scholarly journals MINIMALLY INVASIVE SPINE SURGERY IN THE NUEVO HOSPITAL CIVIL DE GUADALAJARA "DR. JUAN I. MENCHACA"

2016 ◽  
Vol 15 (4) ◽  
pp. 267-271
Author(s):  
MIGUEL ÁNGEL ANDRADE-RAMOS ◽  
YAZMÍN LEMUS-RODRÍGUEZ ◽  
EDGAR FERNANDO ACOSTA-GÓMEZ ◽  
SERGIO VALENTE ESPARZA-GUTIÉRREZ ◽  
FRANCISCO GUERRERO-JAZO ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Case Series ◽  
Neurological Status ◽  
Minimal Invasive ◽  
Bleeding Complications ◽  
Short Term ◽  
Adjacent Structures

ABSTRACT Objective: To describe our experience on a case series treated with minimal invasive techniques in spine surgery, with short-term follow-up and identify complications. Methods: A prospective analysis was performed on 116 patients operated on by the same team from September 2015 to June 2016. Evaluating the short-term follow-up we registered the surgical time, bleeding, complications, hospital stay, pre- and postoperatively neurological status, as well as scales of disability and quality of life. Demographic and surgical procedure data were analyzed with SPSS version 20 program. Results: A total of 116 patients with a mean age of 49.7 + 15.7 (21-85 years) underwent surgery being 76 (65%) with lumbar conditions and 37 (32%) with cervical conditions. The most common procedures were tubular discectomies (31), tubular bilateral decompression (17), lumbar MI-TLIFs (7), and anterior cervical discectomy and fusion (35). The mean blood loss was 50.6 cc, the hospital stay was 1.7 day, pre- and postoperative pain VAS were 7.4 % and 2.3%, respectively, pre- and postoperative Oswestry (ODI) were 64.6% and 13.1%, respectively, pre- and postoperative SF-36 of 37.8% and 90.3%. There were no major complications, except for a surgical wound infection in diabetic patient and three incidental durotomies, one of these being a contained fistula, treated conservatively. Conclusions: The current tendency towards minimally invasive surgery has been justified on multiple studies in neoplastic and degenerative diseases, with the preservation of the structures that support the spine biomechanics. The benefits should not replace the primary objectives of surgery and its usefulness depends on the skills of the surgeon, pathology and the adequate selection of the techniques. We found that the tubular access allows developing techniques such as discectomy, corpectomy and fusion without limiting exposure, avoiding manipulation of adjacent structures, reducing complications and being feasible in a public hospital.

scholarly journals A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

2016 ◽  
Vol 40 (6) ◽  
pp. E7 ◽  
Author(s):  
Syed F. Abbas ◽  
Morgan P. Spurgas ◽  
Benjamin S. Szewczyk ◽  
Benjamin Yim ◽  
Ashar Ata ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Neck Disability Index ◽  
Case Series ◽  
Patient Characteristics ◽  
Short Term ◽  
Instrumented Fusion ◽  
Minimally Invasive Surgical ◽  
Neck Disability

OBJECTIVE Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi). METHODS A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure. RESULTS Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p < 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011). CONCLUSIONS The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive surgical approach that appears to result in similar clinical outcomes when compared with a well-accepted strategy of ventral decompression and instrumented fusion. The current results suggest that future comparative effectiveness studies are warranted as the miPCD technique avoids instrumented fusion.

scholarly journals Outcome of minimal invasive surgery approach for spine infection: a systematic review

2019 ◽  
Vol 7 (11) ◽  
pp. 4422
Author(s):  
Ketut Gede Mulyadi Ridia
Keyword(s):  
Systematic Review ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Spine Surgery ◽  
Invasive Surgery ◽  
Minimal Invasive Surgery ◽  
Minimal Invasive ◽  
Spine Infection ◽  
Minimally Invasive Spine

The concept of minimally invasive surgery has gained increasing popularity in the last several decades, are being introduced as an alternative to limit the surgical complications while achieving best possible outcome. While minimally invasive spine surgery holds promise for lower blood loss, faster patient recovery, shorter hospital stays, and the potential to transition procedures to the ambulatory setting, safety in spinal surgery remains paramount and has (appropriately) tempered some of the enthusiasm for the results of aggressive early adapters. Until now, there has been no literature summarizing the evidence of MIS outcome in treating spondylitis TB of the bone. The purpose of this systematic review was to investigate the outcome of minimal invasive surgery approach for spine infection. authors comprehensively searched PubMed, EMBASE, and Cochrane Library to search for studies about minimally invasive surgery as management of tuberculous spondylitis up to June 7th, 2019. The selection of appropriate studies was performed by independent investigators based on PRISMA guideline. Given the limited number of studies, there was no restriction in terms of patient’s demographics, the specific minimal invasive surgical method, and publication status. Authors identified the method for minimally invasive approach and open approach, the functional outcome, intraoperative outcome, radiological outcome, length of stay, follow up period, and complication. Authors found 81 articles from database. After evaluating full text, 8 articles (346 patients) were found to be eligible. More than 110 patients were treated with open spine surgery, while more than 270 patients were treated using minimally invasive spine surgery the minimal invasive methods were posterior pedicle screws fixation, plate fixation, lateral nail bar fixation, and bilateral pedicle screw fixation. The visualization methods include C-arm fluoroscopy, X-ray fluoroscopy. The follow-up period ranges from 1 to 40 months. The functional outcome were found to be satisfying with minimal complications. MIS yielded satisfactory result in comparison to conventional open surgery for spine infection. More long term future studies should be conducted to in order to search for more solid evidence regarding this claim.

Rhabdomyolysis and acute renal failure following minimally invasive spine surgery

2011 ◽  
Vol 14 (6) ◽  
pp. 785-788 ◽  
Author(s):  
Elias Dakwar ◽  
Stephen I. Rifkin ◽  
Ildemaro J. Volcan ◽  
J. Allan Goodrich ◽  
Juan S. Uribe
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Operative Time ◽  
Case Series ◽  
Potential Complication ◽  
Minimally Invasive Spine ◽  
The Mean

Minimally invasive spine surgery is increasingly used to treat various spinal pathologies with the goal of minimizing destruction of the surrounding tissues. Rhabdomyolysis (RM) is a rare but known complication of spine surgery, and acute renal failure (ARF) is in turn a potential complication of severe RM. The authors report the first known case series of RM and ARF following minimally invasive lateral spine surgery. The authors retrospectively reviewed data in all consecutive patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion with the subsequent development of RM and ARF at 2 institutions between 2006 and 2009. Demographic variables, patient home medications, preoperative laboratory values, and anesthetic used during the procedure were reviewed. All patient data were recorded including the operative procedure, patient positioning, postoperative hospital course, operative time, blood loss, creatine phosphokinase (CPK), creatinine, duration of hospital stay, and complications. Five of 315 consecutive patients were identified with RM and ARF after undergoing minimally invasive lateral transpsoas spine surgery. There were 4 men and 1 woman with a mean age of 66 years (range 60–71 years). The mean body mass index was 31 kg/m2 and ranged from 25 to 40 kg/m2. Nineteen interbody levels had been fused, with a range of 3–6 levels per patient. The mean operative time was 420 minutes and ranged from 315 to 600 minutes. The CPK ranged from 5000 to 56,000 U/L, with a mean of 25,861 U/L. Two of the 5 patients required temporary hemodialysis, while 3 required only aggressive fluid resuscitation. The mean duration of the hospital stay was 12 days, with a range of 3–25 days Rhabdomyolysis is a rare but known potential complication of spine surgery. The authors describe the first case series associated with the minimally invasive lateral approach. Surgeons must be aware of the possibility of postoperative RM and ARF, particularly in morbidly obese patients and in procedures associated with prolonged operative times.

scholarly journals One Year Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0032
Author(s):  
Thomas L. Lewis ◽  
Robbie Ray ◽  
David Gordon
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Patient Reported Outcomes ◽  
Case Series ◽  
Third Generation ◽  
Short Term ◽  
Patient Reported ◽  
The Mean ◽  
One Year

Category: Bunion Introduction/Purpose: The aim of this study was to explore the short-term results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies (MICA) for hallux valgus correction. Between August 2015 and January 2019, 430 MICAs were performed in 295 patients that were eligible for 1 year follow up. Baseline and 1 year post-operative patient reported outcomes were collected for 242 feet in 194 patients (182 females; 12 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 55.9 (range 16.3-84.9, standard deviation (s.d.) 12.5). At one year follow up, the mean MOXFQ scores had improved for each domain: Pain; baseline 41.9 (range 0-100, s.d. 21.8), reduced to 13.8 (range 0-90, s.d. 17.7, p<0.001); Walking; baseline 34.6 (range 0-100, s.d. 24.3) reduced to 9.8 (range 0-89.0, s.d. 18.0, p<0.001); Social interaction; baseline 45.4 (range 0-100, s.d. 22.8), reduced to 8.2 (range 0-75.0, s.d. 14.7, p<0.001). Mean VAS Pain score improved from 29.8 (range 0.0-90.0, s.d. 22.1) to 8.2 (range 0.00-64.0, s.d. 12.8, p<0.001). Mean EQ-5D index score improved from 0.755 (range 0.066-1.000, s.d. 0.136) to 0.891 (range 0.350-1.000, s.d. 0.124, p<0.001). Mean EQ-5D VAS score improved from 83.4 (range 28- 100, s.d. 12.4) to 85.6 (range 0-100, s.d. 14.2, p=0.047). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 1 year. This cohort is being followed over the longer term.

scholarly journals Six Month Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0033
Author(s):  
Thomas L. Lewis ◽  
Robbie Ray ◽  
David Gordon
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Patient Reported Outcomes ◽  
Case Series ◽  
Third Generation ◽  
Short Term ◽  
Specific Patient ◽  
Patient Reported ◽  
The Mean

Category: Bunion Introduction/Purpose: The aim of this study was to explore the short-term results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies for hallux valgus correction. Between August 2015 and July 2019, 478 MICAs were performed in 328 patients that were eligible for 6 month follow up. Baseline and 6 month post-operative patient reported outcomes were collected for 340 feet in 267 patients (247 females; 20 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 54.9 (range 16.3-84.9, standard deviation (s.d.) 12.8). At 6 month follow up, the mean MOXFQ scores had improved for each domain: Pain; baseline 42.5 (range 0-100, s.d. 22.6), reduced to 16.3 (range 0-100, s.d. 18.4, p<0.001); Walking; baseline 35.5 (range 0-100, s.d. 24.8), reduced to 12.2 (range s.d. 19.1, p<0.001); Social interaction; baseline 45.4 (range 0- 100, s.d. 22.6), reduced to 10.9 (range 0-100.0, s.d. 16.9, p<0.001). Mean VAS Pain score improved from 30.5 (range 0.0-90.0, s.d. 22.1) to 10.5 (range 0.00-78.0, s.d. 14.8, p<0.001). Mean EQ-5D index score improved from 0.752 (range 0.066-1.000, s.d. 0.133) to 0.872 (range 0.122-1.000, s.d. 0.133, p<0.001). Mean EQ-5D VAS score remained static from 82.7 (range 0-100, s.d. 13.3) to 83.7 (range 0-100, s.d. 17.8, p=0.386). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 6 months. This cohort is being followed over the longer term.

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

scholarly journals Early morbidity associated with fasciotomies for acute compartment syndrome in children

2018 ◽  
Vol 12 (5) ◽  
pp. 480-487 ◽  
Author(s):  
K. B. L. Lim ◽  
T. Laine ◽  
J. Y. Chooi ◽  
W. K. Lye ◽  
B. J. Y. Lee ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Compartment Syndrome ◽  
Wound Closure ◽  
Case Series ◽  
Skin Grafting ◽  
Acute Compartment Syndrome ◽  
Inpatient Stay ◽  
Wound Infections ◽  
Short Term ◽  
Level Of Evidence

Purpose Acute compartment syndrome (ACS) requires urgent fasciotomy to decompress the relevant muscle compartment/s prior to onset of irreversible myonecrosis and nerve injury. A fasciotomy is not a benign procedure. This study aims to describe and quantify early morbidity directly associated with fasciotomies for ACS in children. Methods Clinical charts of 104 children who underwent 112 fasciotomies over a 13-year period at a tertiary children’s hospital were reviewed. The following were analyzed: ACS aetiology, fasciotomy site, number of subsequent procedures, method of wound closure, short-term complications and length of hospital stay. Results Short-term complications included wound infections (6.7%) and the need for blood transfusion (7.7%). Median number of additional operations for wound closure was two (0 to 10) and median inpatient stay was 12 days (3 to 63; SD 11.7). After three unsuccessful attempts at primary closure, likelihood of needing skin grafting for coverage exceeded 80%. Analyses showed that fasciotomy-wound infections were associated with higher risk for four or more closure procedures. Number of procedures required for wound closure correlated with longer inpatient stay as did ACS associated with non-orthopaedic causes. Conclusion Fasciotomy is associated with significant early morbidity, the need for multiple closure operations, and prolonged hospital stay. The decision for fasciotomy needs careful consideration to avoid unnecessary fasciotomies, without increasing the risk of permanent injury from missed or delayed diagnosis. Skin grafting should be considered after three unsuccessful closure attempts. Less invasive tests or continuous monitoring (for high-risk patients) for compartment syndrome may help reduce unnecessary fasciotomies. Level of Evidence Level IV, Case series

scholarly journals Tibial Plateau Leveling Following Tibial Tuberosity Advancement: A Case Series

2022 ◽  
Vol 9 (1) ◽  
pp. 16
Author(s):  
Daniele Serrani ◽  
Pierre Paul Picavet ◽  
Juan Marti ◽  
Bernard Bouvy ◽  
Marc Balligand ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Case Series ◽  
Major Complication ◽  
Tibial Tuberosity ◽  
Patellar Ligament ◽  
Short Term ◽  
Long Term Follow Up ◽  
Persistent Instability

Persistent stifle instability is a recognized complication following tibial tuberosity advancement techniques (TTAT). The aim of this study is to report the feasibility and outcome of tibial plateau leveling techniques (TPLT) to treat dogs with persistent lameness, suspected to be secondary to persistent stifle instability, following (TTAT). Medical records of dogs presented for persistent lameness after TTAT were reviewed. Preoperative data included orthopedic examination, lameness score and radiographs. Inclusion criteria included performance of a surgery to address persistent lameness and suspected instability. Short-term follow up data included orthopedic examination and radiographs of the stifle. Long-term follow up was based on postoperative Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Seven dogs were included in the study. Mean subjective preoperative lameness score was 3 ± 1.53. Mean preoperative patellar ligament angle relative to the tibial plateau (PLATP) was 94° and mean tibial plateau angle (TPA) was 28°. Six dogs had tibial plateau leveling osteotomy and one had modified cranial closing wedge ostectomy. Mean postoperative PLATP was 79° and mean TPA was 5°. Mean subjective lameness score at follow up was 0.57 ± 0.49. Minor complications were present in 2 dogs and major complication in 1 dog. Mean LOAD questionnaire score was 6.6/52. TPLT can be performed after TTAT and may improve clinical function and stability in these cases in which persistent instability is suspected.

Doxycycline Injection Treatment for Unicameral Bone Cysts: a Case Series

2021 ◽  
Author(s):  
Andrew Albert ◽  
Monte Squiers ◽  
Eric E. Poole ◽  
Bennett W. Hartley ◽  
Maxwell V. Phillips ◽  
...  
Keyword(s):  
Side Effects ◽  
Matrix Metalloproteinases ◽  
Case Series ◽  
Pathologic Fracture ◽  
Bone Cysts ◽  
Short Term ◽  
Symptom Resolution ◽  
Osteoclast Activity ◽  
Injection Treatment

Abstract Background: Unicameral bone cysts (UBCs) are frequently associated with pathologic fracture due to aggressive osteolysis. Methods/Results: We present a case series (n=5) with complex or refractory bone cysts treated with doxycycline injections that exhibited increased ossification and symptom resolution at short term follow up with minimal side effects. Conclusions: In addition to its antibiotic properties, doxycycline is also known to inhibit matrix metalloproteinases, angiogenesis, and osteoclast activity suggesting that UBCs are dependent on MMP, VEGF or RANKL-mediated osteolysis. Further investigation is warranted regarding the use of doxycycline injections in UBCs.

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