When Does an Incidental Chiari I Malformation Require Surgery? A 10-Year Prospective Study on the Evolution and Natural History

Abstract INTRODUCTION The optimal management of incidental CM-I remains elusive, in part, due to a lack of understanding of its natural history. Despite recent efforts, most studies are limited by their retrospective design, small sample size, and variable follow-up as well as indication for surgery. We present a large-scale, long-term, prospective study of the natural history of incidental CM-I in pediatric patients. METHODS A single-institution, prospective review of patients with incidental CM-I was performed from 2008 to 2018. CM-I was defined as “incidental” when it was discovered during workup for an unrelated indication in an otherwise asymptomatic individual. Patients were stratified into observation only, early surgery (<6 mo from initial diagnosis) or delayed surgery (>6 mo) groups. To observe the evolution of CM-I, a minimum follow-up of 1-yr was set as the inclusion criteria for patients in the observation only cohort. Demographics, radiographic features, clinical presentation and indications for surgery were analyzed to define parameters for conservative management and determine predictors of surgery. RESULTS From 777 CM-I patients, 433 (55.73%) were diagnosed incidentally. A total of 390 (90.1%)were managed conservatively while 43 (9.93%) eventually required surgery at an average duration of 10.6 m from diagnosis.Among the surgical cohort, there was a trend toward early surgery with 90.7% undergoing surgery within 3 yr of initial diagnosis (see Kaplan-Meier analysis). Most patients (76%) in the early surgery group presented with a syrinx at initial presentation compared to only 2 (15%) in the delayed surgery group. The remaining patients manifested progressive symptoms.Predictive factors significantly associated with surgery included syrinx, cervicomedullary kinking and gait abnormality (P < .05). CONCLUSION Incidental CM-I has a relatively benign natural history and can be managed in a conservative fashion in majority of pediatric patients. However, careful and longterm follow-up, particularly during the first 3 yr after diagnosis is critical since 9.9% of patients are likely to experience a change in clinical or radiographic status necessitating surgical intervention.

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Dietary fiber intake and total and cause-specific mortality: the Japan Public Health Center-based prospective study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa002 ◽

2020 ◽

Vol 111 (5) ◽

pp. 1027-1035 ◽

Cited By ~ 5

Author(s):

Ryoko Katagiri ◽

Atsushi Goto ◽

Norie Sawada ◽

Taiki Yamaji ◽

Motoki Iwasaki ◽

...

Keyword(s):

Public Health ◽

Prospective Study ◽

Dietary Fiber ◽

Large Scale ◽

Total Mortality ◽

Fiber Intake ◽

Dietary Fiber Intake ◽

All Cause Mortality ◽

Specific Mortality

ABSTRACT Background An inverse association has been shown between dietary fiber intake and several noncommunicable diseases. However, evidence of this effect remains unclear in the Asian population. Objective We examined the association between dietary fiber intake and all-cause and cause-specific mortality, as well as the association between fiber intake from dietary sources and all-cause mortality. Methods We conducted a large-scale population-based cohort study (Japan Public Health Center-based prospective study). A validated questionnaire with 138 food items was completed by 92,924 participants (42,754 men and 50,170 women) aged 45–74 y. Dietary fiber intake was calculated and divided into quintiles. HR and 95% CI of total and cause-specific mortality were reported. Results During the mean follow-up of 16.8 y, 19,400 deaths were identified. In multivariable adjusted models, total, soluble, and insoluble fiber intakes were inversely associated with all-cause mortality. The HRs of total mortality in the highest quintile of total fiber intake compared with the lowest quintile were 0.77 (95% CI: 0.72, 0.82; Ptrend <0.0001) in men and 0.82 (95% CI: 0.76, 0.89; Ptrend <0.0001) in women. Increased quintiles of dietary fiber intake were significantly associated with decreased mortality due to total cardiovascular disease (CVD), respiratory disease, and injury in both men and women, whereas dietary fiber intake was inversely associated with cancer mortality in men but not women. Fiber from fruits, beans, and vegetables, but not from cereals, was inversely associated with total mortality. Conclusion In this large-scale prospective study with a long follow-up period, dietary fiber was inversely associated with all-cause mortality. Since intakes of dietary fiber, mainly from fruits, vegetables, and beans were associated with lower all-cause mortality, these food sources may be good options for people aiming to consume more fiber.

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Investigating the natural history and prognostic factors of ASD in children: the multicEntric Longitudinal study of childrEN with ASD - the ELENA study protocol

BMJ Open ◽

10.1136/bmjopen-2018-026286 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026286 ◽

Cited By ~ 4

Author(s):

Amaria Baghdadli ◽

Stéphanie Miot ◽

Cécile Rattaz ◽

Tasnime Akbaraly ◽

Marie-Maude Geoffray ◽

...

Keyword(s):

Prognostic Factors ◽

Longitudinal Study ◽

Natural History ◽

Large Scale ◽

Clinical Presentation ◽

Autism Diagnostic Observation Schedule ◽

Autism Spectrum ◽

Primary Objective ◽

Children With Asd

IntroductionThere is global concern about the increasing prevalence of autism spectrum disorders (ASDs), which are early-onset and long-lasting disorders. Although ASDs are considered to comprise a unique syndrome, their clinical presentation and outcome vary widely. Large-scale and long-term cohort studies of well-phenotyped samples are needed to better understand the course of ASDs and their determinants. The primary objective of the multicEntric Longitudinal study of childrEN with ASD (ELENA) study is to understand the natural history of ASD in children and identify the risk and prognostic factors that affect their health and development.Methods and analysisThis is a multicentric, longitudinal, prospective, observational cohort in which 1000 children with ASD diagnosed between 2 and 16 years of age will be recruited by 2020 and followed over 6 years. The baseline follow-up starts with the clinical examination to establish the ASD diagnosis. A battery of clinical tools consisting of the Autism Diagnostic Observation Schedule, the revised version of the Autism Diagnostic Interview, measures of intellectual functioning, as well as large-scale behavioural and developmental measurements will allow us to study the heterogeneity of the clinical presentation of ASD subtypes. Subsequent follow-up at 18 months and at 3, 4.5 and 6 years after the baseline examination will allow us to explore the developmental trajectories and variables associated with the severity of ASD. In addition to the children’s clinical and developmental examinations, parents are invited to complete self-reported questionnaires concerning perinatal and early postnatal history, congenital anomalies, genetic factors, lifestyle factors, medical and psychiatric comorbidities, and the socioeconomic environment. As of 1 November 2018, a total of 766 participants have been included.Ethics and disseminationEthical approval was obtained through the Marseille Mediterranean Ethics Committee (ID RCB: 2014-A01423-44), France. We aim to disseminate the findings through national and international conferences, international peer-reviewed journals, and social media.Trial registration numberNCT02625116; Pre-results.

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Impact of delays in initiation of adjuvant endocrine therapy and survival among patients with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.537 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 537-537

Author(s):

Kimberley Lee ◽

Lisa K. Jacobs ◽

Jodi Segal

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Endocrine Therapy ◽

Invasive Breast Cancer ◽

Population Level ◽

Initial Diagnosis ◽

Adjuvant Endocrine Therapy ◽

Delayed Surgery ◽

Delayed Initiation

537 Background: Time to adjuvant endocrine therapy concerns patients and clinicians, but its impact on overall survival is not clear. There are no population level studies that address this question. Our primary objective is to describe the relationship between time from diagnosis of breast cancer to start of adjuvant endocrine therapy and overall survival. Methods: This is a population-based cohort study using prospectively collected population level data from the National Cancer Database (NCDB). The NCDB prospectively collects data on incident cancer cases from over 1500 Commission on Cancer-accredited facilities nationally. NCDB captures approximately 70% of incident cases of cancer in the United States. The participants are women with Stage II and III estrogen or progesterone receptor positive, human epidermal receptor 2 negative, invasive breast cancer who underwent definitive surgical treatment. Results: Of the 391,594 women in this study, 12,162 (3.1%) began treatment with adjuvant endocrine therapy more than 12 months after initial diagnosis of hormone receptor positive, invasive breast cancer. Mean age at diagnosis was 59.7 years (SD 13.4). Predictors of delayed initiation of adjuvant endocrine therapy include Black race or Hispanic ethnicity (adjusted odds ratio [aOR] of Black vs White, 1.57; 95% CI, 1.48-1.66; P < .001, Hispanic vs White, aOR 1.22, 95% CI 1.13-1.32; P < .001), Insurance other than private insurance (Medicare vs Private, aOR 1.09, 95% CI 1.01-1.17; P = .007, Medicaid vs Private, aOR 1.36, 95% CI 1.28-1.45; P < .001), higher stage of disease at diagnosis (Stage III vs II, aOR 1.24, 95% CI 1.19-1.30; P < .001), and delayed surgery or chemotherapy (Delayed surgery vs On-time lumpectomy, aOR 2.76, 95% CI 2.60-2.93; P < .001 and Delayed chemotherapy vs no chemotherapy, aOR 11.5, 95%CI 10.6-12.5). With median follow-up of 63.2 months, 67,335 (17.2%) patients died by the end of follow-up. Delayed initiation of AET resulted in no change in the hazard of death (HR, 1.00; 95% CI, 0.95-1.05; P = .97) compared to initiation within 12 months of diagnosis after adjusting for age, race and ethnicity, insurance type, urban vs rural residence, neighborhood income and education, comorbidity, cancer grade, stage, and receipt of timely or delayed surgery, chemotherapy, and/or radiation therapy. Conclusions: These results suggest that there may be no detriment to survival if initiation of adjuvant endocrine therapy occurs 12 to 24 months after initial diagnosis compared to within 12 months of diagnosis, as currently recommended.

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Associations between Early Surgery and Postoperative Outcomes in Elderly Patients with Distal Femur Fracture: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10245800 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5800

Author(s):

Norio Yamamoto ◽

Hiroyuki Ohbe ◽

Yosuke Tomita ◽

Takashi Yorifuji ◽

Mikio Nakajima ◽

...

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Hospital Admission ◽

Distal Femur ◽

Femur Fracture ◽

Early Surgery ◽

Distal Femur Fracture ◽

Delayed Surgery ◽

Surgery Group ◽

Hospitalization Costs

Previous literature has provided conflicting results regarding the associations between early surgery and postoperative outcomes in elderly patients with distal femur fractures. Using data from the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019, we identified elderly patients who underwent surgery for distal femur fracture within two days of hospital admission (early surgery group) or at three or more days after hospital admission (delayed surgery group). Of 9678 eligible patients, 1384 (14.3%) were assigned to the early surgery group. One-to-one propensity score matched analyses showed no significant difference in 30-day mortality between the early and delayed groups (0.5% versus 0.5%; risk difference, 0.0%; 95% confidence interval, −0.7% to 0.7%). Patients in the early surgery group had significantly lower proportions of the composite outcome (death or postoperative complications), shorter hospital stays, and lower total hospitalization costs than patients in the delayed surgery group. Our results showed that early surgery within two days of hospital admission for geriatric distal femur fracture was not associated with a reduction in 30-day mortality but was associated with reductions in postoperative complications and total hospitalization costs.

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The Natural History of Subarachnoid Haemorrhage with Negative Angiography: A prospective study and 3-year follow-up

British Journal of Neurosurgery ◽

10.3109/02688698808999656 ◽

1988 ◽

Vol 2 (1) ◽

pp. 33-41 ◽

Cited By ~ 6

Author(s):

Robert M. Redfern ◽

Stefan Zygmunt ◽

John D. Pickard ◽

Patrick M. Foy ◽

M. D. M. Shaw

Keyword(s):

Natural History ◽

Subarachnoid Haemorrhage ◽

Prospective Study ◽

Negative Angiography ◽

History Of ◽

A Prospective Study

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Evaluation of Bone Marrow Reticulin Formation in Romiplostim-Treated Adult Patients with Chronic Immune Thrombocytopenic Purpura (ITP).

Blood ◽

10.1182/blood.v112.11.3416.3416 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3416-3416 ◽

Cited By ~ 2

Author(s):

Davi d J Kuter ◽

Ghulam Mufti ◽

Barbara Bain ◽

Robert Hasserjian ◽

Mark Rutstein

Keyword(s):

Bone Marrow ◽

Retrospective Study ◽

Prospective Study ◽

Small Sample ◽

Post Treatment ◽

Treatment Discontinuation ◽

Collagen Deposition ◽

Fiber Network ◽

Pre Treatment

Abstract Introduction: Romiplostim is an investigational Fc-peptide fusion protein (peptibody) that stimulates platelet production by a mechanism similar to endogenous thrombopoietin and is being investigated for its ability to treat patients with chronic ITP. Some degree of reticulin deposition is often a normal finding in bone marrow, and increased reticulin has been detected in patients treated with thrombopoietin mimetics (Kuter et al, Br J Haem 2007). We analyzed bone marrow biopsy samples from ITP patients at baseline and after romiplostim treatment for the presence and degree of reticulin. Methods: Baseline and post-treatment samples were analyzed from two sets of bone marrow data: (1) a prospective study in which both baseline (pre-treatment) and follow-up (post-treatment) samples were taken, and (2) a retrospective study of spontaneously reported observations of reticulin occurring across all romiplostim clinical trials. Assessments were made from aspirate smears, core biopsies, reticulin stains, trichrome stains, and written reports. Only patients with evaluable baseline and post-treatment samples are included in this report. Reticulin was graded according to the following scale: 0 (absent), 1 (fine fibers), 2 (diffuse fine fiber network), 3 (diffuse fiber network with scattered coarse fibers), and 4 (areas of collagen). Grade 0–2 reticulin can be found in bone marrow from healthy individuals, and reticulin grades 1 to 2 have been described in the bone marrow of 66% of ITP patients (Mufti et al, ASH 2006). Results: Six of 10 prospective study patients had both evaluable baseline and follow-up samples. Reticulin grades in all 6 samples at baseline were 0–1. Only 1 patient demonstrated an increase in reticulin (from 0–1 to 1–2 after 3 months of romiplostim). Higher degrees of reticulin deposition (grades >2) were not observed, and trichrome staining demonstrated absence of collagen in all 6 cases. Baseline and follow-up bone marrow samples were available in 5 of 9 retrospective study patients, including one patient from the prospective study in whom reticulin was also spontaneously reported following romiplostim administration. In these 5 patients, the baseline reticulin grade was 0 to 1 in all cases and increased after treatment in all but one case. Reticulin typically decreased soon after discontinuation of romiplostim. Two patients were exposed to drug doses exceeding those used in current clinical studies (≥ 10 μg/kg). One patient showed minimal collagen deposition (reticulin grade 4) that was absent in a further follow-up sample after treatment discontinuation. Conclusion: Increased reticulin was observed in the bone marrow of some romiplostim-treated patients and typically decreased soon after drug withdrawal. There was no evidence that romiplostim exposure led to development of chronic idiopathic myelofibrosis or other clonal disorders in this small sample of patients. Table 1. Reticulin scores in bone marrow samples from ITP patients before and following romiplostim therapy Reticulin Assessment (Weeks after initiating romiplostim) Follow-up during treatment Follow-up after treatment discontinuation Age, Years Prior Splenectomy, Y/N Max Dose, μg/kg Baseline (prior to romiplostim treatment) 1 2 3 1 2 A Reticulin in this patient was also spontaneously reported and included in the retrospective analysis B A focal area of possible collagen deposition was seen on trichrome stain. Prospective study cases 70 Y 7 0–1 1–2 (wk 15) - - - - 43 Y 2 0–1 0–1 (wk 37) - - - - 42 Y 4 0–1 1 (wk 13) - - - - 55 Y 3 0–1 0–1 (wk 34) - - - - 83 N 2 0–1 0–1 (wk 13) - - - - 53 Y 7 0–1A 0–1A (wk 35) - - - - Retrospective study cases of spontaneously reported reticulin 40 Y 9 0–1, focal 2 3 (wk 5) - - 1–2 (wk 17) - 31 Y 18 0 2–3 (wk 26) - - 1–2 (wk 34) 1 (wk 46) 58 Y 15 0–1 1–3B (wk 31) 2–3 (wk 51) 1–2 (wk 67) - - 37 Y 9 1 4 (wk 26) - - 1–2 (wk 38) -

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Outcome of Adolescent & Young Adult (AYA) Patients with Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽

10.1182/blood.v120.21.1568.1568 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1568-1568 ◽

Cited By ~ 1

Author(s):

Jill C. Beck ◽

Martin Bast ◽

Deborah A. Perry ◽

Lynette M. Smith ◽

Dennis D. Weisenburger

Keyword(s):

B Cell ◽

Pediatric Patients ◽

Conflicts Of Interest ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Small Sample ◽

Rank Test ◽

Age Related ◽

Biological Differences

Abstract Abstract 1568 Introduction Non-Hodgkin lymphoma (NHL) represents 60% of lymphoma diagnoses in children, and NHL subtypes change considerably from childhood to adulthood.[1] Recent studies have implicated age-associated biological differences in certain NHL subtypes.[2] AYAs with cancer fall between pediatric and adult patients clinically and potentially biologically. Although environmental stressors and the psychosocial transition of adolescence likely impacts these outcomes, age-related biological differences need to be better understood. The majority of pediatric NHLs are high-grade tumors, whereas low- and intermediate-grade tumors are more common among adults.[1] Recent studies have found that young adults with NHL have poorer survival compared to children.[2] Although the incidence of AYA lymphoma has increased over the past 20 years, survival has not significantly improved, demanding a better understanding of the epidemiology and biology of lymphoma among this patient population.[3] Methods Cases were identified using the Nebraska Lymphoma Study Group database and chart review. All patients with DLBCL from 1983–2010 were identified (n = 1328), and 36 (2.7%) cases are included in this study of AYA DLBCL (age 13–30 years). The Kaplan-Meier method was used to estimate overall survival (OS) and event-free survival (EFS) distributions, and the log-rank test was used to compare survival distributions between groups. OS is defined as the time from the beginning of therapy to death or last follow-up. EFS is defined as the time from the beginning of therapy to progression, death, or last follow-up. P-values less than 0.05 are considered to be statistically significant. SAS software V 9.2 (SAS Institute Inc., Cary, NC) was used for all data analysis. The study was approved by the Institutional Review Board. Results The median age of the 36 AYA DLBCL patients was 24.2 years (range, 14.5–29.8) with a female to male ratio of 1.8:1, and 53% were primary mediastinal B-cell lymphoma. Patient characteristics are shown in table 1. Of the 36 patients, 18 have died and 18 are alive at last follow-up. Fifteen deaths were due to lymphoma, 1 treatment related, 1 unrelated to disease, and 1 of unknown cause. The 5-year EFS is 52% (95% CI 34–67%, figure 1) and OS is 58% (95% CI 49–72%). The median follow-up of patients alive at last follow-up is 8.8 years (range, 1.8 – 29). OS was not affected by gender (p=0.32), stage (p=0.43), LDH (p=0.11), B symptoms (p=0.98), or size of the largest mass at diagnosis (0.93). Nearly all patients (97%) were treated on adult chemotherapy protocols. Discussion This study presents data on 36 AYA patients with DLBCL. The 5-year EFS was 52% and OS was 58%. Pediatric patients report a 5-year EFS of 87–96% [2, 4] compared to adults which have a 5-year EFS of 44–80%.[4] In contrast to other reports, in this study, gender, elevated LDH, and advanced stage (III-IV) did not impact EFS or OS, although the comparisons may be under-powered due to the small sample size. Although pediatric patients have better outcomes compared to adults, AYA patients have worse EFS than both pediatric and adult DLBCL patients, demanding further understanding of the biology of AYA DLBCL and improved treatment strategies. Disclosures: No relevant conflicts of interest to declare.

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myMoves Program: Feasibility and Acceptability Study of a Remotely Delivered Self-Management Program for Increasing Physical Activity Among Adults With Acquired Brain Injury Living in the Community

Physical Therapy ◽

10.2522/ptj.20160028 ◽

2016 ◽

Vol 96 (12) ◽

pp. 1982-1993 ◽

Cited By ~ 13

Author(s):

Taryn M. Jones ◽

Blake F. Dear ◽

Julia M. Hush ◽

Nickolai Titov ◽

Catherine M. Dean

Keyword(s):

Physical Activity ◽

Brain Injury ◽

Large Scale ◽

Acquired Brain Injury ◽

Management Program ◽

Small Sample ◽

Self Management ◽

Activity Data ◽

Study Objective

Abstract Background People living with acquired brain injury (ABI) are more likely to be physically inactive and highly sedentary and, therefore, to have increased risks of morbidity and mortality. However, many adults with ABI experience barriers to participation in effective physical activity interventions. Remotely delivered self-management programs focused on teaching patients how to improve and maintain their physical activity levels have the potential to improve the overall health of adults with ABI. Objective The study objective was to evaluate the acceptability and feasibility of a remotely delivered self-management program aimed at increasing physical activity among adults who dwell in the community and have ABI. Design A single-group design involving comparison of baseline measures with those taken immediately after intervention and at a 3-month follow-up was used in this study. Methods The myMoves Program comprises 6 modules delivered over 8 weeks via email. Participants were provided with regular weekly contact with an experienced physical therapist via email and telephone. The primary outcomes were the feasibility (participation, attrition, clinician time, accessibility, and adverse events) and acceptability (satisfaction, worthiness of time, and recommendation) of the myMoves Program. The secondary outcomes were objective physical activity data collected from accelerometers, physical activity self-efficacy, psychological distress, and participation. Results Twenty-four participants commenced the program (20 with stroke, 4 with traumatic injury), and outcomes were collected for 23 and 22 participants immediately after the program and at a 3-month follow-up, respectively. The program required very little clinician contact time, with an average of 32.8 minutes (SD=22.8) per participant during the 8-week program. Acceptability was very high, with more than 95% of participants being either very satisfied or satisfied with the myMoves Program and stating that it was worth their time. All participants stated that they would recommend the program to others with ABI. Limitations The results were obtained from a small sample; hence, the results may not be generalizable to a larger ABI population. Conclusions A remotely delivered self-management program aimed at increasing physical activity is feasible and acceptable for adults with ABI. Further large-scale efficacy trials are warranted.

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Natural history of untreated syringomyelia in pediatric patients

Neurosurgical FOCUS ◽

10.3171/2011.9.focus11208 ◽

2011 ◽

Vol 31 (6) ◽

pp. E13 ◽

Cited By ~ 23

Author(s):

Ash Singhal ◽

Tim Bowen-Roberts ◽

Paul Steinbok ◽

Doug Cochrane ◽

Angela T. Byrne ◽

...

Keyword(s):

Natural History ◽

Pediatric Patients ◽

Nonoperative Treatment ◽

Motor Deficits ◽

Axial Diameter ◽

History Of ◽

Clinical Changes ◽

Changes Over Time ◽

Over Time

Object The natural history of syringomyelia in pediatric patients remains uncertain. Although symptomatic and operative cases of syringomyelia are well studied, there are fewer articles in the literature on the nonoperative syrinx and its clinical and radiological course. The purpose of this research was to analyze the natural history of untreated syringomyelia in pediatric patients presenting with minimal neurological symptoms. Methods A review of the neurosurgery database at British Columbia's Children's Hospital identified all pediatric patients (< 18 years of age) with syringes identified on MR imaging. Patients were included in this study if they had at least 2 MR images of the spine, at least 1 year apart, while receiving nonoperative treatment. Magnetic resonance imaging was used to determine changes in the size of the syrinx over time. Clinic notes were analyzed to establish demographic and clinical features and to determine any clinical changes over time. Results A total of 17 patients were included in the study. Symptoms at presentation were often mild and included limb numbness (3 cases), headaches (2 cases), mild sensory deficits (2 cases), mild motor deficits (3 cases), and intermittent incontinence (7 cases). The consultant neurosurgeon believed that the syrinx was not contributing to the symptoms in these 17 patients. The syrinx either remained unchanged (7 cases) or diminished in size (8 cases) in a total of 15 patients (88%). In the remaining 2 patients the authors noted an increase in syrinx size, in 1 of whom the clinical course also worsened. Both of these patients had a Chiari malformation and subsequently underwent craniocervical decompression. Overall, the mean change was −0.7 mm of maximal axial diameter (range −2.6 to +2.7 mm). Sixteen patients (94%) exhibited no worsening of symptoms over time. Conclusions Syringomyelia often remains stable in patients receiving nonoperative treatment. However, given that 2 (12%) of 17 syringes in this series enlarged, it is likely appropriate to include periodic imaging in the follow-up of these cases.

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Early Versus Delayed Microdiscectomy for Chronic Sciatica Lasting 4–12 Months Secondary to Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial

Global Spine Journal ◽

10.1177/21925682211054040 ◽

2021 ◽

pp. 219256822110540

Author(s):

Christopher S. Bailey ◽

Andrew Glennie ◽

Parham Rasoulinejad ◽

Andrew Kanawati ◽

David Taylor ◽

...

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Early Surgery ◽

Adverse Event Rate ◽

Delayed Surgery ◽

Surgery Group ◽

Chronic Sciatica

Objectives To compare the effect of delaying surgery on clinical outcome in patients with chronic sciatica secondary to lumbar disc herniation. Methods Patients with sciatica lasting 4–12 months and lumbar disc herniation at the L4–L5 or L5–S1 level were randomized to undergo microdiscectomy (early surgery) or to receive 6 months of nonoperative treatment followed by surgery if needed (delayed surgery). Outcomes were leg pain, Oswestry Disability Index score (ODI), back pain, SF–36 physical component (PCS) and mental component (MCS) summary scores, employment, and satisfaction measured preoperatively and at 6 weeks, 3 months, 6 months, and 1 year after surgery. Results Of the 64 patients in the early surgery group, 56 underwent microdiscectomy an average of 3 ± 2 weeks after enrollment. Of the 64 patients randomized to nonoperative care, 22 patients underwent delayed surgery an average of 53 ± 24 weeks after enrollment. The early surgery group experienced less leg pain than the delayed surgery group, which was the primary outcome, at 6 months after surgery (early surgery 2.8 ± .4 vs delayed surgery 4.8 ± .7; difference, 2.0; 95% confidence interval, .5–3.5). The overall estimated mean difference between groups significantly favored early surgery for leg pain, ODI, SF36-PCS, and back pain. The adverse event rate was similar between groups. Conclusions Patients presenting with chronic sciatica treated with delayed surgery after prolonging standardized non-operative care have inferior outcomes compared to those that undergo expedited surgery.

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