scholarly journals Factors influencing surgical success in concomitant horizontal strabismus

Acta Medica ◽  
2021 ◽  
pp. 1-7
Author(s):  
Aslihan Uzun ◽  
Asena Keles Sahin
Keyword(s):  
Age At Onset ◽  
Strabismus Surgery ◽  
Deviation Angle ◽  
Factors Affecting ◽  
Surgical Success ◽  
Additional Surgery ◽  
Department Of Ophthalmology ◽  
Concomitant Strabismus ◽  
The Mean

Objective: To identify the factors affecting surgical success in patients who underwent horizontal concomitant strabismus surgery. Materials and Methods: Medical records of 143 patients who underwent concomitant horizontal strabismus surgery and who were followed up at least 6 months at Ordu University, Faculty of Medicine, Department of Ophthalmology between January 2015 and December 2020 were reviewed retrospectively. Surgical success was defined as postoperative orthophoria or deviation angle of 10 prism diopters (PD) or less at 6 months after surgery. Results: 101 (70.63%) patients with esotropia and 42 (29.37%) patients with exotropia were operated. The mean follow-up period was 18.54 ± 17.51 months, the mean distance and near preoperative deviation were 46.94 ± 11.62 PD and 47.29 ± 11.81 PD, respectively. The surgical success was 83.92% in all patients, 87.13% in esotropic patients, and 76.19% in exotropic patients. Additional surgery was performed in 8 (5.59%) patients with >20 PD residual strabismus in the following year. Preoperative distance and near deviations were found to be significantly related with surgical success (p=0.020 and p=0.026). As the preoperative deviation decreases, the surgical success increases significantly. The deviation type, age at onset, age at the time of surgery, the interval between diagnosis and surgery, gender, or preoperative amblyopia were not significantly related to surgical success (p>0.05). Conclusion: The surgical success was found to be high following concomitant horizontal strabismus surgery. Since the preoperative deviation angle is the significant factor determining surgical success, preoperative evaluations should be done carefully. Patients and their parents should also be warned about the probability of additional surgery.

scholarly journals Factors Predisposing to Amblyopia After Exotropia Surgery

2021 ◽  
Author(s):  
Qader Motarjemizadeh ◽  
Naser Samadi Aidenloo
Keyword(s):  
Visual Acuity ◽  
Significant Contribution ◽  
Strabismus Surgery ◽  
High Rate ◽  
Deviation Angle ◽  
Age At Surgery ◽  
Determining Factors ◽  
Lazy Eye ◽  
Cox Hazard Model

Amblyopia (lazy eye) is one of the significant complications of strabismus surgery. It is the most important cause of unilateral visual impairment in both children and adults. The current investigation was achieved to determine the postoperative amblyopia rate and to identify factors predisposing to amblyopia following exotropia surgery among patients who had been referred to Imam Khomeini Hospital in Urmia, Iran. The present investigation is a retrospective study that was conducted over three years (2008-2010). The study consisted of sixty patients who underwent their first strabismus surgery for treatment of horizontal deviation. Patients were followed up for at least 24 months, and the rate of postoperative amblyopia was measured. The preoperative deviation, strabismus type (exotropia vs. esotropia), visual acuity, age at surgery , and the number of operated muscles were analyzed as determining factors of postoperative development of amblyopia. Amblyopia was observed in 50% of cases during the follow-up period. No statistically significant differences were observed between amblyopic and non-amblyopic eyes in terms of sex, age at surgery, strabismus type, and visual acuity. But amblyopic eyes showed higher deviation angles compared to nonamblyopic eyes (<0.001). The Cox hazard model analysis revealed a significant contribution of deviation angle to postoperative development of amblyopia. A larger deviation angle has been identified as a positive predictor of postoperative development of amblyopia in our investigated population. Due to such a high rate of postoperative amblyopia, it seems better to initiate and complete amblyopia therapy before strabismus surgery.

scholarly journals Surgical outcomes of acute acquired comitant esotropia of adulthood

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dae Hyun Kim ◽  
Ha Jeong Noh
Keyword(s):  
Success Rate ◽  
Surgical Outcomes ◽  
Medical Records ◽  
Large Angle ◽  
Sudden Onset ◽  
Prism Diopter ◽  
Factors Affecting ◽  
The Mean ◽  
Motor Outcomes

Abstract Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.

scholarly journals Botulinum Toxin Injection with Conjunctival Microincision for the Treatment of Acute Acquired Comitant Esotropia and Its Effectiveness

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Hongjia Xu ◽  
Weifeng Sun ◽  
Shuying Dai ◽  
Yanyan Cheng ◽  
Jing Zhao ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Binocular Vision ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Age At Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Significant Difference ◽  
Angle Of Deviation ◽  
The Mean

Purpose. To report on an improved botulinum toxin injection with conjunctival microincision for beginners, and to determine the effectiveness of botulinum toxin A (BTXA) in the treatment of patients with acute acquired comitant esotropia (AACE). Methods. Medical records of 29 AACE patients were retrospectively analyzed. BTXA was injected into the unilateral or bilateral medial rectus muscle with conjunctival microincision without electromyographic guidance. Success was defined as total horizontal deviation ≤10 prism diopters (PD) and evidence of binocular vision. Results. Twenty-nine patients were included, of whom 22 were male and 7 were female. The mean age at onset was 14.2 ± 7.4 (range, 4–34) years. The mean time from onset of AACE to injection was 18.4 ± 20.3 (range, 1–96) weeks. All patients completed at least 6 months of follow-up, and the mean follow-up after BTXA injection was 12.3 ± 4.8 months (range, 7–24 months). Neurological evaluation and brain magnetic resonance imaging (MRI) were unremarkable in all patients. The mean spherical equivalent refraction was −1.22 ± 2.85D and −0.97 ± 2.80D in the right and left eyes, respectively. Mean preinjective esotropia was 38.4 ± 18.9 PD (range, +10–+80 PD) at near and 40.2 ± 17.7 PD (range, +20–+80 PD) at far distance. The mean angle of deviation at 6 months after injection was 0.6 ± 4.1 PD (range, −3–+15 PD) at near and 3.0 ± 5.9 PD (range, 0–+20 PD) at far distance. There was significant difference in the angle of deviation at near and far fixation between pre-BTXA and post-BTXA 6 months ( p < 0.001 , p < 0.001 , resp.). There was no significant difference in the angle of deviation at near and far fixation between post-BTXA 6 months and post-BTXA at final follow-up ( p  = 0.259 and 0.326, resp.). Mean stereoacuity improved from 338 to 88 arc seconds. During the follow-up period, 5 of 29 patients had recurrent esotropia. Two patients refused all further treatment, and the other 3 patients required incisional strabismus surgery. The success rates were 86.2% (25/29) at 6 months and 82.8% (24/29) at final follow-up. Conclusion. Conjunctival microincision injection of botulinum toxin is a practical and safe method for beginners to locate an extraocular muscle, which is as effective as the traditional methods. Botulinum toxin injection can be preferred as the first-line treatment for AACE patients with potential binocular vision.

Incidences Of Nasal Septal Deviation And Its Effect On Surgical Success In Patients With Congenital Nasolacrimal Dacryostenosis

2021 ◽  
Author(s):  
fatma esin özdemir ◽  
selin Üstün Bezgin ◽  
Zeliha Karademir
Keyword(s):  
Birth Weight ◽  
Endoscopic Examination ◽  
Septal Deviation ◽  
Nasal Septal Deviation ◽  
Surgical Success ◽  
Time Of Surgery ◽  
Vaginal Deliveries ◽  
The Mean ◽  
Type Of Delivery

Abstract OBJECTIVE: An investigation of incidences of nasal septal deviation (NSD) and its effect on surgical success in patients with congenital nasolacrimal dacryostenosis (CNLDO).METHODS: A retrospective review was made of the medical records of patients who presented to the ophthalmology clinic due to epiphora, were diagnosed with CNLDO and underwent probing. The diagnosis was established by history, clinical examination, and fluorescein disappearance test (FDT)1. Patients with FDT grade 2 and 3 underwent surgery. Success was defined as postoperative FDT grade 0–1. The patients were assessed in terms of gestational week, birth weight, type of delivery, nasal endoscopic examination findings (presence of NSD), time of surgery, treatments received, recurrence and complications.RESULTS: The study comprised 72 eyes of 58 patients who were diagnosed with CNLDO and underwent surgical treatment. Of the patients, 44 (75.86%) had unilateral, and 14 (24.14%) had bilateral CNLDO; 41 (56.94%) were female and 31 (43.06%) were male. The mean gestational age at birth was 38.01 weeks (32–41 weeks), the mean birth weight was 3321.25 (2020–4500 g), the number of cases delivered by cesarean section was 40 (55.56%), and 32 (44.44%) were vaginal deliveries. There were 13 (18.06%) patients with detected NSD after endonasal examination and 59 (81.94%) patients with normal endonasal examination in the Otorhinolaryngology (ORL) department. The time of surgery was 10 –34 months (mean: 19.06 months, SD: 5.73), the length of follow-up was 6–16 months (mean: 9.90 months, SD: 2.58). The rate of probing success was 80.6% (58 eyes), and there was recurrence in 19.4% (14 eyes).The success rate of the probing did not statistically significantly differ by gender (p=0.323), the mean birth week (p=0.123), the mean birth weight (p=0.186), the involved eye (p=0.891), the type of delivery (p=0.891), the mean length of follow-up (months) (p=0.701), the mean month of surgery (p=0.607), and the side of NSD (p=0.853). The incidence of NSD was statistically significantly higher in the group in which the probing failed, than in the group in which the probing was successful (p=0.004).CONCLUSION: NSD was identified in 18% of the patients who were diagnosed with CNLDO and underwent surgery. The incidence of NSD was significantly higher in the group where the probing procedure failed. Pre-treatment nasal endoscopy is important for the treatment planning and prognosis of CNLDO patients.

scholarly journals P03.08 Large cerebral arteriovenous malformations management with Volume-staged gamma knife radiosurgery

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii26-iii26
Author(s):  
R M Emad Eldin ◽  
W A Reda ◽  
A M El-Shehaby ◽  
K Abdel Karim ◽  
A Nabeel ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Cerebral Arteriovenous Malformations ◽  
Factors Affecting ◽  
Prescription Dose ◽  
The Mean ◽  
Cerebral Avms ◽  
Grade 3

Abstract BACKGROUND Large cerebral arteriovenous malformations (AVM) pose a management dilemma because of the limited success of any single treatment modality by itself. Surgery alone is associated with significant morbidity and mortality. Similarly, embolization alone has limited efficacy. Volume-staged gamma knife radiosurgery (VSGR) has been developed for the treatment of large AVMs, to increase the efficacy and improve safety of treatment of these lesions. The aim of the study was to assess the efficacy and safety of VSGR technique for the treatment of large cerebral AVMs. METHODS The study included patients treated by VSGR between May 2009 and July 2015. All cases had large AVMs (>10 cc). These were 29 patients. RESULTS Twenty-four patients completed radiographic follow up with 15 obliteration cases (62.5%). There was a total of 56 sessions performed. The mean AVM volume was 16 cc (10.1–29.3 cc). The mean prescription dose was 18 Gy (14–22 Gy). The mean follow up duration was 43 months (21–73 months). One patient died during follow up from unrelated cause. Two cases suffered haemorrhage during follow up. Symptomatic edema developed in 5 (17%) patients. The factors affecting obliteration were smaller total volume, higher dose/stage, non-deep location, compact AVM, AVM score less than 3, >18 Gy dose and <15 cc total volume. The factors affecting symptomatic edema were smaller total volume and shorter time between first and last sessions (p 0.012). T2 image changes were affected by SM grade 3 or more (p 0.013) and AVM score 3 or more (p 0.014). CONCLUSION VSGR provides an effective and safe treatment option for large cerebral AVMs. Smaller AVM volume is associated with higher obliteration rate.

scholarly journals AB0615 MORTALITY AND CAUSES OF DEATH AMONG ROMANIAN SYSTEMIC SCLEROSIS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1603.2-1603
Author(s):  
A. Petcu ◽  
M. M. Tamas ◽  
L. Muntean ◽  
S. P. Simon ◽  
I. Filipescu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Systemic Sclerosis ◽  
Survival Rate ◽  
Causes Of Death ◽  
Age At Onset ◽  
Male Gender ◽  
Raynaud Phenomenon ◽  
Cardiovascular Involvement ◽  
The Mean

Background:Systemic sclerosis (SSc) is associated with an increased risk of death compared to the general population. Survival in SSc patients has improved significantly over the last 20 years with a decrease in renal involvement as a cause of early death and an increase in death caused by cardiopulmonary involvement (1,2). Causes of death in SSc patients have not been described in a Romanian cohort so far.Objectives:To study the causes of death in patients with SSc prospectively followed-up from 2002 to 2018 in a single tertiary centre from Romania.Methods:The cohort consists of 197 patients who fulfill the American College of Rheumatology /EULAR 2013 criteria for SSc. We examined the data of patients who had died during follow up. Patients were reviewed at least twice a year and the cause of death was classified as SSc-related or nonSSc-related. SSc-related deaths were then attributed to the major organ involved. A univariate Cox proportional hazard (PH) regression was used to examine the association between each variable and mortality. Variables reported in the literature to associate with mortality were considered in the multiple Cox PH regression model.Results:Of 197 SSc patients (87.8% females), 47.7% had diffuse SSc and 52.2% had limited SSc. The mean age at diagnosis was 47 (SD 12) years and mean follow up duration was 6.75 years. There were 41 deaths (20.8%). Survival rate was substantially lower in men (P <0.003). The mean age at the time of death in those with diffuse SSc was lower compared to limited SSc (55.8 years vs 68.7 years). Sixty percent of deaths were SSc-related (pulmonary cause[n=11], cardiac cause[n=6], gastrointestinal involvement [GI, n=3], renal crisis [n=2] and others [n=4]). Deaths no related to SSc were associated with cancer and infections. Age at onset of Raynaud phenomenon [HR 1.05], male gender [HR 3.41], diffuse SSc [HR 0.48], presence of tendon friction rub [HR 4.54], digital ulceration [HR 3], esophagitis [HR 2.07] and cardiovascular involvement [HR 3.68], use of corticosteroids[HR 2.13] and cyclophosphamide [HR 2.02] were associated with poor prognosis in multivariate analysis.Conclusion:In our cohort the main causes of death were lung and cardiovascular involvement. Deaths occurred early after the onset of the disease and the survival rate was significantly reduced among men. Multivariate analysis showed that age at onset of Raynaud phenomenon, male gender, diffuse disease form, presence of tendon friction rub, digital ulceration, esophagitis and cardiovascular history, use of corticosteroids and cyclophosphamide were independently associated with mortality.References:[1]Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010 Oct;69(10):1809–15.[2]Rubio-Rivas M, Royo C, Simeon CP, Corbella X, Fonollosa V. Mortality and survival in systemic sclerosis: systematic review and meta-analysis. Semin Arthritis Rheum. 2014 Oct;44(2):208–19.Disclosure of Interests:None declared

Prognostic Factors Affecting the Clinical Outcome of Septic Arthritis of the Shoulder

2016 ◽  
Vol 21 (03) ◽  
pp. 339-344 ◽  
Author(s):  
Chul-Hyun Cho ◽  
Geon-Myeong Oh
Keyword(s):  
Prognostic Factors ◽  
Los Angeles ◽  
Clinical Outcome ◽  
Septic Arthritis ◽  
Clinical Outcomes ◽  
Open Surgery ◽  
Positive Culture ◽  
Factors Affecting ◽  
The Mean

Background: The objective of this study was to determine prognostic factors affecting the clinical outcome of septic arthritis of the shoulder. Methods: We retrospectively reviewed 34 shoulders from 32 patients, two of which had bilateral involvement. Arthroscopic (22 shoulders) or open surgery (12 shoulders) was performed by a single surgeon. The mean follow-up period was 32.4 ± 17.0 months. Clinical outcomes according to the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV) were assessed at the final follow-up period. Various factors were included for statistical analysis. Results: The mean UCLA, ASES scores, and SSV were 28.9 ± 7.2, 81.3 ± 21.0, 79.7 ± 2.5%, respectively. Positive culture was observed in only 13 shoulders (38.2%) and the most common organism was Staphylococcus aureus (seven shoulders). Five shoulders (14.7%) required two or three operations. Age and comorbidity were negatively correlated with the UCLA, ASES score, and/or SSV (p < 0.05). There was no correlation between clinical outcome and various parameters, including gender, location of lesion, history of previous steroid injection, interval between onset of symptoms and surgical intervention, bacterial organisms, operative method, and presence of rotator cuff tear and reoperation (p > 0.05). Conclusions: Both arthroscopic and open surgery for septic shoulders showed satisfactory clinical outcomes. Old age and comorbidity were poor prognostic factors of clinical outcomes after treatment.

scholarly journals Effect of monocular surgery for large-angle horizontal deviation in adults

1970 ◽  
Vol 3 (1) ◽  
pp. 27-30 ◽  
Author(s):  
S Ganguly ◽  
R Pradhan
Keyword(s):  
Visual Acuity ◽  
Large Angle ◽  
Anterior Segment ◽  
Case Series ◽  
Strabismus Surgery ◽  
Slit Lamp ◽  
Surgical Success ◽  
Squint Surgery ◽  
Indirect Ophthalmoscope

Background: Surgical success rate of strabismus is variable. Objective: To evaluate the outcome of monocular strabismus surgery for adults with largeangle deviation. Subjects and methods: This study was that of a retrospective interventional case series. A total of 48 consecutive adult patients with large-angle socially-noticeable strabismus underwent clinical evaluation for squint surgery. They were divided into 2 groups of which 28 had exotropia while 20 had esotropia with deviation ranging from 40 to 80 prism diopters (PD). Visual acuity measurement (V/A), cycloplegic refraction and orthoptic evaluation were done in all cases along with detailed anterior segment evaluation. Fundus examination was carried out with indirect ophthalmoscope and slit-lamp bio-microscopy with + 90 D lens. For each case, a repeat evaluation was done after a six-week interval. The surgical procedure was monocular recession and resection carried out under peri-bulbar anesthesia by the same surgeon. Post-operative visual acuity, fusion, stereopsis and ocular alignment were noted in all cases during follow up visits. Results: Successful ocular alignment (< 10 PD) was achieved in 40 patients while binocularity was noted in 3. Forty patients were happy with the cosmetic outcome and psychosocial rehabilitation. No statistically significant improvement was noted in visual acuity and binocular function. Successful alignment was related to pre-operative deviation of less than 30 degrees. Conclusion: Monocular surgery under peri-bulbar anesthesia is a useful procedure for large-angle horizontal strabismus. Key words: strabismus; exotropia; esotropia; fusion; binocularity DOI: 10.3126/nepjoph.v3i1.4275Nepal J Ophthalmol 2011;3(5):27-30

Postoperative factors affecting neurological recovery after surgery for cervical spondylotic myelopathy

2006 ◽  
Vol 5 (6) ◽  
pp. 483-487 ◽  
Author(s):  
Yuto Ogawa ◽  
Kazuhiro Chiba ◽  
Morio Matsumoto ◽  
Masaya Nakamura ◽  
Hironari Takaishi ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Neurological Recovery ◽  
Recovery Rates ◽  
Factors Affecting ◽  
The Poor ◽  
Poor Recovery ◽  
Age At Surgery ◽  
The Mean ◽  
Recovery Group

Object Many prognostic factors associated with surgery for cervical spondylotic myelopathy (CSM) have been detailed in the literature. All of these factors, however, are defined preoperatively. If it is possible to clarify factors influencing surgical results that can be modulated after surgery, then the overall results of surgery may improve. The purpose of this study was to elucidate such postoperative factors affecting neurological recovery. Methods The authors assessed the surgical outcomes obtained in 183 patients with CSM who underwent expansive open-door laminoplasty between 1993 and 2004 and who underwent follow up for a minimum of 1 year. They classified the cases into two groups according to the degree of neurological recovery: an excellent recovery group, comprising patients in whom the recovery rates were greater than 75%, and a poor recovery group, composed of patients in whom the recovery rates were lower than 30%. Comparisons of various clinical and imaging parameters revealed that the mean age at surgery was significantly lower in patients in the excellent recovery group than that in the poor recovery group. Therefore, the authors repeated the same analyses after adjustment for age. Postoperative cervical range of motion (ROM) was significantly more reduced in the excellent recovery group than in the poor recovery group. There was a significant positive correlation between reduced cervical ROM and recovery rate in the poor recovery group. Conclusions Dynamic stress may ameliorate functional recovery of the degenerated spinal cord even after sufficient decompression. Postoperative preservation of cervical ROM may not always be beneficial for neurological recovery in patients with CSM.

Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion

2010 ◽  
Vol 12 (2) ◽  
pp. 221-231 ◽  
Author(s):  
Richard Bransford ◽  
Fangyi Zhang ◽  
Carlo Bellabarba ◽  
Mark Konodi ◽  
Jens R. Chapman
Keyword(s):  
Blood Loss ◽  
Anterior Approach ◽  
Csf Leak ◽  
Additional Surgery ◽  
Disc Herniations ◽  
Preoperative Status ◽  
The Mean ◽  
Clinical Records ◽  
Thoracic Disc

Object Symptomatic thoracic disc herniations (TDHs) are relatively uncommon and are typically treated with an anterior approach. Various posterior surgical approaches have been developed to treat TDH, but the gold standard remains transthoracic decompression. Certain patients have comorbidities and herniation aspects that are not optimally treated with an anterior approach. A transfacet pedicle-sparing approach was first described in 1995, but outcomes and complications have not been well described. The objective of this study was to assess outcomes and complications in a consecutive series of patients with TDH undergoing posterior transfacet decompression and discectomy with posterior instrumentation and fusion. Methods Eighteen consecutive patients undergoing operative management of TDH were identified from a tertiary care referral database. All patients underwent a transfacet pedicle-sparing decompression and segmental instrumentation with interbody fusion. Outcomes and complications were retrospectively assessed in this patient series. Clinical records were scrutinized to assess levels and types of disc herniation; blood loss; pre- and postoperative motor scores, Nurick grades, and visual analog pain scale scores; and complications such as wrong-level surgery, infection, seroma, and neurological changes. Pre- and postoperative imaging studies were reviewed to assess levels and types of herniation, alignment, and accuracy of instrumentation. Results Of the 18 patients, 9 had TDHs at multiple levels. The patients presented with symptoms including myelopathy, axial back pain, urinary symptoms, and radiculopathy and radiological evidence of 29 compressive TDHs ranging from T1–2 to T12–L1. Discs were classified as central (10) or paracentral (19). All discs were successfully removed with no incidence of wrong-level surgery or CSF leak. The mean estimated blood loss was 870 ml with no dural tears. Nurick grades improved on average from 2.5 to 1.9. All patients reported improvement in symptoms compared with preoperative status. The mean visual analog scale score improved from 59 to 21. Sixteen of the 18 patients spent an average of 4.2 days in the hospital; the 2 other patients spent 58 and 69 days. The average duration of follow-up was 12.2 months in 14 patients; 4 patients were lost to follow-up. Twelve patients had no complications. Five patients developed postoperative wound infections or seromas requiring additional operative debridement. One patient had a misplaced screw and suboptimally positioned interbody graft requiring revision. One transient neurological deterioration (American Spinal Injury Association [ASIA] D to ASIA B) occurred postoperatively associated with an inferior segment fracture 20 days after surgery. This necessitated extending the fusion caudally; the patient subsequently experienced a full return to better-than-baseline neurological status. Conclusions A modified transfacetal pedicle-sparing approach combined with short segmental fusion offers a safe means of achieving concurrent decompression and segmental stabilization and is an option for certain subtypes of TDH. Although 6 patients required additional surgery for postoperative complications, all patients experienced improvement relative to their preoperative status.

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