scholarly journals Revision Surgery for Symptomatic Adjacent Segment Disc Degeneration after Initial Anterior Cervical Fusion: Is ROI-C Better than Plate-Cage Construct?

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Junjie Niu ◽  
Dawei Song ◽  
Yijie Liu ◽  
Heng Wang ◽  
Cheng Huang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Disc Degeneration ◽  
Revision Surgery ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Initial Surgery ◽  
Cervical Surgery ◽  
Cage Group

The optimal revision surgical strategy for patients who develop symptomatic adjacent segment disc degeneration (ASD) is controversial. The risks of intraoperative complications, especially the incidence of dysphagia, were relatively high for revision surgeries. This study was aimed at comparing the efficacy of revision surgery using a traditional plate-cage construct and zero-profile anchored spacer (ROI-C) device in treating symptomatic ASD after initial anterior cervical discectomy and fusion (ACDF) surgery. Forty-two patients who developed symptomatic ASD were retrospectively analyzed and classified into two groups (plate-cage group and ROI-C group). The clinical and radiological results were compared. We further evaluated the complication of dysphagia and dysphagia-related risk factors in these patients. The JOA and NDI scores, C2-7 lordotic angle, and intervertebral space height were significantly improved after revision surgery in both groups. The operative time and intraoperative blood loss both significantly decreased in the ROI-C group. The incidence of postoperative dysphagia was much lower in the ROI-C group than in the plate-cage group (18.75% vs. 57.69%; P = 0.01 ). The presence of dysphagia after initial surgery ( P = 0.003 ) and revision surgery type ( P = 0.01 ) was significantly related to the presence of dysphagia after revision surgery. These results indicated that both the plate-cage construct and ROI-C are effective in treating symptomatic ASD. However, compared with the traditional plate-cage construct, ROI-C with less operative time, less blood loss, and lower incidence of dysphagia is more suitable. Furthermore, ROI-C should preferably be used for patients who present with dysphagia after initial cervical surgery. This study will provide clinical guidance for spinal surgeons to choose the zero-profile device in treating specific and complicated cases, which will significantly improve the therapeutic efficacy of symptomatic adjacent segment degeneration.

scholarly journals A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration

2021 ◽  
Author(s):  
Kun He ◽  
Chunke Dong ◽  
Hongyu Wei ◽  
Feng Yang ◽  
Haoning Ma ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Cortical Bone ◽  
Clinical Efficacy ◽  
Revision Surgery ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
3D Printed

Abstract Background: Revision surgery of adjacent segment degeneration (ASD) commonly need to expose and remove the original fixation. In order to minimize the trauma, reduce the operation time and blood loss, we introduce a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional(3D) printed navigation templates.Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All the operation data, including operation time, blood loss, incision length were recorded. We evaluated the clinical efficacy using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and Computed Tomography (CT) scans were used to evaluate the stability of CBT screws fixation, the accuracy of screws, and the fusion rate.Results: The mean follow-up was 22.4±4.7 months (12-31m), the VAS, ODI, and JOA score were analyzed by SPSS 21.0 and showed significant improvement at 2-weeks and the last follow-up compared with preoperative data(P<0.05). 76 CBT screws were inserted with navigation templates, 2 screws were Grade B, other screws were all Grade 0 or A. Changes of intervertebral height showed good stability of CBT screws fixation(P>0.05). All the patients had satisfactory fusion results.Conclusion: Revision surgery of ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with advantages of the short operation time, small incision, and less blood loss.

The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

2021 ◽  
pp. 155335062098822
Author(s):  
Eirini Giovannopoulou ◽  
Anastasia Prodromidou ◽  
Nikolaos Blontzos ◽  
Christos Iavazzo
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Complication Rate ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Single Site ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Robotic Myomectomy ◽  
The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

Endoscopy-assisted wide-vertex craniectomy, “barrel-stave” osteotomies, and postoperative helmet molding therapy in the early management of sagittal suture craniosynostosis

2000 ◽  
Vol 9 (3) ◽  
pp. 1-6 ◽  
Author(s):  
David F. Jimenez ◽  
Constance M. Barone
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Sagittal Suture ◽  
Reconstructive Procedures ◽  
Early Management ◽  
Custom Made ◽  
The Mean

Object The purpose of this study was to assess the efficacy, safety, associated complications, and outcome in patients with sagittal suture craniosynostosis in whom endoscopy-assisted wide-vertex craniotomy and “barrel-stave” osteotomy were performed. Methods During a 4-year period, 59 patients with sagittal suture synostosis underwent endoscopy-assisted wide-vertex craniectomies, barrel stave–like osteotomies, and postoperatively were fitted with custom-made molding helmets. Data on operative time, blood loss, transfusion rates, hospital length of stay, complications, and hospital charges were collected prospectively. The mean patient age at the time of surgery was 3.7 months. The average blood loss was 31.8 ml; and only one patient required an intraoperative blood transfusion. Nine patients received transfusions of donor blood postoperatively. The mean operative time was 50 minutes, and all but three patients were discharged from the hospital the morning following surgery. There were no intraoperative complications. Normocephaly as well as normal cephalic indices were observed at latest follow up. Conclusions The authors conclude that early treatment of infants with sagittal suture craniosynostosis by using minimally invasive, endoscopy-assisted wide-vertex craniectomies provides excellent results and a significantly lower morbidity rate than traditional calvarial vault reconstructive procedures.

Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients

2006 ◽  
Vol 4 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Shinya Okuda ◽  
Akira Miyauchi ◽  
Takenori Oda ◽  
Takamitsu Haku ◽  
Tomio Yamamoto ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Complications ◽  
Interbody Fusion ◽  
Intraoperative Complications ◽  
Posterior Lumbar Interbody Fusion ◽  
Clinical Results ◽  
Neurological Complications ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion

Object Previous studies of surgical complications associated with posterior lumbar interbody fusion (PLIF) are of limited value due to intrastudy variation in instrumentation and fusion techniques. The purpose of the present study was to examine rates of intraoperative and postoperative complications of PLIF using a large number of cases with uniform instrumentation and a uniform fusion technique. Methods The authors reviewed the hospital records of 251 patients who underwent PLIF for degenerative lumbar disorders between 1996 and 2002 and who could be followed for at least 2 years. Intraoperative, early postoperative, and late postoperative complications were investigated. Intraoperative complications occurred in 26 patients: dural tearing in 19 patients and pedicle screw malposition in seven patients. Intraoperative complications did not affect the postoperative clinical results. Early postoperative complications occurred in 19 patients: brain infarction occurred in one, infection in one, and neurological complications in 17. Of the 17 patients with neurological complications, nine showed severe motor loss such as foot drop; the remaining eight patients showed slight motor loss or radicular pain alone, and their symptoms improved within 6 weeks. Late postoperative complications occurred in 17 patients: hardware failure in three, nonunion in three, and adjacent-segment degeneration in 11. Postoperative progression of symptomatic adjacentsegment degeneration was defined as a condition that required additional surgery to treat neurological deterioration. Conclusions The most serious complications of PLIF were postoperative severe neurological deficits and adjacent-segment degeneration. Prevention and management of such complications are necessary to attain good long-term clinical results.

scholarly journals Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

2020 ◽  
pp. 1-6
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Jeremy M. V. Guinn ◽  
Joshua Rivera ◽  
Sigurd H. Berven ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Demographic Data ◽  
Degenerative Spondylolisthesis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Fat Infiltration ◽  
Single Level ◽  
Goutallier Classification ◽  
Spinopelvic Parameter

OBJECTIVEThe aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.METHODSA total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.RESULTSA total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).CONCLUSIONSFat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

scholarly journals Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

2022 ◽  
Vol 13 (1) ◽  
pp. 123-128
Author(s):  
Pranita Somani ◽  
Priyanka Singh ◽  
Mangala Shinde
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Vaginal Discharge ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Vaginal Route ◽  
Background Removal ◽  
Operative Complications ◽  
Post Operative Complications

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

scholarly journals Impact of patient-specific factors and spinopelvic alignment on the development of adjacent segment degeneration after short-segment lumbar fusion

2021 ◽  
Author(s):  
László Kiss ◽  
Zsolt Szövérfi ◽  
Ferenc Bereczki ◽  
Péter Endre Éltes ◽  
Balázs Szöllösi ◽  
...  
Keyword(s):  
Disc Degeneration ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Patient Specific ◽  
Adjacent Segment ◽  
Short Segment ◽  
Adjacent Disc ◽  
Disc Bulge ◽  
Specific Factors

Abstract Objectives: The main purpose of the study was to analyse the different demographical, morphological, and surgery-related parameters influencing the development or progress of degeneration in adjacent segments after routine, short-segment lumbar fusions.Summary of Background data: Adjacent segment degeneration (ASD) considered as a major long-term complication after lumbar fusions. Possible risk factors are related to the patients’ demographics, spinopelvic anatomy or preoperative lumbar intervertebral disc conditions. The current literature lacks of well-designed prospective studies focusing on the multidimensional nature of the condition.Methods: A prospective cohort of 100 patients who underwent one- or two-level lumbar transforaminal interbody fusions due to lumbar degenerative pathology was conducted. Demographical, radiological findings (spinopelvic parameters, adjacent segmental radiological as well as magnetic resonance imaging (MRI) features) and long-term outcome data (5-year) were analysed to identify factors associated with ASD. Results: ASD patients showed higher level of pain (p=0.004) and disability (p=0.020) at follow-up. In univariate analysis, older age, upper-level lumbar fusion (p=0.007), lower L4-S1 lordosis (p=0.039), PI-LL mismatch (p=0.021), Pfirrmann grade III or higher disc degeneration (p=0.002) and the presence of disc bulge/herniation were (p=0.007) associated with ASD. Final result of multivariate analysis showed major degenerative sign (disc degeneration and/or disc bulge) as a risk factor (OR 3.85, CI 1.43-10.37, p=0.006).Conclusion: By examining the role of different patient- and procedure-specific factors, we found that preoperative major degenerative signs at the adjacent segment increase the risk of ASD causing significantly worse outcome after short-segment lumbar fusion. Adjacent disc conditions should be considered carefully during surgical planning.

Efficacy of Routine Intraoperative Cranio-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves Measuring Between 50° and 90°

2021 ◽  
pp. 219256822110529
Author(s):  
Jacob R. Carl ◽  
Gurpal Pannu ◽  
Evan Cherng-Yeh Chua ◽  
Adam Bacon ◽  
Blythe Durbin-Johnson ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Revision Surgery ◽  
Operative Time ◽  
Curve Correction ◽  
Major Curve ◽  
Estimated Blood Loss ◽  
Retrospective Comparative Study

Study Design Retrospective Comparative Study, Level III. Objective In patients with scoliosis >90°, cranio-femoral traction (CFT) has been shown to obtain comparable curve correction with decreased operative time and blood loss. Routine intraoperative CFT use in the treatment of AIS <90° has not been established definitively. This study investigates the effectiveness of intraoperative CFT in the treatment of AIS between 50° and 90°, comparing the magnitude of curve correction, blood loss, operative time, and traction-related complications with and without CFT. Methods 73 patients with curves less than 90° were identified, 36 without and 37 with cranio-femoral traction. Neuromuscular scoliosis and revision surgery were excluded. Age, preoperative Cobb angles, bending angles, and curve types were recorded. Surgical characteristics were analyzed including number of levels fused, estimated blood loss, operative time, major curve correction (%), and degree of postoperative kyphosis. Results Patients with traction had significantly higher preoperative major curves but no difference in age or flexibility. Lenke 1 curves had significantly shorter operative time and improvement in curve correction with traction. Among subjects with 5 to 8 levels fused, subjects with traction had significantly less EBL. Operative time was significantly shorter for subjects with 5-8 levels and 9-11 levels fused. Curves measuring 50°-75° showed improved correction with traction. Conclusion Intraoperative traction resulted in shorter intraoperative time and greater correction of major curves during surgical treatment of adolescent idiopathic scoliosis less than 90°. Strong considerations should be given to use of intraoperative CFT for moderate AIS.

scholarly journals Body Mass Index and Its Role in Total Laparoscopic Hysterectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shilpa Bhandari ◽  
Pallavi Agrawal ◽  
Aparna Singh
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Body Mass ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Perioperative Outcomes ◽  
Obese Patients ◽  
Duration Of Surgery

Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m2) and nonobese (BMI < 30 Kg/m2). Duration of surgery, intraoperative blood loss, successful laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m2. Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI < 30 kg/m2. The operative time was increased as the BMI of patient increased. Conclusions. Total laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.

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