scholarly journals Decompression alone versus decompression and instrumented fusion for the treatment of isthmic spondylolisthesis: a randomized controlled trial

2021 ◽  
pp. 1-11
Author(s):  
Kayoumars Azizpour ◽  
Pieter Schutte ◽  
Mark P. Arts ◽  
Willem Pondaag ◽  
Gerrit J. Bouma ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Technique ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Neurogenic Claudication ◽  
Low Grade ◽  
Secondary Outcome Measure ◽  
Isthmic Spondylolisthesis ◽  
Instrumented Fusion

OBJECTIVE The most advocated surgical technique to treat symptoms of isthmic spondylolisthesis is decompression with instrumented fusion. A less-invasive classical approach has also been reported, which consists of decompression only. In this study the authors compared the clinical outcomes of decompression only with those of decompression with instrumented fusion in patients with isthmic spondylolisthesis. METHODS Eighty-four patients with lumbar radiculopathy or neurogenic claudication secondary to low-grade isthmic spondylolisthesis were randomly assigned to decompression only (n = 43) or decompression with instrumented fusion (n = 41). Primary outcome parameters were scores on the Roland Disability Questionnaire (RDQ), separate visual analog scales (VASs) for back pain and leg pain, and patient report of perceived recovery at 12-week and 2-year follow-ups. The proportion of reoperations was scored as a secondary outcome measure. Repeated measures ANOVA according to the intention-to-treat principle was performed. RESULTS Decompression alone did not show superiority in terms of disability scores at 12-week follow-up (p = 0.32, 95% CI −4.02 to 1.34), nor in any other outcome measure. At 2-year follow-up, RDQ disability scores improved more in the fusion group (10.3, 95% CI 3.9–8.2, vs 6.0, 95% CI 8.2–12.4; p = 0.006, 95% CI −7.3 to −1.3). Likewise, back pain decreased more in the fusion group (difference: −18.3 mm, CI −32.1 to −4.4, p = 0.01) on a 100-mm VAS scale, and a higher proportion of patients perceived recovery as showing “good results” (44% vs 74%, p = 0.01). Cumulative probabilities for reoperation were 47% in the decompression and 13% in the fusion group (p < 0.001) at the 2-year follow-up. CONCLUSIONS In patients with isthmic spondylolisthesis, decompression with instrumented fusion resulted in comparable short-term results, significantly better long-term outcomes, and fewer reoperations than decompression alone. Decompression with instrumented fusion is a superior surgical technique that should in general be offered as a first treatment option for isthmic spondylolisthesis, but not for degenerative spondylolisthesis, which has a different etiology.

scholarly journals Effect of Individually Tailored Biopsychosocial Workplace Interventions on Chronic Musculoskeletal Pain and Stress Among Laboratory Technicians: Randomized Controlled Trial

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. 459-471 ◽  
Author(s):  
Kenneth Jay
Keyword(s):  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Outcome Measure ◽  
Chronic Musculoskeletal Pain ◽  
Secondary Outcome ◽  
Body Region ◽  
Response Analysis ◽  
Secondary Outcome Measure ◽  
Randomized Controlled

Background: Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem. Objectives: This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements. Study Design: This trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. The trial “Implementation of physical exercise at the Workplace (IRMA09) – Laboratory technicians“ was registered at ClinicalTrials.gov prior to participant enrolment. Setting: The study was conducted at the head division of a large private pharmaceutical company’s research and development department in Denmark. The study duration was March 2014 (baseline) to July 2014 (follow-up). Methods: Participants (n = 112) were allocated to receive either physical, cognitive, and mindfulness group-based training (PCMT group) or a reference group (REF) for 10 weeks at the worksite. PCMT consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area, 2) motor control training, 3) mindfulness, and 4) cognitive and behavioral therapy/education. Participants of the REF group were encouraged to follow ongoing company health initiatives. The predefined primary outcome measure was pain intensity (VAS scale 0 – 10) in average of the regions: neck, shoulder, lower and upper back, elbow, and hand at 10 week follow-up. The secondary outcome measure was stress assessed by Cohen´s perceived stress questionnaire. In addition, an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress, respectively, as outcome measures. Results: A significant (P < 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95%CI: -1.4 to -0.6). No significant effect on stress was observed (treatment by time P = 0.16). Exploratory analyses for each body region separately showed significant pain reductions of the neck, shoulders, upper back and lower back, as well as a tendency for hand pain. Within the PCMT group, general linear models adjusted for age, baseline pain, and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95%CI -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95%CI 0.02 to 0.18]). No such associations were found with the change in stress as outcome. Limitations: Limitations of behavioral interventions include the inability to blind participants to which intervention they receive. Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations

scholarly journals Combining technology and research to prevent scald injuries: results from Cool Runnings randomised controlled trial (Preprint)

2018 ◽  
Author(s):  
Jacqueline Burgess ◽  
Kerrianne Watt ◽  
Roy M Kimble ◽  
Cate M Cameron
Keyword(s):  
Social Media ◽  
Young Children ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
First Aid ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Post Test

BACKGROUND New technologies, widespread availability of the internet, the rise of social media and increased ownership of smartphones provide new opportunities for health researchers to communicate and engage with target audiences. OBJECTIVE This new technology was used to recruit mothers of young children to a smartphone application (app) to increase their knowledge about childhood burns (specifically hot beverage scalds) and correct burn first-aid. This six-month intervention deployed on the Cool Runnings app, used gamification techniques to reinforce intervention messages and engage participants. METHODS A two-group, parallel, single blinded, randomized controlled trial (RCT) to evaluate the efficacy of a smartphone app-based burn prevention intervention. Participants were women aged 18+, living in Queensland, Australia, with at least one child aged 5-12 months at the time of enrolment. The primary outcome measure was change in knowledge around burn risk and correct burn first-aid assessed via two methods: overall score; and categorised as adequate (score =4) vs inadequate (score less than 4). The secondary outcome measure was the efficacy of gamification techniques (measured by: app opens, photo uploads, pop quiz completions and content views). RESULTS In total, 498 participants were recruited via social media and enrolled. At 6-month follow-up, 244 participants completed the post-test questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those who were lost to follow up on any characteristics except for education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge post-test than control group participants on both primary outcome measures (overall knowledge intervention: mean=2.68± 1.00 vs control mean:2.13±1.03; intervention: 20.47% adequate vs control: 7.3%). Consequently, the NNT was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage were 7.3 times more likely to improve overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between each of the four gamification techniques and knowledge change (p<0.001). In addition, participants with low/moderate ‘app activity’ were 8.59 times more likely to have improved knowledge between baseline and 6-month follow-up than those who had no app activity (95%CI=2.9-25.02); participants with high app activity were 18.26 times more likely to have improved knowledge (95%CI=7.1-46.8). CONCLUSIONS Despite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about hot beverage scald risks and burn first-aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to, and engage with targeted populations, results from this RCT provides important information on how smartphone applications can be used for widespread injury prevention campaigns, and public health campaigns generally. CLINICALTRIAL This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000019404)

scholarly journals A Novel Technique for the Reconstructive Formation of an Annular Hymen in Cases of Postpubertal Imperforate Hymen

2021 ◽  
Vol 21 (1) ◽  
pp. e110-115
Author(s):  
Atef M. Darwish
Keyword(s):  
Minimally Invasive ◽  
Outcome Measure ◽  
Reconstructive Surgical Procedures ◽  
Intraoperative Complications ◽  
University Hospital ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Imperforate Hymen ◽  
Novel Technique

Objectives: Imperforate hymen (IH) is a common genital tract anomaly in women which usually presents after puberty. However, surgical treatment is often considered controversial in religious or conservative communities for sociocultural reasons. This study therefore aimed to assess the efficacy of a novel reconstructive technique involving the preservation of the annular hymen. Methods: This prospective interventional study was performed between July 2013 and October 2019 at the minimally invasive surgery unit of a tertiary university hospital in Egypt. A total of 36 women presenting with primary amenorrhoea and haematocolpus were diagnosed with postpubertal IH. A circular hymenotomy was performed on each patient using a 10 mm laparoscopy trocar tip and sleeve to form a new annular hymen under general anaesthesia while preserving the annular hymen. The primary outcome measure was the persistence of hymenal patency and integrity at follow-up. The secondary outcome measure included post-operative patient satisfaction and pain relief. Results: The reported technique was feasible in all cases without intraoperative complications. Patency of the reconstructed annular hymen was confirmed at follow-up in all cases; moreover, no intraoperative complications were reported. There was a significant post-operative improvement in pain scores (P <0.001). Both the patients and their parents/guardians reported a high level of satisfaction with the technique. Conclusion: This novel technique for the correction of IH involving the reconstruction of an annular hymen was found to be a safe, minimally invasive and effective procedure. This technique should be considered a feasible alternative to a conventional hymenotomy as it allows for the resumption of normal hymenal anatomy without overtreatment.   KEYWORDS Congenital Abnormalities; Imperforate Hymen; Hematocolpos; Amenorrhea; Colpotomy; Reconstructive Surgical Procedures; Treatment Outcome; Egypt.

scholarly journals Outcomes of Coccygectomy Using the “Z” Plasty Technique of Wound Closure

2019 ◽  
Vol 9 (8) ◽  
pp. 802-806 ◽  
Author(s):  
Arvind G. Kulkarni ◽  
Sandeep Tapashetti ◽  
Viraj S. Tambwekar
Keyword(s):  
Wound Healing ◽  
Wound Closure ◽  
Outcome Measure ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Patient Reported ◽  
The Mean

Study Design: Technical note. Objectives: Coccygectomy for chronic coccydynia has a high rate of successful clinical outcome. However, the procedure is associated with increased incidence of wound dehiscence and surgical site infection. The main objective was to evaluate the clinical outcomes of coccygectomy using the Z plasty technique of wound closure. Methods: Patients with chronic coccydynia refractory to conservative treatment underwent coccygectomy followed by Z plasty technique of wound closure between January 2013 and February 2018. Primary outcome measure was evaluation of the wound healing in the postoperative period and at follow-up; secondary outcome measure included visual analogue scale (VAS) score for coccygeal pain. Results: Ten patients (male:female 6:4) fulfilled the inclusion criteria. The mean age of patients was 40.78 years (range 19-55 years). The mean follow-up was 1.75 years (range 6 months to 5 years). All wounds healed well with no incidence of wound dehiscence or surgical site infections. The mean VAS improved from 7.33 ± 0.5 to 2.11 ± 1.2 ( P < .05). Nine patients reported excellent outcomes and 1 patient reported poor outcome with regards to relief from coccydynia. Conclusion: Z plasty technique of wound closure is recommended as procedure of choice to avoid wound healing problems and surgical site infections associated with coccygectomy. Coccygectomy remains a successful treatment modality for chronic coccydynia.

scholarly journals Non-surgical oral hygiene interventions on disease activity of Rheumatoid arthritis patients with periodontitis: A randomized controlled trial

2020 ◽  
Vol 14 (1) ◽  
pp. 26-36
Author(s):  
William Buwembo ◽  
Ian Guyton Munabi ◽  
Mark Kaddumukasa ◽  
Haruna Kiryowa ◽  
Muhammad Mbabali ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Oral Hygiene ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Control Group ◽  
Secondary Outcome Measure ◽  
Das 28 ◽  
Periodontal Index

Background . Periodontitis and rheumatoid arthritis have similar epidemiology and pathophysiology. Understanding the interaction between these two diseases is vital in our settings. We set out to assess the effect of oral hygiene interventions on disease activity of rheumatoid arthritis patients with periodontitis in Kampala, Uganda. Methods. Fifty-eight patients attending an arthritis clinic with rheumatoid arthritis and periodontitis were randomly assigned to either an intervention group or a control group. Patients diagnosed with rheumatoid arthritis at least two years before, who were on the same medication, dose, or formulation for RA treatment during the preceding three months, were included. The patients were >18 years of age, would be available for all the study visits in the next six months, had at least six natural teeth, had periodontal disease classified as Dutch Periodontal Index (DPSI) >3 and provided written informed consent. Those who had a chronic disorder requiring chronic or intermittent use of antibiotics, were pregnant, were lactating, or had intent to become pregnant were excluded. The primary outcome measure was a change in Disease Activity Score of 28 Joints (DAS28 score) in two 3-month follow-up periods after the intervention. The secondary outcome measure was a change in periodontal status. Results. There was a statistically significant improvement in the DAS-28 score in both the intervention and control arms during the follow-up period (P<0.01). The participants carrying more than one bacterial species had worse DAS-28 scores. Conclusion. Oral hygiene interventions given to RA patients could drastically improve their RA treatment outcomes, especially in resource-limited settings.

Repetition of Suicide Attempts

Crisis ◽  
2010 ◽  
Vol 31 (4) ◽  
pp. 194-201 ◽  
Author(s):  
José M. Bertolote ◽  
Alexandra Fleischmann ◽  
Diego De Leo ◽  
Michael R. Phillips ◽  
Neury J. Botega ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Emergency Departments ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Suicidal Behaviors ◽  
Suicide Attempters

Background: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings. Aims: To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People’s Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Methods: Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt – the secondary outcome measure presented in this paper – were identified by follow-up calls or visits. Subsequent completed suicide – the primary outcome measure – has been reported in a previous paper. Results: Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, χ² = 0.013; p = .909), but there were differences in rates across the five sites. Conclusions: This study from five low- and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.

Surgical Treatment of Low-Grade Isthmic Spondylolisthesis With Transsacral Fibular Strut Grafts

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 758-763 ◽  
Author(s):  
Peter G. Passias ◽  
Michal Kozanek ◽  
Kirkham B. Wood
Keyword(s):  
Surgical Treatment ◽  
Posterior Approach ◽  
Low Grade ◽  
Complication Rates ◽  
Isthmic Spondylolisthesis ◽  
Modified Technique ◽  
Instrumented Fusion ◽  
Radiographic Outcomes ◽  
Circumferential Fusion

Abstract Background: The ideal surgical treatment for adult low-grade isthmic spondylolisthesis (ALIS) remains unknown. Isolated anterior and posterior procedures are popular but have resulted in equivocal outcomes, whereas combined anterior and posterior procedures are associated with higher complication rates despite improved outcome. Objective: To evaluate the clinical and radiographic outcomes following the treatment of ALIS using a 1-stage posterior approach with posterior decompression and posterolateral arthrodesis combined with an interbody fibular allograft strut. Methods: Fifteen patients underwent fusion by a single surgeon using our modified technique. Seven patients were female and 8 were male, with a mean age of 48 years. All patients were classified as Meyerding grade II slips and underwent a posterior approach only, a decompressive laminectomy, and a circumferential fusion with the use of a transsacral fibular allograft and a posterolateral instrumented fusion. Postoperative clinical and radiographic evaluations were performed at 3, 6, and 12 months, and then on an annual basis. Results: The average follow-up interval was 61 months. Three complications were seen: a single dural tear, an L5 radiculopathy secondary to a malpositioned pedicle screw, and one patient with urinary retention. The spines of all patients were determined to be fused by the 6-month postoperative visit. All patients returned to their normal activities of daily living. Significant improvements in the visual analog score were seen at all follow-up intervals. Conclusion: Transsacral interbody fibular allograft can be used successfully to supplement a posterolateral instrumented fusion in selected patients with low-grade ALIS.

scholarly journals Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis

2017 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Akshay Jain ◽  
R.K. Jain ◽  
Vivek Kiyawat
Keyword(s):  
Back Pain ◽  
Pedicle Screws ◽  
Direct Access ◽  
Instrumented Fusion ◽  
Loss Of Correction ◽  
Vas Score ◽  
Transpedicular Approach ◽  
Thoracolumbar Region ◽  
Radiological Healing

<sec><title>Study Design</title><p>Retrospective analysis.</p></sec><sec><title>Purpose</title><p>We evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach.</p></sec><sec><title>Overview of Literature</title><p>For surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach.</p></sec><sec><title>Methods</title><p>A total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year.</p></sec><sec><title>Results</title><p>Mean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°.</p></sec><sec><title>Conclusions</title><p>Transpedicular decompression with instrumented fusion is a safe and effective approach for management of patients with thoracic and thoracolumbar tuberculosis.</p></sec>

scholarly journals Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

2018 ◽  
Vol 103 (10) ◽  
pp. 1395-1400 ◽  
Author(s):  
Rashmi G Mathew ◽  
Sahar Parvizi ◽  
Ian E Murdoch
Keyword(s):  
Cataract Surgery ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Risk Of Failure ◽  
Increased Risk ◽  
Significant Difference ◽  
Measure Change ◽  
Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

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