Evaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. A retrospective comparison with younger patients

2002 ◽  
Vol 96 (2) ◽  
pp. 173-179 ◽  
Author(s):  
Yuji Handa ◽  
Toshihiko Kubota ◽  
Hisamasa Ishii ◽  
Kazufumi Sato ◽  
Akira Tsuchida ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Elderly Patients ◽  
Cervical Myelopathy ◽  
The Elderly ◽  
Duration Of Symptoms ◽  
Younger Patients ◽  
Content Type ◽  
Canal Stenosis ◽  
The Mean ◽  
Fine Print

Object. It remains unclear whether elderly patients with compressive cervical myelopathy can be expected to experience a promising surgery-related outcome after undergoing expansive laminoplasty. The purposes of this study were to evaluate the efficacy of expansive laminoplasty in elderly patients with cervical myelopathy due to multisegmental spondylotic canal stenosis and to analyze the effect of preoperative prognostic factors on outcome in elderly compared with younger patients. Methods. The authors reviewed the cases of 22 elderly (> 70 years of age) and 39 younger patients in whom expansive open-door laminoplasty was performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. The pre- and 12-month postoperative clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) disability scale. Factors affecting the clinical outcome were statistically analyzed by evaluating the recovery rate calculated from the JOA scale. There were no significant differences in the mean value of the preoperative factors, especially preoperative duration of symptoms and severity of preoperative disease, between the elderly and younger patient groups. In all patients, age at the time of the operation was shown to exert no significant influence on clinical outcome. The mean recovery rate was 58.8% in the elderly group and 61.8% in the younger group, and there was no significant intergroup difference. Improvement or attenuation in impaired upper- and lower-leg motor function was shown in all patients as was an absence in decline of sensory impairment of the extremities. In the elderly group, both the duration of symptoms and the severity of canal stenosis significantly (p < 0.05) affected the clinical outcome. In the younger group, the severity of preoperative symptoms had a significant (p < 0.05) influence on clinical outcome, whereas duration of the symptoms did not appreciably affect clinical improvement. Conclusions. Open-door expansive laminoplasty showed a promising effect on clinical outcome in elderly and younger patients with multisegmental cervical canal stenosis. Significant predictive factors for clinical outcome in the elderly patients were the duration of symptoms and the severity of stenosis, which may involve the static factor causing the cervical myelopathy. To improve the elderly patients' disability, surgery must be performed as early as possible before irreversible changes in the spinal cord develop.

Gamma knife radiosurgery for craniopharyngiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 47-56 ◽  
Author(s):  
Wen-Yuh Chung ◽  
David Hung-Chi Pan ◽  
Cheng-Ying Shiau ◽  
Wan-Yuo Guo ◽  
Ling-Wei Wang
Keyword(s):  
Clinical Outcome ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Stereotactic Aspiration ◽  
Cystic Component ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to elucidate the role of gamma knife radiosurgery (GKS) and adjuvant stereotactic procedures by assessing the outcome of 31 consecutive patients harboring craniopharyngiomas treated between March 1993 and December 1999. Methods. There were 31 consecutive patients with craniopharyngiomas: 18 were men and 13 were women. The mean age was 32 years (range 3–69 years). The mean tumor volume was 9 cm3 (range 0.3–28 cm3). The prescription dose to the tumor margin varied from 9.5 to 16 Gy. The visual pathways received 8 Gy or less. Three patients underwent stereotactic aspiration to decompress the cystic component before GKS. The tumor response was classified by percentage reduction of tumor volume as calculated based on magnetic resonance imaging studies. Clinical outcome was evaluated according to improvement and dependence on replacement therapy. An initial postoperative volume increase with enlargement of a cystic component was found in three patients. They were treated by adjuvant stereotactic aspiration and/or Ommaya reservoir implantation. Tumor control was achieved in 87% of patients and 84% had fair to excellent clinical outcome in an average follow-up period of 36 months. Treatment failure due to uncontrolled tumor progression was seen in four patients at 26, 33, 49, and 55 months, respectively, after GKS. Only one patient was found to have a mildly restricted visual field; no additional endocrinological impairment or neurological deterioration could be attributed to the treatment. There was no treatment-related mortality. Conclusions. Multimodality management of patients with craniopharyngiomas seemed to provide a better quality of patient survival and greater long-term tumor control. It is suggested that GKS accompanied by adjuvant stereotactic procedures should be used as an alternative in treating recurrent or residual craniopharyngiomas if further microsurgical excision cannot promise a cure.

Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy

1997 ◽  
Vol 86 (6) ◽  
pp. 990-997 ◽  
Author(s):  
R. Loch Macdonald ◽  
Michael G. Fehlings ◽  
Charles H. Tator ◽  
Andres Lozano ◽  
J. Ross Fleming ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Cerebrospinal Fluid Leak ◽  
Posterior Longitudinal Ligament ◽  
Morbidity Rate ◽  
Preoperative Pain ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Cervical Corpectomy ◽  
The Mean ◽  
Anterior Cervical Corpectomy

✓ This study was conducted to determine the safety and efficacy of multilevel anterior cervical corpectomy and stabilization using fibular allograft in patients with cervical myelopathy. Thirty-six patients underwent this procedure for cervical myelopathy caused by spondylosis (20 patients), ossified posterior longitudinal ligament (four patients), trauma (one patient), or a combination of lesions (11 patients). The mean age (± standard deviation) of the patients was 58 ± 10 years and 30 of the patients were men. The mean duration of symptoms before surgery was 30 ± 6 months and 11 patients had undergone previous surgery. Prior to surgery, the mean Nurick grade of the myelopathy was 3.1 ± 1.4. Seventeen patients also had cervicobrachial pain. Four vertebrae were removed in six patients, three in 19, and two in 11 patients. Instrumentation was used in 15 cases. The operative mortality rate was 3% (one patient) and two patients died 2 months postoperatively. Postoperative complications included early graft displacement requiring reoperation (three patients), transient dysphagia (two patients), cerebrospinal fluid leak treated by lumbar drainage (three patients), myocardial infarction (two patients), and late graft fracture (one patient). One patient developed transient worsening of myelopathy and three developed new, temporary radiculopathies. All patients achieved stable bone union and the mean Nurick grade at an average of 31 6 20 months (range 0–79 months) postoperatively was 2.4 ± 1.6 (p < 0.05, t-test). Cervicobrachial pain improved in 10 (59%) of the 17 patients who had preoperative pain and myelopathy improved at least one grade in 17 patients (47%; p < 0.05). Twenty-six surviving patients (72%) were followed for more than 24 months and stable, osseous union occurred in 97%. These results show that extensive, multilevel anterior decompression and stabilization using fibular allograft can be achieved with a perioperative mortality and major morbidity rate of 22% and with significant improvement in pain and myelopathy.

Endoscopic partial laminectomy for cervical myelopathy

2005 ◽  
Vol 2 (2) ◽  
pp. 170-174 ◽  
Author(s):  
Shoji Yabuki ◽  
Shin-ichi Kikuchi
Keyword(s):  
Cervical Myelopathy ◽  
Symptomatic Improvement ◽  
Intraoperative Blood Loss ◽  
Content Type ◽  
Operative Duration ◽  
Cervical Compressive Myelopathy ◽  
Wound Pain ◽  
The Mean ◽  
Compressive Myelopathy ◽  
Fine Print

Object. The authors report the results of endoscopic partial laminectomy performed in 10 patients with degenerative cervical compressive myelopathy. Methods. Endoscopic partial laminectomy was performed safely in 10 patients with cervical myelopathy. All of the patients experienced symptomatic improvement with slight postoperative wound pain. The mean operative duration was 164 ± 35 minutes and the mean intraoperative blood loss was 45.5 ± 27 ml. Conclusions. Endoscopic partial laminectomy may be used as a minimally invasive alternative for the treatment of cervical compressive myelopathy.

Anomaly of the axis causing cervical myelopathy

1999 ◽  
Vol 91 (1) ◽  
pp. 121-123 ◽  
Author(s):  
Hiroyuki Asakawa ◽  
Kiyoyuki Yanaka ◽  
Kiyoshi Narushima ◽  
Kotoo Meguro ◽  
Tadao Nose
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Craniovertebral Junction ◽  
Posterior Arch ◽  
Cervical Canal ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Canal Stenosis ◽  
Remarkable Recovery ◽  
Fine Print

✓ Although the craniovertebral junction is one of the most common sites at which anomalies develop, spina bifida occulta of the axis (C-2) associated with cervical myelopathy is extremely rare. The authors present the case of a 46-year-old man who developed progressive tetraparesis caused by a cervical canal stenosis at the level of the axis. The spinal cord was compressed by an invaginated bifid lamina of the axis. The patient made a remarkable recovery after undergoing decompressive laminectomy of C-3 and removal of the bifid posterior arch of the axis.

Prolonged Survival despite High Disease Burden in Elderly (≥55) Patients with Hb SS or Hb Sβ0 Thalassemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 710-710
Author(s):  
Damian Silbermins ◽  
Laura M. De Castro ◽  
Allison E Ashley-Koch ◽  
Jude C Jonassaint ◽  
Melanie E. Garrett ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Elderly Patients ◽  
Sickle Cell ◽  
Disease Burden ◽  
The Elderly ◽  
Study Cohort ◽  
Younger Patients ◽  
The Mean ◽  
Long Acting

Abstract In 1994, the average age of death of patients with sickle cell disease (SCD) in the US was 42 years for males and 48 for females. We theorized that patients who lived appreciably beyond these ages would therefore have lower disease burden than patients overall, and that lack of specific disease complications would be characteristic of such patients. From 2001 until 2006, we enrolled 541 unrelated adult patients (age ≥18) with Hb SS or Hb Sβ0 at three comprehensive sickle cell centers in a study designed to identify factors associated with clinical outcomes in SCD. Our database includes demographic, clinical, and laboratory data on all participants. We identified 61 patients 50 years and older and 32 patients 55 years and older. Among the latter, the average age was 60.6, with a median of 58 years (range 55–83); 65% were female. Although patients with SCD are generally thought to have a low prevalence of hypertension, the mean BP in this older cohort was 142/75, and 55% of patients were taking anti-hypertensives. Patients ≥55 had the following history of SCD-related complications: acute chest syndrome – 69%, priapism (males only) – 46%, stroke – 16%, TIA – 10%, seizure – 3%, AVN of shoulders or hips – 40%, leg ulcers – 38%, heart failure – 16%, gallstones – 64%, and retinopathy – 40%. Compared to all patients, elderly SCD patients had higher prevalence of TIA (10% vs 5%), retinopathy (40% vs 21%), and heart failure (16% vs 6%), and lower prevalence of seizures (3% vs 12%). When compared to younger patients, the elderly had a similar rate of AVN (40% vs 30%) but a significantly higher number had undergone surgical joint interventions (33% vs 10%; p=0.0001). The percentage of patients who had had cholecystectomies and splenectomies was uniform through the whole study cohort. Most interestingly, 60% of patients ≥ 55 had findings consistent with pulmonary hypertension, defined as TR jet ≥ 2.5 m/s on echocardiography. This represented approximately twice the prevalence seen in the entire study cohort. Significant proteinuria (≥ 1+) was present in 41% of patients, again approximately twice as frequently as seen in younger patients. Interviews and review of records showed that 47% of elderly patients had not required any hospitalizations during the past year (compared to only 27% in the total study cohort), while 20% were hospitalized only once, 20% were hospitalized 2–4 times, and 6% were hospitalized >4 times. Review of medication usage revealed that 35% were taking hydroxyurea (HU) at the time of enrollment, and 13% used long-acting narcotics daily (compared to 39% and 24% of the total cohort, respectively). When hematologic parameters were compared for elderly patients who were or were not taking HU, no significant differences were observed for Hb, Hct, WBC and platelet counts, although the mean Hb for patients taking or not taking HU were 8.5 and 7.8 g/dL respectively. We conclude that when compared to the overall population, the elderly had a higher prevalence of pulmonary hypertension, systemic hypertension, TIA and joint replacement, suggesting that contrary to our hypothesis, the degree to which they had experienced SCD-related end-organ damage was not decreased. While the frequency of HU use was similar to all patients, HU did not have clear effects on hematologic parameters in the elderly, raising the question of its efficacy in this population. Finally, the elderly did have some indicators of lower disease severity—namely, lower use of daily long-acting narcotics and fewer admissions for painful episodes. While research has traditionally focused on the high-risk SCD population, we believe that further investigation of elderly patients as a “lower risk” group is warranted to further advance our understanding of the relationship of SCD complications to survival.

Craniofacial resections in the elderly: an outcome study

2004 ◽  
Vol 101 (6) ◽  
pp. 935-943 ◽  
Author(s):  
Stephen J. Hentschel ◽  
Remi Nader ◽  
Dima Suki ◽  
Amer Dastgir ◽  
David L. Callender ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Elderly Group ◽  
Cancer Center ◽  
Control Group ◽  
Disease Specific Survival ◽  
Systemic Complications ◽  
Content Type ◽  
Disease Specific ◽  
Fine Print

Object. The elderly population is increasing in number and is healthier now than in the past. The purpose of this study was to examine complications and outcomes following craniofacial resection (CFR) in elderly patients and to compare findings with those of a matched younger cohort. Methods. All patients 70 years of age or older undergoing CFR at the M. D. Anderson Cancer Center (elderly group) between December 1992 and July 2003 were identified by examining the Department of Neurosurgery database. A random cohort of 28 patients younger than 70 years of age (control group) was selected from the overall population of patients who underwent CFR. There were 28 patients ranging in age from 70 to 84 years (median 74 years). Major local complications occurred in seven elderly patients (25%) and in six control patients (21%) (p = 0.75), and major systemic complications occurred in nine elderly patients (32%) and in three control patients (11%) (p = 0.05). There was one perioperative death in both groups of patients. The median duration of disease-specific survival for the elderly patients was not reached (mean 6.8 years); however, it was 8.3 years for control patients (p = 0.24). Predictors of poorer overall survival from a multivariate analysis of the elderly group included presence of cardiac disease (p = 0.005), a major systemic perioperative complication (p = 0.03), and a preoperative Karnofsky Performance Scale score less than 100 (p = 0.04). Conclusions. In this study of elderly patients who underwent CFR, there was no difference in disease-specific survival when compared with a matched cohort of younger patients. There was, however, an increased incidence of perioperative major systemic complications in the elderly group.

Synovial cysts of the thoracic spine

2004 ◽  
Vol 1 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
J. Bradley White ◽  
James J. Lynch ◽  
Gary M. Miller ◽  
William E. Krauss
Keyword(s):  
Spine Surgery ◽  
Spastic Paraparesis ◽  
Sensory Level ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Spinal Segments ◽  
Synovial Cysts ◽  
The Mean ◽  
Fine Print

Object. Thoracic synovial cysts (TSCs) are rare and are usually the subject of case reports. The authors studied the clinical manifestations, radiological aspects, and surgical treatment in a series of patients at their institution who harbored TSCs. They also review the literature to discuss the potential factors involved in the pathogenesis of this lesion. Methods. A database search of 16,000 patients who underwent decompressive spine surgery at the Mayo Clinic (Rochester, MN) between 1976 and 2003 disclosed nine patients (0.06%) in whom a diagnosis of TSC had been made. All patients were men. The mean age at presentation was 73 ± 5 years and mean duration of symptoms was 5 ± 3 months. The mean duration of follow up was 4 ± 3 years. The patients had no history of trauma or spine surgery. All patients had spastic paraparesis; two had urinary difficulties. Detailed neurological examination revealed myelopathy and radiculopathy with a sensory level of T10—L4. Magnetic resonance imaging revealed bilateral cysts in four patients and unilateral lesions in five. Three of the cysts were at the T-10 interspace, seven at the T-11 interspace, and three at the T-12 interspace. Seven cysts were on the right and six were on the left. Computerized tomography myelography performed in five patients revealed a gas bubble in the TSC in two patients. All patients underwent laminectomy/partial facetectomy, excision of the cyst, and decompression of the thecal sac and nerve root without any complications. None of these patients underwent a fusion. Eight patients (89%) experienced moderate to excellent relief of their preoperative signs and symptoms and one patient (11%) remained stable. There was no evidence of cyst recurrence at the site of surgery or other spinal segments at follow-up examination in any patient. Conclusions. When compared with their lumbar and cervical spine counterparts, TSCs are exceedingly rare. Their rarity may be explained by the decreased mobility of the thoracic spinal segments. The origin of TSCs is more likely degenerative rather than traumatic. Based on their experience and the follow-up duration, surgery provided durable relief from symptoms.

Spinal meningiomas in patients younger than 50 years of age: a 21-year experience

2003 ◽  
Vol 98 (3) ◽  
pp. 258-263 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Ofer M. Zikel ◽  
Cody A. Koch ◽  
Bernd W. Scheithauer ◽  
William E. Krauss
Keyword(s):  
Mayo Clinic ◽  
Older Patients ◽  
Control Group ◽  
Younger Patients ◽  
Content Type ◽  
Spinal Meningiomas ◽  
The Mean ◽  
Worse Prognosis ◽  
Fine Print

Object. Spinal meningiomas occur most frequently in older patients. They are well-circumscribed and slow-growing tumors that are associated with good patient outcomes following surgery. Spinal meningiomas occurring in younger patients may be more aggressive, with a worse prognosis. The authors present their 21-year experience with spinal meningiomas in patients younger than 50 years of age. Methods. The authors reviewed data obtained in 40 patients (age < 50 years) treated at the Mayo Clinic, Rochester, during the past 21 years; in all cases the lesions were histologically confirmed spinal meningiomas. Five men (12.5%) and 35 women (87.5%) (mean age 34.5 ± 10.9 years) underwent 52 operations for 41 tumors. The mean follow-up duration was 82 ± 93 months (range 0–445 months). The data obtained in these patients were compared with those derived from a random control cohort of 40 patients older than age 50 years in whom spinal meningiomas were resected at the Mayo Clinic during a similar period. In this cohort, there were 33 women and seven men whose mean age was 67.1 ± 9.5 years. The mean follow-up duration for the older group was 88 ± 72.3 months (range 18–309 months). Compared with the random cohort of older patients, younger patients there tended to have more tumors located in the cervical spine (39%) as well as a greater number of predisposing factors such as neurofibromatosis Type 2, radiation exposure, or trauma. Nine (22%) of the patients younger than 50 years of age required reoperation for residual or recurrent tumor compared with two (5%) in the older patient control group. The overall mortality rate at the completion of the study for the younger patients was 10%. Conclusions. Spinal meningiomas in younger patients have a worse prognosis than similar tumors in older patients.

Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma

2003 ◽  
Vol 98 (6) ◽  
pp. 1188-1193 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Shigeaki Kobayashi ◽  
Kazuhiro Hongo ◽  
Tsuyoshi Tada ◽  
Atsushi Sato ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Vestibular Schwannoma ◽  
Perioperative Management ◽  
Tumor Resection ◽  
Communicating Hydrocephalus ◽  
Tumor Diameter ◽  
Younger Patients ◽  
Content Type ◽  
Patients Âgés ◽  
Fine Print

Object. The clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma were retrospectively analyzed to improve the perioperative management of the circulation of cerebrospinal fluid. Methods. A retrospective analysis was performed in 236 patients with unilateral vestibular schwannomas. The patients' ages ranged from 17 to 83 years (mean 53.6 ± 13.2 years), and the diameters of the tumors the patients harbored ranged from 5 to 60 mm (mean 30.5 ± 12.7 mm). Hydrocephalus was present before tumor resection in 33 patients (14%) and in six of these patients focal dilation of the sylvian fissures was noted. There was a significant correlation between the incidence of hydrocephalus and tumor size. The incidence of preoperative hydrocephalus among elderly patients (≥ 65 years of age) was 28.6% and that among younger patients (< 65 years of age) was 10.8%. Tumors in elderly patients with hydrocephalus (mean tumor diameter 32.8 ±11.7 mm; 12 patients) were significantly smaller than those in younger patients (mean tumor diameter 41.7 ± 10.9 mm; 21 patients). Among patients with tumors smaller than 30 mm (114 patients), the incidence of hydrocephalus in elderly patients (25%) was 12-fold higher than that in younger patients (2.1%). Six patients with hydrocephalus who had focal dilation of the sylvian fissures were significantly older than 27 patients with hydrocephalus in whom there was no focal dilation. The dilated sylvian fissures collapsed in two patients spontaneously after tumor resection and in the other four patients after shunt placement. Conclusions. The incidence of associated hydrocephalus is higher in older patients. Communicating hydrocephalus tends to occur in elderly patients. Enlargement of the ventricles with focal dilation of the sylvian fissures should not be misinterpreted as physiological brain atrophy.

Lumbar spinous process—splitting laminectomy for lumbar canal stenosis

2005 ◽  
Vol 3 (5) ◽  
pp. 405-408 ◽  
Author(s):  
Kota Watanabe ◽  
Toshihiko Hosoya ◽  
Tateru Shiraishi ◽  
Morio Matsumoto ◽  
Kazuhiro Chiba ◽  
...  
Keyword(s):  
Spinous Process ◽  
Paraspinal Muscles ◽  
Paravertebral Muscle ◽  
Content Type ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
The Mean ◽  
Supporting Structures ◽  
Lumbar Spinous Process ◽  
Fine Print

✓ In conventional laminectomy for lumbar canal stenosis (LCS), intraoperative damage of posterior supporting structures can lead to irreversible atrophy of paraspinal muscles. In 2001, the authors developed a new procedure for lumbar laminectomy, the lumbar spinous process—splitting laminectomy (LSPSL). In this new procedure, the spinous process is split longitudinally in the middle and then divided at its base from the posterior arch, leaving the bilateral paraspinal muscles attached to the lateral aspects. Ample working space for laminectomy is obtained by retracting the split spinous process laterally together with its attached paraspinal muscles. After successfully decompressing nerve tissues, each half of the split spinous process is reapproximated using a strong suture. Thus, the supra- and interspinous ligaments are preserved, as is the spinous process, and damage to the paraspinal muscles is minimal. Eighteen patients with LCS underwent surgery in which this new technique was used. Twenty patients in whom conventional laminectomy was undertaken were chosen as controls. At 2 years, the clinical outcomes (as determined using the Japanese Orthopaedic Association [JOA] scores and recovery rate) and the rate of measured magnetic resonance imaging—documented paravertebral muscle atrophy were evaluated and compared between the two groups. The mean JOA score recovery rates were 67.6 and 59.2%, respectively, for patients treated with LSPSL and conventional laminectomy; the mean rates of paravertebral muscle atrophy were 5.3 and 23.9%, respectively (p = 0.0005). Preservation of posterior supporting structures and satisfactory recovery rate after 2 years indicated that this technique can be a useful alternative to conventional decompression surgery for lumbar canal stenosis.

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