scholarly journals Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis

2019 ◽  
Vol 46 (5) ◽  
pp. E14
Author(s):  
Michael Kern ◽  
Matthias Setzer ◽  
Lutz Weise ◽  
Ali Mroe ◽  
Holger Frey ◽  
...  

OBJECTIVEThe treatment of patients with spinal stenosis and concurrent degenerative spondylolisthesis is controversial. Two large randomized controlled clinical trials reported contradictory results. The authors hypothesized that a substantial number of patients will show evidence of micro-instability after a sole decompression procedure.METHODSThis study was a retrospective analysis of all cases of lumbar spinal stenosis treated at the Frankfurt University Clinic (Universitätsklinik Frankfurt) from 2010 through 2013. Patients who had associated spondylolisthesis underwent upright MRI studies in flexion and extension for identification of subtle signs of micro-instability. Clinical outcome was assessed by means of SF-36 bodily pain (BP) and physical functioning (PF) scales.RESULTSA total of 21 patients were recruited to undergo upright MRI studies. The mean duration of follow-up was 65 months (SD 16 months). Of these 21 patients, 10 (47%) showed signs of micro-instability as defined by movement of > 4 mm on flexion/extension MRI. Comparison of mean SF-36 BP and PF scores in the group of patients who showed micro-instability versus those who did not showed no statistically significant difference on either scale.CONCLUSIONSThere seems to be a substantial subset of patients who develop morphological micro-instability after sole decompression procedures but do not experience any clinically significant effect of the instability.

2013 ◽  
Vol 1;16 (1;1) ◽  
pp. 15-25
Author(s):  
Wang Yingwei

Background: Postherpetic neuralgia (PHN) is often refractory to existing treatments. Pulsed radiofrequency (PRF) is known to be effective for treating neuropathic pain. In common, the targets of PRF treatment were the segmental dorsal root ganglion (DRG) neurons responsible for the pain. A potential complication that can occasionally occur with PRF treatment is damage to the adjacent tissue and organ. The effectiveness of the angulus costae as a puncture site for PRF has not been tested in thoracic PHN treatment. Objective: The goal of this study was to investigate the therapeutic efficacy and safety of PRF for treating thoracic PHN through the puncture of the angulus costae. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Methods: Ninety-six patients with thoracic (T2-11) PHN were equally randomized assigned into 2 groups. The electrode needle punctured through the angulus costae of each patient guided by x-ray; PRF at 42°C for 120 seconds was applied after inducing paresthesia involving the affected dermatome area. PRF was applied in the PRF group (n = 48) twice. It was also applied in the sham group (n = 48) twice without radiofrequency energy output. The treatment was done once a week for 3 weeks. Tramadol was used for flare pain when the visual analog scale (VAS) ≥ 3. Outcomes Assessment: The therapeutic effect was evaluated by VAS, SF-36 health survey questionnaire, side effects (type, frequency, and onset time) before treatment, at days 3, 7, and 14, and at months one, 2, 3 and 6 after PRF. The average of tramadol (mg/d) administrated within the first month after treatment was also recorded. Results: The postprocedure VAS scores in the PRF group were significantly lower than those in the sham group and lasted for 6 months after treatment (P < 0.05). The SF-36 score, such as physical functioning, physical role, bodily pain, general health perceptions, social function, emotional role, and mental health index were significantly improved until 6 months after treatment in the PRF group compared to the sham group (P < 0.01-0.05). The average dosage of tramadol administered (mg/d) within the first month after treatment was also significantly reduced in the PRF group compared to the sham group (P < 0.05). There were no obvious signs of pneumothorax, bleeding, infection, or other severe side effects in either group (P > 0.05). Limitations: Single center study, relatively small number of patients. Conclusions: The strategy that the angulus costae be used as the PRF puncture point of an electrode needle and the final localization of the needle tip as determined by sensory testing is an effective and safe therapeutic alternative for thoracic PHN treatment. Benefits include that the procedure is minimally invasive, provides short-term pain relief, and improves quality of life. Clinical Trial Registration: NO ISRCTN25588650. Key words: Thoracic, postherpetic neuralgia, pulsed radiofrequency, angulus costae


2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004 ◽  
Author(s):  
Chris Kreulen ◽  
Trevor Shelton ◽  
Jacqueline Nguyen ◽  
Eric Giza ◽  
Martin Sullivan

Category: Ankle, Arthroscopy, Hindfoot, Sports, Trauma Introduction/Purpose: Surgical management of osteochondral lesions of the talus (OLT) present an ongoing treatment challenge. Previously, matrix-induced autologous chondrocyte implantation (MACI) demonstrated improved pain and function at 7-years postoperative, providing evidence that MACI is a reliable method for treating cartilage. However, it is unknown the long- term results of MACI in OLT. The purpose of this study was to assess 13-year clinical follow-up data and the long-term success of this implant by comparing patient reported outcome measures (PROMs) pre-operatively, at 7-years post-operative, and at 13- years post-operative. Methods: A prospective investigation of MACI was performed on 10 patients with OLTs who had failed previous arthroscopic treatment. Of the 10 patients, 9 were available for 7-year and 13-year follow-up. Short Form Health Survey (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot evaluation were utilized at pre-operative, 7-year, a 13-year postoperative. For each patient, a paired t-test was used to compare 13-year post-operative PROMs to pre-operative PROMs. A single factor analysis of variance (ANOVA) determined whether PROMs were different between pre-operative, 7-year post- operative, and 13-year post-operative time intervals. When a significant difference was detected, a post-hoc Tukey’s determined which time periods were different. Results: SF-36 data at 13-years showed significant improvements in Physical Functioning (p=0.012), Lack of Bodily Pain (p=0.017), and Social Functioning (p=0.007) compared with preoperative data. There were no differences in other components of the SF-36 outcomes (p>0.05). Although the AOFAS was on average 12 points higher at 13-years postoperative, this was not statistically significant (p=0.173). As for comparing PROMs over time, 13-years post-operative PROMs were comparable to 7-years post- operative (Table 1). There were better PROMs for Physical Functioning, Bodily Pain, and Social Functioning at 7- and 13-years post-operative compared to pre-operative while Physical Role Functioning was also better at 7-years post-operative compared to pre-operative. Conclusion: This study shows MACI provides greater pain relief and function at 13-years post-operative with stable long-term follow-up. MACI should be considered for osteochondral lesions that fail initial microfracture.


2007 ◽  
Vol 22 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Paul McAfee ◽  
Larry T. Khoo ◽  
Luiz Pimenta ◽  
Andy Capuccino ◽  
Domagoj Coric ◽  
...  

Object Total disc replacement is an alternative to lumbar fusion, but patients with spinal stenosis, spondylolisthesis, and facet arthropathy are often excluded from this procedure because increased adjacent-segment motion can exacerbate dorsal spondylotic changes. In such cases of degenerative spondylolisthesis with stenosis, decompression and fusion remain the gold standard of treatment. To avoid attendant loss of motion at the treated segment, the TOPS system is a novel total posterior arthroplasty prosthesis that allows for an alternative dynamic, multiaxial, three-column stabilization and motion preservation. The purpose of this study is to report preliminary surgical data and clinical outcomes in patients treated with the TOPS lumbar total posterior arthroplasty system. Methods Twenty-nine patients were enrolled in a nonrandomized, multicenter, prospective pilot study outside the US. All patients had spinal stenosis and/or spondylolisthesis at L4–5 due to facet arthropathy. Radiographs and scores on outcome measures including the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI), Short Form-36, and Zurich Claudication Questionnaire were prospectively recorded before surgery and at 6-week, 3-month, 6-month, and 1-year intervals after surgery. Prior to instrumentation, a bilateral total facetectomy and laminectomy at L4–5 or L3–4 was performed via a standard midline posterior approach. After decompression, the TOPS screws were inserted into four pedicles to achieve maximal purchase with triangulating bicortical trajectories. An appropriately sized TOPS arthroplasty implant was then applied. The mean surgical time was 3.1 hours, and patients' clinical status improved significantly following treatment with the TOPS device. The mean ODI score decreased compared with baseline by 41% at 1 year, and the 100-mm VAS score declined by 76 mm over the same time period. Radiographic analysis showed that lumbar motion was maintained, disc height was preserved, and no evidence of screw loosening was found. No device malfunctions or migrations and no device-related adverse events were reported during the study. Conclusions The TOPS total posterior arthroplasty system represents a novel, dynamic, posterior arthroplasty device that provides multiaxial stability in flexion, extension, rotation, and lateral bending after total facetectomy and neural decompression. The surgical data indicate that it can be safely applied via a traditional approach with low surgical morbidity and excellent 1-year functional and radiographic outcomes in patients with degenerative spondylolisthesis accompanied by stenosis and back pain.


SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 30 ◽  
Author(s):  
Zi-Yang Chia ◽  
Hee-Nee Pang ◽  
Mann-Hong Tan ◽  
Seng-Jin Yeo

Introduction: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty. Methods: We studied 195 knees with an average follow-up of two years. Flexion-extension gaps were obtained from computer calculation upon cementation of implants in both flexion (90°) and extension. The gap difference (GD) was defined as the measured difference between the gaps in flexion and extension. Results: At 2 years after surgery, the mean ROM in the balanced group, with GD less than or equal to 2 mm, was 115.1° ± 16.6° and the mean ROM in the imbalanced group was 116.7° ± 12.1°. This was not statistically significant with p-value 0.589. Balanced flexion-extension gaps also did not show significant difference in terms of mechanical alignment, with 0.29 ± 0.89 in the balanced group at 2 years, and 0.65 ± 1.51 in the imbalanced group with p-value 0.123. Balanced gaps however, were associated with improved outcomes in terms of physical functioning, bodily pain, social functioning, Oxford and Knee scores at 6 months and improved social functioning scores at 2 years. Conclusions: Computer navigation is a useful tool for assessing the gap balance in TKA. Balanced flexion-extension gaps, with gap differences of less than or equal to 2 mm, is associated with improved clinical outcomes at 6 months.


2008 ◽  
Vol 139 (4) ◽  
pp. 511-518 ◽  
Author(s):  
Amy Anne Donatelli-Lassig ◽  
Sonia A. Duffy ◽  
Karen E. Fowler ◽  
David L. Ronis ◽  
Douglas B. Chepeha ◽  
...  

Objective To determine differences in quality of life (QOL) between patients with head and neck cancer who receive chemoradiation versus chemoradiation and neck dissection. Methods A prospective cohort study was conducted at two tertiary otolaryngology clinics and a Veterans Administration hospital. Sample: 103 oropharyngeal patients with Stage IV squamous cell carcinoma treated via chemoradiation ± neck dissection. Intervention: self-administered health survey to collect health, demographic, and QOL information pretreatment and 1 year later. Main outcome measures: QOL via SF-36 and HNQoL. Descriptive statistics were calculated for health/clinical characteristics, demographics, and QOL scores. t tests evaluated changes in QOL over time. Results Sixty-five patients underwent chemoradiation and 38 patients underwent chemoradiation and neck dissection. Only the pain index of the SF-36 showed a significant difference between groups ( P < 0.05) with the neck dissection group reporting greater pain. Conclusions After post-treatment neck dissection, patients experience statistically significant decrement in bodily pain domain scores, but other QOL scores are similar to those of patients who underwent chemoradiation alone.


2007 ◽  
Vol 22 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Paul McAfee ◽  
Larry T. Khoo ◽  
Luiz Pimenta ◽  
Andy Capuccino ◽  
Domagoj Coric ◽  
...  

Object Total disc replacement is an alternative to lumbar fusion, but patients with spinal stenosis, spondylolisthesis, and facet arthropathy are often excluded from this procedure because increased adjacent-segment motion can exacerbate dorsal spondylotic changes. In such cases of degenerative spondylolisthesis with stenosis, decompression and fusion remain the gold standard of treatment. To avoid attendant loss of motion at the treated segment, the TOPS system is a novel total posterior arthroplasty prosthesis that allows for an alternative dynamic, multiaxial, three-column stabilization and motion preservation. The purpose of this study is to report preliminary surgical data and clinical outcomes in patients treated with the TOPS lumbar total posterior arthroplasty system. Methods Twenty-nine patients were enrolled in a nonrandomized, multicenter, prospective pilot study outside the US. All patients had spinal stenosis and/or spondylolisthesis at L4–5 due to facet arthropathy. Radiographs and scores on outcome measures including the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI), Short Form-36, and Zurich Claudication Questionnaire were prospectively recorded before surgery and at 6-week, 3-month, 6-month, and 1-year intervals after surgery. Prior to instrumentation, a bilateral total facetectomy and laminectomy at L4–5 or L3–4 was performed via a standard midline posterior approach. After decompression, the TOPS screws were inserted into four pedicles to achieve maximal purchase with triangulating bicortical trajectories. An appropriately sized TOPS arthroplasty implant was then applied. The mean surgical time was 3.1 hours, and patients' clinical status improved significantly following treatment with the TOPS device. The mean ODI score decreased compared with baseline by 41% at 1 year, and the 100-mm VAS score declined by 76 mm over the same time period. Radiographic analysis showed that lumbar motion was maintained, disc height was preserved, and no evidence of screw loosening was found. No device malfunctions or migrations and no device-related adverse events were reported during the study. Conclusions The TOPS total posterior arthroplasty system represents a novel, dynamic, posterior arthroplasty device that provides multiaxial stability in flexion, extension, rotation, and lateral bending after total facetectomy and neural decompression. The surgical data indicate that it can be safely applied via a traditional approach with low surgical morbidity and excellent 1-year functional and radiographic outcomes in patients with degenerative spondylolisthesis accompanied by stenosis and back pain.


2005 ◽  
Vol 23 (28) ◽  
pp. 6931-6940 ◽  
Author(s):  
Timothy J. Whelan ◽  
Paul E. Goss ◽  
James N. Ingle ◽  
Joseph L. Pater ◽  
Dongsheng Tu ◽  
...  

Purpose To evaluate the impact of letrozole compared with placebo after adjuvant tamoxifen on quality of life (QOL) in the MA.17 trial. Methods Patients completed the Short Form 36-item Health Survey (SF-36) and the Menopause Specific Quality of Life Questionnaire (MENQOL) at baseline, 6 months, and annually. Mean change scores from baseline were compared between groups for summary measures and domains. A response analysis compared the proportion of patients who demonstrated an important change in QOL. Results Of 5,187 randomly assigned women in the trial, 3,612 (69.9%) participated in the QOL substudy: 1,799 were allocated to placebo and 1,813 were allocated to letrozole. No differences were seen between groups in mean change scores from baseline for the SF-36 physical and mental component summary scores at 6, 12, 24, and 36 months. Small (< 0.2 standard deviations) but statistically significant differences in mean change scores from baseline were seen for the SF-36 domains of physical functioning (12 months), bodily pain (6 months) and vitality (6 and 12 months), and the MENQOL vasomotor (6, 12, and 24 months) and sexual domains (12 and 24 months). On the response analysis, a significant difference was seen between groups for the bodily pain domain (percentage of patients reporting a worsening of QOL, 47% placebo v 51% letrozole; P = .009) and the vasomotor domain (22% placebo v 29% letrozole; P = .001). Conclusion Letrozole did not have an adverse impact on overall QOL. Small effects were seen in some domains consistent with a minority of patients experiencing changes in QOL compatible with a reduction in estrogen synthesis.


2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Luiz Claudio Lacerda Rodrigues ◽  
Jamil Natour

Abstract Objective To evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis. Methods Sixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale). Results No significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group. Conclusions Lumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment. Trial registration Clinicaltrials.gov (NCT02879461).


2020 ◽  
Author(s):  
Fei-Long Wei ◽  
Cheng-Pei Zhou ◽  
Ming-Rui Du ◽  
Kai-Long Zhu ◽  
Hao-Ran Gao ◽  
...  

Abstract Background: Oblique lateral interbody fusion (OLIF) expands the inner volume of the spinal canal by indirect decompression. However, there were few studies to assess OLIF for LSS. The aim of this study was to evaluate outcomes and safety after percutaneous delta endoscopic decompression (PED) and OLIF. Methods: Ninety-four patients with lumbar spinal stenosis (LSS) underwent PED or OLIF with percutaneous pedicle screw fixation (PPS) between January 2016 and December 2018 were retrospectively studied. Patients were assessed by estimated blood loss (EBL), operative time, hospital stay, cost, reoperation, complications, the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), Japanese Orthopaedic Association score (JOA) and Short Form-36 (SF-36). Results: Compared with OLIF group, the OLIF group was with longer operation time and hospital stay, more blood loss and more cost (p=0.001, 0.005, 0.001 and 0.001, respectively). Compared with preoperative data, VAS and ODI were significantly reduced and JOA and SF-36 increased significantly with the statistically significant difference (all p <0.05). There was no significant difference in postoperative main outcomes except VAS (lumbar) and ODI between the two groups (all p >0.05). But patients in the PED group were with lower VAS (lumbar) and ODI (p=0.012 and 0.042, respectively). In addition, the PED group was with SF-36 physical-component summary score (p=0. 0.036). The PED group was with lower all complication rate (2.4% PED vs 9.8% OLIF), intra-operative complication rate (2.4% PED vs 3.9% OLIF) and post-operative complication rate (0.0% PED vs 5.9% OLIF), but the difference was not statistically significant (p=0.336, 0.517 and 0.402, respectively). And there was no statistical difference in and reoperation rate (2.4% PED vs 3.8% OLIF) (p= 0.715).Conclusions: PED and OLIF had satisfactory results for LSS. In general, PED was superior to OLIF in relieving patients with low back pain and improving function without any obvious shortcomings. Therefore, we recommend PED for LSS.Level of Evidence: 3


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6557-6557
Author(s):  
Beverly Moy ◽  
Dongsheng Tu ◽  
Harriet Richardson ◽  
Elizabeth Maunsell ◽  
Paul E. Goss

6557 Background: Racial/ethnic minority postmenopausal women reported fewer side effects than whites on the aromatase inhibitor (AI) letrozole in MA.17. We present symptoms and QoL according to race and ethnicity in women taking EXE for BC prevention in MAP.3. Methods: Adjusted proportions ever experiencing symptoms or reporting worsened SF-36 domains (change scores from baseline decreased by ≥ -5 points) among racial minorities (M) and whites (W), and Hispanics (H) and non-Hispanics (non-H), were compared using logistic regression models adjusting for age, body mass index (BMI), country, marital status, education level and employment status. Results: Of 2285 women randomized to EXE, 2231 (97.6%) women had race information: 129 M (6.1%) and 2102 W (93.9%).Compared to W, M were significantly older, had higher BMI, had lower Gail scores, received more drugs for cardiovascular diseases, and were more likely to live in the United States.M women experienced fewer sweats (12% vs. 22%; p = 0.005) and less vaginal dryness (8% vs. 16%; p=0.03). No significant difference between W and M was seen in the proportion with worsened QoL on any SF-36 domain. Ethnicity was known for 2198 women on EXE (96.2%): 241 H (11.0%) and 1957 non-H (89%). The following were less frequent among H women: hot flashes (21% vs. 42%; p<0.0001); fatigue (14% vs. 24%; p=0.01); sweats (5% vs. 24%; p<0.0001); insomnia (6% vs. 11%; p=0.001); heartburn (5% vs. 16%; p=0.001); nausea (3% vs. 7%; p=0.02); arthritis (5% vs. 12%; p=0.02); depression (7% vs. 11%; p=0.005); back pain (2% vs. 10%; p=0.002); cough (4% vs. 11%; p=0.02); and vaginal dryness (4% vs. 17%; p<0.0001). Fewer H women reported worsening in SF-36 bodily pain (60 vs. 66%; p=0.02) but more reported worsening in SF-36 mental health (59% vs. 48%; p=0.02). Conclusions: Consistent with MA.17 findings, racial/ethnic minorities experienced fewer adverse events on AI. H women had less bodily pain but reported worsening mental health. These differences may be important for minority women contemplating EXE for BC prevention. Genotypic variations and pharmocogenomics that might account for these differences merit investigation.


Sign in / Sign up

Export Citation Format

Share Document