scholarly journals Degenerative scoliosis of the ventricle: diagnosis, classification and surgical approach in older patients

2021 ◽  
Author(s):  
Anton Yarikov
Keyword(s):  
Surgical Treatment ◽  
Physical Therapy ◽  
Conservative Therapy ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Surgical Techniques ◽  
Neurological Status ◽  
Point Of View ◽  
Degenerative Scoliosis ◽  
Instrumental Methods

Adult scoliosis is a deformity of the spine with an angle of more than 10 (according to Cobb) in people with a fully formed bone system. Due to the aging of the population, the improvement of surgical techniques, the appearance of new implants and the improvement of anesthetic aids, the problem of degenerative scoliosis is increasingly being considered from the point of view of the possibilities of surgery. There are many theories that contribute to the formation of degenerative scoliosis. Conservative therapy of degenerative scoliosis includes non-steroidal anti-inflammatory drugs, corset therapy, epidural and paravertebral injections with glucocorticosteroids, physical therapy, and physical therapy. With complete ineffectiveness of conservative therapy and with a significant decrease in the quality of life of the patient, the question of performing surgical intervention is individually decided. Currently, the question of the role and scope of surgical intervention in individuals with this pathology remains debatable. The choice of surgical intervention depends on a thorough assessment of clinical symptoms, neurological status, data of instrumental methods of examination and mandatory consideration of the parameters of the global vertebral-pelvic balance. Therefore, in this article, special attention is paid to the algorithms of surgical treatment based on the choice of the type of decompression and the length of the fusion. The paper describes the generally accepted criteria for selecting the level of spondylosynthesis. Special attention is paid to the risk factors for surgical treatment. As well as the complications associated with surgical treatment are described.

scholarly journals OPTIONS FOR SURGICAL TREATMENT OF CHRONIC C2 ODONTOID FRACTURES

2019 ◽  
Vol 16 (1) ◽  
pp. 16-24
Author(s):  
A. A. Kuleshov ◽  
A. N. Shkarubo ◽  
N. A. Eskin ◽  
M. S. Vetrile ◽  
I. N. Lisyansky ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Odontoid Process ◽  
Neurological Status ◽  
Odontoid Fractures ◽  
Before And After ◽  
Upper Cervical ◽  
Cervical Segment ◽  
C2 Vertebra ◽  
Clinical Cases

The paper presents a review of three clinical cases of treating patients with chronic fractures of the odontoid process of C2 vertebra using various combinations of surgical techniques. In all cases, complete decompression of the spinal cord and stabilization of the upper cervical segment of the spine were achieved. A decrease in the range of motion in the cervical spine was observed, which did not affect patient satisfaction. A gradual regression of the neurological status and increase in muscle strength were recorded. Comparative analysis of the neurological status was carried out before and after surgical treatment. When assessing the general condition of patients using the index of disability due to pain in the neck (NDI), an improvement in the quality of life was noted. These data show the opportunities and peculiarities of methods for treating patients with chronic C2 odontoid fractures.Type of publication: description of clinical cases. Evidence level: IV.

Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

2021 ◽  
Author(s):  
Max J. Scheyerer ◽  
Christian Herren ◽  
Christian Kühne ◽  
Jörg Neufang ◽  
Philipp Pieroh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Therapy ◽  
Surgical Intervention ◽  
Standard Procedure ◽  
Thoracolumbar Spine ◽  
Trauma Surgery ◽  
Treatment Strategies ◽  
German Society ◽  
Surgical Indications ◽  
Pyogenic Spondylodiscitis

Abstract Background Despite advances, the morbidity and mortality rates of patients with spondylodiscitis remains high, with an increasing incidence worldwide. Although conservative therapy has progressed, several cases require surgical intervention. However, the indication and opportunities for surgical treatment are still disputable. Methods In a joint consensus, the members of the ‘Spondylodiscitis’ working group of the Spine Section of the German Society for Orthopaedics and Trauma Surgery considered current literature, particularly the newly published S2k guideline of the AWMF, and examined the surgical indications and treatment strategies for thoracolumbar spondylodiscitis. Results Surgical intervention for spondylodiscitis is only required in a small percentage of patients. In studies comparing conservative and surgical therapies, most patients benefitted from surgery, regardless of the surgical technique selected. Presently, the standard procedure is a combined dorsoventral approach, in which a monolateral attempt should always be made. The choice of material (PEEK, titanium) for ventral support does not influence the clinical result.

scholarly journals Epidemiology of Lateral Ankle Ligament Injury: Trends in Clinical Management and Likelihood of Progression to Surgical Intervention

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
William G. Messamore ◽  
Matthew Vopat ◽  
Brandon L. Morris ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Physical Therapy ◽  
Ankle Sprain ◽  
Ligament Reconstruction ◽  
Surgical Intervention ◽  
Surgical Patients ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: Lateral ankle ligament sprains occur frequently in both general and athletic populations. Most patients recover from their injury without complication, however, some experience persistent pain and instability following lateral ankle injury, which requires treatment with surgical stabilization. The purpose of this study is to determine the utilization and associated costs of non-operative treatment modalities, such as physical therapy (PT), non-steroidal anti-inflammatory medication, and ankle bracing, as well the incidence of lateral ankle sprains that receive surgical treatment and the costs incurred by surgical treatment of chronic lateral ankle instability. Methods: Data was collected using the Pearl Diver Humana dataset using ICD-9, ICD-10, and CPT codes pertaining to ankle sprain, ankle ligament repair or reconstruction, physical therapy, ankle brace ordering, and non-steroidal anti-inflammatory medication (NSAID) ordering. Patients diagnosed with an ankle sprain were sub-divided into three categories: non-operative treatment, surgical ligament repair, and surgical ligament reconstruction. Incidence, cost, and PT usage was compared between patient groups. Cost analysis was performed per group using associated ICD/CPT cost and physical therapy cost. NSAID use and ankle bracing use was also examined. Results: Of patients who sustained lateral ankle injury, 64% were female and 36% were male. 306,180 (98.8%) patients successfully completed non-operative management. 2,774 (1.2%) patients underwent surgical intervention. 63,276 (20.7%) non- operative patients received physical therapy, whereas 1,536 (55.4%) surgically treated patients received PT after surgery. Only 725 (26.1%) surgical patients received pre-operative PT. Median time for total PT treatment of surgical patients was 21.8 weeks, while non-operative patients received treatment for a median time of 58.7 weeks. On average non-operative patients generated 11 billed days in PT while surgical patients received 8 days of PT before surgery and 11 days in PT after surgery. Average total cost per patient was $923.32 for non-operative patients, $3,384.63 for surgical ligament repair, and $3,659.98 for surgical ligament reconstruction. Conclusion: The vast majority of patients with lateral ankle ligament sprains do not progress to surgical treatment. Patients treated non-operatively used fewer physical therapy visits per patient and generated less cost compared to surgically treated patients. Only 20% of non-operative patients received physical therapy. Additionally, a higher proportion of surgically treated patients participated in PT compared to patients treated non-operatively.

scholarly journals Surgical treatment of children with complications of foreign bodies of the gastrointestinal tract

2021 ◽  
pp. 221-225
Author(s):  
Yu. Yu. Sokolov ◽  
S. A. Korovin ◽  
D. V. Donskoy ◽  
G. T. Tumanyan ◽  
A. V. Dzyadchik
Keyword(s):  
Surgical Treatment ◽  
Gastrointestinal Tract ◽  
Foreign Bodies ◽  
Surgical Intervention ◽  
Clinical Stage ◽  
Clinical Manifestations ◽  
Clinical Stages ◽  
Complicated Course ◽  
Laparoscopic Techniques ◽  
Instrumental Methods

Introduction. At the present time the expansion of the spectrum of urgent diseases of the abdominal cavity organs is registered due to the patients with complications of foreign bodies of the gastrointestinal tract. Development of rational treatment-diag nostic algorithm will promote to improve the results of surgical treatment of children with complications of foreign bodies of gastrointestinal tract.Aim. To determine the efficacy of laparoscopic techniques in children with complications of foreign bodies of the gastrointestinal tract..Materials and methods. 38 children with foreign bodies of the gastrointestinal tract of different characteristics, which required surgical treatment, were included in the study.Results and discussion. On the basis of analysis of clinical and medical history data, results of instrumental methods of preoperative diagnostics and laparoscopy three clinical stages of the disease were distinguished. Statistically reliable differences of the presented indicators in different terms of the disease were proved. Surgical intervention involved laparoscopy, during which the volume of surgical intervention was specified. Laparoscopic techniques were effective in the groups of patients with I, II and III stages of the disease in 100, 46 and 20% of observations, respectively.Conclusions. Clinical manifestations in complications of foreign bodies of the gastrointestinal tract are determined by the characteristics of the latter and the clinical stage of the disease. Laparoscopic techniques can be effective at initial stages of the disease. At a complicated course of the disease the required volume of surgical intervention can be performed during laparotomy. The variety of clinical manifestations of foreign bodies of the gastrointestinal tract complications is determined by the characteristics of the damaging agents and the clinical stage of the disease. Laparoscopic techniques of surgical treatment may be a priority in the absence of a complicated course of the disease; in late stages of the disease laparotomy is the operation of choice.Conclusion. Analysis of treatment results of children with complications of FBs of GIT revealed statistically significant differences in some clinical and anamnestic data, results of instrumental methods of preoperative diagnosis and intraoperative manifestations, which allowed us to define three clinical stages of the disease.

scholarly journals LONG-TERM RESULTS AFTER VIDEO ENDOSCOPIC MYOTOMY BY HELLER WITH FUNDOPLICATION BY DOR IN PATIENTS WITH 2-4 STAGES OF ACHALASIA

2021 ◽  
pp. 40-49
Author(s):  
V. A. Gankov ◽  
E. A. Tseimakh ◽  
G. I. Bagdasaryan ◽  
A. R. Andreasyan ◽  
S. A. Maslikova
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Long Term Results ◽  
Esophageal Function ◽  
X Ray ◽  
Leading Symptom ◽  
Instrumental Methods

Relevance. Treatment of achalasia of the cardia (AС) is currently palliative, aimed at reducing the manifestation of clinical symptoms of the disease. Together with instrumental methods of examination of esophageal function, the Eckardt scale and the GIGLI questionnaire are convenient and simple tools for evaluating results in the long-term postoperative period.The aim of the study was to evaluate the long-term results of surgical treatment of patients with 2-4 stages of AС, after laparoscopic Нeller myotomy with anterior hemiesophagofundoplication by Dor to the results of special methods of esophageal examination and patient questionnaires using the Eckardt scale and the GIGLI questionnaire.Materials and methods. The work included the results of examinations of 103 patients who underwent video laparoscopic Нeller myotomy, with anterior hemiesophagofundoplication by Dor. The period of examination in the postoperative period was from 3 to 7 years. The results of X-ray examination of the esophagus and stomach, manometry of the esophageal and esophageal-gastric junction before and after surgery were studied , and patients were also surveyed according to the Eckardt scale and the GIGLI questionnaire.Results. The analysis of the results of instrumental methods of studying the function of the esophagus in the pre – and postoperative periods showed that the given manometry of the esophagus and esophageal-gastric junction, X-ray of the esophagus and stomach significantly improved in the postoperative period in patients with all stages of the disease. The results of patients of 4th stage AC compared with the results of 2nd and 3rd stages patients were worse(p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the results were better in patients with stage 2, worse in patients with stage 4 of AK (p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the 2nd stage patients results were better, 4th stage patients results were worse (p<0,05).Conclusions. After video-endoscopic Нeller myotomy with fundoplication by Dor, the indicators of esophageal manometry and esophageal and stomach radiography significantly improve, the results of the Eckardt scale and GIGLI questionnaire survey of patients show a significant decrease in the severity of clinical manifestations of AC in the balls. This method of surgical treatment can be recommended already at the 2nd stage of AC and as an organpreserving operation for 4th stage.

On the question of peptic ulcers of the anastomosis and jejunum

1930 ◽  
Vol 26 (8) ◽  
pp. 793-796
Author(s):  
N. I. Shaviner
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Clinical Course ◽  
Point Of View ◽  
Peptic Ulcers ◽  
Duodenal Ulcers ◽  
Gastric Or Duodenal Ulcers

The reasons for the occurrence of peptic ulcers after one or another surgical intervention for gastric or duodenal ulcers remain poorly understood. Indications of ulcerative constitutions, methods of surgical intervention, deficiencies in instrumentation, etc., as the causes of peptic ulcers, remain purely theoretical. The study of this question, obviously, should proceed along the path of collecting a lot of material and comparing individual cases. To this end, we present in this report two observations of postoperative peptic ulcers, which, from our point of view, are of interest both in terms of clinical course and surgical treatment.

scholarly journals Outpatient management of patients with discogenic lumbosacral radiculopathy

2021 ◽  
pp. 420-425
Author(s):  
V. S. Prokopovich
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Muscle Relaxant ◽  
Conservative Therapy ◽  
Surgical Intervention ◽  
Outpatient Management ◽  
Lumbosacral Radiculopathy ◽  
Intravenous Drip ◽  
Outpatient Practice ◽  
Group B

Disсоgenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pains, but has a worse forecast and is more often accompanied by a long disabilities. Most patients with DLSR can effectively be treated under polyclinic conditions, but it is not clear how effective conservative methods of DLSR therapy are used in real outpatient practice. This study was carried out in order to analyze the outpatient maintenance of patients with DLSR, which were surgical treatment (lumbar microdiskectomy) due to the ineffectiveness of conservative therapy.Materials and methods. 90 patients (33 men, 57 women, average age – 59.78 ± 12) years suffered surgical treatment (microdiskectomy) due to the ineffectiveness of conservative DLSR. The duration of the disease to operation ranged from 2 to 14 weeks and was an average of 6 ± 3 weeks.Results. Patients were not informed about the favorable course of the DLSR, the possibilities of natural (without surgical intervention) of the regression of the disk hernia, as well as expediency to maintain all types of activity, avoid a long bed mode. Only half of the patients were conducted by therapeutic gymnastics. 94.4% of patients received non-steroidal anti-inflammatory funds, 92.2% – muscle relaxant, 79.8% – a complex of vitamins of group B, and epidural blockade with anesthetics and corticosteroids were not used. Relatively widely used ineffective methods of therapy of the DLSR: paravertebral blockade of analgesics (42.2%), intravenous drip administration of actovegin and/or pentoxyfalline (26.7%), magnetotherapy and/or laser and therapy (36.7%).Conclusion. In an outpatient practice, patients with DLSR do not receive effective conservative treatment, which may be a reason for the early (after 6 weeks) directions for surgical treatment. Polyclinic doctors are poorly informed about the effective conservative methods of DLSR therapy.

scholarly journals DIAGNOSIS AND EMERGENCY SURGICAL TREATMENT OF GIANT LEFT ATRIAL SARCOMA: CLINICAL CASES

2019 ◽  
Vol 34 (1) ◽  
pp. 130-136
Author(s):  
G. E. Gogin ◽  
N. V. Eremina ◽  
A. V. Molochkov ◽  
M. N. Alekhin
Keyword(s):  
Differential Diagnosis ◽  
Surgical Treatment ◽  
Left Atrium ◽  
Left Atrial ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Primary Diagnosis ◽  
Pathological Process ◽  
Emergency Surgical Intervention ◽  
Clinical Cases

We present two clinical cases of the late primary diagnosis of cardiac sarcoma with an unusual intracavitary growth in the left atrium with the left atrioventricular orifice obstruction requiring an emergency surgical intervention. A variety of concomitant clinical symptoms that mask the underlying pathological process and impede differential diagnosis has been described.

scholarly journals DIAGNOSIS AND EMERGENCY SURGICAL TREATMENT OF GIANT LEFT ATRIAL SARCOMA: CLINICAL CASES

2019 ◽  
Vol 34 (1) ◽  
pp. 130-136
Author(s):  
G. E. Gogin ◽  
N. V. Eremina ◽  
A. V. Molochkov ◽  
M. N. Alekhin
Keyword(s):  
Differential Diagnosis ◽  
Surgical Treatment ◽  
Left Atrium ◽  
Left Atrial ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Primary Diagnosis ◽  
Pathological Process ◽  
Emergency Surgical Intervention ◽  
Clinical Cases

We present two clinical cases of the late primary diagnosis of cardiac sarcoma with an unusual intracavitary growth in the left atrium with the left atrioventricular orifice obstruction requiring an emergency surgical intervention. A variety of concomitant clinical symptoms that mask the underlying pathological process and impede differential diagnosis has been described.

LUMBAR DISC VACUUM PHENOMENON: ITS CLINICAL IMPLICATIONS AND SURGICAL TREATMENT

2006 ◽  
Vol 10 (04) ◽  
pp. 187-196
Author(s):  
Jinfu Lin ◽  
Myung-Sang Moon
Keyword(s):  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Lumbar Disc ◽  
Acute Onset ◽  
Thigh Pain ◽  
Degenerative Scoliosis ◽  
Vacuum Phenomenon ◽  
Chemical Factors ◽  
Painful Spine ◽  
Clinical Pictures

In this paper, we describe the clinical symptoms, diagnosis, and surgical treatment of painful lumbar discs with the vacuum phenomenon (VP). The sole indication for anterior arthrodesis was painful discs with VP. Sixteen patients were included and retrospectively reviewed; of these, 10 patients had back and thigh claudication pain, and 5 patients had acute onset of excruciating back or thigh pain. Unilateral thigh pain tended to be on the concave side of lumbar scoliosis. Dynamic myelography and reformatted computed tomography (CT) were useful imaging tools to detect VP. Bone scan was useful in detecting painful discs in degenerative scoliosis, and selective nerve block was useful in differentiating compressive root pain. Mechanical and chemical factors were postulated for the pathogenesis of VP discs in patients with chronic and acute pain. Satisfactory outcomes were achieved in 94% (n = 15) of patients by anterior arthrodesis with cage. VP is a useful pain and fusion indicator in painful spine with or without deformities. The term "discogenic claudication" is proposed to describe clinical pictures of the vacuum sign.

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