Dispositivos interespinosos en discectomías lumbares primarias. ¿Favorecen la recurrencia de la hernia de discos? [Interspinous device in primary lumbar discectomy. Does it favor the recurrence of disc herniation?]

Objetivo: Evaluar si la colocación de los dispositivos interespinosos siliconados tipo DIAM favorecen una tasa más alta de recidiva de la hernia discal homolateral clínica y por imágenes comparada con la discectomía pura.Materiales y Métodos: Se realizó un estudio prospectivo, observacional, aleatorizado desde mayo de 2009 hasta mayo de 2013, en nuestro Centro. Se evaluó a 123 pacientes, 3 se perdieron en el seguimiento; l muestra incluyó 120 sujetos. Todos fueron operados por el mismo equipo quirúrgico. Se formaron dos grupos: grupo A: discectomía más colocación de dispositivo interespinoso siliconado, 30 pacientes (16 mujeres y 14 hombres), con mayor frecuencia L4-L5 (27 pacientes, 90%) y grupo B: discectomías puras, 90 pacientes (53 mujeres y 37 hombres) con más frecuencia L4 y L5 (72 pacientes, 80%).Resultados: Seis de los pacientes del grupo A (20%) tuvieron una recidiva clínica y por imágenes, y 3 (10%) fueron operados nuevamente; en el grupo B, hubo 4 recidivas discales (4,4%), uno fue operado nuevamente (1,1%). Se hallaron diferencias significativas en las tasas de recidiva y reintervención entre los grupos (p = 0,0073 y p = 0,0188, respectivamente).Conclusiones: Los beneficios de los dispositivos interespinosos para tratar el canal estrecho lumbar secundario a hernia de disco son controvertidos, pero en nuestro estudio, se halló una diferencia significativa según el grupo. Al mantener el movimiento del segmento y cambiar ligeramente las cargas fisiológicas aumentarían la tasa de recidiva discal; no obstante, son necesarios estudios con mayor evidencia científica para corroborar estas tendencias. AbstractObjective: The objective of this study was to evaluate if discectomy with placement of an interspinous silicon DIAM spacer is associated with a different rate of clinical and radiographic ipsilateral disc herniation recurrence than discectomy alone.Methods: A prospective, observational,randomized study was performed from May 2009 to May 2013 at XXXXX. Of the 123 patients included in the study, 3 were lost to follow-up, leaving 120 patients for data analysis. All patients were operated on by the same surgical team. Patients received one of two types of treatment. Group A consisted of 30 patients (16 women and 14 ment) who underwent discectomy with placement of an interspinous silicone DIAM spacer. Group B was composed of 90 patients (53 women and 37 men) who received discectomy alone.Results: Discectomy at L4-L5 was the most common level, occurring in 90% (27) Group A patients and 80% (72) Group B patients. Group A demonstrated clinical and radiographic disc herniation recurrence in 6/30 (20%) of patients. Disc herniation recurrence developed in 4/90 (4.4%) Group B patients. One patient underwent reoperation (1.1%). Both recurrence and reoperation was significantly higher in Group A (p = 0.007 and p = 0.019, respectively).Conclusions: The benefits of interespinosos devices for the treatment of the lumbar spinal stenosis secondary to herniated disc while they are controversial in the present study showed significant difference according to the Group. In this study, patients that underwent discectomy and interspinous spaceer placement had higher reoperation and recurrence rates than discectomy patients that did not receive an interspinous spacer. Interspinous spacers may increase the rate of disc herniation by maintaining movement at the level of prior disc herniation and changing the physiologic load. More studies are needed to corroborate and evaluate these trends.

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Closed versus open lateral internal anal sphincterotomy in a chronic anal fissure

International Surgery Journal ◽

10.18203/2349-2902.isj20170861 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1055 ◽

Cited By ~ 1

Author(s):

Anandaravi B. N. ◽

Ramaswami B.

Keyword(s):

Anal Fissure ◽

Recurrence Rate ◽

Chronic Anal Fissure ◽

Randomized Study ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Closed Technique ◽

Significant Difference ◽

Group A ◽

Group B

Background: Anal fissure is a common proctological problem, which presents with pain in the anal region during and after defecation. The aim of the study was to determine the best technique for surgical treatment of chronic anal fissure patients.Methods: The study was designed as a prospective randomized study. The study was conducted in surgical unit, K.R. Hospital, MMCRI, Mysore, India from January 2015 to June 2016. A total of 100 patients undergoing surgery were divided into two groups. In group A there were 50 patients who were treated by closed lateral internal anal sphincterotomy, and in group B there were 50 patients who were managed by open lateral internal anal sphincterotomy method. Patients were followed up for 6 months following surgery to observe for pain, bleeding, infection, incontinence, and recurrence. The exclusion criteria were patients who had in addition haemorrhoids or any other anorectal diseases.Results: There was acceptable difference in postoperative acute complications between the two methods of internal anal sphincterotomy. However, in group A, three patients (6%) versus 10 (20%) were complicated with incontinence postoperatively, whereas the recurrence rate was 4 versus 4% in group A versus group B, respectively (P = 0.015).Conclusions: There was significant difference between closed and open methods of lateral internal sphincterotomy in recurrence rate, healing rate, and other complications. Closed lateral internal sphincterotomy is treatment of choice for chronic anal fissure and can be done effectively and safely with acceptable rate of complications. Our recommendations are that closed technique should be adopted by experienced surgeons and Trainee should be initially trained by open technique then be shifted to closed technique.

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Simple Decompression versus Anterior Submuscular Transposition of the Ulnar Nerve in Severe Cubital Tunnel Syndrome: A Prospective Randomized Study

Neurosurgery ◽

10.1227/01.neu.0000145854.38234.81 ◽

2005 ◽

Vol 56 (1) ◽

pp. 108-117 ◽

Cited By ~ 147

Author(s):

Olga Gervasio ◽

Giuseppe Gambardella ◽

Claudio Zaccone ◽

Damiano Branca

Keyword(s):

Ulnar Nerve ◽

Randomized Study ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Prospective Randomized Study ◽

Significant Difference ◽

Group A ◽

Tunnel Syndrome ◽

Group B ◽

Simple Decompression

Abstract OBJECTIVE: The authors report the results of a clinical series of selected patients with severe cubital tunnel syndrome. The degree of ulnar nerve compression was evaluated by use of a grading system that includes measurements of motor and sensitive function. The submuscular transposition with flexor-pronator mass Z lengthening was compared with simple decompression through a prospective randomized study. METHODS: From February 1998 to June 2003, 70 patients with severe cubital tunnel syndrome were included in this study: 35 patients were submitted to simple decompression (Group A), and 35 patients were treated by anterior deep submuscular transposition (Group B). The preoperative status was determined by use of Dellon's classification. The selected patients had Dellon's Grade 3 (severe syndrome). The mean follow-up period after surgery was 47 months for Group A and 46.94 months for Group B. RESULTS: Postoperative clinical and electrophysiological outcomes were assessed 6 months after surgery in all 70 patients. According to the Bishop scoring system, 19 patients (54.3%) of Group A were clinically graded as excellent, 9 (25.7%) were graded as good, and 7 (20%) were graded as fair; in Group B, 18 patients (51.43%) were graded as excellent, 11 (31.43%) as good, and 6 (17.14%) as fair. Neither severe complications nor recurrences were observed in the two groups. CONCLUSION: No statistically significant difference was found between the two groups with regard to the clinical or the electrophysiological outcome. The surgical treatment gains in Group A and B were 80% and 82.86%, respectively (good to excellent results).

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Prospective Randomized Study between Open Vs Closed Lateral Anal Internal Sphincterotomy in Patients with Chronic Fissure in Ano

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.36 ◽

2020 ◽

Vol 3 (1) ◽

pp. 167-171

Author(s):

Anand Shanmugaiah ◽

Saravanan Pandian

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Randomized Study ◽

Fissure In Ano ◽

Internal Sphincterotomy ◽

Post Surgery ◽

Significant Difference ◽

Group A ◽

Group B

Background: One of the the most common cause of pain during defecationin young patientsis chronic fissure in ano. Surgical treatment of choice for chronic fissure in ano is internal sphincterotomy. This procedure can be performed by open or closed method. The aim of the study was to compare the closed and open anal internal sphincterotomy in patients admitted in our hospital with chronic anal fissure. Subjects and Methods: 105 patients admitted in department of general surgery with chronic fissure in ano were divided into two groups. 50 patients (Group A) who were treated by closed method and 55 patients (Group B) who were managed by open lateralanal sphincterotomy method. A 3 months follow up done in both post-surgery to observe for pain, bleeding, infection, incontinence, and recurrence. Results: Significant difference was observed in postoperative acute complications between the two methods of internal anal sphincterotomy. Conclusion: Lateral anal sphincterotomy is the treatment of choice for chronic anal fissure, either open or closed method. However, the closed method was observed to have lesserpost operative complication compared to the open method.

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Comparing 60 versus 120 shocks per minute for shock-wave lithotripsy of solitary renal calculi: A controlled randomized study

Journal of Clinical Urology ◽

10.1177/2051415820945924 ◽

2020 ◽

pp. 205141582094592

Author(s):

Tamer A Ali ◽

Mohamed A Abdelaal ◽

Moamen M Amin ◽

Mohamed K Saif-Elnasr

Keyword(s):

Shock Wave ◽

Shock Wave Lithotripsy ◽

Randomized Study ◽

Renal Stones ◽

Renal Calculi ◽

Successful Outcome ◽

Significant Difference ◽

Group A ◽

The Difference ◽

Group B

Objective: This study aimed to compare the difference in outcome of shock-wave lithotripsy (SWL) using a slow rate of 60 shocks per minute versus a rapid rate of 120 shocks per minute generated by an electromagnetic lithotripter for renal calculi. Methods: From May 2017 to June 2019, 156 patients ( Mage=38.7 years) with single radio-opaque renal stones smaller than 20 mm were included and randomly divided into two groups: group A, 78 patients who received 60 shocks per minute; and group B, 78 patients who received 120 shocks per minute. Patients were radiologically reviewed at 3 months for an outcome. Results: There was no statistically significant difference between mean stone area treated ( p=0.222) or additional analgesic use in the form of patient-controlled analgesia (PCA; alfentanil; p=0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. In group A, 60% of patients had a successful outcome compared with 61.4% in group B ( p=0.869) following a single treatment. Post-treatment complications were similar in both groups at 12% for group A and 10.7% for group B ( p=0.797). Conclusions: There was no statistically significant difference between the delivery of 60 and 120 shocks per minute during SWL for the treatment of solitary renal stones with a mean stone area of 62 mm2 regarding the outcome, complications or PCA use when using a Dornier Compact Delta II lithotripter.

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The Effects of Timing of Ankle Blocks in Forefoot, Midfoot, or Hindfoot Reconstruction With the Use of an Ankle Tourniquet

Foot & Ankle Specialist ◽

10.1177/1938640017754233 ◽

2018 ◽

Vol 11 (6) ◽

pp. 527-533

Author(s):

James Gwosdz ◽

Lattisha Bilbrew ◽

Daniel Jupiter ◽

Vinod Panchbhavi

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Randomized Study ◽

Comparative Trial ◽

Vas Score ◽

Level Ii ◽

Significant Difference ◽

Group A ◽

Group B ◽

Tourniquet Inflation

Background. Ankle blocks are used in the ambulatory surgery setting to control postoperative pain, which is often worst in the first 24 hours after surgery. We conducted a trial to determine whether the timing of ankle block administration in relation to ankle tourniquet inflation has an effect on perceived pain and narcotic consumption. Methods. A prospective randomized study was conducted between August 2015 and January 2016. Patients were assigned to three groups. In group A, an ankle block was performed before ankle tourniquet inflation; in group B, immediately after ankle tourniquet inflation; and in group C, immediately after ankle tourniquet inflation with additional local anesthetic placed around the incision at the end of the procedure. Pain was assessed by a visual analogue scale (VAS) score, which was recorded at discharge, 24 hours, 48 hours, and 2 weeks after surgery. Narcotic consumption was recorded at 24 and 48 hours after surgery. Results. The only statistically significant difference in mean VAS scores occurred at 24 hours, when patients who received an ankle block after tourniquet inflation with local incisional anesthetic at closure (group C) had a mean VAS score 2.8 points lower (3.5 vs 6.3; P = .025) than those who received only an ankle block after tourniquet inflation (group B). There was no difference in narcotic consumption between groups at 24 and 48 hours. Conclusions. The timing of ankle block in relation to tourniquet inflation did not have an effect on pain control in forefoot, midfoot, and hindfoot reconstruction. The synergistic effect of an ankle block with additional incisional anesthetic at closure, is more effective than ankle block alone and is the ideal combination for postoperative pain control in foot surgery. Levels of Evidence: Therapeutic, Level II: Prospective, comparative trial

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Bite Force Assessment of Mandibular Interforaminal Fractures Treated with Combination of Microplate and Miniplate—A Randomized Control Study

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1055/s-0038-1646776 ◽

2018 ◽

Vol 2 (1) ◽

pp. s-0038-1646776 ◽

Cited By ~ 1

Author(s):

D. Anand ◽

Kavitha Prasad ◽

RM Lalitha ◽

K. Ranganath ◽

BR Rajnikanth ◽

...

Keyword(s):

Randomized Study ◽

Study Groups ◽

Bite Force ◽

Control Group ◽

Mandibular Fractures ◽

Clinical Parameters ◽

Hardware Failure ◽

Significant Difference ◽

Group A ◽

Group B

The purpose of this study was to compare the mechanical behavior of combination of microplate and miniplate with two standard miniplates for fixation of mandibular fractures in the interforaminal region on the basis of bite force and other clinical parameters. A prospective randomized study was conducted on 20 patients with mandibular fracture requiring open reduction and internal fixation (ORIF) who were randomly categorized into Group A and Group B with 10 patients in each group. Ten healthy persons whose age and gender matched with study groups were included in control Group C. Pre- and postoperative bite force was measured at specified intervals in both the study groups and was compared with the control group. The bite force values were comparatively less in Group A than Group B, although there was no statistically significant difference. Also, bite force values were less in both the study groups when compared with the control group. No statistically significant difference was found in other clinical parameters such as infection, fracture mobility, and hardware failure. The results were suggestive that the use of microplate and miniplate combination in management of minimally displaced mandibular fractures in the interforaminal region provides stable fixation comparable to two miniplate combination.

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Comparison between endoscope assisted powered and conventional adenoidectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20205619 ◽

2020 ◽

Vol 7 (1) ◽

pp. 50

Author(s):

Dimple Sahni ◽

Gurleen Kaur ◽

Sanjeev Bhagat ◽

Parvinder Singh ◽

Peeyush Verma ◽

...

Keyword(s):

Random Sampling ◽

Recovery Time ◽

Operative Time ◽

Randomized Study ◽

Intraoperative Blood Loss ◽

Systematic Random Sampling ◽

Medical College ◽

Significant Difference ◽

Group A ◽

Group B

Background: Adenoidectomy is one of the commonest operations done on children. It is conventionally performed using the curettage method. This present study was done to compare the results of endoscopic powered adenoidectomy and conventional adenoidectomy.Methods: The present prospective randomized study was conducted among 50 patients between 4-16 years of age requiring adenoidectomy with or without tonsillectomy in department of ENT in Government Medical College and Rajindra Hospital, Patiala. All the 50 patients were divided into two groups (group A and group B) by systematic random sampling. Group A consisted of 25 patients who underwent conventional curettage adenoidectomy and group B consisted of 25 patients who underwent Microdebrider-Assisted Adenoidectomy. Results: In group A and B, mean±SD intraoperative blood loss (in ml) was 20.60±7.96 and 30.60±7.96 respectively. Mean±SD operative time (in minutes) was 28.60±4.71 in group A, while in group B it was 39.60±4.71 with statistically significant difference. Complete adenoid removal was found in 52% of the subjects in group A while it was found in 96% of the subjects in group B with statistically significant difference. In group A, mean±SD recovery time (in hrs) observed was 33.52±10.58 while in group B, recovery time (in hours) observed was 36.22±11.31.Conclusions: Based on the results of this study, it can be concluded that the new method of microdebrider assisted powered adenoidectomy was found to be safer and more useful tool for adenoidectomy than conventional method.

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The Gaseous Ozone Therapy as a Promising Antiseptic Adjuvant of Periodontal Treatment: A Randomized Controlled Clinical Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020985 ◽

2022 ◽

Vol 19 (2) ◽

pp. 985

Author(s):

Biagio Rapone ◽

Elisabetta Ferrara ◽

Luigi Santacroce ◽

Skender Topi ◽

Antonio Gnoni ◽

...

Keyword(s):

Therapy Group ◽

Randomized Study ◽

Periodontal Treatment ◽

Controlled Clinical Trial ◽

Ozone Therapy ◽

Periodontal Tissues ◽

Gaseous Ozone ◽

Significant Difference ◽

Group A ◽

Group B

Background: the establishment of periodontitis is regulated by the primary etiological factor and several individual conditions including the immune response mechanism of the host and individual genetic factors. It results when the oral homeostasis is interrupted, and biological reactions favor the development and progression of periodontal tissues damage. Different strategies have been explored for reinforcing the therapeutic effect of non-surgical periodontal treatment of periodontal tissue damage. Gaseous ozone therapy has been recognized as a promising antiseptic adjuvant, because of its immunostimulating, antimicrobial, antihypoxic, and biosynthetic effects. Then, we hypothesized that the adjunct of gaseous ozone therapy to standard periodontal treatment may be leveraged to promote the tissue healing response. Methods: to test this hypothesis, we conducted a prospective randomized study comparing non-surgical periodontal treatment plus gaseous ozone therapy to standard therapy. A total of 90 healthy individuals with moderate or severe generalized periodontitis were involved in the study. The trial was conducted from September 2019 to October 2020. Forty-five patients were randomized to receive scaling and root-planning (SRP) used as conventional non-surgical periodontal therapy plus gaseous ozone therapy (GROUP A); forty-five were allocated to standard treatment (GROUP B). The endpoint was defined as the periodontal response rate after the application of the ozone therapy at 3 months and 6 months, defined as no longer meeting the criteria for active periodontitis. Statistical analysis was performed employing SPSS v.18 Chicago: SPSS Inc. Results: periodontal parameters differed significantly between patients treated with the two distinct procedures at 3 months (p ≤ 0.005); a statistically significant difference between groups was observed from baseline in the CAL (p ≤ 0.0001), PPD (p ≤ 0.0001) and BOP (p ≤ 0.0001) scores. Conclusions: The present study suggests that SRP combined with ozone therapy in the treatment of periodontitis revealed an improved outcome than SRP alone.

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Clinical Effect of Lateral Transforaminal Endoscopic Surgery in the Treatment of Lumbar Disc Herniation

Proceedings of Anticancer Research ◽

10.26689/par.v5i6.2806 ◽

2021 ◽

Vol 5 (6) ◽

pp. 68-72

Author(s):

Weiya Zhang

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Endoscopic Surgery ◽

Early Stage ◽

Lumbar Disc ◽

Normal Function ◽

Significant Difference ◽

Group A ◽

Group B ◽

Transforaminal Endoscopic Surgery

Objective: To analyze the efficacy of lateral transforaminal endoscopic surgery in the treatment of lumbar disc herniation. Methods: A total of 44 patients with lumbar disc herniation, treated in Yancheng No.1 People’s Hospital from January 2019 to June 2020, were randomly divided into two groups; the 24 patients in group A were treated by lateral transforaminal endoscopic surgery, while the 20 patients in group B were treated by routine lamina fenestration and nucleus pulposus surgery. Results: The curative effect of group A (91.67%) was higher than that of group B (85.0%), P > 0.05; there was no significant difference in the angle from straight leg raise between group A and group B (P > 0.05); the Oswestry Disability Index (ODI) and the visual analogue scale (VAS) of group A were lower than those of group B (P < 0.05); the incision length, intraoperative blood loss, and hospital stay of the patients in group A were better than those in group B, P < 0.05. Conclusion: Lateral transforaminal endoscopic surgery can significantly reduce pain, improve symptoms, and help to restore normal function in the early stage for patients with lumbar disc herniation.

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Topical vancomycine and bacterial culture from intervertebral herniated disc prevent postoperative osteodiscitis

Romanian Neurosurgery ◽

10.2478/romneu-2014-0057 ◽

2014 ◽

Vol 21 (4) ◽

pp. 417-422

Author(s):

Danil Adam ◽

Toma Papacocea ◽

Ioana Hornea ◽

Cristiana Moisescu

Keyword(s):

Intervertebral Disc ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Bacterial Infections ◽

Lumbar Disc ◽

Postoperative Treatment ◽

Herniated Disc ◽

Open Approach ◽

Group A ◽

Group B

Abstract Osteodiscitis represents a serious complication of lumbar disc herniation operations. The treatment of osteodiscitis is controversial and expensive to society. It extends over a period of several months from diagnosis. Reducing postoperative osteodiscitis by using simple measures may limit patient's suffering and reduce costs. The purpose of this study is to evaluate the early diagnosis of bacterial infections of the intervertebral disc by isolating germs located in the herniated disc fragment and topical Vancomycine powder application, along with the conventional anti-infective therapy. Medical files of patients who were operated on for lumbar disc herniations during 01.01.2013 - 30.06.2014 were reviewed. The diagnosis of lumbar disc herniation was established based on the clinical evaluation, confirmed by MRI results. The surgical intervention was performed by mini-open approach: fenestration and foraminotomy completed with removal of the herniated disc fragment and disc remnants from the intervertebral space. A group of 162 patients (group A) received conventional therapy for prevention of post-operative infections with 2 doses of cephalosporin. In the second group of 137 patients (group B), after the removal of the herniated disc fragments, 1g of Vancomycine powder was topically applied and the disc fragments were bacteriologically analyzed. They received the conventional treatment of preventing post-operative infections with cephalosprin - 2 doses. The two groups of patients were similar in terms of demographic characteristics: age, sex, operative level. Out of the 162 patients of group A, one patient developed postoperative osteodiscitis and was treated for 3 months with antibiotics. Regarding patients in group B, in four cases Staphylococcus was isolated from the disc fragments. Postoperative treatment for these patients with prolonged antibiotic therapy over the standard period avoided the developement of the clinical picture of osteodiscitis. Postoperative osteodiscitis requires prolonged antibiotherapy. By using simple measures, like topical Vancomycine powder application and early isolation of germs from the herniated intervertebral disc, followed by the immediate establishment of appropriate antibiotic treatment, this serious complication is avoided.

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