scholarly journals Closed Drainage versus Non-drainage for Single-level Lumbar Discectomy: a prospective randomized controlled study

2020 ◽  
Author(s):  
Hua Guo ◽  
Zhaohua Ji ◽  
Xi Gao ◽  
Yuting Zhang ◽  
Li Yuan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Epidural Hematoma ◽  
Lumbar Discectomy ◽  
Wound Infections ◽  
Postoperative Fever ◽  
Single Level ◽  
Closed Drainage ◽  
Significant Difference ◽  
The Difference ◽  
Drainage Group

Abstract Background In spine surgery, postoperative epidural hematoma and wound infections can have devastating neurologic compromise. Closed drainage is commonly used for prevention of postoperative hematoma, infection, and associated neurologic impairment after lumbar decompression, but it remains unclear whether closed drainage reduces postoperative complications and improves clinical outcomes or not. The purpose of this study was to determine the efficacy of closed drainage in reducing complications and improving clinical outcomes after single-level lumbar discectomy. Methods 420 patients with single-level lumbar disc herniation were recruited between March 2012 and March 2015 (169 females and 251 males, age 50.0±6.4 years). Patients were randomly assigned to either closed drainage group (214 patients) or non-drainage group (206 patients). The rates of postoperative complications (fever, symptomatic epidural hematoma, wound infections, and requiring revision surgery) were compared between the two groups using a chi square test or Fisher exact test. Pain intensity was evaluated by VAS. Functional ability was measured for all the patients using ODI. The lower extremity VAS score and ODI score were evaluated preoperatively, postoperatively, and at the last follow-up. The operation area VAS scores were evaluated preoperative, postoperative day 1, week 1, week 2, month 1, and at the last follow-up. The scoring results were compared between the two groups using a t test. Results The difference in postoperative fever between patients in the closed drainage group (18.7%) and non-drainage group (28.2%) was statistically significant ( p <0.05). This is mainly due to the difference of patients with fever less than 38.5 °C . There was no significant difference in symptomatic epidural hematoma, infection rate, and re-operation rate when the two groups were compared. Only compared the postoperative day 1 operation area VAS score, the closed drainage group (5.1±0.8) was better than the non-drainage group (6.0±0.7) and with a significant statistical difference ( p <0.05). The left scoring results compared between the two groups were not significant difference ( p >0.05). Conclusions We believe that closed drainage can be beneficial to reduce postoperative fever rate and alleviate postoperative operation area pain in the early postoperative period, but it has no effect on preventing postoperative occurrence of symptomatic epidural hematoma, wound infections, need for revision surgery; and improving clinical outcomes in single-level lumbar discectomy.

scholarly journals Identification and Characterization of Unique Subgroups of Chronic Pain Individuals with Dispositional Personality Traits

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
S. Mehta ◽  
D. Rice ◽  
A. McIntyre ◽  
H. Getty ◽  
M. Speechley ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Personality Traits ◽  
Clinical Outcomes ◽  
High Risk Group ◽  
Comprehensive Treatment ◽  
Cluster Membership ◽  
Significant Difference ◽  
Secondary Objective ◽  
The Difference ◽  
And Coping

Objective.The current study attempted to identify and characterize distinct CP subgroups based on their level of dispositional personality traits. The secondary objective was to compare the difference among the subgroups in mood, coping, and disability.Methods.Individuals with chronic pain were assessed for demographic, psychosocial, and personality measures. A two-step cluster analysis was conducted in order to identify distinct subgroups of patients based on their level of personality traits. Differences in clinical outcomes were compared using the multivariate analysis of variance based on cluster membership.Results.In 229 participants, three clusters were formed. No significant difference was seen among the clusters on patient demographic factors including age, sex, relationship status, duration of pain, and pain intensity. Those with high levels of dispositional personality traits had greater levels of mood impairment compared to the other two groups (p<0.05). Significant difference in disability was seen between the subgroups.Conclusions.The study identified a high risk group of CP individuals whose level of personality traits significantly correlated with impaired mood and coping. Use of pharmacological treatment alone may not be successful in improving clinical outcomes among these individuals. Instead, a more comprehensive treatment involving psychological treatments may be important in managing the personality traits that interfere with recovery.

scholarly journals Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

2021 ◽  
Vol 10 (9) ◽  
pp. 1802
Author(s):  
Grzegorz Meder ◽  
Paweł Żuchowski ◽  
Wojciech Skura ◽  
Violetta Palacz-Duda ◽  
Milena Świtońska ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Statistical Significance ◽  
Stent Retriever ◽  
Single Center Experience ◽  
Significant Difference ◽  
First Pass ◽  
Need To Evaluate ◽  
The Difference

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.

scholarly journals Initial Clinical Outcomes of Percutaneous FullEndoscopic Lumbar Discectomy Using an Interlaminar Approach at the L4-L5

2017 ◽  
Vol 4 (20;4) ◽  
pp. E507-E512 ◽  
Author(s):  
Jun-ichiro Nakamura
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Disc Herniation ◽  
Operative Time ◽  
Small Sample ◽  
Lumbar Discectomy ◽  
Interlaminar Approach ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
The Mean

Background: Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported. Objective: This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF. Study Design: Retrospective evaluation. Setting: An urban minimally invasive spine hospital. Methods: Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1. Results: The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.). Limitations: A small sample size and a short follow-up period. Conclusions: The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation. Keywords: Percutaneous full-endoscopic lumbar discectomy, interlaminar approach, clinical outcome, herniated nucleus pulpous, MacNab criteria, intracanalicular disc herniation, learning curve

scholarly journals Should syndesmotic screws be removed or retained? A meta-analysis

2020 ◽  
Author(s):  
Wanjin Qin ◽  
Peng Yang ◽  
Nanning Lv ◽  
Kaiwen Chen ◽  
Huilin Yang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Search Terms ◽  
Central Register ◽  
Significant Difference ◽  
The Difference ◽  
Mean Differences ◽  
American Orthopaedic

Abstract Background The aim of this study was to evaluate the different clinical outcomes after removing or retaining syndesmotic screws, and the difference in clinical outcomes after retaining broken or loose syndesmotic screws was also evaluated. Methods A systematic literature search was performed using PubMed, Web of Science, EMBASE and the Cochrane Central Register of Controlled Trials. In this meta-analysis, we conducted online searches using the search terms “syndesmotic diastasis”, “syndesmotic injury”, “syndesmotic screw”, “syndesmotic fixation”, and “tibiofibular syndesmosis”. The analysis was performed on individual patient data from all the studies that met the selection criteria. Clinical outcomes were expressed as standard mean differences for continuous outcomes with 95% confidence intervals. Heterogeneity was assessed using the Chi 2 test and the I 2 statistic. Results There were 2 randomized controlled trials (RCTs) and 6 observational articles included in this analysis. In the comparison between retained and removed screws and the comparison between broken or loose and removed screws, no significant difference was found in terms of visual analogue scale (VAS), Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. Broken or loose screws were associated with better AOFAS scores compared with removed or intact screws, and no significant difference was found in terms of VAS and OMAS scores. Conclusions According to our analysis, there was no significant difference in clinical outcomes between removed and retained screws. Broken or loose screws were not associated with bad functional outcomes and may even lead to better function compared with removed or retained screws.

scholarly journals Povidone-iodine versus normal saline solution in preoperative vaginal cleansing before office hysteroscopy: a randomized controlled trial

2017 ◽  
Vol 7 (1) ◽  
pp. 5
Author(s):  
Ahmed M. Abbas ◽  
Asmaa S. Shaltout ◽  
Shymaa S. Ali ◽  
Armia Michael ◽  
Ahmed Altraigey ◽  
...  
Keyword(s):  
Normal Saline ◽  
Povidone Iodine ◽  
Controlled Trial ◽  
Uterine Cavity ◽  
Office Hysteroscopy ◽  
Postoperative Infections ◽  
Postoperative Fever ◽  
Group I ◽  
Significant Difference ◽  
The Difference

Background: Hysteroscopy is well-thought-out the gold standard for assessing the uterine cavity, and now can be done as an office process due to enhanced endoscopic advances with no need to in-patient admission. Objective of the present study was to compare the difference in the rate of postoperative vaginal irritation symptoms and postoperative infections after using povidone iodine (PI) and normal saline (NS) solution in vaginal cleaning before outpatient office hysteroscopy (OH).Methods: Women attended to the hospital for diagnostic OH were included for present study. Eligible women were randomly allocated in a 1:1 ratio to two groups. Group I "PI group" women exposed to PI for vaginal cleansing before hysteroscopy, and group II "NS group” women exposed to the NS solution for vaginal cleansing. The primary outcome of the study was to compare the difference in the rate of postoperative vaginal irritation symptoms and postoperative infections in both groups.Results: The mean age of the study participants was 34.26±4.14 years for NS group compared to 35.22±4.01 years for PI group (p=0.652). The PI group reported higher rate of vaginal irritation than NS group with no statistically significant difference between the two groups (p=0.179). Both groups were similar in postoperative fever, urinary tract infection and vaginitis (p>0.05).Conclusions: This study concluded that preoperative vaginal disinfection at the time of OH with a NS solution is less frequently causing postoperative vaginal irritation symptoms. Additionally, it is as effective as the usual agent (PI) in preventing postoperative infections.

scholarly journals Application of a new integrated low-profile anterior plate and cage system in single-level cervical spondylosis: a preliminary retrospective study

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Leixin Wei ◽  
Chen Xu ◽  
Minjie Dong ◽  
Yibo Dou ◽  
Ye Tian ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Clinical Outcomes ◽  
Cervical Spondylosis ◽  
Anterior Plate ◽  
Japanese Orthopedic Association ◽  
Single Level ◽  
Arm Pain ◽  
Cage System ◽  
Low Profile ◽  
Significant Difference

Abstract Background Although ACDF has been widely used in treating cervical spondylosis and related diseases, the complications along with this anterior surgical technique have hindered its application and affected the postoperative outcome of the patients. Here, we investigated the clinical and radiological outcomes of a new integrated low-profile anterior plate and cage system for anterior cervical discectomy and fusion (ACDF) in treating cervical spondylosis. Methods A total of 96 cervical spondylosis patients who underwent single-level ACDF between 2018 to 2020 in our institute were enrolled. There were 28 patients using the new implants and 68 patients using the zero-profile (Zero-P) implants. The Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) were used to evaluate the clinical outcomes. The cervical and segmental Cobb angle and range of motion (ROM) were used to assessed the radiological outcomes. Incidence of complications were also recorded. All data were recorded at pre-operation, 6-month and 12-month post-operation. Results All patients were followed-up for at least 1-year, the mean follow-up time was over one year. The fusion rate was similar in the two groups. There was no significant difference in the postoperative JOA score recovery rate, postoperative VAS score of neck and arm pain, postoperative ROM, and incidence of complications between two groups (P > 0.05). However, postoperative cervical and segmental Cobb angle were better maintained in the new low-profile implant group compared to Zero-P group. Conclusions The clinical outcomes of the new low-profile implant were satisfactory and comparable to that of zero-profile system. It may have advantages in improving and maintaining the cervical lordosis, and can be an alternative device for single-level cervical spondylosis treated with ACDF.

scholarly journals Outcomes of Discectomy by Using Full-Endoscopic Visualization Technique via the Transcorporeal and Transdiscal Approaches in the Treatment of Cervical Intervertebral Disc Herniation: A Comparative Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Youliang Ren ◽  
Junsong Yang ◽  
Chien-Min Chen ◽  
Kaixuan Liu ◽  
Xiang-Fu Wang ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Clinical Outcomes ◽  
Vertebral Body ◽  
Intervertebral Disc Herniation ◽  
Arm Pain ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
The Mean ◽  
The Difference

Objective. To compare the difference in clinical and radiographic outcomes between anterior transcorporeal and transdiscal percutaneous endoscopic cervical discectomy (ATc-PECD/ATd-PECD) approaches for treating patients with cervical intervertebral disc herniation (CIVDH). Method. We selected 77 patients with single-segment CIVDH and received ATc-PECD or ATd-PECD in the Second Affiliated Hospital of Chongqing Medical University between March 1, 2010, and July 1, 2015. 35 patients suffered from ATc-PECD, and there were 42 patients in the ATd-PECD group. Obtaining the data of 1, 3, 6, 12, and 24 months postoperatively, the VAS for neck and arm pain and the modified MacNab criteria were used to evaluate the clinical outcomes, comparing radiographic outcomes and complications of these two groups. Results. We found that the mean operative time was significantly longer in the ATc-PECD group (P<0.05). At the 2-year follow-up, the mean VAS score for neck and arm pain was significantly decreased in both two groups. There was no significant difference in the VAS score for arm pain and neck pain between the two groups at the 2-year follow-up (P=0.783 and P=0.785, respectively). For the ATc-PECD group, the difference in the height of IVS or vertebral body was significant between the preoperative and postoperative groups (P<0.05, respectively). For the ATd-PECD group, there was only a significant decrease in the height of the IVS (P<0.05); the decrease in the surgical vertebral body was not significant between the preoperative and postoperative groups (P>0.05). Conclusion. In the 2-year follow-up, there is no significant difference in the clinical outcomes between the 2 approaches. While the longer time was consumed in the ATc-PECD group, the lower rate of disc collapse and recurrence is notable. Additionally, when the center diameter of tunnel was limited to 6 mm, the bony defect can be healed without the occurrence of the collapse of the superior endplate, and ATc-PECD may be preferable in the endoscopic treatment of CIVDH.

scholarly journals Drainage or nondrainage for single-level anterior cervical discectomy with fusion and plating

2019 ◽  
Author(s):  
Pengfei Li ◽  
Dean Chou ◽  
Yuqiang Wang ◽  
Limin Wang ◽  
Ganggang Zhang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Epidural Hematoma ◽  
Japanese Orthopaedic Association ◽  
Length Of Hospital Stay ◽  
Anterior Cervical Discectomy ◽  
Control Group ◽  
Study Group ◽  
Postoperative Fever ◽  
Cervical Discectomy ◽  
Single Level

Abstract Background Currently, conventional placement of natural pressure drainage after single-level anterior cervical discectomy with fusion and plating (ACDF) is used clinically to prevent complications such as symptomatic epidural hematoma and incision infection. Nevertheless, a literature review reported that there is no uniform standard for whether to place drainage after single-level ACDF surgery, and comparative studies on this subject are rare.Methods A prospective study of 100 patients who underwent single-level ACDF from January 2017 to June 2018 and met the selection criteria were randomly divided into the control group (45 patients with drainage after surgery) and the study group (48 patients without drainage after surgery). The same types of preoperative preparation, surgical technique and postoperative management were used in the two groups. The perioperative indicators, postoperative clinical efficacy and complications were compared between the two groups.Results The preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, Visual Analogue Scale (VAS) scores and Neck Dysfunction Index (NDI) scores in the two groups were significantly different (P < 0.05). The length of hospital stay in the study group was significantly shorter than that in the control group (P < 0.05). There were no significant differences in postoperative fever, surgical site infection, symptomatic epidural hematoma, rate of incision healing, or complications between the two groups (P>0.05).Conclusions The safety and clinical outcome of patients with drainage after single-level ACDF were consistent with those of nondrainage patients. Additionally, nondrainage after single-level ACDF resulted in a decreased length of hospital stay and lessened the associated expenses.

Endovascular Clot Retrieval by Hub-and-Spoke Service Delivery is Feasible Compared with Direct-to-Mothership

2018 ◽  
Vol 46 (3-4) ◽  
pp. 170-175 ◽  
Author(s):  
Penelope van Veenendaal ◽  
Bernard Yan ◽  
Leonid Churilov ◽  
Richard Dowling ◽  
Steven Bush ◽  
...  
Keyword(s):  
Service Delivery ◽  
Clinical Outcomes ◽  
Artery Occlusion ◽  
Large Artery ◽  
Service Model ◽  
Good Clinical Outcome ◽  
Hub And Spoke ◽  
Significant Difference ◽  
The Difference ◽  
Regional Hospitals

Background: Endovascular clot retrieval (ECR) improves outcomes for acute ischaemic stroke with large artery occlusion. However, the provision of ECR requires resource-intensive comprehensive stroke centres (CSC), which are impractical to establish in regional hospitals. An alternative is a “hub-and-spoke” model, whereby ischaemic strokes are triaged at the regional primary centres and where eligible, transferred to a CSC. We aimed to compare the outcomes of patients directly admitted to a CSC with patients treated in the “hub-and-spoke” model. We hypothesize that there are no significant differences in clinical outcomes between the 2 systems. Methods: We included patients undergoing ECR at a CSC. Patients were categorised into 2 groups; the first group included patients directly admitted to the CSC and the second group included patients in the “hub-and-spoke” model. Good clinical outcome was defined as modified Rankin Scale 0–2 and the difference between the 2 groups was tested by logistic regression. Results: Of 178 patients, 50 (28%) presented directly to CSC and 128 (72%) were transferred from a referring hospital. The median age was 70 (interquartile range 58–77) and 61% were male. Thrombolysis in ischaemic cerebral-infarction 2b/3 recanalisation was achieved in 79% of patients. Of the direct group, 63% (95% CI 48–77%) achieved good clinical outcomes compared to 52% (95% CI 43–61%) in the “hub-and-spoke” group (p = 0.233). Conclusion: This state-wide service model demonstrates comparable clinical outcomes to that described in clinical trials. We found no significant difference in outcome between patients directly admitted to CSC and those with “hub-and-spoke” service delivery.

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