scholarly journals FUNCTIONAL RESULTS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY

2017 ◽  
Vol 16 (2) ◽  
pp. 101-105 ◽  
Author(s):  
MARVIN JESUALDO VARGAS UH ◽  
AMADO GONZÁLEZ MOGA ◽  
HUGO SANTOS BENITEZ ◽  
GABRIEL HUERTA HERNANDEZ ◽  
JUAN ENRIQUE GUZMÁN CARRANZA
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Functional Results ◽  
Neurological Status ◽  
Japanese Orthopedic Association ◽  
Hyperintense Signal ◽  
Grade Ii ◽  
The Mean ◽  
Neurological State

ABSTRACT Objective: To analyze the functional outcome of surgical treatment of cervical spondylotic myelopathy. Methods: A retrospective study involving 34 patients with CSM, operated from January 2014 to June 2015. The neurological status was assessed using the Nurick and modified Japanese Orthopedic Association (mJOA) scales preoperatively and at 12 months. Sex, age, time of evolution, affected cervical levels, surgical approach and T2-weighted magnetic resonance hyperintense signal were also evaluated. Results: A total of 14 men and 20 women participated. The mean age was 58.12 years. The average progression time was 12.38 months. The preoperative neurological state by mJOA was mild in 2 patients, moderate in 16 and severe in 16, with a mean of 11.44 points. The preoperative Nurick was grade II in 14 patients, grade III in 8, grade IV in 10 and grade V in 2. The T2-weighted hyperintense signal was documented in 18 patients (52.9%). The functional outcome according to the mJOA recovery rate was good in 15 patients (44.1%) and poor in 19 (55.9%). The degree of Nurick recovery was good in 20 (58.8%) and poor in 14 (41.2%). Conclusions: Decompressive surgery of the spinal cord has been shown to be effective in the treatment of cervical spondylotic myelopathy in well-selected patients. Although it is suggested that there are certain factors that correlate with functional outcome, we believe that more prospective randomized studies should be conducted to clarify this hypothesis.

scholarly journals Functional outcome assessment for surgical decompression of cervical spondylotic myelopathy

2021 ◽  
Vol 9 (1) ◽  
pp. 70
Author(s):  
Tinu Ravi Abraham ◽  
Ajax John ◽  
P. K. Balakrishnan ◽  
Tom Jose
Keyword(s):  
Spinal Cord ◽  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Functional Results ◽  
Surgical Decompression ◽  
Herniated Disc ◽  
Average Hospital ◽  
Japanese Orthopedic Association ◽  
Cost Effective Treatment

Background: Cervical spondylotic myelopathy (CSM) is one of the most common dysfunctions of spinal cord occurs due to degenerative changes in cervical spine disc and facet joints. It is a form of progressive spine disease including herniated disc and spinal cord stenosis which manifests as changes in gait, skilled hand movements, muscle strength, bladder dysfunction etc. Recent studies and trials have established that surgical decompression of cervical spinal is a cost-effective treatment modality which provide satisfactory functional recovery. This study aimed at the functional outcome of surgical decompression of CSM.Methods: The prospective study of 100 cases of cervical myelopathy for which decompressive surgery was done from August 2020 to August 2021. Results were analysed according to Nuricks and modified Japanese orthopedic association scoring system (MJOA).Results: Seventy one males and 29 females were included in this study with average age was 53 and average hospital stay was 3.55 days. Average pre-op Nurick score was 1.93, while score after 6 months and 1year were 1.44 and 1.15respectively. Average pre-op MJOA score was 13.63, while score after 6 months and 1 year were 14.58 and 15.74 respectively.Conclusions: The functional results of decompressive surgeries for cervical myelopathy are satisfactory. Both anterior and posterior approaches are recommended for multiple cervical myelopathy with comparable outcomes. DM and age was observed as the independent predictor for functional outcome, while, gender and level of disease got less significant predictive value.

scholarly journals Scrotal reconstruction with superomedial fasciocutaneous thigh flap

2018 ◽  
Vol 45 (1) ◽  
Author(s):  
DANIEL FRANCISCO MELLO ◽  
AMERICO HELENE JÚNIOR
Keyword(s):  
Surgical Treatment ◽  
Complication Rate ◽  
Longitudinal Direction ◽  
Functional Results ◽  
Fasciocutaneous Flap ◽  
Surgical Time ◽  
Cross Sectional ◽  
Skin Loss ◽  
Scrotal Reconstruction ◽  
The Mean

ABSTRACT Objective: to describe the use of a superomedial fasciocutaneous thigh flap for scrotal reconstruction in open areas secondary to the surgical treatment of perineal necrotizing fasciitis (Fournier’s gangrene). Methods: retrospective analysis of cases treated at the Plastic Surgery Service of Santa Casa de Misericórdia, São Paulo, from 2009 to 2015. Results: fifteen patients underwent scrotal reconstruction using the proposed flap. The mean age was 48.9 years (28 to 66). Skin loss estimates in the scrotal region ranged from 60 to 100%. Definitive reconstruction was performed on average 30.6 days (22 to 44) after the initial surgical treatment. The mean surgical time was 76 minutes (65 to 90) to obtain the flaps, bilateral in all cases. Flap size ranged from 10cm to 13cm in the longitudinal direction and 8cm to 10cm in the cross-sectional direction. The complication rate was 26.6% (four cases), related to the occurrence of segmental and partial dehiscence. Conclusion: the superomedial fasciocutaneous flap of thigh is a reliable and versatile option for the reconstruction of open areas in the scrotal region, showing adequate esthetic and functional results.

scholarly journals Role of leukocyte free platelet rich plasma in planter fasciitis: a prospective study

2017 ◽  
Vol 5 (12) ◽  
pp. 5432
Author(s):  
Chandre Shekhar ◽  
Alamgir Jhan ◽  
Ganesh Singh ◽  
Pankaj Singh ◽  
Shailendre S. Bhandhari
Keyword(s):  
Placebo Group ◽  
Functional Outcome ◽  
Platelet Rich Plasma ◽  
Functional Results ◽  
Visual Analogue Scale Pain ◽  
Functional Score ◽  
Outcome Scores ◽  
The Mean ◽  
Post Graduate Institute

Background: Planter fasciitis, is by definition, inflammation of planter fascia. Most of the cases are well treated conservatively and a few responds to surgery only. Objectives of present study were evaluating the efficacy of a single injection of leukocyte free platelet rich plasma in plantar fasciitis and to derive a correlation between the clinical and radiological outcome.Methods: The present study consisted of 120 patients of bilateral (PF), (240 feet). These patients were divided into two groups PRP group of 60 patients and Placebo group of 60 patients. The study was conducted on patients attending Orthopaedics outpatient department Post Graduate Institute of Medial Education and Research (PGIMER) from July 2011 to June 2012. A primary efficacy criterion was changes from baseline in pain using (VAS). Functional results, level of satisfaction and outcome were measured by – AOFAS Foot Scale. Correlation of clinical with radiological outcome were performed.Results: There was a significant decrease in the visual analogue scale (pain score) in the PRP. Group while in placebo group it was increased significantly at the end of 6 month. Functional outcome scores were improved significantly from their baseline values in PRP group while in placebo group the mean functional score were deteriorated at 6 months follow up. There was no improvement seen in functional status with normal saline injection. In PRP group the mean heal pad thickness was reduced significantly at 6 months follow up while in placebo group was not changed significantly at 6 months follow up. Correlation between radiological parameters and VAS was found to be positive while it was found negative with other functional outcome scores like AOFAS.Conclusions: Platelet-rich plasma (PRP), which is a natural concentrate of autologous growth factors,plays a role in the regeneration process in treatment of (PF).

Scaphoid Non-Union: Factors Affecting the Functional Outcome of Open Reduction and Wedge Grafting with Herbert Screw Fixation

1993 ◽  
Vol 18 (2) ◽  
pp. 219-224 ◽  
Author(s):  
R. NAKAMURA ◽  
E. HORII ◽  
K. WATANABE ◽  
K. TSUNODA ◽  
T. MIURA
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Open Reduction ◽  
Screw Fixation ◽  
Functional Results ◽  
Bony Union ◽  
Proximal Fragment ◽  
Factors Affecting ◽  
Non Union ◽  
Herbert Screw

50 patients with scaphoid non-union were treated by open reduction, anterior wedge bone grafting and internal fixation using the Herbert screw. Intra-operative image intensiner control enabled us to insert the screw into the scaphoid accurately. An excellent or good functional outcome was less likely when more than 5 years had elapsed since injury, the non-union was in the proximal third, when sclerosis of the proximal fragment was present, and when reduction of carpal and scaphoid deformity was unsatisfactory. These four factors are believed to be the primary determinants affecting the functional results of the surgical treatment of scaphoid non-union, even when bony union is achieved.

Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

2012 ◽  
Vol 16 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masatoshi Sumi ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Shuichi Kaneyama ◽  
Takako Kanatani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Mr Imaging ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Rank Test ◽  
Imaging Findings ◽  
Significant Difference ◽  
The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

scholarly journals Predictive Factors Influencing Functional Results After Proximal Hamstring Tendon Avulsion Surgery: A Patient-Reported Outcome Study After 227 Operations From a Single Center

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110430
Author(s):  
Raymond Best ◽  
Anorte Meister ◽  
Malin Meier ◽  
Jochen Huth ◽  
Ulrich Becker
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Predictive Factors ◽  
Hamstring Tendon ◽  
Patient Reported ◽  
Duration Of Surgery ◽  
The Mean ◽  
Concomitant Factors ◽  
Proximal Hamstring ◽  
Tendon Avulsion

Background: Although debilitating, proximal hamstring tendon avulsion injuries are rare and often overlooked or misdiagnosed. Consequently, delayed diagnosis and surgical treatment may result in poor outcomes. Studies investigating a correlation between postoperative functional outcomes and this delay in surgical treatment or other concomitant factors in large cohorts have not yet been performed to our knowledge. Purpose/Hypothesis: The purpose of this study was to conduct an investigation in a large patient group regarding factors that could influence a patient’s functional outcome after hamstring surgery. We hypothesized that this outcome would significantly correlate to the time between trauma and surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients who received surgical treatment of proximal hamstring tendon avulsion injuries in our institution between the years 2010 and 2020 were asked to complete a validated, injury-specific outcome measurement, the Perth Hamstring Assessment Tool (PHAT; 0-100 points). In addition to calculating these outcomes, we evaluated the association of the obtained results with possible predictive factors such as age, sex, stump retraction shown on magnetic resonance imaging (MRI), and timing and duration of surgery. Results: A total of 226 patients (227 operations) were eligible for the study, and 204 cases of hamstring tendon avulsion injury met our inclusion criteria. The return rate for the PHAT questionnaire was 85.3%. The mean PHAT score revealed good results (79.8 ± 19.1). Irrespective of concomitant factors, the scores of male patients were significantly higher compared with those of female patients (83.8 ± 16.9 vs 75.8 ± 20.6 respectively; P = .004). The mean time to surgery was 5.7 weeks after trauma, and more delayed surgery correlated significantly with lower PHAT scores ( P = .003; r = –0.228). The mean degree of stump retraction on MRI (5 cm) did not significantly influence PHAT scores ( P = .525; r = –0.06). Conclusion: Delay of surgery and female sex were disadvantageous in terms of a good functional outcome measure (PHAT score) after hamstring tendon refixation surgery. By contrast, patient age as well as the retraction of the tendon stump on preoperative MRI did not influence PHAT scores in the present study.

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 Surgical Treatment of Cervical Spondylotic Myelopathy Leads to Functional Improvement in Hand Strength and Dexterity: A Prospective Quantitative Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tyler S Cole ◽  
Kaith K Almefty ◽  
Jakub Godzik ◽  
Randall Hlubek ◽  
Jay D Turner
Keyword(s):  
Surgical Treatment ◽  
Grip Strength ◽  
Cervical Spondylotic Myelopathy ◽  
Hand Function ◽  
Functional Improvement ◽  
Pinch Strength ◽  
Japanese Orthopedic Association ◽  
Signal Change ◽  
Spinal Cord Dysfunction ◽  
Postoperative Improvement

Abstract INTRODUCTION Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. The goal of this study was to establish the functional impact of CSM severity on hand function using quantitative testing and evaluate the response to intervention. METHODS A total of 33 consecutive patients planned for surgical treatment of CSM were prospectively enrolled. A licensed occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to assess grip strength, 2) hydraulic pinch gauge test to assess pinch strength, and 3) 9-hole peg test to assess upper extremity dexterity. Tests were performed preoperatively and at 6 to 8 wk postoperatively. Patients were stratified into mild, moderate, and severe myelopathy based on modified Japanese Orthopedic Association (mJOA) score. RESULTS 61% patients underwent anterior approach decompression with mean of 2.9 ± 1.5 levels treated. Preoperative pinch (P < .001) and grip (P = .014) strength were lower in moderate and low mJOA patients compared to high mJOA patients. Significant postoperative improvement was observed in all hand function domains with MCI improvement at 6 wk ranging from 33% of patients in dominant strength tests to 72% of patients in nondominant dexterity tests; patients with moderate baseline mJOA were more likely to have MCI improvement in dominant grip (58.3%) compared to low (30%) and high (9%) mJOA groups (P = .041). Dexterity as measured by mean dominant peg percentile was less than 1 in patients with cord signal change increasing in percentile to 15.7 with only subarachnoid effacement (P = .032). CONCLUSION CSM patients achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated most with preoperative mJOA, however baseline dexterity correlated most with severity of stenosis on MRI. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA were the most likely to have improvement in dominant grip strength postoperatively.

scholarly journals The results of surgical treatment for cervical spondylotic myelopathy

2005 ◽  
Vol 52 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Danilo Radulovic ◽  
S. Ivanovic ◽  
M. Jokovic ◽  
G. Tasic
Keyword(s):  
Surgical Treatment ◽  
Cervical Spondylotic Myelopathy ◽  
Intervertebral Disc Degeneration ◽  
Functional Results ◽  
Surgical Decompression ◽  
Grading System ◽  
Operative Complications ◽  
Postoperative Improvement ◽  
Selection Of

Objective: Cervical spondylotic myelopathy is the most serious consequence of cervical intervertebral disc degeneration. The purpose of this study is to evaluate functional results of surgical treatment of patients with cervical spondylotic myelopathy who underwent anterior or posterior decompressive operations. Methods: we prospectively analyzed 57 patients with cervical spondylotic myelopathy who were operated in Institute for Neurosurgery in Belgrade (1995-2002). The severity of myelopathy is graded by Nurick myelopathy grading system. The average follow-up period was 20 months. Results: Postoperative improvement showed 75% of patients and 21% remained unchanged. Myelopathy worsening was observed in two patients, 4%. We didn't have serious operative complications. Selection of surgical approach was not significantly correlated with surgical outcome. Conclusion: surgical decompression of cervical medulla is safe treatment that gives good chances for functional recovery in patients with cervical spondylotic myelopathy.

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