scholarly journals Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0021
Author(s):  
Mauricio Drummond ◽  
Caroline Ayinon ◽  
Albert Lin ◽  
Robin Dunn
Keyword(s):  
Physical Therapy ◽  
Rotator Cuff ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Corticosteroid Injection ◽  
Calcific Tendinitis ◽  
Ultrasound Guided ◽  
Calcium Deposits

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

scholarly journals Calcification of the Anterior Acromial Insertion of the Deltoid Muscle

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Kiminori Yukata ◽  
Ashish Suthar ◽  
Yutaka Suetomi ◽  
Kazuhiro Yamazaki ◽  
Kazuteru Doi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Conservative Management ◽  
Insertion Site ◽  
Deltoid Muscle ◽  
Calcific Tendinitis ◽  
Plain Radiography ◽  
Left Shoulder ◽  
Relieve Pain ◽  
Calcium Deposits

A 45-year-old man presented with severe left shoulder pain that was not associated with trauma. Plain radiography with the arm in an elevated position and ultrasonography demonstrated calcium deposits at the anterior acromial insertion site of left deltoid muscle. Conservative management could successfully relieve pain. At the 3-year follow-up, the calcification completely disappeared. To the best of our knowledge, calcium deposits at the acromial insertion site of the deltoid have not been reported in the literature. Clinicians who suspect calcific tendinitis but do not observe calcification around the rotator cuff should carefully palpate and examine other sites, such as the deltoid origin, and use ultrasonography or radiography.

scholarly journals Predictive factor for failure of conservative management in the treatment of calcific tendinitis of the shoulder

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Caroline Ayinon ◽  
Mark Rodosky ◽  
Dharmesh Vyas ◽  
Bryson Lesniak ◽  
Albert Lin ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Rotator Cuff Repair ◽  
Corticosteroid Injection ◽  
Calcific Tendinitis ◽  
Line Treatment ◽  
First Line ◽  
Cuff Repair ◽  
First Line Treatment

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) and accounts for up to 7% of all presentations of shoulder pain. Conservative treatment with physical therapy (PT) and corticosteroid injection is often the first line treatment. When conservative management fails, arthroscopic surgery for removal of the calcium may be considered. Surgical removal is often followed by rotator cuff repair to address the resulting tendon defect. This study was performed to assess predictive factors for failure of conservative management as well as to characterize the rate of rotator cuff repair in the setting of calcific tendinitis. We hypothesize that larger calcific lesion would have a higher likelihood to fail conservative treatment and the majority of patients requiring surgery will require a concomitant rotator cuff repair. Methods: A retrospective review of patients who were diagnosed with calcific tendinitis at our institution between 2009 and 2019 was performed. Demographics, comorbidities, pain score (VAS), ASES, ROM and patient-reported quality of life measures were recorded and analyzed. All patients underwent a radiograph and MRI. Size of the calcific lesion was measured based on its largest diameter on radiograph. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. p<0.05 was considered to be statistically significant. Results: 239 patients were identified in the study period; 127 (53.1%) were female. Mean age was 54 years and BMI 29.2 with mean follow up of 6 months. Preoperative pain score was 6.3 and ASES score was 47.9. 160 had an intact RTC (67.2%) and 78 had a partial RTC tear (32.8%). The calcific lesion was located in the supraspinatus in 148 patients (63.8%), infraspinatus in 32 patients (13.8%), subscapularis in 9 patients (3.9%), teres minor in 1 patient (0.4%) and combined tendons in 42 patients (18.1%). 93/239 (38.9%) patients failed conservative treatment after an average of 4.4 months necessitating surgical management. Failure rate for PT was 36.6% (24/71), for subacromial corticosteroid injection was 31.6% (25/79) and 33.8% (24/71) for ultrasound guided aspiration. Among patients who underwent surgery the majority of patients, 77/93 (82.8%) required a concomitant rotator cuff repair. Sub-analysis demonstrates that calcific lesions > 1 cm was significantly associated with failure of conservative treatment (odds ratio=2.81, 95% CI 1.25-6.29, p<0.05). All patients who underwent surgery demonstrated significant improvements in pain scores (6.3 to 2.3 VAS), ASES (47.9 to 90.49), forward flexion (133° to 146.8°) and external rotation (49.2° to 57.6°) (p<0.05) postoperatively. Conclusions: Patients with calcific lesions >1 cm have a 2.8x-increased likelihood of failing conservative treatment in the setting of calcific tendinitis of the shoulder. The majority of patients who undergo surgical management for removal of the calcific deposit will require a concomitant rotator cuff repair and have significant improvements in shoulder pain and function. While conservative management is often considered a first-line treatment, the size of the lesion may play a significant role regarding whether conservative treatment will be successful, and patients should be counseled accordingly. Once surgery is decided, orthopedic surgeons should also be aware of the high likelihood of concomitant rotator cuff repair for preoperative planning and discussion.

scholarly journals Acute Symptoms on Rotator Cuff Calcific Tendinitis is Effectively Relieved by Ultrasound Guided Percutaneous Needle Lavage Procedure: a Case Report

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0048
Author(s):  
Tommy Mandagi ◽  
Nyoman Aditya Sindunata ◽  
Prettysia Suvarly ◽  
John Butarbutar
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Acute Pain ◽  
Corticosteroid Injection ◽  
Calcific Tendinitis ◽  
Left Shoulder ◽  
Ultrasound Guided ◽  
Good Outcome ◽  
Limited Range Of Motion ◽  
Infraspinatus Tendon

Introduction: Rotator cuff calcific tendinitis (RCCT) frequently manifests as acute shoulder pain during the acute resorptive phase. Pain typically worse at night and limited range of motion (ROM) with muscle spasm. Several treatment options have been proposed. In this case, a single needle ultrasound-guided percutaneous lavage (UGPL) combined with corticosteroid subdeltoid bursa injection (SDBI) with a good outcome. Case Presentation: A Female, 59 years old, presents with left RCCT acute pain (VAS 7/10) for 2 days and limited painful shoulder ROM. Inflammation and local tenderness found on the left shoulder, ultrasonography shows calcification in the left infraspinatus tendon with sub-deltoid bursa fluid. Patient in sitting position, ultrasound probe placed at long axis of infraspinatus tendon. Using a 23G needle 5 ml syringe, 1% lidocaine infiltrated until the needle penetrates the calcification site. Then a small amount of normal saline (NaCl) with lidocaine injected in a pulsating manner, observed until chalky matter backflows, mixed with NaCl in the syringe. Repeat this procedure until chalky backflow is minimal. Finally, 10 ml of Triamcinolone Acetonide 40 mg mixed with 2 ml lidocaine 2% SDBI using the same needle. Dramatic shoulder pain relieve (VAS 2/10) is immediately achieved after the procedure. One week follow up, the patient is pain-free and regains full ROM of her left shoulder. Discussion: Several methods are proposed for the treatment of acute RCCT, including corticosteroid injection and arthroscopy debridement. UPGL is an attractive option because it is minimally invasive, can be performed in-office setting, and pain relief is obtained immediately by decompressing and removing inflamed calcified sites. Conclusion: The treatment in acute pain RCCT using UGPL combined with corticosteroid SDBI provides a good outcome.

scholarly journals A COMPARATIVE STUDY OF CONSERVATIVE MANAGEMENT VERSUS ULTRASOUND GUIDED ASPIRATION OF SMALL AMOEBIC LIVER ABSCESS

2020 ◽  
Vol 7 (2) ◽  
pp. 165-171
Author(s):  
Osman Musa ◽  
Mohd Faizan Khan ◽  
Bichitra Nath Shukla ◽  
Nisar Ahmed Ansari ◽  
Brijesh Rathore
Keyword(s):  
Liver Abscess ◽  
Conservative Management ◽  
Medical Management ◽  
Surgical Intervention ◽  
Amoebic Liver Abscess ◽  
Ultrasound Guided ◽  
Chief Complaints ◽  
Right Lobe ◽  
The Right

To compare the outcome of patients undergoing conservative management versus ultrasound guided aspiration of small amoebic liver abscess (=<200ml). This observational prospective study was conducted on 60 patients, aged between 18 to 80 years,After confirming the diagnosis, patients were exposed to medical management or USG guided Aspiration. Patients coming for regular follow-up after completing treatment were included in the study. It was found that the majority of the patients were male (86.7%) and with mean age of the studied patients was 37.10±12.66 years. Chief complaints were pain (100%) followed by fever (85.0%) and Nausea/Vomiting (48.3%) pallor (33.3%), icterus (25.0%) and Tenderness (16.7%). Majority of patients had the right lobe of the liver affected (93.4 %) with Single abscess (94.0%). Duration of Hospital stay and time of half reduction in size was significantly higher in conservative management than the USG guided Aspiration. Reoccurrence of abscess in conservative management was in 6 (20.0%) and need of Surgical intervention was in 4 (13.3%) patients while in USG guided Aspiration group only 1 (3.3%) patient shows Reoccurrence. No mortality was observed in our study. In the present study abscess containing volume of pus (<200 cc) was treated with either conservative treatment or USG guidedAspiration. Our data suggested that the USG guided Aspiration and conservative medical management in treatment ofAmoebic liver abscess are almost equal.

scholarly journals Study of impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB

2018 ◽  
Vol 4 (2) ◽  
pp. 448
Author(s):  
Arshed Ali ◽  
Jasif Nisar ◽  
Ihsan Ali ◽  
Rauf Ahmad
Keyword(s):  
Quality Of Life ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Diagnostic Methods ◽  
Before And After ◽  
The Impact

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">SDB is an important cause of morbidity in children. SDB has been associated with decreased quality of life (QOL). In this study, we tried to determine The impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A total of 112 pediatric patients were included with SDB, who visited our OPD. Diagnostic methods include history and physical examination, audiotaping or videotaping, pulse oximetry. OSA 18 questionnaire was used to assess the quality of life with conservative treatment (pre and post-treatment) and after surgical intervention-before and after adenoidectomy or adenotonsillectomy.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">We had 112 patients with majority being males 69 (61.60%) and females 43 (38.30%), majority of patients were in the age group of 5-7 yrs (49.10%). In 47 patients (who underwent adenotonsillectomy/tonsillectomy), OSA-18 questionnaire was used pre-operatively, at 2 and 6 months. OSA-18 when used pre-operatively showed majority of patients 33 (70.21%) having score &gt;80, and 14 (29.79%) patients having score between 60-80. No patient was below 60 score. Mean OSA-18 score pre-operatively was 84.15. OSA-18 score at 2 months and at 6 months were 30.06 and 26.40 respectively, which showed a lot of improvement in post-operative score and hence the post –operative quality of life. In 65 patients (conservative treatment) OSA-18 was used pre-conservative, at 2 and 6 months of treatment. OSA-18 when used before conservative treatment<strong> </strong>showed majority of patients 44 (67.6 9%) having score 60-80, and 21 (32.30%) patients having score between &gt;80. No patient was below 60 score. OSA-18 score at 2 months showed improvement in 69.23% patients (&lt;40), OSA-18 at 6 months showed recurrence in 12.33% patients. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">SDB substantially impact QOL in pediatric patients. QOL significantly improves following adenotonsillectomy. There is subset of patients 12.33% with SDB in whom there was recurrence of symptoms after conservative treatment. Thus showing that conservative management is inferior to surgical management in the treatment of SDB. SDB improved after an observation period. Thus, observation with close follow-up is another treatment option.</span></p><p> </p>

scholarly journals AB0642 SACROILIAC JOINT INJECTIONS PERFORMED WITH ULTRASOUND GUIDANCE IN PATIENTS WITH SACROILIITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1615.2-1616
Author(s):  
A. R. Cunha ◽  
C. Mazeda ◽  
R. Aguiar ◽  
A. Barcelos
Keyword(s):  
Sacroiliac Joint ◽  
Ultrasound Guidance ◽  
Disease Duration ◽  
Corticosteroid Injection ◽  
Controlled Study ◽  
Ultrasound Guided ◽  
Sonographic Guidance ◽  
Number Of Patients ◽  
Joint Injections

Background:Sacroiliitis is the hallmark of axial Spondyloarthritis (axSpA). ASAS-EULAR management recommendations for axSpA, consider glucocorticoid injections directed to the local site of musculoskeletal inflammation as a treatment option for pain relief, besides treatment with oral non-steroidal anti-inflammatory (NSAIDs) before starter biotechnological treatment. However, there are few studies to evaluate efficacy of this technique with a small number of patients and a short follow-up. Ultrasonography has been used as a valuable option to guide this technique.Objectives:To evaluate the efficacy and safety of ultrasound-guided injections of sacroiliac joints (SIJs) in patients with sacroiliitis using clinical and laboratory outcomes at baseline and at 4-6thweeks.Methods:This study involved patients with axSpA with acute sacroiliitis, ≥18 and ≤ 65 years old, with body mass index (BMI) < 30kg/m2attending the Rheumatology Outpatient Clinic, which had been poorly controlled (ASDAS>2.1) by conventional therapy (physiotherapy, NSAIDs at maximum tolerated dosing during ≥ 4 weeks). Sociodemographic, clinical (disease duration, BMI, BASDAI, BASFI, ASDAS) and laboratory (CRP) data was collected from the medical records at baseline and at 4-6thweeks.Statistical analyses were conducted using SPSS version 25. Continuous variables were described with mean/median ± standard deviation (SD).SIJs injection was performed, under ultrasound guidance, using standard procedures with 2mL of lidocaine 1% and 40mg of methylprednisolone, with a 22-gauge needle. The procedure was performed by the same operator. Written informed consents were obtained from all patients.Results:We performed eleven sacroiliac injection in eleven consecutive patients (one procedure per patient). Nine patients (81.8%) were female, mean age (±SD) of 40.6(±9.4) years, median disease duration(±SD) of 0.9(±6.2) years and median BMI(±SD) of 24.2(±3.3). Eight patients (72.7%) had Nr-axSpA. All patients were non-responders to NSAIDs.At 4-6thweeks there was a decreased in median (±SD) BASDAI (5.4±1.9 vs 4.1±1.9), BASFI (4.2±1.4 vs 3.5±2.3) and ASDAS (3.2±0.8 vs 2.2±0.6) indexes.Conclusion:As previous studies demonstrated, this technique seems to be safe and quite effective.Our goal is to increase the number of patients undergoing this technique and have a longer follow up to evaluate its efficacy. The study has several limitations: the mid- and long-term effects should be evaluated in the future based on the results of the short-term effects and the study was not conducted as a double-blinded, controlled study.References:[1]van der Heijde D, Burgos-Vargas R, Ramiro S.,et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2017; 76:978–991[2]Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum 1992; 35:564–8.[3]Pekkafahli MZ, Kiralp MZ, Basekim CC et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003;22:553–9[4]Klauser A, De Zordo T, Feuchtner G et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008; 59:1618–1624.Disclosure of Interests:Ana Rita Cunha: None declared, Carolina Mazeda: None declared, Renata Aguiar: None declared, Anabela Barcelos Speakers bureau: Bene, Eli-Lilly, Pfizer, MSD, Novartis

scholarly journals Haglund’s disease: surgical outcome of calcaneal osteotomy

2017 ◽  
Vol 3 (2) ◽  
pp. 278 ◽  
Author(s):  
Veerabhadra Javali ◽  
Virupaksha N. Reddy
Keyword(s):  
Conservative Treatment ◽  
Surgical Outcome ◽  
Surgical Intervention ◽  
Lateral Approach ◽  
Lateral View ◽  
Aofas Score ◽  
Postoperative Score ◽  
Calcaneal Osteotomy ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.<strong></strong></p><p class="abstract"><strong>Results:</strong> 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. <span>The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. </span>Three minor complications were noted<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease<span lang="EN-IN">.</span></p>

A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas

2021 ◽  
pp. 1-6
Author(s):  
Joshua S. Catapano ◽  
Andrew F. Ducruet ◽  
Candice L. Nguyen ◽  
Tyler S. Cole ◽  
Jacob F. Baranoski ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Conservative Management ◽  
Conventional Therapy ◽  
Surgical Intervention ◽  
Middle Meningeal Artery ◽  
Adjusted Analysis ◽  
Subdural Hematomas ◽  
Tertiary Center ◽  
Meningeal Artery

OBJECTIVEMiddle meningeal artery (MMA) embolization is a promising treatment strategy for chronic subdural hematomas (cSDHs). However, studies comparing MMA embolization and conventional therapy (surgical intervention and conservative management) are limited. The authors aimed to compare MMA embolization versus conventional therapy for cSDHs using a propensity-adjusted analysis.METHODSA retrospective study of all patients with cSDH who presented to a large tertiary center over a 2-year period was performed. MMA embolization was compared with surgical intervention and conservative management. Neurological outcome was assessed using the modified Rankin Scale (mRS). A propensity-adjusted analysis compared MMA embolization versus surgery and conservative management for all individual cSDHs. Primary outcomes included change in hematoma diameter, treatment failure, and complete resolution at last follow-up.RESULTSA total of 231 patients with cSDH met the inclusion criteria. Of these, 35 (15%) were treated using MMA embolization, and 196 (85%) were treated with conventional treatment. On the latest follow-up, there were no statistically significant differences between groups in the percentage of patients with worsening mRS scores. Of the 323 total cSDHs found in 231 patients, 41 (13%) were treated with MMA embolization, 159 (49%) were treated conservatively, and 123 (38%) were treated with surgical evacuation. After propensity adjustment, both surgery (OR 12, 95% CI 1.5–90; p = 0.02) and conservative therapy (OR 13, 95% CI 1.7–99; p = 0.01) were predictors of treatment failure and incomplete resolution on follow-up imaging (OR 6.1, 95% CI 2.8–13; p < 0.001 and OR 5.4, 95% CI 2.5–12; p < 0.001, respectively) when compared with MMA embolization. Additionally, MMA embolization was associated with a significant decrease in cSDH diameter on follow-up relative to conservative management (mean −8.3 mm, 95% CI −10.4 to −6.3 mm, p < 0.001).CONCLUSIONSThis propensity-adjusted analysis suggests that MMA embolization for cSDH is associated with a greater extent of hematoma volume reduction with fewer treatment failures than conventional therapy.

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