is less than that of candesartan-amlodipine, although without any significant difference (p > 0.05). It follows that the effectiveness of candesartan (85%) is greater than that of the candesartan-amlodipine combination (84.50%). Candesartan therapy is thereby more cost-effective with an ICER value of IDR 580,993/%. CONCLUSION: Hypertension therapy by candesartan is more cost-effective than candesartan-amlodipine therapy with a cost addition of IDR 580,993.

Effects of acupressure at the P6 and LI4 points on the anxiety level of soldiers in the Iranian military

2020 ◽  
pp. jramc-2019-001332 ◽  
Author(s):  
Saeid Amini Rarani ◽  
N Rajai ◽  
S Sharififar
Keyword(s):  
Military Service ◽  
Cost Effective ◽  
Anxiety Level ◽  
Anxiety Score ◽  
Control Group ◽  
Double Blind ◽  
Stressful Environment ◽  
Significant Difference ◽  
The Mean ◽  
Army Soldiers

IntroductionMilitary service is a stressful environment. Methods to reduce stress may result in the mental health promotion of military forces. There are various methods for relieving anxiety. Acupressure is one of them. Hence, this study was carried out to explore effects of acupressure at the P6 and LI4 acupressure points on the anxiety level of army soldiers.MethodsA randomised double-blind design was undertaken. A total of 120 Iranian army soldiers were randomly assigned to three groups, namely P6, LI4 and control. The P6 and LI4 acupressure points are effective in lowering the anxiety level. In the intervention groups, acupressure was applied at the P6 and LI4 points three times for 10 min at 30 min intervals. In the control group, the thumb pad, which is not an acupressure point, was pressed. The anxiety level of the subjects was measured before the intervention and 30 min after the last intervention. The instruments included a demographics questionnaire and the State-Trait Anxiety Inventory.ResultsThere was no significant difference between the three groups with respect to the anxiety level in the preintervention phase. However, the mean anxiety score in the P6 group decreased significantly from 53.35±9.7 to 49.02±9.3 (p=0.005). The mean anxiety score in the LI4 group also decreased significantly from 53.37±8.39 to 45.47±8.16 (p<0.001). In the control group, there was no significant difference between the preintervention and postintervention phases (p=0.16). In the postintervention phase, the analysis of variance test showed a significant difference between the three groups in terms of the anxiety level (p=0.04).ConclusionsAcupressure can reduce soldiers’ anxiety at the acupressure points, especially at the LI4 point. It is recommended that this simple and cost-effective intervention be used to relieve soldiers’ anxiety in stressful situations.Trial registration number20150715023216N4.

Long-term results for total lumbar facet joint replacement in the management of lumbar degenerative spondylolisthesis

2020 ◽  
Vol 32 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Yossi Smorgick ◽  
Yigal Mirovsky ◽  
Yizhar Floman ◽  
Nahshon Rand ◽  
Michael Millgram ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Facet Joint ◽  
Degenerative Spondylolisthesis ◽  
Leg Pain ◽  
Long Term Results ◽  
Neurogenic Claudication ◽  
Prospective Clinical Study ◽  
Vas Score ◽  
The Mean

OBJECTIVEThe authors evaluated the long-term clinical outcome of a total posterior arthroplasty system in the surgical treatment of lumbar spinal stenosis with degenerative spondylolisthesis.METHODSBetween June 2006 and July 2007, 10 patients with neurogenic claudication due to spinal stenosis and single-level degenerative spondylolisthesis were enrolled in a nonrandomized prospective clinical study. The patients were evaluated with radiographs and MRI scans, the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the SF-36 health survey preoperatively and at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 7 years, and 11 years postoperatively.RESULTSThe mean VAS score for leg pain dropped from 83.5 before surgery to 13 at 6 weeks and 17 at 11 years after surgery. The mean VAS score for back pain dropped from 56.2 preoperatively to 12.5 at 6 weeks and 14 at 11 years after surgery. The mean ODI score decreased from 49.1 preoperatively to 13.5 at 6 weeks and 16 at 11 years after surgery. MRI at 11 years demonstrated stenosis adjacent to the stabilized segment in one patient. This patient was not symptomatic. The authors did not find evidence of progression of the spondylolisthesis in any of the cases. In one patient, conversion to posterolateral fusion was performed due to an early device malfunction.CONCLUSIONSThe results of this 11-year follow-up study demonstrate that, in patients with spinal stenosis and degenerative spondylolisthesis, decompression and posterior arthroplasty maintain clinical improvement and radiological stability.

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