SURGICAL RESULTS OF THE OBLIQUE PARASPINAL APPROACH IN UPPER LUMBAR DISC HERNIATION AND THORACOLUMBAR JUNCTION

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Jin-Sung Kim ◽  
Sang-Ho Lee ◽  
Ki-Hyoung Moon ◽  
Ho-Yeon Lee
Keyword(s):  
Visual Analogue Scale ◽  
Oswestry Disability Index ◽  
Analogue Scale ◽  
Leg Pain ◽  
Thoracolumbar Junction ◽  
Spinal Instability ◽  
X Rays ◽  
Paraspinal Approach ◽  
Disc Herniations

ABSTRACT OBJECTIVE This study was conducted to investigate the efficacy of treating central or paramedian disc herniations of the upper lumbar levels, including the thoracolumbar junction, through the oblique paraspinal approach. We published a technical case report on this subject in 2004. METHODS Nineteen consecutive patients with intracanalicular disc herniations of the upper lumbar levels underwent the oblique paraspinal approach, which utilizes an operating microscope, from March 2005 through January 2008. Their clinical and radiological data were collected and analyzed. The patients were assessed with standard examinations preoperatively and evaluated with dynamic lumbar x-rays, 3-dimensional computed tomographic scans, magnetic resonance imaging, standard pain and disability measurements, a visual analogue scale, the Oswestry disability index, and a patient satisfaction rate that checked their pain scores postoperatively. RESULTS The average follow-up period was 28.1 months, with a maximum of 48 months. The visual analogue scale for back and leg pain and the Oswestry disability index, which recorded a preoperative mean of 6.7%, 7.2%, and 64.7% and a postoperative mean of 3.2%, 3.0%, and 21.47%, respectively, showed statistically significant improvement at the time of the last follow-up evaluation, compared with preoperative scores. There have been neither recurrent disc herniations nor spinal instability during the follow-up period. CONCLUSION In this study, 19 cases of intracanalicular disc herniations at the upper lumbar levels, including the thoracolumbar junction, were successfully excised with the oblique paraspinal approach without recurrence or instability. We found that the oblique paraspinal approach, which resulted in satisfactory clinical outcomes with few complications, could be one of the main surgical procedures used to treat intracanalicular disc herniations at the upper lumbar levels.

A Comparative Analysis of the Results of Vertebroplasty and Kyphoplasty in Osteoporotic Vertebral Compression Fractures

2010 ◽  
Vol 67 (3) ◽  
pp. ons171-ons188 ◽  
Author(s):  
Krishna Kumar ◽  
Rita Nguyen ◽  
Sharon Bishop
Keyword(s):  
Visual Analogue Scale ◽  
Health Survey ◽  
Oswestry Disability Index ◽  
Analogue Scale ◽  
Short Form ◽  
Vertebral Compression Fractures ◽  
Short Form 36 ◽  
Scale Scores ◽  
Euroqol 5D

Abstract BACKGROUND: The most common complication of osteoporosis is vertebral fractures, which occur more frequently than all other fractures (hip, wrist, and ankle). OBJECTIVE: To prospectively analyze vertebroplasty compared with kyphoplasty for the treatment of osteoporotic vertebral compression fractures using improvement in pain, functional capacity, and quality of life as outcome measures. METHODS: The study population included 28 patients in the vertebroplasty group and 24 patients in the kyphoplasty group. The mean follow-up period was 42.2 weeks and 42.3 weeks in the vertebroplasty and kyphoplasty groups, respectively. Outcomes were measured pre- and postoperatively using the visual analogue scale, the Oswestry Disability Index, the EuroQol-5D questionnaire, and the Short-Form 36 Health Survey. RESULTS: In the vertebroplasty group, visual analogue scale scores improved from a mean of 8.0 cm to 5.5 cm at last follow-up (P = .001). Preoperatively, the Oswestry Disability Index was 57.6, which improved to 38.4 (P = .006). The EuroQol-5D score preoperatively was 0.157 and improved to 0.504 (P = .001). The Short-Form 36 Health Survey showed greatest improvement in the areas of physical health, role physical, body pain, and vitality. In the kyphoplasty group, visual analogue scale scores improved from a mean of 7.5 cm preoperatively to 2.5 cm postoperatively (P = .000001). The mean Oswestry Disability Index preoperatively was 50.7 and improved to 28.8 (P = .002). The EuroQol-5D score improved from a mean of 0.234 preoperatively to 0.749 (P = .00004). The Short-Form 36 Health Survey showed greatest improvement in the areas of physical health, physical functioning, role physical, body pain, and social functioning. CONCLUSION: Both vertebroplasty and kyphoplasty are effective at improving pain, functional disability, and quality of life; however, kyphoplasty provides better results, which are maintained over long-term follow-up.

An Oblique Paraspinal Approach for Intracanalicular Disc Herniations of the Upper Lumbar Spine: Technical Case Report

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-E487-ONS-E488 ◽  
Author(s):  
Ki-Hyoung Moon ◽  
Sang-Ho Lee ◽  
Byoung Joon Kong ◽  
Song-Woo Shin ◽  
Arun Bhanot ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Clinical Presentation ◽  
Facet Joint ◽  
Leg Pain ◽  
Herniated Disc ◽  
Motor Weakness ◽  
Paraspinal Approach ◽  
Disc Herniations ◽  
Surgical Field

Abstract OBJECTIVE: To present our experience of treating the central or paramedian disc herniations of the upper lumbar levels through a paraspinal approach. CLINICAL PRESENTATION: We present four patients with intracanalicular disc herniations at the L1–L2 or L2–L3 level. All patients had unilateral or bilateral radicular leg pain and motor weakness. TECHNIQUE: Considering the unique characteristics of the upper lumbar spine, we performed the oblique paraspinal approach to expose the central portion of disc and removed the herniated disc effectively. Postoperatively, their symptoms were improved. There was no instability during the follow-up period. @@CONCLUSION:@@ The oblique paraspinal approach for the treatment of central disc herniations at the upper lumbar levels is an effective nonfusion technique that preserves most of the facet joint and provides a wide surgical field.

scholarly journals Vertebroplasty in Osteoporotic Spine Fractures: A Quality of Life Assessment

2005 ◽  
Vol 32 (4) ◽  
pp. 487-495 ◽  
Author(s):  
Krishna Kumar ◽  
A.K. Verma ◽  
Jefferson Wilson ◽  
Alika LaFontaine
Keyword(s):  
Quality Of Life ◽  
Back Pain ◽  
Visual Analogue Scale ◽  
Quantitative Evaluation ◽  
Oswestry Disability Index ◽  
Analogue Scale ◽  
Life Assessment ◽  
Index Value

ABSTRACT:Objective:Our goal was to perform a quantitative evaluation of the improvement in functional capacity, quality of life, mental function, reduction in drug intake and impact on hospital admissions after vertebroplasty in the treatment of osteoporotic compression fractures. The efficacy of vertebroplasty in relief of pain has been addressed in previous publications but the quantitative evaluation of improvement in quality of life has not been addressed before.Methods:This is a prospective study of 42 patients with 83 symptomatic vertebral fractures treated by vertebroplasty with a mean follow-up of 9.1 months. The outcome was measured by pre and postoperatively utilizing the Visual Analogue Scale, the Oswestry Disability Index, the Rolland Morris Scale for Back Pain and EuroQol-5D questionnaire (EQ-5D). The postoperative evaluations were performed at one week, one month, three month, and six month intervals thereafter.Results:In 34 out of 39 active patients, marked pain relief was noted (87%). The Visual Analogue Scale score improved from a mean preoperative score of 8.2 to a mean postoperative score of 2.9 (p=0.0000003) at one week follow up and 3.9 at the last follow-up. The Rolland Morris Scale for Back Pain showed a drop from a mean preoperative rating of 13 to a mean postoperative rating of 10, showing a 25% improvement (p= 0.0207). The Oswestry Disability Index preoperatively was 64.4 which improved to 43.8 postoperatively, showing a 32% improvement (p= 0.0207). The EQ-5D showed a mean preoperative index value of 0.097 and mean postoperative index value of 0.592 (p = 0.0000003). All p-values were determined by the Willcoxin sign-ranked test.Conclusion:Vertebroplasty is a safe and efficacious procedure with a resulting improvement in pain and quality of life.

Oral Analogue Scale as an Outcome Measure After Displaced Intra-articular Calcaneal Fractures

1998 ◽  
Vol 19 (10) ◽  
pp. 694-697 ◽  
Author(s):  
Paul Morin ◽  
Rick Buckley ◽  
Rena Stewart ◽  
Rob Vandey Gutche
Keyword(s):  
Visual Analogue Scale ◽  
Health Surveys ◽  
Analogue Scale ◽  
Outcome Measure ◽  
Calcaneal Fractures ◽  
Written Form ◽  
Functional Outcome Measures ◽  
Disease Specific ◽  
Specific Health

Functional outcome measures of displaced intra-articular calcaneal fractures have been documented using general health surveys (SF36) and disease-specific health surveys (Visual Analogue Scale). A simple oral analogue scale (OAS) was collected on 115 patients with 124 displaced intra-articular calcaneal fractures at 2 years or more after fractures. There was a high correlation ( r = 0.72, P < 0.0001) between the verbal OAS and the written Visual Analogue Scale. We believe that the OAS may assist in follow-up outcome assessment and management in this difficult trauma patient population. Outcomes may be accomplished verbally rather than in written form.

Comparison between customised foot orthoses and insole combined with the use of extracorporeal shock wave therapy in plantar fasciitis, medium-term follow-up results: A randomised controlled trial

2020 ◽  
pp. 026921552097661
Author(s):  
Manuel Coheña-Jiménez ◽  
Manuel Pabón-Carrasco ◽  
Ana Juana Pérez Belloso
Keyword(s):  
Shock Wave ◽  
Visual Analogue Scale ◽  
Plantar Fasciitis ◽  
Analogue Scale ◽  
Extracorporeal Shock Wave Therapy ◽  
Foot Orthoses ◽  
Shock Wave Therapy ◽  
Extracorporeal Shock Wave ◽  
Custom Made

Objective: To determine the clinical results of custom-made foot orthoses versus placebo flat cushioning insoles combined with an extracorporeal shock wave therapy on pain and foot functionality in patients with plantar fasciitis. Design and setting: A randomised controlled clinical trial with follow-up at six months. Faculty of Podiatry and Centre Clinical private of Physiotherapy, Seville, Spain. Subjects and interventions: Patients with plantar fasciitis were randomly assigned to either group A ( n = 42), which received custom-made foot orthoses, or group B ( n = 41), which received placebo insoles. All the participants received active extracorporeal shock wave therapy including stretching exercises. Recruitment period was from Mach 2019 to July 2020. Main measurements: The main outcome was foot pain, measured by visual analogue scale and the secondary outcome measures were recorded by Roles and Maudsley scores respectively, at the beginning and at one week, one month and six months. Results: Eighty-eight patients were assessed for eligibility. Eighty-three patients were recruited and randomised. This study showed significant differences between both groups according to the visual analogue scale. In control group, the difference was at baseline ( P 0.01) and, in the experimental group was at the one- and six-month follow-up ( P 0.001). The mean (SD) visual analogue scale at baseline were Control group 6.31 (1.69) and Experimental group 5.27 (1.64); and at six months were 7.52 (3.40) and 3.29 (4.26), respectively. The custom-made foot orthosis was perceived as ‘good’ (85%) and ‘excellent’ (97.5%) at medium-long term. Conclusion: Wearing a custom-made foot orthosis leads to a improvement in patients with plantar fasciitis; it reduced foot pain and improved foot functionality.

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

2019 ◽  
Vol 44 (8) ◽  
pp. 845-849 ◽  
Author(s):  
Angela A. Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
The Mean ◽  
Scar Score

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

One-Year Outcome Study of Anatomic Reconstruction of Lesser Metatarsophalangeal Joints

2019 ◽  
Vol 13 (4) ◽  
pp. 286-296 ◽  
Author(s):  
Jeremy J. Cook ◽  
Emily A. Cook ◽  
Daniel D. Hansen ◽  
Michael Matthews ◽  
Timothy Karthas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Visual Analogue Scale ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Analogue Scale ◽  
Anatomic Repair ◽  
Plantar Plate ◽  
One Year ◽  
Radiographic Alignment

Background: Lesser metatarsophalangeal joint (MTPJ) and plantar plate pathologies are commonly seen forefoot conditions. Traditional rebalancing techniques are commonly used but can have concerning adverse effects. The purpose of this study was to analyze the 1-year outcomes of a new technique consisting of anatomic repair of the plantar plate and collateral ligaments involving lesser MTPJs. Methodology: A retrospective cohort study of 50 consecutive patients treated with anatomic plantar plate and collateral ligament reconstruction were evaluated for lesser MTPJ imbalances between 2013 and 2016. The primary outcome was postoperative digital stability defined as a normal dorsal drawer test and normal paper pull-out test. Secondary outcomes included pre- and postoperative visual analogue scale pain measurements, MTPJ radiographic alignment, and ACFAS Forefoot module scores. Results: All patients had digital instability prior to the surgical intervention. Final follow-up revealed that 92% of patients showed improved digital stability, P = .0005. Multivariate regression found statistically significant improvement in pain reduction via the visual analogue scale of 51.2 mm ( P < .0001) and ACFAS Forefoot module scores improved to 92 ( P < .0001). The 45 joints with preoperative abnormal transverse plane deformity, had either complete (n = 29) or partial (n = 16) radiographic MTPJ correction. Conclusion: These results suggest that anatomic repair of lesser MTPJ improved digital stability, pain, function and radiographic alignment with greater than one year of follow-up. Levels of Evidence: Level IV: Retrospective cohort study

Efficacy of HA Block Kyphoplasty for Old Osteoporotic Spine Fractures

2006 ◽  
Vol 309-311 ◽  
pp. 1371-1374
Author(s):  
Taichi Nishimura ◽  
Hiromi Matsuzaki ◽  
Akihiro Okawa ◽  
Masashi Oshima
Keyword(s):  
Visual Analogue Scale ◽  
Vertebral Fractures ◽  
Neurological Disorder ◽  
Analogue Scale ◽  
Final Evaluation ◽  
Spine Fractures ◽  
Correction Loss ◽  
Pulmonary Infarction ◽  
The Mean

We have successfully treated osteoporotic spine fractures for about three years, by using transpedicular kyphoplasty with hydroxyapatite blocks (HA Block: PENTAX) (refer with: Fig. 1), The 13 patients, four men and nine women, ranged from 61 to 86 years in age (mean, 73 years). The mean Visual Analogue Scale (VAS) was 8.5 points before operation, improved to 2.7 points on the next day of operation, and improved significantly to 1.8 points at the final evaluation. The mean deformity rate (Anterior height / Posterior height x 100) was 66.3% before operation, but improved to 91.7% immediately after operation. At the time of follow-up, this rate was 78.6%, indicating that the correction loss was 13.1%. This procedure caused none of serious complications such as neurological disorder and pulmonary infarction. Kyphoplasty with HA blocks may be safe and effective in the treatment of chronic vertebral fractures.

CAN PATIENTS WITH SAGITTALLY WELL-COMPENSATED LUMBAR DEGENERATIVE KYPHOSIS BENEFIT FROM SURGICAL TREATMENT FOR INTRACTABLE BACK PAIN?

Neurosurgery ◽  
2009 ◽  
Vol 64 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee ◽  
Jung Mok Kim ◽  
Jun-Hong Min ◽  
Kyung-Mi Han ◽  
...  
Keyword(s):  
Back Pain ◽  
Oswestry Disability Index ◽  
Lumbar Lordosis ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Leg Pain ◽  
Compensatory Mechanisms ◽  
The Mean ◽  
Numeric Rating

Abstract OBJECTIVE To analyze pre- and postoperative x-rays of sagittal spines and to review the surgical results of 21 patients with lumbar degenerative kyphosis whose spines were sagittally well compensated by compensatory mechanisms but who continued to suffer from intractable back pain METHODS We performed a retrospective review of 21 patients treated with combined anterior and posterior spinal arthrodesis. Inclusion criteria were: lumbar degenerative kyphosis patients with intractable back pain and whose spines were sagittally well compensated by a compensatory mechanism, defined as a C7 plumb line to the posterior aspect of the L5–S1 disc of less than 5 cm. Outcome variables included: radiographic measures of preoperative, postoperative, and follow-up films; clinical assessment using the mean Numeric Rating Scale, Oswestry Disability Index, and Patient Satisfaction Index; and a review of postoperative complications. RESULTS All patients were female (mean age, 64.5 years; age range, 50–74 years). The mean preoperative sagittal imbalance was 19.5 (± 17.6) mm, which improved to −15.8 (± 22.2) mm after surgery. Mean lumbar lordosis was 13.2 degrees (± 15.3) before surgery and increased to 38.1 degrees (± 14.4) at follow-up (P &lt; 0.0001). Mean thoracic kyphosis was 5.5 degrees (± 10.2) before surgery and increased to 18.9 degrees (± 12.4) at follow-up (P &lt; 0.0001). Mean sacral slopes were 12.9 degrees (± 11.1) before surgery and increased to 26.3 degrees (± 9.6) at follow-up (P &lt; 0.0001). The mean Numeric Rating Scale score improved from 7.8 (back pain) and 8.1 (leg pain) before surgery to 3.0 (back pain) and 2.6 (leg pain) after surgery (P &lt; 0.0001). The mean Oswestry Disability Index scores improved from 56.2% before surgery to 36.7% after surgery (P &lt; 0.0001). In 18 (85.5%) of 21 patients, satisfactory outcomes were demonstrated by the time of the last follow-up assessment. CONCLUSION This study shows that even lumbar degenerative kyphosis patients with spines that are sagittally well compensated by compensatory mechanisms may suffer from intractable back pain and that these patients can be treated effectively by the restoration of lumbar lordosis.

Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases

2012 ◽  
Vol 37 (7) ◽  
pp. 605-609 ◽  
Author(s):  
A. Klahn ◽  
M. Nygaard ◽  
R. Gvozdenovic ◽  
M. E. H. Boeckstyns
Keyword(s):  
Rheumatoid Arthritis ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Revision Rate ◽  
Gradual Increase ◽  
Biomechanical Properties ◽  
Fast Recovery ◽  
Trapeziometacarpal Osteoarthritis ◽  
The Mean

We present a prospective follow-up of 39 Elektra prostheses in 37 patients (32 women and five men), with a mean age of 56.5 (range 46–71) years; 34 patients had osteoarthritis and three had rheumatoid arthritis. Patients were followed using clinical examination, including measurement of pain on a visual analogue scale, mobility, and strength, after 6, 12, 26, and 52 weeks, and annually thereafter. Radiological examination was done preoperatively and after 6, 26, and 52 weeks, and annually thereafter. The mean follow-up time was 48 (range 3–91) months. Although we observed a fast recovery, including maintenance of mobility and a gradual increase in grip strength, there was a revision rate of 7/38 (24%) after 36 months, increasing to 17/38 (44%) after 72 months. The main reason for revision was loosening of the trapezial component, and biomechanical properties of the trapezial fixation may be the key problem in treating trapeziometacarpal osteoarthritis using a total prosthesis.

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