scholarly journals Dissatisfaction Risk Factors of Patients after Laminectomy for Thoracic Ossification of Ligamentum Flavum: A Retrospective Cohort Study of Different Follow-Up Periods

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Zhiwei Wang ◽  
Sidong Yang ◽  
Xianda Gao ◽  
Zheng Wang ◽  
Wenyuan Ding ◽  
...  
Keyword(s):  
Influencing Factors ◽  
Ligamentum Flavum ◽  
Postoperative Treatment ◽  
Delayed Wound Healing ◽  
Improvement Rate ◽  
Score Improvement ◽  
Intercostal Pain ◽  
Ossification Of Ligamentum Flavum ◽  
Symptom Recurrence

Objectives. To explore the influencing factors of satisfaction with postoperative treatment in patients diagnosed with thoracic ossification of the ligamentum flavum during different follow-up periods. Methods. This was a retrospective study of 57 patients who were diagnosed with thoracic ossification of ligamentum flavum (TOLF) and treated with laminectomy in the Spine Surgery Department of the Third Hospital of Hebei Medical University from January 2010 to January 2017. The Patient Satisfaction Index (PSI) was collected at discharge and at 6-month, 1-year, and the last follow-up. According to the evaluation results, the patients could be divided into a satisfied group and a dissatisfied group. The patient’s Japanese Orthopaedic Association (JOA) score improvement rate was evaluated at the last follow-up. Possible influencing factors of the two groups of patients were compared and the related influencing factors of satisfaction with postoperative treatment in patients during different follow-up periods were summarized. Results. At the time of discharge, the dissatisfied and satisfied groups had significant differences in variables of diabetes mellitus, duration of preoperative symptoms, urination disorder, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, hospital stay, hospitalization expenses, postoperative pain in LE VAS, delayed wound healing, postoperative depression, and intercostal pain ( P < 0.05 ). There were also significant differences in urination disorder, postoperative pain according to the LE VAS, JOA score, and postoperative depression during the 6-month follow-up ( P < 0.05 ). There were no significant differences in other variables between the two groups ( P > 0.05 ). One year after the operation, there were significant differences between the dissatisfied group and the satisfied group in urination disorder, JOA score, and symptom recurrence ( P < 0.05 ). There were also significant differences in the JOA score and symptom recurrence at the final follow-up ( P < 0.05 ). For further analysis, the duration of preoperative symptoms in the satisfied group was less than 24 months and the duration of preoperative symptoms in the dissatisfied group was more than 24 months. The JOA scores of patients in the satisfied group and the dissatisfied group increased gradually with the improvement of neurological function in different follow-up periods, but, at the last follow-up, the JOA scores of patients in the satisfied group were significantly higher than those in the dissatisfied group. Conclusions. In conclusion, for thoracic ossification of ligamentum flavum patients who received laminectomy, dissatisfaction with the early and medium-term postoperative results may be related to diabetes, the duration of preoperative symptoms, hospitalization expenses, delayed wound healing, intercostal pain, and urination disorder, and dissatisfaction with the long-term postoperative results might be related to the low JOA score improvement rate and symptom recurrence.

scholarly journals Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

2021 ◽  
Author(s):  
Jing-Yu Wang ◽  
Fu-Sheng Liu ◽  
Jing Li ◽  
Xiao-Bin Wang
Keyword(s):  
Sagittal Plane ◽  
Pearson Correlation ◽  
Isthmic Spondylolisthesis ◽  
Improvement Rate ◽  
Clinical Prognosis ◽  
Vas Score ◽  
Score Improvement ◽  
Significant Difference ◽  
Sagittal Parameters

Abstract Background: Spinal and pelvic sagittal plane balance is closely related to good clinical prognosis, so in the treatment of 2-level isthmic spondylolisthesis, attention should be paid not only to adequate nerve decompression, but also to the correction of lumbosacral sagittal plane parameters. The purpose of this study was to observe the clinical prognosis and sagittal parameters of patients with isthmic spondylolisthesis treated with PLIF, and to find out the risk factors leading to poor prognosis. Methods: From January 2006 to August 2018, the clinical data of patients with 2-level isthmic spondylolisthesis treated with PLIF in the Second Xiangya Hospital of Central South University were retrospectively collected. The clinical symptoms (JOA score and VAS score) and the sagittal parameters of lumbosacral segment (PI, PT, LL, L4-S1 SL, LDI, PI-LL, LL and L4-S1 SL) were recorded before operation, immediately after operation and at the last follow-up. According to the improvement rate of JOA score, the patients were divided into two subgroups, poor(P) group and good(G) group. The parameters within and between the two subgroups were compared. Meanwhile, Pearson correlation analysis was conducted between sagittal parameters and JOA score improvement rate.Results: A total of 52 patients were enrolled in this study, the average age was (59.96 ±9.11) years, and the mean follow-up time was (31.88 ±8.37) months. Group G (n = 37) and group P (n = 15). In terms of clinical symptom improvement and sagittal plane parameters, except PI, the other parameters of the patients were improved compared with those before operation, and the difference was statistically significant. In the intra-group comparison, except PI, other indexes in group G were significantly improved, while in group P, there was no significant difference in PI, LL, L4-S1 SL, LDI, PI-LL before and after operation. In the comparison between groups, there was no significant difference in baseline data between group G and group P; postoperative VAS score(back pain) in group G was lower than that in group P, but there was no significant difference in VAS score( leg pain); in terms of JOA score and JOA score improvement rate, group G was significantly better; △L4-S1 SL ,L4-S1 SL and LDI were larger in group G, and the proportion of patients with normal LDI was higher than that in group P. Pearson correlation analysis showed that postoperative △L4-S1 SL, LDI and L4-S1 SL were positively correlated with JOA improvement rate. 2 patients with failed internal fixation occurred in group P, and the postoperative LDI was less than 50%. Conclusion: PLIF is an effective method for the treatment of 2-level isthmic spondylolisthesis. ΔL4-S1 SL, L4-S1 SL and good LDI may be important sagittal parameters affecting the clinical prognosis of L4 and L5 isthmus spondylolisthesis.

En Bloc Resection of Lamina and Ossified Ligamentum Flavum in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1181-1186 ◽  
Author(s):  
Lian-shun Jia ◽  
Xiong-sheng Chen ◽  
Sheng-yuan Zhou ◽  
Jiang Shao ◽  
Wei Zhu
Keyword(s):  
Evaluation System ◽  
Ligamentum Flavum ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Neurological Dysfunction ◽  
Thoracic Myelopathy ◽  
En Bloc ◽  
Improvement Rate ◽  
The Mean

Abstract OBJECTIVE We performed a retrospective patient chart review to determine the feasibility and safety of en bloc resection of lamina and ossified ligamentum flavum in the treatment of thoracic ossification of ligamentum flavum (OLF). METHODS From January 2000 to June 2006, 36 patients with thoracic OLF underwent en bloc resection of lamina and ossified ligamentum flavum by a burr-grinding technique. The range of resection included one lamina superior and one lamina inferior to the diseased segments. Ossified dura mater was removed if present, and simultaneous repair was carried out. RESULTS The mean preoperative Japanese Orthopedic Association (JOA) score (an evaluation system for thoracic myelopathy with a total score of 11 points) was 5 points (range, 3–9 points). The mean JOA score at the last follow-up visit (mean follow-up period, 3.9 years) was 8.44 points (range, 6–11 points). The range of improvement was from 2 to 6 points, and the mean improvement rate was 60.5% (range, 33.3%–100%). No postoperative aggravation of neurological dysfunction, leakage of cerebrospinal fluid (CSF), wound infection, kyphosis, or recurrence occurred. A CSF cyst found in one patient 3 weeks postoperatively was absorbed automatically after 10 months. CONCLUSION The en bloc resection technique described here is both safe and effective.

scholarly journals Full-Endoscopic Decompression with the Application of an Endoscopic-Matched Ultrasonic Osteotome for Removal of Ossification of the Thoracic Ligamentum Flavum

2021 ◽  
pp. 275-281
Author(s):  
Yuan-Ting Zhao
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Surgery ◽  
Ligamentum Flavum ◽  
Japanese Orthopaedic Association ◽  
Thoracic Myelopathy ◽  
Improvement Rate ◽  
Cord Injury ◽  
Endoscopic Spinal Surgery

Background: Resection of the ossification of the thoracic ligamentum flavum (OTLF) with a high-speed burr may cause a high rate of perioperative complications, such as dural laceration and/or iatrogenic spinal cord injury. Objectives: The aim of this study was to investigate the safety and feasibility of the endoscopicmatched ultrasonic osteotome in full-endoscopic spinal surgery for direct removal of OTLF. Study Design: Retrospective study. Setting: All data were from Honghui Hospital in Xi’an. Methods: This study conducted between December 2017 and December 2018, included 27 consecutive patients who met the study criteria, had single-level OTLF, and underwent fullendoscopic decompression under local anesthesia. The postoperative follow-up was scheduled at 1, 3, 6, and 12 months postoperatively. Outcomes evaluations included the Visual Analog Scale (VAS) score for lower extremity pain and the modified Japanese Orthopaedic Association (mJOA) score and improvement rate for the assessment of thoracic myelopathy. Removal of OTLF was measured by comparing the pre- and postoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans. Results: The operation was completed in all patients without conversion to open surgery. The operation time ranged from 65 to 125 minutes (average, 83.7 ± 12.3 minutes). All patients were followed up for 12 to 18 months, with an average follow-up of 14.3 ± 1.3 months. Satisfactory neurologic decompression was confirmed by postoperative CT and MRI, and no revision surgery was required. The VAS and mJOA scores showed statistically higher improvement at the 1-month follow-up and the last follow-up compared with the preoperative assessment (P < 0.05). According to the improvement rate at the final follow-up, 20 cases were classified as good, 6 cases were fair, and 1 case remained unchanged. Limitations: A single-center, noncontrol study. Conclusions: The endoscopic-matched ultrasonic osteotome can be considered quite safe and feasible for direct removal of OTLF during full-endoscopic spinal surgery in strictly selected patients, as this allows for effective direct decompression of OTLF while minimizing trauma and instability. In addition, because of the design characteristics of the ultrasonic osteotome, surgical complications, especially dural tears and spinal cord injury, can also be effectively controlled. Key words: Percutaneous endoscopic spinal surgery, ultrasonic osteotome, ossification of thoracic ligamentum flavum, microsurgery, thoracic myelopathy, minimally invasive procedures

Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis

2014 ◽  
Vol 21 (6) ◽  
pp. 944-950 ◽  
Author(s):  
Lisheng Kan ◽  
Jian Kang ◽  
Rui Gao ◽  
Xiongsheng Chen ◽  
Lianshun Jia
Keyword(s):  
Scale Score ◽  
Cervical Spondylosis ◽  
Cervical Disc ◽  
Improvement Rate ◽  
Score Improvement ◽  
The Mean ◽  
Reconstructive Techniques ◽  
Anterior Cervical Corpectomy ◽  
Two Hybrid

Object To date, formulation of the optimal surgical protocol for noncontiguous multilevel cervical spondylosis remains controversial, and the corresponding clinical data continue to be limited. The purpose of this study was to compare the clinical and radiological outcomes of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis (2 contiguous disc levels and 1 “skip” disc level [nonoperated level between 2 operated levels]). The incidence of adjacent-segment degeneration (ASD) was also evaluated. Methods Sixty-three consecutive patients with noncontiguous 3-level cervical spondylosis who underwent two different hybrid methods of treatment were retrospectively reviewed. The patients were divided into 2 groups, the fusion group and the arthroplasty group. A titanium mesh cage and an anterior cervical plate were used after the anterior cervical corpectomy, and then a stand-alone cage (the fusion group) or an artificial cervical disc (the arthroplasty group) was used after the discectomy. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score and the JOA scale score improvement rate preoperatively and during follow-up. Radiological results were assessed using global angle and global range of motion (ROM) of the cervical spine. The ASD was also evaluated. Results The JOA scores of the patients significantly improved postoperatively and were well maintained within the follow-up period, as did the JOA scale score improvement rate. The mean global angle of the cervical spine of the patients significantly increased postoperatively. At the last follow-up evaluation, the mean global ROM was retained by patients in the arthroplasty group (p > 0.05) but not by patients in the fusion group (p = 0.00). There was no significant difference in the incidence of ASD between the 2 groups (p = 0.114). However, at the skip levels, patients in the fusion group had a higher incidence of ASD than patients in the arthroplasty group (p = 0.038). Conclusions Both of the hybrid procedures (anterior cervical corpectomy and fusion [ACCF] + anterior cervical discectomy and fusion, and ACCF + cervical disc arthroplasty [CDA]) yielded favorable clinical and radiological outcomes in the treatment of noncontiguous 3-level cervical spondylosis. Moreover, the ACCF + CDA procedure may have the ability to decrease the likelihood of ASD in appropriate patients.

scholarly journals Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor

2007 ◽  
Vol 2 (1) ◽  
pp. 6 ◽  
Author(s):  
Wenbao Wang ◽  
Linghua Kong ◽  
Heyuan Zhao ◽  
Ronghua Dong ◽  
Jing Zhou ◽  
...  
Keyword(s):  
Ligamentum Flavum ◽  
Thoracic Myelopathy ◽  
Ossification Of Ligamentum Flavum

TREATMENT OF SPINAL TUMORS USING CYBERKNIFE FRACTIONATED STEREOTACTIC RADIOSURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 297-307 ◽  
Author(s):  
Gregory J. Gagnon ◽  
Nadim M. Nasr ◽  
Jay J. Liao ◽  
Inge Molzahn ◽  
David Marsh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Stereotactic Radiosurgery ◽  
University Hospital ◽  
Postoperative Treatment ◽  
Spinal Tumors ◽  
Radiation Toxicity ◽  
Pain Scores ◽  
Component Scores

Abstract OBJECTIVE Benign and malignant tumors of the spine significantly impair the function and quality of life of many patients. Standard treatment options, including conventional radiotherapy and surgery, are often limited by anatomic constraints and previous treatment. Image-guided stereotactic radiosurgery using the CyberKnife system (Accuray, Inc., Sunnyvale, CA) is a novel approach in the multidisciplinary management of spinal tumors. The aim of this study was to evaluate the effects of CyberKnife stereotactic radiosurgery on pain and quality-of-life outcomes of patients with spinal tumors. METHODS We conducted a prospective study of 200 patients with benign or malignant spinal tumors treated at Georgetown University Hospital between March 2002 and September 2006. Patients were treated by means of multisession stereotactic radiosurgery using the CyberKnife as initial treatment, postoperative treatment, or retreatment. Pain scores were assessed by the Visual Analog Scale, quality of life was assessed by the SF-12 survey, and neurological examinations were conducted after treatment. RESULTS Mean pain scores decreased significantly from 40.1 to 28.6 after treatment (P &lt; 0.001) and continued to decrease over the entire 4-year follow-up period (P &lt; 0.05). SF-12 Physical Component scores demonstrated no significant change throughout the follow-up period. Mental Component scores were significantly higher after treatment (P &lt; 0.01), representing a quality-of-life improvement. Early side effects of radiosurgery were mild and self-limited, and no late radiation toxicity was observed. CONCLUSION CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile.

scholarly journals Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Cuilan Li ◽  
Shiyan Tang ◽  
Xingcheng Gao ◽  
Wanping Lin ◽  
Dong Han ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Combined Treatment ◽  
Clinical Manifestations ◽  
Abnormal Uterine Bleeding ◽  
Lower Uterine Segment ◽  
Improvement Rate ◽  
Uterine Scar ◽  
Lost To Follow Up

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum.Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery.Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up.Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

scholarly journals Assessing post-radiotherapy handover notes from a family physician perspective

2018 ◽  
Vol 25 (1) ◽  
pp. 49
Author(s):  
A. Dang ◽  
S. Miller ◽  
D. Horvat ◽  
T. Klassen-Ross ◽  
M. Graveline ◽  
...  
Keyword(s):  
Side Effects ◽  
Family Physicians ◽  
Essential Information ◽  
Treatment Side Effects ◽  
Counselling Services ◽  
Contact Information ◽  
Score Improvement ◽  
Information Treatment ◽  
Treatment Intent

Background Across our province, post-radiotherapy (rt) handover notes are sent to family physicians (fps) after rt. Based on previous fp feedback, we created a revised post-radiotherapy handover note with more information requested by fps. The purpose of this study was to determine whether the revised handover note improved the note as a communication aid.Methods Potential common and rare treatment side effects, oncologist contact information, and treatment intent were added to the revised handover note. Both versions were sent alongside a questionnaire to fps. Paired t-tests were carried out to compare satisfaction differences.Results There was a response rate of 37% for the questionnaires. Significantly greater clarity in the following categories was observed: responsibility for patient follow-up (mean score improvement of 1.2 on a 7-point Likert scale, p < 0.001), follow-up schedule (1.1, p < 0.001) as well as how and when to contact the oncologist (1.4, p = 0.001). Family physicians were also more content with how the institute transitioned care back to them (1.5, p = 0.012). Overall, fps were generally satisfied with the content of the revised post-rt handover note and noted improvement over the previous version. The frequency of investigations and institute supports initiated such as counselling services were suggested further additions.Conclusions The inclusion of potential treatment side effects, oncologist contact information, treatment intent and a well-laid out follow-up schedule were essential information needed by fps for an effective post-rt completion note. With these additions, the revised post-rt handover note showed significant improvement.

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