Cervical Laminoplasty as a Management Option for Patients With Cervical Spondylotic Myelopathy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Anthony L. Petraglia ◽  
Vasisht Srinivasan ◽  
Michelle Coriddi ◽  
M. Gordon Whitbeck ◽  
James T. Maxwell ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Medical Center ◽  
Demographic Data ◽  
Adult Population ◽  
Postoperative Outcome ◽  
Outcome Data ◽  
Consecutive Series ◽  
Cervical Laminoplasty ◽  
Presenting Symptoms

Abstract BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of spinal cord dysfunction in the adult population. Laminoplasty is an effective decompressive procedure for the treatment of CSM. OBJECTIVE We present our experience with 40 patients who underwent cervical laminoplasty using titanium miniplates for CSM. METHODS We performed a retrospective review of the medical records of a consecutive series of patients with CSM treated with laminoplasty at the University of Rochester Medical Center or Rochester General Hospital. We documented patient demographic data, presenting symptoms, and postoperative outcome. Data are also presented regarding the general cost of constructs for a hypothetical 3-level fusion. RESULTS Forty patients underwent cervical laminoplasty; all were available for follow-up. The mean number of levels was 4. All patients were myelopathic, and 17 (42.5%) had signs of radiculopathy preoperatively. Preoperatively, 62.5% of patients had a Nurick grade of 2 or worse. The average follow-up was 31.3 months. The median length of stay was 48 hours. On clinical evaluation, 36 of 40 patients demonstrated an improvement in their myelopathic symptoms; 4 were unchanged. Postoperative kyphosis did not develop in any patients. CONCLUSION The management of CSM for each of its etiologies remains controversial. As demonstrated in our series, laminoplasty is a cost-effective, decompressive procedure for the treatment of CSM, providing a less destabilizing alternative to laminectomy while preserving mobility. Cervical laminoplasty should be considered in the management of multilevel spondylosis because of its ease of exposure, ability to decompress, effective preservation of motion, maintenance of spinal stability, and overall cost.

Children With Encopresis: A Study of Treatment Outcome

PEDIATRICS ◽  
1976 ◽  
Vol 58 (6) ◽  
pp. 845-852 ◽  
Author(s):  
Melvin D. Levine ◽  
Harry Bakow
Keyword(s):  
Treatment Outcome ◽  
Treatment Program ◽  
Marked Improvement ◽  
Medical Center ◽  
Outcome Data ◽  
Careful Monitoring ◽  
Maintenance Program ◽  
Pediatric Treatment ◽  
One Year

A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.

scholarly journals Hyperbaric Oxygen for Radiation Necrosis of the Brain

2019 ◽  
Vol 47 (1) ◽  
pp. 92-99
Author(s):  
Jayson Co ◽  
Marcus Vinicius De Moraes ◽  
Rita Katznelson ◽  
A. Wayne Evans ◽  
David Shultz ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Median Time ◽  
Hyperbaric Oxygen ◽  
Demographic Data ◽  
Symptom Improvement ◽  
Presenting Symptoms ◽  
Transient Improvement ◽  
Brain Radiation

Abstract:Introduction:Hyperbaric oxygen therapy (HBOT) shows promising results in treating radionecrosis (RN) but there is limited evidence for its use in brain RN. The purpose of this study is to report the outcomes of using HBOT for symptomatic brain RN at a single institution.Methods:This was a retrospective review of patients with symptomatic brain RN between 2008 and 2018 and was treated with HBOT. Demographic data, steroid use, clinical response, radiologic response and toxicities were collected. The index time for analysis was the first day of HBOT. The primary endpoint was clinical improvement of a presenting symptom, including steroid dose reduction.Results:Thirteen patients who received HBOT for symptomatic RN were included. The median time from last brain radiation therapy to presenting symptoms of brain RN was 6 months. Twelve patients (92%) had clinical improvement with median time to symptom improvement of 33 days (range 1–109 days). One patient had transient improvement after HBOT but had recurrent symptomatic RN at 12 months. Of the eight patients with evaluable follow-up MRI, four patients had radiological improvement while four had stable necrosis appearance. Two patients had subsequent deterioration in MRI appearances, one each in the background of initial radiologic improvement and stability. Median survival was 15 months with median follow-up of 10 months. Seven patients reported side effects attributable to HBOT (54%), four of which were otologic in origin.Conclusions:HBOT is a safe and effective treatment for brain RN. HBOT showed clinical and radiologic improvement or stability in most patients. Prospective studies to further evaluate the effectiveness and side effects of HBOT are needed.

Spinal Cord Intradural Arteriovenous Fistulae: Anatomic, Clinical, and Therapeutic Considerations in a Series of 32 Consecutive Patients Seen between 1981 and 2000 with Emphasis on Endovascular Therapy

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 973-983 ◽  
Author(s):  
Georges Rodesch ◽  
Michel Hurth ◽  
Hortensia Alvarez ◽  
Marc Tadie ◽  
Pierre Lasjaunias
Keyword(s):  
Spinal Cord ◽  
Adult Population ◽  
Clinical Status ◽  
Clinical Results ◽  
Cervical Cord ◽  
Karnofsky Performance Scale ◽  
Presenting Symptoms ◽  
Arteriovenous Shunts ◽  
Thoracolumbar Region

Abstract OBJECTIVE: To review our series of intradural spinal cord arteriovenous fistulas (SCAVFs), analyzing symptoms and related angioarchitecture, and to study the morphological and clinical results of embolization. METHODS: Thirty-two SCAVFs (in 22 adults and 10 children) were treated between 1981 and 2000. These lesions were classified as microarteriovenous fistulas (mAVFs) or macroarteriovenous fistulas (MAVFs) according to shunt morphology. Location, architecture, presenting symptoms, and age group were detailed. The selection of patients for endovascular versus surgical treatments was analyzed, as were the anatomic and clinical results obtained by embolization with n-butylcyanoacrylate. Clinical status was evaluated according to the Karnofsky Performance Scale score. RESULTS: Ten SCAVFs were found in the pediatric population (four mAVFs and six MAVFs). All four mAVFs presented with acute symptoms. Three mAVFs (two cervical and one thoracic) presented hematomyelia; in one patient with a thoracic AVF, subarachnoid hemorrhage was suspected. All six MAVFs were located in the thoracolumbar cord (five associated with hereditary hemorrhagic telangiectasias). Four of the six MAVFs presented with hemorrhage. In the adult population, there were 21 mAVFS (95%) and one MAVF (5%). Only two mAVFs were found in the cervical cord, all other shunts affecting the thoracolumbar region. Hemorrhage was present in 6 of the 22 cases seen in adults (27%). The symptoms of SCAVFs did not differ from those found in spinal cord arteriovenous shunts of nidus type. Pial venous reflux and congestion were the most frequently encountered features in both the adult and pediatric groups. Arterial aneurysms (different from false aneurysms) were not found in association with hemorrhagic presentation of SCAVFs. Mean follow-up in our series was 3.3 years. Of the MAVFs, 86% were embolized, with 67% cured. The others had more than 75% occlusion. All patients followed up improved significantly. Of the mAVFs, 48% were treated endovascularly. Successful embolization was performed in 75% of patients. One patient was not embolized because of vasospasm, whereas 67% percent of mAVFs were completely occluded, 22% were more than 90% occluded, and 11% were 75% occluded. Complementary surgery was deemed unnecessary. All patients with mAVFs improved significantly at follow-up. Transient complications occurred in 22% of all patients, with no permanent morbidity or mortality. No patient bled or rebled after embolization. Thirty-six percent of mAVFs were operated on because of anticipated technical difficulties for endovascular approach or distal localization of the shunt. CONCLUSION: Endovascular treatment of SCAVFs stabilizes, normalizes, or improves neurological symptoms in all patients at long-term follow-up, with no bleeds or rebleeds. Embolization of SCAVFs with glue is a safe treatment that compares favorably with other approaches and significantly improves the poor natural history of the disease.

scholarly journals Enoxaparin Utilization Evaluation and Its Clinical and Laboratory Outcomes in Pediatric Patients in a Children’s Teaching Hospital

2020 ◽  
Author(s):  
Uldooz Samadi Bahrami ◽  
Alieh Safari Sharari ◽  
Hadis Pourkarami ◽  
Toktam Faghihi
Keyword(s):  
Teaching Hospital ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Thrombotic Event ◽  
Bleeding Event ◽  
Evaluation Study ◽  
Outcome Data ◽  
Clinical Response Rate ◽  
Duration Of Treatment

Backgrounds: In recent years, low molecular weight heparin use has increased in children. Dose of enoxaparin to achieve target anti-Xa and time to achieve anti-Xa are evolving and efficacy outcome data in terms of laboratory and clinical response rate in children still remains to be elucidated. Thus, in this drug utilization and evaluation study, we assessed patterns of enoxaparin use, its concordance with guidelines and laboratory and clinical outcomes in pediatric patients in a Children’s teaching hospital.   Methods: In a prospective observational study, all pediatric patients with a thrombotic event who underwent treatment with enoxaparin were included. Demographic data, clinical outcome data based on follow-up sonography results, laboratory response based on anti-Xa and concordance with guidelines in terms of initial daily dose, duration of treatment, performing sonography to evaluate response, anti Xa check and time of anti-Xa check were evaluated. Results: During a 9-month period, 41 pediatric patients suffered a thrombotic event and received enoxaparin. Median age of participants was 18.5 months. The anti-Xa level became therapeutic on mean day 4.7 with a mean enoxaparin dose of 1.24 mg/kg. Among participants 42% achieved therapeutic anti-Xa with initial empirical dosing. Less than 25 % of participants had a follow-up sonography and among them, 77% demonstrated complete thrombosis resolution after 4-6 weeks of enoxaparin therapy. We observed one major bleeding event. Concordance with guidelines was low in the aspects of duration of treatment, performing sonography to evaluate response and anti-Xa check. Conclusion: With initial empiric dosing, it may take several days before anti-Xa become therapeutic. Among half of the children, a higher than recommended 1 mg/kg dose was required to achieve therapeutic anti-Xa level. Educational processes are mandatory regarding enoxaparin use and monitoring among clinicians to improve concordance with guidelines.  

scholarly journals Surgery in multisegmental cervical spondylotic myelopathy: Outcome analysis in a series of 65 patients

2013 ◽  
Vol 02 (02) ◽  
pp. 170-174
Author(s):  
K.B. Shankar ◽  
Shashank Kale ◽  
Bhawani Sharma ◽  
Sumit Sinha
Keyword(s):  
Clinical Outcome ◽  
Surgical Approach ◽  
Cervical Spondylotic Myelopathy ◽  
Outcome Analysis ◽  
Cervical Laminoplasty ◽  
Japanese Orthopedic Association ◽  
Excellent Outcome ◽  
The Mean ◽  
Cervical Plating

Abstract Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or posterior approaches. The aim of study was to analyze the surgical outcomes of MS-CSM treated by either anterior cervical discectomy with fusion and cervical plating (ACDF) or cervical laminoplasty (LP). Sixty-five patients with MS-CSM (two or more levels) underwent either ACDF (n=13) or LP (n=52). ACDF was performed in patients having these criteria: (i) three or less levels involved, (ii) myeloradiculopathy, (iii) pre-dominant anterior compression radiologically, (iv) <50 years age. LP was chosen in: (i) more than three levels involved (ii) posterior compression radiologically, (iii) >50 years age. Patients were evaluated pre- and post-operatively on the basis of modified Japanese Orthopedic Association (mJOA) scoring and Hirabayashi formula. Thirty-five patients were followed up (8 in ACDF group and 27 in LP group). The mean follow-up period was 37.5 months (12.5-54 months). The mean pre-operative mJOA score in the ACDF group and the LP group was 11±2.62 and 10.6±2.04, respectively. The mean final post-operative mJOA score in the ACDF group (n=8) in follow-up was 14.12±2.36 (P<0.05) and in the LP group (n=27) was 14.63±1.64 (P<0.05). 86% had good-to-excellent outcome while 8.5% had poor outcome. Overall, the mean recovery was 64.73±18.9%. On analyzing two groups separately, the mean recovery in the ACDF group was 59.62±24.2, while in the LP group was 66.25±17.3 (P<0.05). The choice of ACDF and LP in MS-CSM depends on pre-operative clinical and radiological parameters. If the surgical approach is chosen correctly, the surgery in MS-CSM can result in significant improvement in the clinical outcome of these patients.

scholarly journals Medium-Long-Term Clinical and Radiographic Outcomes of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Central Primary Metatarsalgia: Do Maestro Criteria Have a Predictive Value in the Preoperative Planning for This Percutaneous Technique?

2018 ◽  
Vol 2018 ◽  
pp. 1-12
Author(s):  
Carlo Biz ◽  
Marco Corradin ◽  
Wilfried Trepin Kuete Kanah ◽  
Miki Dalmau-Pastor ◽  
Alessandro Zornetta ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Predictive Value ◽  
Preoperative Planning ◽  
Callus Formation ◽  
Demographic Data ◽  
Percutaneous Technique ◽  
Consecutive Series ◽  
Metatarsal Bones

Background. The purpose of this prospective study was first to evaluate the safety and effectiveness of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) in treating central metatarsalgia, identifying possible contraindications. The second objective was to verify the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Methods. A consecutive series of patients with metatarsalgia was consecutively enrolled and treated by DMMO. According to Maestro criteria, preoperative planning was carried out by both clinical and radiological assessment. Patient demographic data, AOFAS scores, 17-FFI, MOXFQ, SF-36, VAS, and complications were recorded. Maestro parameters, relative morphotypes, and bone callus formation were assessed. Statistical analysis was carried out (p < 0.05). Results. Ninety-three patients (93 feet) with a mean age of 62.4 (31-87) years were evaluated. At mean follow-up of 58.7 (36-96) months, all of the clinical scores improved significantly (p < 0.0001). Most of the osteotomies (76.3%) had healed by 3-month follow-up, while ideal harmonious morphotype was restored only in a few feet (3.2%). Clinical and radiological outcomes were not different based on principal demographic parameters. Long-term complications were recorded in 12 cases (12.9%). Conclusion. DMMO is a safe and effective method for the treatment of metatarsalgia. Although Maestro criteria were useful to calculate the metatarsal bones to be shortened and a significant clinical improvement of all scores was achieved, the ideal harmonious morphotype was restored only in a few feet. Hence, our data show that Maestro criteria did not have a predictive value in clinical outcomes of DMMO.

NEUROSURGICAL TREATMENT FOR ANEURYSM REMNANTS OR RECURRENCES AFTER COIL OCCLUSION

Neurosurgery ◽  
2008 ◽  
Vol 63 (4) ◽  
pp. 684-692 ◽  
Author(s):  
Jean-Paul Lejeune ◽  
Laurent Thines ◽  
Christian Taschner ◽  
Philippe Bourgeois ◽  
Hilde Henon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Glasgow Outcome Scale ◽  
Postoperative Outcome ◽  
Consecutive Series ◽  
Anterior Circulation ◽  
Microsurgical Treatment ◽  
Coil Occlusion ◽  
Neurosurgical Treatment ◽  
Temporary Occlusion

ABSTRACT OBJECTIVE Neurosurgical management of residual aneurysms (RA) after coiling remains a challenging issue. We present a consecutive series of 21 patients who underwent microsurgical treatment of a previously coiled aneurysm. METHODS We retrospectively reviewed a consecutive series of 21 patients who underwent operations for an RA after coiling between 1997 and 2007. Postcoiling follow-up imaging included brain magnetic resonance angiography and digital subtraction angiography. The decision for surgical treatment was made when an RA was significant and unsuitable for re-embolization. Data related to the RA and to the surgical technique were analyzed. Postoperative outcome was evaluated with the Glasgow Outcome Scale. RESULTS Twenty aneurysms were initially ruptured. Twelve had undergone complete coil occlusion, whereas 6 had a residual neck, 2 had a residual lobule, and 1 had a residual sac. The aneurysms were in the anterior circulation in 18 cases and in the posterior circulation in 3 cases. Twenty RAs were excluded with the apposition of 1 clip beneath the coils, 2 required a temporary occlusion, 2 required extraction of the coils, and 1 presented with an operative rupture. All aneurysms, except 2 that had their residual neck wrapped, were completely occluded. The postoperative Glasgow Outcome Scale score was unchanged in 90% of patients, and 2 patients sustained a moderate disability. CONCLUSION Microsurgical treatment of RA after endovascular treatment is effective, provided that patients are selected appropriately. The surgical treatment of recanalized aneurysms after coiling is challenging but can result in a good outcome with low morbidity and no mortality.

Kikuchi Disease in Korean Children: Clinical Features and Disease Courses.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2285-2285 ◽  
Author(s):  
Jun Eun Park ◽  
Hyun Joo Jung ◽  
Chul-Ho Kim ◽  
Jeong Hong ◽  
Jae Ho Han
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Medical Center ◽  
University Hospital ◽  
First Episode ◽  
Excision Biopsy ◽  
Cervical Lymph Nodes ◽  
Korean Children ◽  
Presenting Symptoms

Abstract OBJECTIVES: Kikuchi’s disease (KD) is a benign, self-limiting disorder of unknown origin with lymphadenopathy and fever, and prevalent in young Asian women. The initial presentations mimic malignancies or other serious infections, and the biopsy of lymph nodes affected is the only definite diagnostic tool of KD. We analyzed data from a series of pediatric cases collected at a single medical center and suggest proper guideline of management for patients with KD. METHODS: The medical records of children under 16 years of age, who underwent lymph node biopsies and received histiopathologic diagnosis of KD at Ajou University Hospital, South Korea from January 2000 to June 2007, were retrospectively reviewed. RESULTS: Twenty six pediatric patients with KD included 10 boys and 16 girls. In all cases except two, the cervical lymph nodes were involved. Twenty (76.9%) patients had fever as a presenting symptom, and 5 patients (19.2%) had various skin rash. Leukopenia was noted in 8 cases (30.8%), but there was no case of leukocytosis. The levels of ESR and LDH were slightly elevated, but CRP and liver enzymes were within normal range. No KD patients in this study developed any other autoimmune disorders during follow-up period. Eleven (55%) cases with fever improved immediately after excision biopsy of affected lymph nodes. Eight (30.8%) cases treated with steroid showed dramatic responses. Six patients (23.1%) had resolutions of symptoms simply with symptomatic treatments. The recurrence happened in 6 (23.1%) children within a few weeks from the first episode. CONCLUSIONS: Contrary to previous reports on Asian cases, KD in Korean children is not rare in young boys, and fever is more common presenting symptoms. It’s relationship with autoimmune diseases or infection of EBV is not clear. Symptoms such as fever improved in some cases only by the removal of affected lymph node for excision biopsy. In agreement with previous reports, patients treated with steroid recovered dramatically. Therefore, we suggest an earlier excision biopsy for patients suspicious with KD and an immediate treatment of cases with severe symptoms with steroid. The recurrence rate in this study was higher than that in previous studies, therefore, a spell of follow-up period after disappearance of symptoms is advisable for patients with original diagnosis of KD.

Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation

1991 ◽  
Vol 74 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Richard L. Saunders ◽  
Philip M. Bernini ◽  
Thomas G. Shirrefks ◽  
Alexander G. Reeves
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Consecutive Series ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Long Duration ◽  
Swallowing Dysfunction ◽  
Long Term Follow Up ◽  
Perioperative Complication

✓ Since 1984, a consecutive series of patients with cervical spondylotic myelopathy has been treated by central corpectomy and strut grafting. This report focuses on 40 cases operated on between 1984 and 1987 and followed from 2 to 5 years. The perioperative complication rate was 47.5%, with a 7.5% incidence of persistent sequelae: severe C-5 radiculopathy in one patient, swallowing dysfunction in one, and hypoglossal nerve palsy in one. No single factor (age, duration of symptoms, or severity of myelopathy) was absolutely predictive of outcome; however, syndromes of short duration had the best likelihood of cure. Similar outcomes were associated, individually, with long duration of symptoms, age over 70 years, and severe myelopathy. After factoring a 5% regression of improvement, the long-term cure rate was 57.5% and the failure rate was 15%. Myelopathy worsening was not documented.

Prevalence and natural history of arachnoid cysts in adults

2013 ◽  
Vol 118 (2) ◽  
pp. 222-231 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Samuel Terman ◽  
Craig Kilburg ◽  
Hugh J. L. Garton ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Natural History ◽  
Brain Mri ◽  
Arachnoid Cysts ◽  
Consecutive Series ◽  
Middle Fossa ◽  
Presenting Symptoms ◽  
History Analysis ◽  
Number Of Patients ◽  
History Of

Object Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined. Methods We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis. Results A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period. Conclusions Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.

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