scholarly journals Do Intraoperative Neurophysiological Changes During Decompressive Surgery for Cervical Myeloradiculopathy Affect Functional Outcome? A Prospective Study

2020 ◽  
pp. 219256822095177
Author(s):  
Keyur Kantilal Akbari ◽  
Vigneshwara Badikillaya ◽  
Muralidharan Venkatesan ◽  
Sajan K. Hegde
Keyword(s):  
Functional Outcome ◽  
Evoked Potential ◽  
Japanese Orthopaedic Association ◽  
Motor Evoked Potential ◽  
Functional Improvement ◽  
Cervical Compressive Myelopathy ◽  
Before And After ◽  
Group A ◽  
The Mean ◽  
Compressive Myelopathy

Study Design: Prospective cohort. Objective: To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy). Methods: Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. During surgery motor-evoked potential (MEP) and somatosensory evoked potential (SSEP) at baseline and before and after decompression were documented. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes.” Patients were divided into subgroups based on IONM changes: group A (those with positive changes) and group B (those with no change or deterioration). Nurick grade and modified Japanese Orthopaedic Association (mJOA) score were evaluated before and after surgery. Results: Nine patients (32.1%) showed improvement in MEP. The mean preoperative Nurick grade and mJOA score of group A and B were (2.55 ± 0.83 and 11.11 ± 1.65) and (2.47 ± 0.7 and 11.32 ± 1.24), respectively. The mean postoperative Nurick grade of groups A and B at 6 months was 1.55 ± 0.74 and 1.63 ± 0.46, respectively, and this difference was not significant. The mean postoperative mJOA score of groups A and B at 6 months was 14.3 ± 1.03 and 12.9 ± 0.98, respectively, and this difference was statistically significant ( P = .011). Spearman correlation coefficient showed significant positive correlation between the IONM change and the mJOA score at 6 months postoperatively ( r = 0.47; P = .01). Conclusion: Our study shows that impact of positive changes in MEP during IONM reflect in functional improvement at 6 months postoperatively in cervical compressive myelopathy patients.

scholarly journals Motor-Evoked Potential Confirmation of Functional Improvement by Transplanted Bone Marrow Mesenchymal Stem Cell in the Ischemic Rat Brain

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Dong-Kyu Jang ◽  
Sang-In Park ◽  
Young-Min Han ◽  
Kyung-Sool Jang ◽  
Moon-Seo Park ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Rat Brain ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Functional Improvement ◽  
Control Group ◽  
Motor Pathway ◽  
Bipolar Stimulation ◽  
Marrow Mesenchymal Stem Cells ◽  
Monopolar Stimulation

This study investigated the effect of bone marrow mesenchymal stem cells (BMSCs) on the motor pathway in the transient ischemic rat brain that were transplanted through the carotid artery, measuring motor-evoked potential (MEP) in the four limbs muscle and the atlantooccipital membrane, which was elicited after monopolar and bipolar transcortical stimulation. After monopolar stimulation, the latency of MEP was significantly prolonged, and the amplitude was less reduced in the BMSC group in comparison with the control group (). MEPs induced by bipolar stimulation in the left forelimb could be measured in 40% of the BMSC group and the I wave that was not detected in the control group was also detected in 40% of the BMSC group. Our preliminary results imply that BMSCs transplanted to the ischemic rat brain mediate effects on the functional recovery of the cerebral motor cortex and the motor pathway.

Surgical outcomes in adult patients with syringomyelia associated with Chiari malformation Type I: the relationship between scoliosis and neurological findings

2007 ◽  
Vol 6 (3) ◽  
pp. 216-221 ◽  
Author(s):  
Atsushi Ono ◽  
Futoshi Suetsuna ◽  
Kazumasa Ueyama ◽  
Toru Yokoyama ◽  
Shuichi Aburakawa ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Clinical Status ◽  
Japanese Orthopaedic Association ◽  
Foramen Magnum ◽  
Neurological Dysfunction ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Group A ◽  
The Mean ◽  
Group B

Object The clinical characteristics of pediatric scoliosis associated with syringomyelia have been reported in previous studies, but scoliosis associated with syringomyelia in adults is rarely treated, and there is a paucity of detailed studies. In the present study of adult syringomyelia associated with Chiari malformation Type I, the authors investigated the relationships among the syrinx, scoliosis, and neurological data. Methods The population was composed of 27 patients (≥ 20 years of age) who underwent foramen magnum decompression for the treatment of syringomyelia. The patients were divided into two groups: those with scoliosis of 10° or more (Group A) and those without scoliosis (Group B). The authors assessed the length of the syrinx, duration of morbidity, and clinical status before and after surgery based on the Japanese Orthopaedic Association (JOA) Scale. There were 15 cases in Group A and 12 in Group B. The mean length of the syrinx was 12.8 vertebral bodies (VBs) in Group A and 7.2 VBs in Group B. The mean duration of morbidity was 14.2 years in Group A and 6.8 years in Group B. The mean preoperative JOA score was 10.1 in Group A and 14.4 in Group B, whereas the mean postoperative JOA scores were 11.9 and 15.8, respectively. There were significant differences between Groups A and B in length of the syrinx, duration of morbidity, and pre- and postoperative JOA scores. Conclusions In patients with syringomyelia and scoliosis the syringes spanned a greater number of VBs, the duration of morbidity was greater, neurological dysfunction was more severe, and surgical results were poorer. Scoliosis could be a predicting factor of the prognosis in patients with syringomyelia and Chiari malformation Type I.

Clinical results of cervical myelopathy in patients older than 80 years of age: evaluation of spinal function with motor evoked potentials

2009 ◽  
Vol 11 (4) ◽  
pp. 421-426 ◽  
Author(s):  
Nobuhiro Tanaka ◽  
Kazuyoshi Nakanishi ◽  
Yoshinori Fujimoto ◽  
Hirofumi Sasaki ◽  
Naosuke Kamei ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Motor Evoked Potentials ◽  
Japanese Orthopaedic Association ◽  
Motor Evoked Potential ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Conduction Time ◽  
Average Recovery Rate ◽  
The Mean ◽  
Spinal Function

Object In this prospective analysis the authors describe the clinical results of surgical treatment in patients > 80 years of age in whom spinal function was evaluated with motor evoked potential (MEPs) monitoring. Methods The authors included 57 patients > 80 years of age who were suspected of having cervical myelopathy. The mean age of the patients was 83.0 years (range 80–90 years). The central motor conduction time (CMCT) was calculated from the latencies of the MEPs following transcranial magnetic stimulation and from M and F waves following peripheral nerve stimulation. Results Preoperative electrophysiological evaluation demonstrated significant elongation of CMCT or abnormalities in MEP waveforms in 37 patients (65%), and 35 patients of these underwent laminoplasty. In 30 patients cervical spondylotic myelopathy was diagnosed and 5 patients ossification of the posterior longitudinal ligament was diagnosed. The preoperative mean Japanese Orthopaedic Association Scale score was 8.6 (range 3–12.5) and the mean postoperative score was 12.6 (range 6–14.5) with an average recovery rate of 45% (range −21 to 100%). There were no major complications in any of the patients during the operative period and there were no cases of death resulting from operative intervention. Conclusions Sufficient clinical results are expected even in patients with myelopathy who are older than 80 years of age, provided the patients are correctly selected by electrophysiological evaluation with MEPs and CMCT.

Endoscopic partial laminectomy for cervical myelopathy

2005 ◽  
Vol 2 (2) ◽  
pp. 170-174 ◽  
Author(s):  
Shoji Yabuki ◽  
Shin-ichi Kikuchi
Keyword(s):  
Cervical Myelopathy ◽  
Symptomatic Improvement ◽  
Intraoperative Blood Loss ◽  
Content Type ◽  
Operative Duration ◽  
Cervical Compressive Myelopathy ◽  
Wound Pain ◽  
The Mean ◽  
Compressive Myelopathy ◽  
Fine Print

Object. The authors report the results of endoscopic partial laminectomy performed in 10 patients with degenerative cervical compressive myelopathy. Methods. Endoscopic partial laminectomy was performed safely in 10 patients with cervical myelopathy. All of the patients experienced symptomatic improvement with slight postoperative wound pain. The mean operative duration was 164 ± 35 minutes and the mean intraoperative blood loss was 45.5 ± 27 ml. Conclusions. Endoscopic partial laminectomy may be used as a minimally invasive alternative for the treatment of cervical compressive myelopathy.

scholarly journals Transcranial Electrical Motor Evoked Potential in Predicting Positive Functional Outcome of Patients after Decompressive Spine Surgery: Review on Challenges and Recommendations towards Objective Interpretation

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Mohd Redzuan Jamaludin ◽  
Khin Wee Lai ◽  
Joon Huang Chuah ◽  
Muhammad Afiq Zaki ◽  
Yan Chai Hum ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Functional Outcome ◽  
Evoked Potential ◽  
Motor Nerve ◽  
Motor Evoked Potential ◽  
Nerve Roots ◽  
Motor Pathway ◽  
Positive Functional ◽  
Prognostic Tool ◽  
Objective Interpretation

Spine surgeries impose risk to the spine’s surrounding anatomical and physiological structures especially the spinal cord and the nerve roots. Intraoperative neuromonitoring (IONM) is a technology developed to monitor the integrity of the spinal cord and the nerve roots via the surgery. Transcranial motor evoked potential (TcMEP) (one of the IONM modalities) is adopted to monitor the integrity of the motor pathway of the spinal cord and the motor nerve roots. Recent research suggested that the IONM is conducive as a prognostic tool towards the patient’s functional outcome. This paper summarizes the researches of IONM being adopted as a prognostic tool. In addition, this paper highlights the problems associated with the signal parameters as the improvement criteria in the previous researches. Lastly, we review the challenges of TcMEP to achieve a prognostic tool focusing on the factors that could interfere with the generation of a stable TcMEP response. The final section will discuss recommendations for IONM technology to achieve an objective prognostic tool.

scholarly journals Comparison of septoplasty with and without packing and splints.

2021 ◽  
Vol 28 (04) ◽  
pp. 459-463
Author(s):  
Amrat Kumar ◽  
Ashok Kumar ◽  
Shabir Mehar ◽  
Dileep Kumar ◽  
Muhammad Wasi Ullah Khan
Keyword(s):  
Comparative Study ◽  
Nasal Packing ◽  
Treatment Results ◽  
New Techniques ◽  
Before And After ◽  
Group A ◽  
Vas Scores ◽  
The Mean ◽  
Group B ◽  
Study Setting

Objective: During septoplasty, nasal packing is routinely used by surgeons for hemostasis and balancing the cartilage and bony skeleton of the nose. However, these new techniques are not totally mild and therefore new ways are adopted to check their efficiency and reason their value. The study was performed to compare the use of plastic intranasal splints with or without anterior nasal packing to determine the need of nasal packing after septoplasty. Study Design: Comparative Study. Setting: ISRA University Hyderabad. Period: March 2018 to April 2019. Material & Methods: A total of 50 patients presenting with nasal septum in this period were prospectively examined. For the purpose of comparative study, we divided the patients into two groups: Group A –Patients who underwent septoplasty with packing and Group-B –Patients who underwent septoplasty without packing. We recorded the pain felt using Visual analogue scale before and after the surgery and also noted the Mean Age gender wise and recorded treatment results for statistical analysis using SPSS Version-20. Results: In our data, a total fifty (50) patients comprising 28 Males (68%) and 22 Females (32%) were listed in the study. The mean± standard deviation VAS scores of Group-A was at 5.2 ±0.9 and Group-B is 2.9±0.61 showing less pain in Group B-without splints and packing. However the complication rate in patients without Splints and packing was only 18%. Conclusion: Thus we find septoplasty without nasal splints and packing is more effective and cause lesser bleeding and pain to patients.

scholarly journals BEVACIZUMAB FOR RETINAL VEIN OCCLUSION

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Andrea Radotma Silitonga ◽  
Sindy Boru Sembiring ◽  
Christina Josephina Bangun ◽  
Heri Purwoko
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Real Life ◽  
Intravitreal Bevacizumab ◽  
Functional Improvement ◽  
Vein Occlusion ◽  
Before And After ◽  
Treatment Naïve ◽  
The Mean

Introduction: Central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) caused sudden visual decrease that most often treatable. This paper aims to describe clinical characteristic and outcome using bevacizumab for macular edema caused by retinal vein occlusion in real-life practice. Methods: This retrospective study included 91 treatment-naïve eyes with macular edema due to CRVO (55 eyes) and BRVO (36 eyes), who were treated with intravitreal bevacizumab (IVB) in pro re nata (PRN) regimen. Best corrected visual acuity (BCVA) and central macular thickness (CMT) before and after treatment were evaluated. Result: The mean age of patients was 60.3 + 11.2 years for CRVO and 55.7 + 8.2 years for BRVO. The mean baseline BCVA in the CRVO group was 1.41 + 0.55 logMAR. There was statistically significant improvement in BCVA after intravitreal bevacizumab compared to baseline (p < 0.001) in CRVO and BRVO group. Twenty six (47.3%) eyes with CRVO had BCVA > 1.0 logMAR (Snellen 20/200) at the last follow-up. In the BRVO group, the mean baseline BCVA was 0.93 + 0.48 logMAR. At the end of the follow up, 19 eyes (52.8%) with BRVO had BCVA > 0.3 logMAR (Snellen 20/40). There was also statistically significant improvement in CMT between all time points and baseline (p < 0.001) in both groups. At the end of the follow up, 26 (47.3%) eyes with CRVO and 25 eyes (69.4%) in BRVO group presented resolution of macular edema (CMT < 300). Conclusion: Intravitreal bevacizumab resulted in significant anatomical and functional improvement in macular edema associated with CRVO and BRVO, although outcome in CRVO group was sub-optimal.

scholarly journals Comparing efficacy and safety of sodium valproate with propranolol in paediatric migraine prophylaxis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Varsha Gajbhiye ◽  
Lamture Yashwant R ◽  
Sadama Quazi
Keyword(s):  
Sodium Valproate ◽  
Migraine Prophylaxis ◽  
Efficacy And Safety ◽  
Before And After ◽  
Propranolol Group ◽  
Paediatric Age ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Brain

Migraine is a common disorder of the paediatric age group. Propranolol has been used in prophylaxis for migraine.  The use of Sodium valproate in the prophylaxis of migraine is not known. It is postulated that it increases the level of GABA in the brain that will decrease events related to migraine in the cortex. All parents of the patient were advised to keep diaries for noting time, date, severity and duration of headache during the study period, which was for a period of 6 wks. The decreased frequency of headache more than in Group A was 68% and propranolol group was 68.89%. In group A(sodium valproate), patients showed a reduction in headache duration and 52% in Group B. 20% of them headache free in Group A and 18% in Group B. Decrease in the severity of headache in Group A was 52% while 50% in Group B. The mean headache frequency before and after treatment was reduced from 8 to 2.5 attacks per month in group A and from 8.2 to 2.6 in group B. The t-value is 11 for group A. Sodium valproate is more effective and safer in migraine prophylaxis as compared with propranolol.

scholarly journals Anatomical and functional outcome after bilateral scrotal flap in penile reconstruction

2014 ◽  
Vol 8 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Pornthep Pungrasmi ◽  
Anon Chayasadom ◽  
Apichai Angspatt
Keyword(s):  
Foreign Body ◽  
Sexual Activity ◽  
Functional Outcome ◽  
Surgical Excision ◽  
Foreign Body Granuloma ◽  
Surgical Removal ◽  
Penile Skin ◽  
One Stage ◽  
Before And After ◽  
The Mean

Abstract Background: Injection of alloplastic material underneath the penile skin for penile augmentation causes many complications such as inflammation, infection, ulceration, and pain during sexual activity. One of the treatments for complications after these penile augmentation procedures is surgical excision of the foreign body granuloma followed by penile skin coverage with bilateral scrotal flaps. There are no prior prospective studies published about anatomical and functional outcomes. Objective: To study the anatomical and functional outcome of one-stage bilateral scrotal flap reconstruction in patients after surgical removal of paraffinoma from penile shafts. Methods: Patients who suffered from complications of penile foreign body granuloma were treated by surgical excision and reconstruction with bilateral scrotal flaps. The penile lengths and circumferences when flaccid and erect were recorded preoperatively and postoperatively. The patients were interviewed using questionnaires and satisfaction scored to determine their sexual experiences were recorded before and after surgery. Results: Thirteen patients were enrolled in this study. The mean follow-up time was 23.5 (11.5-40.5) weeks. The mean erectile length and the maximal circumference were 11.8 (9-15) cm, 14.5 (11.5-17) cm preoperatively, and 11.7 (10-14) cm, 11.8 (10-13) cm postoperatively. Satisfaction scores of sexual activity is 6.84 (0-9) preoperatively, and 8.38 (5-10) postoperatively. Conclusion: One-stage bilateral scrotal flap coverage is a good option for penile skin reconstruction. This technique can achieve satisfactory results both anatomically and functionally.

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