A short-segment fusion strategy using a wide-foot-plate expandable cage for vertebral pseudarthrosis after an osteoporotic vertebral fracture

2020 ◽  
Vol 33 (6) ◽  
pp. 862-869
Author(s):  
Ryo Taiji ◽  
Masanari Takami ◽  
Yasutsugu Yukawa ◽  
Hiroshi Hashizume ◽  
Akihito Minamide ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Adverse Events ◽  
Spinal Fusion ◽  
Visual Analog Scale ◽  
Osteoporotic Vertebral Fracture ◽  
Analog Scale ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Final Observation ◽  
The Mean

OBJECTIVEVarious surgical treatments have been reported for vertebral pseudarthrosis after osteoporotic vertebral fracture (OVF). However, the outcomes are not always good. The authors now have some experience with combined anterior-posterior short-segment spinal fusion (1 level above and 1 level below the fracture) using a wide-foot-plate expandable cage. Here, they report their surgical outcomes with this procedure.METHODSBetween June 2016 and August 2018, 16 consecutive patients (4 male and 12 female; mean age 75.1 years) underwent short-segment spinal fusion for vertebral pseudarthrosis or delayed collapse after OVF. The mean observation period was 20.1 months. The level of the fractured vertebra was T12 in 4 patients, L1 in 3, L2 in 4, L3 in 3, and L4 in 2. Clinical outcomes were assessed using the lumbar Japanese Orthopaedic Association (JOA) scale and 100-mm visual analog scale for low-back pain. Local kyphotic angle, intervertebral height, bone union rate, and instrumentation-related adverse events were investigated as imaging outcomes. The data were analyzed using the Wilcoxon signed-rank test.RESULTSThe mean operating time was 334.3 minutes (range 256–517 minutes), and the mean blood loss was 424.9 ml (range 30–1320 ml). The only perioperative complication was a superficial infection of the posterior wound that was cured by irrigation. The lumbar JOA score and visual analog scale value improved from 11.2 and 58.8 mm preoperatively to 20.6 and 18.6 mm postoperatively, respectively. The mean local kyphotic angle and mean intervertebral height were 22.6° and 28.0 mm, respectively, before surgery, −1.5° and 40.5 mm immediately after surgery, and 7.0° and 37.1 mm at the final observation. Significant improvement was observed in both parameters immediately after surgery and at the final observation when compared with the preoperative values. Intraoperative endplate injury occurred in 8 cases, and progression of cage subsidence of 5 mm or more was observed in 2 of these cases. Proximal junctional kyphosis was observed in 2 cases. There were no cases of screw loosening. No cases required reoperation due to instrument-related adverse events. Bone union was observed in all 14 cases that had CT evaluation.CONCLUSIONSThis short-segment fusion procedure is relatively minimally invasive, and local reconstruction and bone fusion have been achieved. This procedure is considered to be attempted for the surgical treatment of osteoporotic vertebral pseudarthrosis after OVF.

scholarly journals Outcome Evaluation of Patients with Burst Thoracolumbar Fractures: A Case Series

2018 ◽  
Vol 37 (04) ◽  
pp. 304-308
Author(s):  
Mohammad Jamali ◽  
Yashar Goorakani ◽  
Niloofar Solat ◽  
Reza Taheri ◽  
Sulmaz Ghahramani
Keyword(s):  
Functional Outcome ◽  
Visual Analog Scale ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Outcome Evaluation ◽  
Thoracolumbar Fractures ◽  
Analog Scale ◽  
Short Segment ◽  
Long Term Follow Up ◽  
The Mean

Objective The aim of the present study was to evaluate the outcome of short segment instrumentation in patients affected by burst thoracolumbar fractures. Methods A total of 19 patients with unstable burst fractures of the thoracolumbar spine were eligible for short segment instrumentation. Their functional outcome (by using the Oswestry and Denis scales) and back pain (using the visual analog scale) were evaluated after 12 months. Results The mean age of the patients was 30.7 years old, and most of them were male (n = 15). The mean hospital stay was 4.6 days. The mean ± standard deviation (SD) of the pain score according to the visual analog scale was 1.63 ± 1.25 after 12 months of surgery, and there were no patients classified with grades 4 or 5 on the Denis work scale. The average Oswestry disability index (ODI) was 17% during the follow-ups. Conclusions The outcome of the studied patients, including the clinical pain and the functional outcome of postsurgical patients, suggested that the short-segment instrumentation could be an appropriate method for patients with unstable thoracolumbar junction fractures. However, a long-term follow-up is recommended.

Effect of Chlorophyllin on Urinary Odor in Incontinent Geriatric Patients

1983 ◽  
Vol 17 (10) ◽  
pp. 732-734 ◽  
Author(s):  
Milap C. Nahata ◽  
Carole A. Slencsak ◽  
Judith Kamp
Keyword(s):  
Visual Analog Scale ◽  
Washout Period ◽  
Geriatric Patients ◽  
Odor Intensity ◽  
Controlled Study ◽  
Analog Scale ◽  
Double Blind ◽  
Mean Intensity ◽  
The Mean ◽  
Percent Decrease

This randomized, double-blind, crossover, placebo-controlled study involved 20 incontinent geriatric patients; all had indwelling Foley catheters. Each patient received chlorophyllin 100 mg/d for two weeks and placebo daily for two weeks, separated by a washout period of one week. For each subject, the intensity of urinary odor was measured ten times during both the treatment and placebo regimen and three times during the washout period, using a visual analog scale. A decrease in urinary odor was associated with chlorophyllin in 12 patients and with placebo in 6 patients at the end of two weeks on each regimen. Chlorophyllin treatment was associated with about a 21-percent decrease in mean urinary odor intensity, whereas placebo increased the odor by about 9 percent. The mean intensity of urinary odor was lowest during the second week of chlorophyllin treatment. Despite the decrease in urinary odor in many patients receiving chlorophyllin, its effect was not significantly greater than that of placebo. Our data suggest that chlorophyllin 100 mg/d for two weeks may not be effective in incontinent geriatric patients with mild to moderate urinary odor.

scholarly journals Effects of Mobilization Time on Occurrence of New Fractures after Vertebroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Ahmet Onur Akpolat ◽  
Sinan Karaca
Keyword(s):  
Risk Factor ◽  
Vertebral Fracture ◽  
Local Anesthesia ◽  
Postoperative Period ◽  
Statistical Difference ◽  
Treatment Options ◽  
Fracture Treatment ◽  
Osteoporotic Vertebral Fracture ◽  
The Mean

Introduction. Osteoporotic vertebral fracture treatment options include vertebroplasty, in which development of new fractures is among the possible complications which may develop during the postoperative period. We aim to evaluate whether or not postoperative mobilization time has effect on occurrence of new fractures. Materials and Methods. A total of 126 patients, consisting of 30 (39.7%) males and 96 (60.3%) females, who underwent sedation-assisted vertebroplasty under local anesthesia between January 2014 and June 2017 were retrospectively evaluated. Preoperative and postoperative visual analogue scores (VASs) and mobilization time (hours) were assessed. Day of new fracture occurrence during follow-up was assessed. Results. The mean follow-up period was 9 months (7–13 months). The most common fracture segment was the L1 vertebra (15.9%). The preoperative VAS was 8.29 ± 0.95, and the postoperative VAS was 2.33 ± 0.91. The change in VAS was statistically significant (p=0.01, p<0.05). Of all the patients, 21 (16.66%) had developed new fractures. No statistical difference was observed between mobilization time (hours) and formation of new fractures (p=0.48, p>0.05). Conclusion. We came to the conclusion that mobilization time (hours) was not a risk factor in the development of new fractures. In addition, there is no relationship between mobilization time and localization of new fractures.

Total subaxial reconstruction

2010 ◽  
Vol 13 (4) ◽  
pp. 424-434 ◽  
Author(s):  
Vincent C. Traynelis
Keyword(s):  
Cervical Spine ◽  
Visual Analog Scale ◽  
Anterior Decompression ◽  
Analog Scale ◽  
Excellent Outcome ◽  
Arm Pain ◽  
Subaxial Cervical Spine ◽  
Pain Scores ◽  
The Mean

Object Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery. Methods The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression. Results There were 16 men and 11 women whose mean age was 59 years (range 35–86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2–7 surgery, and in all others the procedure crossed the cervicothoracic junction. Following surgery patients remained intubated for an average of 3.3 days (range 1–22 days). The mean hospital length of stay was 11 days (range 3–45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre- and postoperative visual analog scale neck pain scores were 6.0 and 2.1, respectively (p = 0.0004), and mean visual analog scale arm pain scores decreased by 3.7 following surgery (p = 0.001). Based on Odom criteria, the author found that 8 patients had an excellent outcome and 14 patients a good outcome. There were 4 patients in whom the outcome was judged to be fair and the single death was recorded as a poor outcome. The mean preoperative Nurick score was 2.68. Postoperatively the group improved to an average score of 1.5; the difference between the 2 was statistically significant (p = 0.002). Conclusions Segmental anterior decompression and reconstruction of the entire subaxial cervical spine, combined with an instrumented posterolateral fusion, can be performed with acceptable morbidity and is of significant benefit in selected patients.

scholarly journals Use of cuff tear arthroplasty head prosthesis for rotator cuff arthropathy treatment in elderly patients with comorbidities

2016 ◽  
Vol 14 (4) ◽  
pp. 520-527 ◽  
Author(s):  
Cassiano Diniz Carvalho ◽  
◽  
Carlos Vicente Andreoli ◽  
Alberto de Castro Pochini ◽  
Benno Ejnisman
Keyword(s):  
Rotator Cuff ◽  
Visual Analog Scale ◽  
Analog Scale ◽  
Shoulder Hemiarthroplasty ◽  
Scale Reduction ◽  
Cuff Tear ◽  
Functional Behavior ◽  
Significant Difference ◽  
The Mean ◽  
Rotator Cuff Arthropathy

ABSTRACT Objective To evaluate the clinical and functional behavior of patients undergoing cuff tear arthroplasty at different stages of the disease. Methods Cuff tear arthroplasty hemiarthroplasties were performed in 34 patients with rotator cuff arthropathy and associated comorbidities, classified according to Seebauer. The mean age was 76.3 years, and the sample comprised 23 females (67.6%) and 11 males (32.4%). The mean follow-up period was 21.7 months, and evaluations were performed using the Visual Analog Scale for pain and the Constant scale. Results There were no statistically significant differences in the mean reduction in the Visual Analog Scale or in the Constant scale increase between the female and male groups. The variation between the pre- and postoperative Visual Analog Scale and Constant scale evaluations was significant. There was also no statistically significant difference between the Seebauer classification groups regarding the mean Visual Analog Scale reduction, or the mean Constant scale increase. Conclusion Cuff tear arthroplasty shoulder hemiarthroplasty is a good option for rotator cuff arthropathy in patients with comorbidities.

scholarly journals Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

2019 ◽  
Vol 10 (02) ◽  
pp. 225-233
Author(s):  
Mantu Jain ◽  
Rabi Narayan Sahu ◽  
Sudarsan Behera ◽  
Rajesh Rana ◽  
Sujit Kumar Tripathy ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Vertebral Body ◽  
Posterior Approach ◽  
Spinal Tuberculosis ◽  
X Rays ◽  
Analog Scale ◽  
Bony Fusion ◽  
Universal Approach ◽  
The Mean

ABSTRACT Background: Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach. Settings and Design: A retrospective case study series in a tertiary level hospital. Aims: The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a “universal approach” in tubercular spondylodiscitis of variable presentation. Materials and Methods: The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period. Statistical Analysis Used: The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired t-test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis. Results: The mean number of vertebrae involved was 3.29 ± 0.86 (2–6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause. Conclusions: The procedure in safe and has satisfactory results in variable group affection of Pott’s spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.

Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note

2019 ◽  
Vol 31 (3) ◽  
pp. 326-333
Author(s):  
Ryo Kanematsu ◽  
Junya Hanakita ◽  
Toshiyuki Takahashi ◽  
Yosuke Tomita ◽  
Manabu Minami
Keyword(s):  
Spinal Cord ◽  
Spinal Fusion ◽  
Thoracic Spine ◽  
Posterior Longitudinal Ligament ◽  
Anterolateral Approach ◽  
Thoracic Myelopathy ◽  
Kyphotic Angle ◽  
Thoracic Spinal Cord ◽  
Csf Leakage ◽  
The Mean

OBJECTIVESurgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the anatomical complexity of the thoracic spine and the fragility of the thoracic spinal cord. Several surgical approaches have been described, but it remains unclear which of these is the most effective. The present study describes the microsurgical removal of OPLL in the middle thoracic level via the transthoracic anterolateral approach without spinal fusion, including the surgical outcome and operative tips.METHODSBetween 2002 and 2017, a total of 8 patients with thoracic myelopathy due to OPLL were surgically treated via the transthoracic anterolateral approach without spinal fusion. The surgical techniques are described in detail. Clinical outcome, surgical complications, and the pre- and postoperative thoracic kyphotic angle were assessed.RESULTSThe mean patient age at the time of surgery was 55 years (range 47–77 years). There were 5 women and 3 men. The surgically treated levels were within T3–9. The clinical symptoms and Japanese Orthopaedic Association (JOA) score improved postoperatively in 7 cases, but did not change in 1 case. The mean JOA score increased from 6.4 preoperatively to 7.5 postoperatively (recovery rate 26%). Intraoperative CSF leakage occurred in 4 cases, and was successfully treated with fibrin glue sealing and spinal drainage. The mean follow-up period was 82.6 months (range 15.3–169 months). None of the patients had deterioration of the thoracic kyphotic angle.CONCLUSIONSAnterior decompression is the logical and ideal procedure to treat thoracic myelopathy caused by OPLL on the concave side of the spinal cord; however, this procedure is technically demanding. Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. The use of microscopic procedures might negate the need for bone grafting or spinal instrumentation.

scholarly journals EFFECTIVENESS OF SPIRULINA MOUTHWASH ON REDUCTION OF DENTAL PLAQUE AND GINGIVITIS: A CLINICAL STUDY

2017 ◽  
Vol 9 (7) ◽  
pp. 136
Author(s):  
Radhika Maniyar ◽  
Umashankar G. K.
Keyword(s):  
Visual Analog Scale ◽  
Dental Plaque ◽  
Rank Test ◽  
Analog Scale ◽  
Mean Values ◽  
Significant Difference ◽  
Intervention Protocol ◽  
The Mean ◽  
The Individual

Objective: The present study evaluated the effectiveness of Spirulina mouthwash on the reduction of dental plaque and gingivitis.Methods: A single-blind clinical trial was conducted among thirty patient’s aged 18-40 y visiting dental college and hospital in Bangalore city. Mouthwash was prepared using 0.5% Spirulina. Intervention protocol consisted of instructing the patients to rinse with 10 ml of mouthwash for 1 minute twice daily for 7 d. Plaque index and Gingival index were used to assess the variables at the baseline and after the intervention. The perception of the individual subjects with regard to the use of mouthwash was assessed using 10 cm long visual analog scale (VAS). Statistical analysis was carried out using Wilcoxon signed rank test for mean pre and post plaque and gingival scores respectively. Descriptive statistics was performed for VAS questionnaireResults: The results showed a highly significant difference (p<0.001) between the mean plaque scores at the baseline (2.16±0.34) and at the follow up (1.27±0.46). The mean gingival scores at the baseline (1.86±0.38) and at the follow-up (1.05±0.43) also showed a highly significant difference (p<0.001). Regarding the Visual Analog Scale, the mean values of 5 or greater than suggested the responses to be favourable as the values were reflectedConclusion: The study showed that Spirulina mouthwash resulted in significant reduction in dental plaque and gingivitis. Also, the mouthwash was convenient to use without any adverse effects. Hence, the use of herbal mouth rinses such as Spirulina should be supported.

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