Prophylaxis of Ischemic Damage to the Ovaries, Taking Into Account Peculiarities of Blood Supply to the Uterus During Endovascular Treatment of Le Yo Fibroids

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization.Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli.Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II.Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

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Short and Long-Term Follow up Results of Daily 5 Mg Tadalafil as a Treatment for Erectile Dysfunction and Premature Ejaculation

10.21203/rs.3.rs-473408/v1 ◽

2021 ◽

Author(s):

Tarek Gharib ◽

Ibrahim Abdelal ◽

Adel Elatreisy ◽

Elsayed Salih ◽

Ahmed Sebaey

Keyword(s):

Erectile Dysfunction ◽

Premature Ejaculation ◽

P Value ◽

Group I ◽

Significant Difference ◽

Long Term Follow Up ◽

The Mean ◽

Group Ii

Abstract Objective: To evaluate effectiveness and safety of a 5mg tadalafil daily treatment for men with erectile dysfunction (ED) and premature ejaculation (PE) and assessment of long-term follow up by persistence of improvement 2 years after stoppage of tadalafil.Materials and Methods: The study included 160 patients diagnosed with erectile dysfunction from April 2018 to June 2020. All were evaluated using the international index of erectile function questionnaire-5 (IIEF-5) to evaluate ED and intravaginal ejaculatory latency time (IELT) for PE. Patients subdivided into two equal groups. I included 80 patients treated with tadalafil 5 mg daily for 3 months, and group II included 80 patients treated with a placebo for same period. After 3 months treatment and 2 years later after stoppage of tadalafil, all patients were assessed for ED and PE using the same questionnaires. Results: The mean IELT and IIEF pretreatment were 37±11.24 s and 13.2±4.2 respectively for group I, while in group II was 35.98±10.8 s and 13.12±4.11, respectively. After 3 months of treatment, the mean value of IELT in group I showed a highly significant improvement from 37±11.24 sec to 120.5±47.37 sec (p-value < 0.001), but for group II, the mean values of IELT showed no significant improvement from baseline 35.98±10.8 to endpoint 39.43±13.6 ( p-value > 0.05). As regarding the IIEF, there was a highly significant improvement from baseline 13.2±4.2 to endpoint 20.45±4.5 in group I (p-value < 0.001) while there was no significant difference in group II from baseline 13.12±4.11 to endpoint 15±4.84 (p-value > 0.05) . 2 years later after stoppage of tadalafil , 75 patients from group I complete follow up and there was significant improvement in IELT and IIEF form base line (37±11.24) (13.2±4.2) to endpoint (98±18.3) (19.1±2.3) respectively but less than the results after 3 months treatment.ConclusionDaily Tadalafil 5 mg was effective, tolerable, and safe treatment for patients suffering from ED and PE. Long-term follow up after 2 years declared persistence of significant improvement.

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Histological and biochemical serum effects of alpha-tocopherol on ischemia/reperfusion-related injuries induced in the pelvic limb of rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502005000500007 ◽

2005 ◽

Vol 20 (5) ◽

pp. 375-381 ◽

Cited By ~ 8

Author(s):

Marcelo Gomes da Silva ◽

Aldemar Araújo Castro ◽

Eduardo Antonio Gonçalves Ramos ◽

Ediriomar Peixoto ◽

Fausto Miranda Jr ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Creatine Phosphokinase ◽

Ischemia Reperfusion ◽

Alpha Tocopherol ◽

Male Rats ◽

Control Group ◽

Infrarenal Aorta ◽

Arterial Blood ◽

Group I ◽

Group Ii

PURPOSE: To evaluate the protective action of alpha-tocopherol in ischemia/reperfusion injuries of pelvic member of rats. METHODS: Thirty adult male rats of the Wistar strain were randomized into three experimental groups of 10: Group I - control group with no ischemia or reperfusion. Groups II and III - four hours of ischemia and of hours of reperfusion by means of clamping of the infrarenal aorta. The animals of Group II were treated with saline and those of Group III were treated with i.v. alpha-tocopherol (50 mg/kg). Parameters studied were biopsies of the soleus muscle, dosing of creatine phosphokinase, lactate dehydrogenase, potassium, calcium and arterial blood gasometry. RESULTS: The results of biopsies of the soleus muscles studied by optical microscopy, were not significant in terms of presence of edema among the three groups studied. Variables inflammation and necrosis were not observed, therefore cannot be statistically analyzed. As to dosing of calcium and lactate dehydrogenase, the pH, pO2 and pCO2 values were not significant for all groups studied. We observed that the levels of potassium (Group II > Group I, Fcalculated = 5.84; Fcritical = 3.33), creatine phosphokinase (Group II > Groups I and III, Hcalculated = 13.92; Hcritical = 5.99) and bicarbonate (Groups I and III > Group II, Hcalculated = 11.98; Hcritical = 5.99) presented significant results among groups. CONCLUSION: From the serum biochemical perspective, the treatment with alpha-tocopherol has attenuated the metabolic injuries in the ischemia/reperfusion syndrome in this experimental model.

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Peculiarities of treatment and healing of trophic ulcers of the lower extremities of the mixed genesis

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2019.07.36 ◽

2019 ◽

Vol 86 (7) ◽

pp. 36-41

Author(s):

V. I. Liakhovskyi ◽

O. M. Bezkorovaynyy ◽

A. V. Sydorenko

Keyword(s):

Blood Supply ◽

Comparison Group ◽

Healing Process ◽

Local Treatment ◽

Lower Extremities ◽

Main Group ◽

Local Temperature ◽

Group I ◽

Group Ii ◽

The Impact

Objective. To study the impact of sulodexide on the healing process of trophic ulcers of the mixed genesis in the lower extremities. Materials and methods. Analysis of the medical cards data was done for 105 patients, who in 2015 - 2019 yrs have had treated the trophic ulcers of the mixed genesis of the ankles in Department of Vascular Surgery of the Poltava Regional Clinical Hospital. The causes of development of trophic ulcers were confirmed by data of ultrasonographic color angioscanning of the lower extremities and pelvis with measurement of the ankle-brachial pressure index and arteriography. All the patients did not accepted the proposal for performing of correcting and restoration surgical treatment on the lower extremities vessels. Depending on the treatment prescribed the patients were divided into two groups. Into the Group I (comparative) 53 (50.5%) patients were included, who obtained a casual conservative treatment, directed to improvement of the lower extremities blood supply, as well as the blood rheological properties, which included venotonic, analgesic, antibacterial preparations and local treatment, depending on the wound process stage. Into the Group II (the main) 52 (49.5%) patients were included, who on the background of typical treatment have obtained sulodexide in a dose 600 LU (lipoproteidlipase units) on 200 ml of physiological solution of sodium chloride up to 15 days long with subsequent therapy in the dose of 1 capsule twice a day (500 LU) during up to 60 days. In the Group I there were 32 (60.4%) men and 21 (39.6%) women, and in the Group II – 30 (57.7%) men and 22 (42.3%) women. Average age of patients in the Group I have constituted (65.8 ± 4.38), and in the Group II – (66.2 ± 5.04) yrs old. The pain intensity in accordance to the ten-point numerical rating scale was checked before the treatment beginning, in 7 and 14 - 15 days, the trophic ulcers square was measured, local temperature of the patient’s body, pН-metry and cytological investigations of the wounds exudate were done in all the patients before the treatment. Besides this, 38 (71.7%) patients of the comparison group and 40 (76.9%) patients of the main group were followed during 90 - 120 days after leaving a stationary. Results. In the patients, who have obtained sulodexide additionally, reparative processes in the trophic ulcers regions of the lower extremities have become accelerated, the pain syndrome have been lowered rapidly, the water index normalized, the blood supply improved, the ankle-brachial index enhanced, a local temperature raised, cytological picture of the wound exudate improved, what promoted more rapid healing of ulcers and reduction of the stationary stay duration. During the planned visits of the patients in 90 - 120 days a complete healing of trophic ulcers of the lower extremities in 31 (77.5%) patients of the main group and in 24 (63.2%) patients of the comparison group was proved. Conclusion. Application of sulodexide in the treatment dosage is expedient to include into complex of treatment for trophic ulcers of the mixed origin in the lower extremities.

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The effects of extracorporeal cardiopulmonary circulation on serum total and free prostate specific antigen levels

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2005.009 ◽

2005 ◽

Vol 43 (1) ◽

Author(s):

Yılmaz Aksoy ◽

Hülya Aksoy ◽

Münacettin Ceviz ◽

Ahmet Yavuz Balcı ◽

Güray Okyar ◽

...

Keyword(s):

Prostate Specific Antigen ◽

Extracorporeal Circulation ◽

Artery Bypass ◽

Specific Antigen ◽

Control Group ◽

Ischemic Damage ◽

Group I ◽

Significant Difference ◽

Baseline Values ◽

Group Ii

AbstractThe aim of this study was to investigate whether or not there is an increase in serum total and free prostate specific antigen levels (t-PSA, f-PSA) in patients with and without benign prostatic hyperplasia (BPH) undergoing extracorporeal circulation during cardiovascular bypass. The study included a total of 50 men. Of these, 35 patients underwent elective coronary artery bypass grafting with extracorporeal circulation [with (n=20, group I) and without (n=15, group II) BPH]. Another 15 patients underwent renal or ureteral surgery (group III) and served as a control group. Serum t-PSA and f-PSA levels were measured before surgery and 3h and 3days after surgery. All patients underwent urethral catheterization 24h before surgery. In groups I and II, patients had an increase in t-PSA 3h after surgery compared to baseline values (p=0.0001 and p=0.011, respectively). Also, 3days after surgery, mean t-PSA levels were higher than baseline levels (p=0.004) in group I. Serum t-PSA levels were higher at 3h than at day 3 in groups I and II (p=0.003 and p=0.02, respectively). Mean serum f-PSA levels obtained 3h after surgery were increased in both groups I and II when compared to baseline values (p=0.0001 and p=0.001, respectively). There was no significant difference between f-PSA values before and 3days after surgery in all groups. In the control group, there was no significant increase in either serum t-PSA or f-PSA levels obtained at different times. There was a modest increase in the percentage of free prostate specific antigen (% f-PSA) 3h after the operation in group II (p=0.025); the values returned to baseline within 3days. It was suggested that t-PSA and f-PSA serum levels increase due to extracorporeal cardiopulmonary circulation as a consequence of ischemic damage to the prostate. In patients with BPH, this rise may be higher than in those without BPH, because BPH patients generally have larger prostate volumes that may be more vulnerable to ischemic damage. Because f-PSA has a shorter half-life, postsurgical levels of f-PSA may not show this ischemic damage to the prostate during the late postoperative period and f-PSA appears to be cleared more rapidly than t-PSA.

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Reversible Bronchiectasis in COVID-19 Survivors With Acute Respiratory Distress Syndrome: Pseudobronchiectasis

Frontiers in Medicine ◽

10.3389/fmed.2021.739857 ◽

2021 ◽

Vol 8 ◽

Author(s):

Qiongjie Hu ◽

Yiwen Liu ◽

Chong Chen ◽

Ziyan Sun ◽

Yujin Wang ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Ct Images ◽

Group I ◽

Long Term Follow Up ◽

Group Ii ◽

Traction Bronchiectasis

To retrospectively analyze whether traction bronchiectasis was reversible in coronavirus disease 2019 (COVID-19) survivors with acute respiratory distress syndrome (ARDS), and whether computed tomography (CT) findings were associated with the reversibility, 41 COVID-19 survivors with ARDS were followed-up for more than 4 months. Demographics, clinical data, and all chest CT images were collected. The follow-up CT images were compared with the previous CT scans. There were 28 (68%) patients with traction bronchiectasis (Group I) and 13 (32%) patients without traction bronchiectasis (Group II) on CT images. Traction bronchiectasis disappeared completely in 21 of the 28 (75%) patients (Group IA), but did not completely disappear in seven of the 28 (25%) patients (Group IB). In the second week after onset, the evaluation score on CT images in Group I was significantly higher than that in Group II (p = 0.001). The proportion of reticulation on the last CT images in Group IB was found higher than that in Group IA (p < 0.05). COVID-19 survivors with ARDS might develop traction bronchiectasis, which can be absorbed completely in most patients. Traction bronchiectasis in a few patients did not disappear completely, but bronchiectasis was significantly relieved. The long-term follow-up is necessary to further assess whether traction bronchiectasis represents irreversible fibrosis.

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Modern aspects of pathogenetic endometriosis therapy

HEALTH OF WOMAN ◽

10.15574/hw.2017.117.101 ◽

2017 ◽

pp. 101-108

Author(s):

O.V. Grishchenko ◽

◽

V.V. Bobrytska ◽

O.L. Chernyak ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Rating Scale ◽

Combined Therapy ◽

Combined Treatment ◽

Abnormal Uterine Bleeding ◽

Pain Scale ◽

Uterine Bleeding ◽

Emotional Status ◽

Group I ◽

Group Ii

The objective: to optimize treatment of endometriosis using a combined hormonal Luvyna medicine. Materials and methods. The study included 50 patients 22-36 years old with a diagnosis of endometriosis. In line with the patient’s therapy are divided into groups: I group (n = 25) received the Luvyna on a continuous 63/7 scheme, then 3 months in scheme 21/7; group II (n = 25) after surgical treatment of endometriosis (gistero-, laparoscopy) also received the medicine in a similar way. The mode of menstrual function disorders, pain on a visual rating scale of pain, psycho-emotional status, concomitant dysfunction of adjacent organs were evaluated. Results. According to the results of therapy established algodismenorei reduction in symptoms I group – 80%, II – 83%, abnormal uterine bleeding I – 96%, II – 100%; the disappearance of heavy uterine bleeding, improving the function of adjacent organs, psycho-emotional status in both groups. Reduced pain on a pain scale from 8±2.0 to 2±0.5 in the group I and from 7±2.5 to 1±1.0 in the group II. Conclusion. Luvina is a highly effective medicine for the treatment of endometriosis, comparable to the combined treatment - surgery, followed by the appointment of combined oral contraceptives. Recommended mode 63/7, followed by a reception 21/7, including after surgical treatment. Key words: endometriosis, Luvyna, conservative therapy, combined therapy.

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Ovarian reserve in patients with borderline ovarian tumors after surgical treatment

Medical alphabet ◽

10.33667/2078-5631-2020-16-21-25 ◽

2020 ◽

pp. 21-25

Author(s):

N. A. Chugunova ◽

L. V. Pokul

Keyword(s):

Surgical Treatment ◽

Ovarian Reserve ◽

Ovarian Tissue ◽

Color Doppler ◽

Ovarian Tumors ◽

Reproductive Age ◽

Group Iii ◽

Borderline Ovarian Tumors ◽

Group I ◽

Group Ii

Borderline ovarian tumors are often diagnosed in women under the age of 40 years (31.8 %), which determines the need to optimize the management of this cohort of patients, taking into account the possibility of maintaining their reproductive function. Purpose of the study. Assessment of the ovarian reserve based on a comprehensive sonographic diagnosis of the ovarian reserve in patients of reproductive age with borderline ovarian tumors. Materials and methods. Group I (n = 103) included patients with borderline serous epithelial ovarian tumors. Group II (n = 95) was formed from women with mucinous epithelial ovarian tumors. Comparison group III (n = 189) included patients with benign ovarian cystadenomas. Ultrasound scanning of the pelvic organs and color Doppler mapping (DLC) were performed using Aloka 3500, Semiens G‑60 ultrasound scanners operating in real time and equipped with a pulsed doppler using a 3.5 MHz convex sensor and a 7.5 MHz transvaginal sensor. Results. The number of antral follicles does not depend on the volume of the ovary. The healthy remaining ovarian tissue of the ovary is most pronounced in groups I and III, significantly less represented in group II (p ≤ 0.0001). Three months after adnexectomy, ovulatory function in the intact (healthy) ovary was preserved in 71% (n = 49) of women from group I; in 89% (n = 73) of patients of group II and in 93% (n = 25) of respondents of group III, with a predominance in group II (φ* = 2.7; p ≤ 0.0010 and φ* = 1.6; p ≤ 0.0500). After a conservative operation, the function of the operated (resected) ovary detected ovulation in 62% (n = 21) of group I participants; 68% (n = 9) of women of group II and 86% (n = 139) of patients of group III. After 6 months, an increase in the number of antral ovaries and the number of ovulations with a predominance of ovarian reserve in group III (p ≤ 0.0010 and p ≤ 0.0001) was generally observed. Conclusions. Integrated ultrasound is a reliable and objective method that evaluates the features of the ovulatory reserve in patients with borderline and benign ovarian tumors, which makes it possible to formulate a prognosis of a woman’s reproductive health after various types of surgical treatment.

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Modern approaches to endovascular treatment of uterine leiomyoma

GYNECOLOGY ◽

10.26442/2079-5696_2018.5.63-67 ◽

2018 ◽

Vol 20 (5) ◽

pp. 63-67

Author(s):

L S Kokov ◽

M M Damirov ◽

G E Belozerov ◽

O N Oleynikova

Keyword(s):

Endovascular Treatment ◽

Blood Supply ◽

Uterine Leiomyoma ◽

Ovarian Function ◽

Vascular Anatomy ◽

Uterine Arteries ◽

Endovascular Occlusion ◽

Iatrogenic Complications ◽

Surgical Methods ◽

Angiographic Examination

Individual features of the blood supply to the uterus and ovaries in 20-25% of cases cause failures in endovascular treatment of patients with uterine leiomyoma (ULM) and are forced to return to traditional surgical methods. The purpose of the study is to assess the possibilities of preventing iatrogenic complications of endovascular treatment of ULM through the use of separating occlusion of the uterine arteries, taking into account the characteristics of the blood supply to the uterus and ovaries. Materials and methods. The work is based on the analysis of the results. X-ray endovascular occlusion of the uterine arteries for ULM performed in 88 women aged 34-46 years (mean age 38.8 ± 2.5 years). The patients were divided into 2 groups: the 1st group comprised 65 patients without visible uterine-ovarian interarterial anastomoses. They performed standard embolization of the uterine arteries (EUA) using spherical PVA microemboli (COOK, USA), Embosphere (Merit Medical, USA) with a diameter of 500-700 microns. The second group consisted of 23 patients in whom utero-ovarian inter-arterial anastomoses were detected. In patients of this group, EUAs were produced with Embox cylindrical emboli (Plastis-M, Russia) with a length of 10 mm and a diameter of 500-700 μm, which occlude only the bed of the uterine arteries and are not capable of to overcome utero-ovarian inter-arterial anastomoses. In the 2nd group of EUA patients wore the character of occlusion, separating the uterine and ovarian arteries. The original EUA protocol was applied, which includes, in addition to the standard stages of selective arteriography of the uterine arteries, performing preliminary abdominal aortography to visualize the ovarian arteries and pelvic arteriography to assess pelvic vascular anatomy and identify utero-ovarian interarterial anastomoses. The results of the study. A total angiographic examination of the ovarian and uterine arteries, including a review angiography of the infrarenal section and bifurcation of the aorta, ileal vessels. In 23 (26.1%) patients with angiographic examination, uterine-ovarian arterio-arterial anastomoses. In 13 patients (56.5% of the detected anastomoses), these were type 1 anastomoses. In 10 patients (43.5% of the detected anastomoses), type 3 anastomoses were detected. Endovascular occlusion of the uterine arteries was performed in all patients. In 5 (7.69%) patients from the 1st group after EUA, amenorrhea occurred. In contrast, in all 23 patients from the 2nd group in the postembolization period, no observation of ovarian function was observed in any of the observations. Conclusion. For endovascular treatment of ULM in the presence of pronounced utero-ovarian interarterial anastomoses, the method of separating uterine artery occlusion is a safe and effective way to prevent ischemic damage to the ovaries.

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Assessing cytokine status of patients with chronic endometritis combined with endometrial hyperplastic processes in reproductive period

Russian Journal of Infection and Immunity ◽

10.15789/2220-7619-aoc-1357 ◽

2020 ◽

Vol 10 (4) ◽

pp. 762-768

Author(s):

L. V. Tkachenko ◽

N. I. Sviridova ◽

N. A. Zharkin ◽

N. A. Burova ◽

E. B. Belan

Keyword(s):

Histological Examination ◽

Inflammatory Process ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Cytokine Level ◽

Enzyme Linked Immunosorbent Assay ◽

Cervical Canal ◽

Chronic Endometritis ◽

Group I ◽

Group Ii

The goal of our study was to examine local and serum cytokine level involved in regulating inflammation in patients with chronic endometritis combined with endometrial hyperplastic processes. On admission, all patients underwent hysteroscopy with separate diagnostic curettage followed by histological examination of samples isolated from the uterine and cervical canal mucosa. Such manipulations were indicated due to abnormal uterine bleeding as well as suspected endometrial pathology based on ultrasound examination. According to the histological examination data of the endometrial samples, all patients were divided into two groups: group I contained 45 women with CE combined with PEG without atypia; group II — 38 patients with morphologically verified CEE combined with AEG without atypia. Level of IL-1P, IL-2, IL-6, IFNy, TNFa in biological fluids (aspirate from the uterus; serum) was measured by using enzyme-linked immunosorbent assay. We found that in both groups (91.1% and 89.6%, respectively) the vast majority of patients was hospitalized due to abnormal uterine bleeding. Oligomenorrhea alternated with intermenstrual bleeding (66.7% and 71.2%, respectively) and dominated in pattern of menstrual cycle disorders in the examined patients, whereas 11 (24.4%) and 7 (18.4%) patients from group I and II, respectively, were noted to suffer from severe menstrual bleeding. Overall, analyzing the data on cytokine level both in the uterine aspirate and serum evidences about ongoing inflammatory process found at examination time point. Upon that, such process was not only local, but also exhibited signs of a systemic inflammatory response. The data on cytokine level in the uterine aspirate from patients with CE coupled to PGE or CGE without atypia point at local inflammatory process characterized by significantly increased concentration of IL-ф, IL-2, IL-6, TNFa and IFNy. At the same time, higher level of IL-ф and IFNy in patients from group II might indicates that degree of morphological changes in the endometrium could affect the level of local cytokine production. Thus, the data obtained evidence that immune changes in chronic endometritis combined with non-atypical endometrial hyperplastic processes mostly occur locally. In this regard, measuring cytokine concentration in the uterine aspirate is a diagnostic predictor and serves as a sign for monitoring therapeutic effectiveness of therapy in this cohort of patients.

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Distraction, Compression, Extension, and Reduction Combined With Joint Remodeling and Extra-articular Distraction: Description of 2 New Modifications for Its Application in Basilar Invagination and Atlantoaxial Dislocation

Neurosurgery ◽

10.1227/neu.0000000000000737 ◽

2015 ◽

Vol 77 (1) ◽

pp. 67-80 ◽

Cited By ~ 35

Author(s):

P. Sarat Chandra ◽

Manik Prabhu ◽

Nishant Goyal ◽

Ajay Garg ◽

Avnish Chauhan ◽

...

Keyword(s):

Normal Values ◽

Basilar Invagination ◽

Atlantoaxial Dislocation ◽

Effective Technique ◽

Group Iii ◽

Group I ◽

Long Term Follow Up ◽

Group Ii

Abstract BACKGROUND: Recent strategies for treatment of basilar invagination (BI) and atlantoaxial dislocation (AAD) are based on simultaneous posterior reduction and fixation. OBJECTIVE: To describe new modifications of the procedure distraction, compression, extension, and reduction (DCER), ie, joint remodeling (JRM) and extra-articular distraction (EAD) in patients with “vertical” joints, and to quantify the improvement in joint indices, ie, sagittal inclination (SI), craniocervical tilt (CCT), and coronal inclination. METHODS: Prospective study (May 2010 to September 2014). Joint indices measured included (normal values): SI (87.15 ± 5.65°), CCT (60.2 ± 9.2°), and coronal inclination (110.3 ± 4.23°). Surgical procedures included DCER alone (performed in SI <100°, group I) or JRM with DCER (in SI: 100–160°, group II), or EAD with DCER in severe BI with almost vertical joints (SI >160°, group III). RESULTS: Seventy-nine patients were selected (mean, 22.5 years of age). All conventional indices improved significantly (P < .001). CCT improved in all groups (P < .01); group I (n = 32): 54 ± 8.7° (preoperative 80.71 ± 12.72°); group II (n = 40): 58 ± 7.0° (preoperative 86.5 ± 14°); group III (n = 7): 62 ± 10.0° (preoperative 104 ± 11.2°). SI improved in both group I and II, P < .01 (cannot be measured in group III). At long-term follow-up (n = 64, 29 ± 8 months, range 12–39 months), the Nurick grade improved to 1.5 ± 0.52 (preoperative: 3.4 ± 0.65; P < .001). CONCLUSION: DCER seems to be an effective technique in reducing both BI and AAD. JRM and EAD with DCER are useful in moderate to severe BI and AAD (with SI >100°). Joint indices provide useful information for surgical strategy and planning.

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