scholarly journals Application of ASTLOF Scoring System in the Treatment of Acute Symptomatic Thoracolumbar Compression Fractures

2020 ◽  
Author(s):  
Qing-Da Li ◽  
Jun-Song Yang ◽  
Chao Jiang ◽  
Yi-Fan Ma ◽  
Xin Tian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Scoring System ◽  
Compression Fractures ◽  
Better Than

Abstract Background: Osteoporotic vertebral compression fracture (OVCF) is a common injury in the elderly, often caused by low-energy injuries. Improper treatment will not only affect the stability and balance of the spine, but in severe cases will lead to neurological damage and increase the risk of death. This retrospective study aims to explore the principles of treatment of patients with the assessment system of thoracolumbar osteoporotic fracture (ASTLOF) in acute symptomatic thoracolumbar compression fractures when the ASTLOF score = 4 points.Methods: The clinical data of patients with acute symptomatic thoracolumbar compression fractures admitted from February 2018 to February 2020 were retrospectively analyzed. Each patient was evaluated according to the ASTLOF scoring system, and patients with ASTLOF score = 4 were selected, a total of 108 patients. According to different treatment methods, they were divided into 32 cases in the non-surgical treatment (NST) group and 76 cases in the surgical treatment (ST)group. The visual analog score (VAS), Oswestry disability index (ODI), the recovery of injured vertebral body height, and the incidence of adjacent segment fractures were used for comprehensive evaluation.Results: During the follow-up, the VAS score and ODI score showed that the early pain relief and functional improvement of the surgical treatment group were better than those of the conservative treatment group (P<0.05); the Cobb angle of the surgical treatment group was 3 months and 6 months after the operation, and the vertebral body was injured. The degree of improvement of margin height was better than that of the conservative treatment group (all P<0.05); in the surgical treatment group, 6 cases of adjacent vertebral fractures occurred after surgery, accounting for 7.89%, and 2 cases of the conservative treatment group had adjacent vertebral fractures, accounting for 6.25% There was no statistically significant difference between the two groups (P>0.05).Conclusions: When the ASTLOF scoring system is used in the treatment of acute symptomatic thoracolumbar compression fractures, patients with ASTLOF score =4 should be treated with surgery in time, which can relieve pain early and quickly, perform functional exercises as soon as possible, and reduce complications related to long-term bed rest. Whether it increases the risk of adjacent vertebral fractures requires long-term follow-up studies in a large number of cases.

Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management

2014 ◽  
Vol 14 (3) ◽  
pp. 245-254 ◽  
Author(s):  
Giuseppe Talamonti ◽  
Giuseppe D'Aliberti ◽  
Michele Nichelatti ◽  
Alberto Debernardi ◽  
Marco Picano ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Statistical Significance ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Prophylactic Surgery ◽  
Long Term Results

Object The goal of this study was to compare long-term results of surgery with the outcomes of conservative treatment in patients with asymptomatic lipomas of the conus medullaris. Methods The parents of 56 consecutive children with a diagnosis of asymptomatic lipoma of the conus medullaris underwent detailed neurosurgical consultation. The pros and cons of both prophylactic surgery and conservative treatment were carefully presented. Both options were offered, and the parents were free to choose the preferred management. A total of 32 children underwent surgical treatment, and 24 were conservatively treated. Afterward, all patients entered the same protocol of serial neurological and urological follow-up at the Centro Spina Bifida. The mean follow-up periods were 9.7 years in the surgical treatment group and 10.4 years in the conservative treatment group. Results Permanent surgical morbidity was 3.1% (1 patient). During follow-up, tethered cord syndrome occurred in 9.7% of the surgically treated patients (3 of 32 patients) and in 29.1% of the conservatively managed children (7 of 24 patients). This difference did not result in statistical significance, but a clear trend in favor of surgery emerged. Young age at surgery and a cord/sac ratio < 50% appeared to be determining factors in the prevention of subsequent tethered cord syndrome. Conclusions The small size of this series does not provide enough statistical evidence that surgical treatment can really improve the natural history of asymptomatic lipomas of the conus medullaris. Nevertheless, surgery appears at least advisable since it reduces by 75% the odds of TCS (p = 0.067), which is quite close to statistical significance.

A Comparison of Splint Versus Pinning the Distal Interphalangeal Joint for Acute Closed Tendinous Mallet Injuries

2020 ◽  
Vol 25 (02) ◽  
pp. 172-176
Author(s):  
Shigeki Nagura ◽  
Taku Suzuki ◽  
Takuji Iwamoto ◽  
Noboru Matsumura ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Custom Made ◽  
Wire Fixation ◽  
Distal Interphalangeal ◽  
The Mean ◽  
Better Than

Background: The vast majority of acute closed tendinous mallet injuries are treated with a splint. Very few studies have directly compared splinting versus pinning the distal interphalangeal joint for this injury. The aim of this cohort study is to determine the outcomes of both methods. Methods: A total of 59 patients with acute tendinous mallet injury were retrospectively enrolled (29 patients in conservative treatment and 30 patients in surgical treatment). Conservative treatment was performed using custom-made thermoplastic splint and surgical treatment was conducted with oblique K-wire fixation of the distal interphalangeal (DIP) joint. The DIP joint was immobilized for eight weeks in both treatments. Active ranges of motion of the affected finger and Miller’s classification were evaluated postoperatively. Results: The mean extension lag of the DIP joint in the surgical treatment group was significantly better than it was with conservative treatment (2.1° vs 13.8°). Three patients who were noncompliant with the splint showed poor results, while no patients in the surgical treatment group had a poor result. Conclusions: Surgical treatment with K-wire fixation leads to satisfactory results for acute tendinous mallet injury.

scholarly journals Kyphoplasty for Elderly Patients With Vertebral Compression Fractures—Do We Save Lives? Mortality Rates Analysis Comparison in a Long-Term Follow-Up Cohort

2021 ◽  
pp. 219256822098228
Author(s):  
Raphael Lotan ◽  
Yossi Smorgick ◽  
Yoram Anekstein ◽  
Oren Rudik ◽  
Ilia Prosso ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Retrospective Cohort ◽  
Mortality Rates ◽  
Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Medical Centers ◽  
Significant Difference ◽  
Long Term Follow Up

Study Design: Retrospective cohort. Objectives: We aimed to compare a large cohort of patients with vertebral compression fractures (VCF) treated in 2 centers using different protocols (conservative vs BKP) and compare mortality rates on a long-term follow-up. Methods: Retrospective cohort held in 2 medical centers (W and AH). All patients admitted with VCF from November 2008 to January 2015 were enrolled in the study. Exclusion criteria were patients admitted with non-osteoporotic pathological fractures (such as metastatic or MM). Results: Our study included 208 patients treated for VCF, 127 were treated with BKP (88 females, 69.3%) and 81 were treated conservatively (59 females, 72.8%). Patients from Centre W were older and frailer compared to the patients from AH center (Average age 75.12 ± 11.16 vs 69.13 ± 9.61 years and Frailty score of 0.16 ± 0.1 vs 0.12 ± 0.1 respectively, T-test, p < 0.01 for both). Hazard ratios (HR) for age, female gender and frailty were significant for increased mortality, frailty had the highest HR of 182.42 (CI 29.05-1145.33, p < 0.01). Multivariate Cox model was fitted and after accounting for Gender, Age and Frailty, no significant difference was found between the 2 medical centers mortality rates (p = 0.59), thus no difference in mortality rates between BKP and conservative treatment in our study. Conclusion: long-term follow-up following BKP treatment for VCF did not show a reduced mortality rate compared to conservative treatment after accounting for frailty, age and gender. Frailty was the most important factor in predicting mortality. Further RCTs are needed to compare the quality of life differences between the 2 treatment strategies.

Rib-Based Anchors are Associated with Proximal Translational Deformity in Early Onset Spinal Deformity Patients undergoing Growth-Friendly Surgical Treatment

2020 ◽  
Vol 4 (2) ◽  
pp. 1-5
Author(s):  
Robert F Murphy
Keyword(s):  
Surgical Treatment ◽  
Vertebral Body ◽  
Surgical Procedures ◽  
Spinal Deformity ◽  
Early Onset ◽  
Thoracic Kyphosis ◽  
Tertiary Level ◽  
Level Institution

Objective/Background: No studies to date have evaluated the the effect of rib-based anchors on the translational relationship between the rib and spine. We hypothesized that there would be an increase in the translational distance between the rib anchor and anterior vertebral body in early onset spinal deformity patients managed with long-term rib-based anchors. Methods: All patients with EOSD from a single tertiary level institution treated with a growth-friendly technique surgery utilizing proximal rib-based anchors from 2006-2015 with a minimum of 2-year follow-up were included. Thoracic kyphosis and the translational distance from the rib anchor to the corresponding anterior vertebral body were measured. Results: Twenty-seven patients (13 female, 14 male) qualified for inclusion. Mean age at implantation of the index proximal rib-based construct was 5±1.9 years (range, 1-9). EOSD etiology was congenital: 3, neuromuscular: 17, syndromic: 3, and idiopathic: 4. Mean kyphosis improved from 31±33° preoperatively to 25±20° immediately post-operatively. No significant changes in kyphosis were noted over 1 and 2 year follow-up (p=0.3). Twenty-one (78%) patients demonstrated an increase in translational distance from the rib anchors to the adjacent anterior vertebral body. Immediately post-operatively, mean distance was 25±1 mm and increased at 1-year (26±1 mm) and significantly at 2-year (29±1 mm) follow-up (p=0.005). Conclusion: The use of long term rib-based anchors may lead to an increase in the distance between the rib utilized for proximal fixation and the associated vertebral body, generating what appears to be increased anterior translation of the spine. This translation, in conjunction with increased or increasing overall thoracic kyphosis, may be the source of unexpected obstacles at the time of future surgical procedures for revision or final fusion.

scholarly journals Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique

2009 ◽  
Vol 27 (6) ◽  
pp. E9 ◽  
Author(s):  
Peter C. Gerszten ◽  
Edward A. Monaco
Keyword(s):  
Vertebral Body ◽  
Spinal Canal ◽  
Open Surgery ◽  
Cement Augmentation ◽  
Compression Fractures ◽  
Fracture Stabilization ◽  
Spinal Radiosurgery ◽  
Treatment Paradigm

Object Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and radiation therapy for the underlying malignant process. Spinal radiosurgery provides excellent long-term radiographic control for vertebral metastases. Percutaneous cement augmentation using polymethylmethacrylate (PMMA) may be contraindicated in lesions with spinal canal compromise due to the risk of displacement of tumor resulting in spinal cord or cauda equina injury. However, there is also significant morbidity associated with open corpectomy procedures in patients with metastatic cancer, especially in those who subsequently require adjuvant radiotherapy. This study evaluated a treatment paradigm for malignant vertebral compression fractures consisting of transpedicular coblation corpectomy combined with closed fracture reduction and fixation, followed by spinal radiosurgery. Methods Eleven patients (6 men and 5 women, mean age 58 years) with symptomatic vertebral body metastatic tumors associated with moderate spinal canal compromise were included in this study (8 thoracic levels, 3 lumbar levels). Primary histologies included 4 lung, 2 breast, 2 renal, and 1 each of thyroid, bladder, and hepatocellular carcinomas. All patients underwent percutaneous transpedicular coblation corpectomy immediately followed by balloon kyphoplasty through the same 8-gauge cannula under fluoroscopic guidance. Patients subsequently underwent radiosurgery to the affected vertebral body (mean time to treatment 14 days). Postoperatively, patients were assessed for pain reduction and neurological morbidity. Results There were no complications associated with any part of the procedure. Adequate cement augmentation within the vertebral body was achieved in all cases. The mean radiosurgical tumor dose was 19 Gy covering the entire vertebral body. The procedure provided long-term pain improvement and radiographic tumor control in all patients (follow-up range 7–44 months). No patient later required open surgery. No radiation-induced toxicity or new neurological deficit occurred during the follow-up period. Conclusions This treatment paradigm for pathological fractures of percutaneous transpedicular corpectomy combined with cement augmentation followed by radiosurgery was found to be safe and clinically effective. This technique combines minimally invasive procedures that avoid the morbidity associated with open surgery while providing spinal canal decompression and immediate fracture stabilization, and then administering a single-fraction tumoricidal radiation dose.

scholarly journals Natural History of Rotator Cuff Tears

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
W. Jaap Willems
Keyword(s):  
Surgical Treatment ◽  
Rotator Cuff ◽  
Treatment Algorithm ◽  
Rotator Cuff Tears ◽  
Long Term Follow Up ◽  
History Of ◽  
Tear Size ◽  
Better Than

Rotator cuff tears are a frequent phenomenon with an increasing incidence when the patient gets older. A considerable number of tears remain asymptomatic during a lifetime. However, still, a substantial number of asymptomatic tears become symptomatic. There is, at present evolving evidence that surgical treatment of small to medium-sized tears does better than conservative treatment, even after a long term follow-up. A treatment algorithm is suggested to help the clinician in decision making, where tear size and age are important factors in the prognosis of surgical treatment. Keywords: Rotator cuff; Ruptures; Natural historyf tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.

A combined lateral-crestal approach of sinus floor elevation: A report on three cases

2020 ◽  
Author(s):  
Xin Zhang ◽  
Yuting Zhang ◽  
Jian Wang ◽  
Qianbing Wan ◽  
Lei Li
Keyword(s):  
Clinical Study ◽  
Conservative Treatment ◽  
Lateral Approach ◽  
Clinical Report ◽  
Sinus Lift ◽  
Sinus Floor Elevation ◽  
Long Term Follow Up ◽  
Sinus Floor

This clinical report describes a combined lateral-crestal approach to elevate the sinus floor when placing implants on a wide maxillary posterior ridge. The buccally enlarged osteotomy broadens vision of practitioners and facilitates access of instruments in the sinus. Compared to the traditional lateral approach of sinus lift, the proposed technique may offer a more conservative treatment modality. And a clinical study with sufficient subjects and long term follow up is needed to validate the potential and limitations of the proposed technique.

scholarly journals Follow-up study of compression fractures of the thoracic and lumbar vertebral bodies by conservative treatment.

1987 ◽  
Vol 35 (4) ◽  
pp. 1430-1434
Author(s):  
Takashi Toyoumi ◽  
Sekio Tominaga ◽  
Kazutomo Date ◽  
Keiji Ohuchi ◽  
Minoru Katayama ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Compression Fractures ◽  
Follow Up Study ◽  
Vertebral Bodies

scholarly journals Efficacy and safety of condylectomy with minimally invasive surgery in the treatment of interdigital corns of the lesser toes compared to conservative treatment

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Luis M. Marti-Martinez ◽  
Rubén Lorca-Gutierrez ◽  
Salvador Pedro Sánchez-Pérez ◽  
Jonatan Garcia-Campos ◽  
Nadia Fernández Ehrling ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Minimally Invasive ◽  
Functional Status ◽  
Invasive Surgery ◽  
Joint Stiffness ◽  
Efficacy And Safety ◽  
Clinical And Functional Status

Abstract Background Minimally invasive surgery (MIS) procedures cause less trauma to the patient and might improve recovery. This study aimed to determine the efficacy and safety of condylectomy with MIS to treat interdigital corns of the lesser toes. Methods This prospective cohort study was conducted in seven podiatry centers. Patients with interdigital corns of the lesser toes, progressing for more than a year, with one or more recurrences in the last year following conservative treatments were eligible. The recruited patients were classified according to their treatment: conservative or surgical (condylectomy with MIS) and were compared. Patient satisfaction, pain, the clinical and functional status of the foot and the appearance of sequelae were assessed at 3 and 6 months after treatment. Results At 6 months, patients in the surgical treatment group showed no pain on pressure, which significantly differed from the conservative treatment group (p <  0.001). They also improved clinical and functional status of the foot, reaching values comparable to those of the standard population. No paresthesia, joint stiffness or instability, toe malalignment, or corn transfer to a contiguous site resulted from the surgical treatment. Conclusions Condylectomy with MIS is effective and safe to treat interdigital corns of the lesser toes.

scholarly journals Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Michael Ryan ◽  
Benton Emblom ◽  
E. Lyle Cain ◽  
Jeffrey Dugas ◽  
Marcus Rothermich
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Osteochondritis Dissecans ◽  
Surgical Techniques ◽  
The Other ◽  
Return To Play ◽  
Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

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