scholarly journals Comparision of Spinopelvis Alignment with Short Segment Reduction and Fusion (Plif) In Low and High Grade Spondylolistesis

2020 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Age Groups ◽  
Posterior Lumbar Interbody Fusion ◽  
Visual Analogue Score ◽  
Pain Reduction ◽  
Disc Height ◽  
Neurological Deficits ◽  
Duration Of Symptoms ◽  
Post Operative Pain ◽  
Ethical Committee Approval ◽  
Clinical And Radiological Outcome

Study Design: A prospective clinicoradiological study of PLIF was conducted in similar types and high grades > 2 spondylolisthesis in 40 patients, with 20 patients as controls with grade < 2. Objective: The objective was to assess the clinicoradiological profile of various spinopelvic parameters like pelvic incidence, pelvic version, sacrohorizontal angle, slip reduction and disc height increment using structural and standalone graft and its consequences on the post-operative outcome as assessed by Visual Analogue Score and Oswestry Disability Index. Methods: Before starting the study Institutional ethical committee approval was taken and approval no 654 was given for the study and prior consents were taken by all the patients included in the study and was documented. This study involved a total number of 40 patients of spondylolisthesis >2 and 20 patients of <2 of all the age groups with progressive neurological deficits, and pain not relieved by conservative measures. All patients underwent wide laminectomy, facetectomy, complete discectomy and posterior lumbar interbody fusion with intraoperative slip reduction maneuvers, disc height maintained with interbody stand-alone graft or structured grafts made of PEEK or Titanium cages. Conclusions: There was no correlation between duration of symptoms and post operative pain reduction. A fusion rates of 92% were achieved with intra operative slip reduction. The results obtained in comparison with slip reduction and post operative pain reduction are directly proportional and statistically not significant. A decrease in pelvic version and increase in sacrohorizontal angle were noted following surgery. Restoration and incrementing the disc height is associated with statistically significant pain relief. Polyetheretherketone (PEEK) inter body spacer has best clinical and radiological outcome in terms of maintenance of the disc height followed by titanium cage and stand alone graft respectively. All these results had significant positive predictive value in all cases of spondylolisthesis > 2 and was statistically insignificant in patients with grade <2.

scholarly journals An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naureen Keric ◽  
Darius Kalasauskas ◽  
Sophia L. Kreth ◽  
Martin B. Glaser ◽  
Harald Krenzlin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Age Groups ◽  
Treatment Strategies ◽  
The Elderly ◽  
Outcome Analysis ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
Ganglion Gasseri

Abstract Background Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) presents an excellent treatment in neurovascular compression cases, percutaneous thermocoagulation (PT) of the ganglion Gasseri is an alternative option. This study aimed to evaluate post-operative complication rate and outcome of both treatment strategies related to the patient’s age. Methods The medical records of all patients with the diagnosis of trigeminal neuralgia undergoing an MVD or PT of the ganglion Gasseri (between January 2007 and September 2017) were reviewed to determine the efficacy and the complication rate of both methods in regard to the patient’s age. Results Seventy-nine patients underwent MVD surgery and 39 a PT. The mean age of patients in the MVD group was 61 years and 73 years in the PT group. There were 59 (50%) female patients. Nerve-vessel conflict could be identified in 78 (98.7%) MVD and 17 (43.6%) PT patients on preoperative MRI. Charlson comorbidity index was significantly higher in PT group (2.4 (1.8) versus 3.8 (1.8) p < 0.001). The Barrow pain score (BPS) at the last follow-up demonstrated higher scores after PT (p = 0.007). The complication rate was markedly higher in PT group, mostly due to the facial hypesthesia (84.6% versus 27.8%; p < 0.001). Mean symptom-free survival was significantly shorter in the PT group (9 vs. 26 months, p < 0.001). It remained statistically significant when stratified into age groups: (65 years and older: 9 vs. 18 months, p = 0.001). Duration of symptoms (OR 1.005, 95% CI 1.000–1.010), primary procedure (OR 6.198, 95% CI 2.650–14.496), patient age (OR 1.033, 95% CI 1.002–1.066), and postoperative complication rate (OR 2.777, 95% CI 1.309–5.890) were associated with treatment failure. Conclusion In this patient series, the MVD is confirmed to be an excellent treatment option independent of patient’s age. However, while PT is an effective procedure, time to pain recurrence is shorter, and the favorable outcome (BPS 1 and 2) rate is lower compared to MVD. Hence MVD should be the preferred treatment and PT should remain an alternative in very selected cases when latter is not possible but not in the elderly patient per se.

scholarly journals Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low Middle-Income Country

2021 ◽  
Vol 27 ◽  
pp. 107602962110228
Author(s):  
Bushra Moiz ◽  
Ronika Devi Ukrani ◽  
Aiman Arif ◽  
Inaara Akbar ◽  
Muhammed Wahhaab Sadiq ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Care Center ◽  
Tertiary Care ◽  
Age Groups ◽  
Activated Protein C ◽  
Positive Association ◽  
Cerebral Venous Sinus Thrombosis ◽  
P Value ◽  
Middle Income ◽  
Duration Of Symptoms

Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement ( P-value 0.009) but not with duration of symptoms ( P-value 0.344), hospital stay ( P-value 0.466), age ( P-value 0.863) or gender ( P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.

scholarly journals Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

2014 ◽  
Vol 27 (2) ◽  
pp. 204 ◽  
Author(s):  
Ana Lebre ◽  
Jorge Velez ◽  
Diana Seixas ◽  
Eduardo Rabadão ◽  
Joaquim Oliveira ◽  
...  
Keyword(s):  
Average Duration ◽  
Signs And Symptoms ◽  
Neurological Deficits ◽  
Imaging Method ◽  
Low Back ◽  
Positive Serology ◽  
Abscess Drainage ◽  
Duration Of Symptoms ◽  
Spinal Magnetic Resonance Imaging ◽  
Appropriate Therapy

<strong>Introduction:</strong> Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy.<br /><strong>Material and Methods:</strong> Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period (1988-2012).<br /><strong>Results:</strong> We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring.<br /><strong>Discussion:</strong> Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial.<br /><strong>Conclusions:</strong> Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its’ duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

scholarly journals Role of laparoscopy in incisional hernia and relative benefit of the laparoscopic incisional hernia repair to the open incisional hernia repair

2020 ◽  
Vol 7 (7) ◽  
pp. 2165
Author(s):  
Sudhir Singh Pal ◽  
Azad Kumar Mourya
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Mesh Repair ◽  
Laparoscopic Group ◽  
Incisional Hernia Repair ◽  
Visual Analogue Score ◽  
Laparoscopic Incisional Hernia Repair ◽  
Post Operative Pain ◽  
Open Mesh Repair

Background: Incisional hernia is a common complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long term outcomes.Methods: The study was conducted on 50 patients admitted at GMC Bhopal with approval from college ethical committee.Results: In 50 cases 21 were male and 29 were female. 7 male (14%) and 15 female (30%) patients had undergone laproscopic mesh repair (LMR) and 14 male (28%) and 14 female (28%) patients had undergone open mesh repair (OMR). Total complication in OMR group is 10 (35%) and in LMR group is 2 (9.09%). Mean duration of hospital stay in LMR group was 6.6 days and in OMR group was 15.57 days. Post-operative patients of LMR group returned back to the work early (mean 12 days) compared to OMR group (mean 20.7 days). Mean post-operative day of movement in LMR group was 1 day and in OMR group was 2.03 days. Pain measured using visual analogue score on 3rd post-operative day showed decreased pain score in laparoscopic group (mean 2) compared to open group (mean 5.35).Conclusions: Laparoscopic incisional hernia repair provides lesser post-operative pain, lesser complications, shorter hospital stay and lesser economic impact as they returned to work early. Thus patients have less morbidity and improved quality of life. 

scholarly journals A comparative study between the Universal Spinal System® (USS) and the CD Horizon® Legacy™ (CDH) in the management of thoracolumbar fractures

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 42
Author(s):  
Ahmed Samir Barakat ◽  
Ahmed Elattar ◽  
Khaled Fawaz ◽  
Ahmed Maher Sultan ◽  
Wael Koptan ◽  
...  
Keyword(s):  
Body Height ◽  
Pain Reduction ◽  
X Rays ◽  
Thoracolumbar Fractures ◽  
Short Segment ◽  
Legacy System ◽  
Neurological Improvement ◽  
Clinical And Radiological Outcome ◽  
One Year ◽  
Short Segment Fixation

Introduction: For the treatment of unstable non-osteoporotic thoracolumbar fractures, the clinical and radiological outcome of short-segment fixation with the USS™ – Universal Spine System (DePuy Orthopedics, Inc., Warsaw, IN, USA) and the CD HORIZON® LEGACY™ 5.5 Spinal System, (Medtronic Sofamor Danek USA, Inc., Memphis, TN, USA) were compared. Methods: From March 2015 to January 2016, 40 consecutive patients with unstable traumatic thoracolumbar fractures who met our inclusion criteria were treated with either the USS system or CDH Legacy system. Segmental kyphosis angle (SKA) and anterior body height (ABH) of fractured vertebrae, and ASIA Impairment Scale (AIS) were evaluated. Radiological fusion was confirmed with plain X-rays and when indicated with computerized tomography (CT). Results: The mean immediate kyphotic angle correction was 16.6° for the Schanz and 6.4 for the Legacy system, and the immediate mean anterior vertebral body height correction was 0.92 cm for the Schanz and 0.51 cm for the Legacy system. Our study shows a significant statistical difference between Schanz and Legacy systems regarding post-operative segmental kyphosis and height correction immediately postoperatively, at 6 months and at one-year follow-up (p-value < 0.005). The degree of pain reduction and neurological improvement was not influenced by the screw system. Conclusion: Usage of USS in thoracolumbar fracture as a short-segment fixation led to a near anatomical reduction when compared to the Legacy system. However, there was no advantage regarding pain reduction and neurological outcome.

scholarly journals A COMPARITIVE STUDY BETWEEN EPIDURAL BUTORPHANOL, NALBUPHINE AND FENTANYL FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES

2017 ◽  
Vol 10 (5) ◽  
pp. 383
Author(s):  
Swarna Banerjee ◽  
Shaswat Kumar Pattnaik
Keyword(s):  
Side Effects ◽  
Demographic Data ◽  
Age Groups ◽  
Study Drug ◽  
Sensory Block ◽  
Lower Abdomen ◽  
Post Operative Pain ◽  
Catheter Group ◽  
Group A ◽  
Group B

Background: Achieving satisfactory post-operative analgesia with neuraxial administration of narcotics has been the subject of much research. The use of epidural opioids had become an increasingly popular technique for management of acute post-operative pain in recent times. This study evaluates post-operative analgesic benefits in patients administered epidural butorphanol, nalbuphine, and fentanyl as adjuvants with local anesthetics postoperatively for surgery under epidural anesthesia.Methods: A total of 75 patients belonging to age groups 18-60 years who were scheduled for surgeries of lower abdomen were randomly divided into groups of 25 each. Epidural technique was adopted for surgery of the lower abdomen for all patients with 0.5% bupivacaine. In the post-operative period, the study drug was given through epidural catheter. Group A received butorphanol 2 mg, Group B received fentanyl 100 μg, and Group C received nalbuphine 10 mg with 0.125% bupivacaine diluted to 10 ml in normal saline each. Onset, duration, quality of analgesia, hemodynamic changes, and side effects – such as sedation, pruritus, nausea, vomiting, respiratory depression, and urinary retention - were recorded and compared.Results: The demographic data were comparable in all three groups. The onset of sensory block was significantly earlier in Group B (fentanyl) than other two groups. Duration was significantly longer in Group A (butorphanol). No serious cardiorespiratory side effects were noted in any of groups.Conclusion: Fentanyl produces the faster onset of analgesia with adverse effects like pruritus. Butorphanol administered epidurally has the advantage of longer duration of analgesia than fentanyl or epidural nalbuphine with side effects such as nausea, vomiting, and sedation.Keywords: Epidural analgesia, Butorphanol, Fentanyl, Nalbuphine.

scholarly journals Occurrence of Typhoid Fever Complications and Their Relation to Duration of Illness Preceding Hospitalization: A Systematic Literature Review and Meta-analysis

2019 ◽  
Vol 69 (Supplement_6) ◽  
pp. S435-S448 ◽  
Author(s):  
Ligia María Cruz Espinoza ◽  
Ellen McCreedy ◽  
Marianne Holm ◽  
Justin Im ◽  
Ondari D Mogeni ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Meta Analysis ◽  
Severe Disease ◽  
Strong Association ◽  
Age Groups ◽  
Antimicrobial Treatment ◽  
Hospitalized Patients ◽  
Duration Of Symptoms ◽  
Pubmed Database ◽  
Meta Analyses

Abstract Background Complications from typhoid fever disease have been estimated to occur in 10%–15% of hospitalized patients, with evidence of a higher risk in children and when delaying the implementation of effective antimicrobial treatment. We estimated the prevalence of complications in hospitalized patients with culture-confirmed typhoid fever and the effects of delaying the implementation of effective antimicrobial treatment and age on the prevalence and risk of complications. Methods A systematic review and meta-analysis were performed using studies in the PubMed database. We rated risk of bias and conducted random-effects meta-analyses. Days of disease at hospitalization (DDA) was used as a surrogate for delaying the implementation of effective antimicrobial treatment. Analyses were stratified by DDA (DDA <10 versus ≥10 mean/median days of disease) and by age (children versus adults). Differences in risk were assessed using odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were evaluated with the I2 value and funnel plot analysis, respectively. Results The pooled prevalence of complications estimated among hospitalized typhoid fever patients was 27% (95% CI, 21%–32%; I2 = 90.9%, P < .0001). Patients with a DDA ≥ 10 days presented higher prevalence (36% [95% CI, 29%–43%]) and three times greater risk of severe disease (OR, 3.00 [95% CI, 2.14–4.17]; P < .0001) than patients arriving earlier (16% [95% CI, 13%– 18%]). Difference in prevalence and risk by age groups were not significant. Conclusions This meta-analysis identified a higher overall prevalence of complications than previously reported and a strong association between duration of symptoms prior to hospitalization and risk of serious complications.

The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect

1994 ◽  
Vol 80 (4) ◽  
pp. 659-666 ◽  
Author(s):  
Van V. Halbach ◽  
Randall T. Higashida ◽  
Christopher F. Dowd ◽  
Stanley L. Barnwell ◽  
Kenneth W. Fraser ◽  
...  
Keyword(s):  
Mass Effect ◽  
Response To Therapy ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Neurological Signs ◽  
Wall Calcification ◽  
Aneurysm Occlusion ◽  
Fine Print

✓ Endovascular obliteration of intracranial aneurysms with preservation of the parent artery (endosaccular occlusion) has been advocated for patients who fail or are excluded from surgical clipping and cannot undergo Hunterian ligation therapy. To clarify the effect that endosaccular occlusion has on the presenting neurological signs, 26 patients with aneurysms and symptoms related to mass effect who underwent this therapy were followed for a mean of 60 months. Only patients with objective neurological deficits who had not suffered a hemorrhage were included in this series. Response to therapy was classified into one of three groups: “resolved,” if the patient had complete resolution of presenting signs; “improved,” if significant and sustained improvement was recorded in the neurological examinations, and “unchanged,” if no change was observed. Thirteen patients (50%) were classified as resolved, 11 (42.3%) as improved, and two (7.7%) as unchanged. A comparison of patients classified as resolved with those who were improved revealed that the former group had less wall calcification (30% vs. 60%) and a shorter duration of symptoms. Patients with neurological sign resolution (62%) were more likely to have totally occluded aneurysms on late follow-up arteriograms than those who had improvement (28%) or were unchanged (0%). This study suggests that endosaccular embolization therapy can improve or alleviate presenting neurological signs unrelated to hemorrhage or distal embolization in the majority of cases.

Complications of Acute Sinusitis in Children

2005 ◽  
Vol 133 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Lance E. Oxford ◽  
John McClay
Keyword(s):  
Sinus Thrombosis ◽  
Tertiary Care ◽  
Outcome Data ◽  
Acute Sinusitis ◽  
Neurological Deficits ◽  
Ocular Motility ◽  
Duration Of Symptoms ◽  
Streptococcus Milleri ◽  
Intracranial Complications ◽  
Orbital Complications

OBJECTIVE: To review the demographic, microbiologic, and outcome data for children with complications of acute sinusitis. STUDY DESIGN AND SETTING: Retrospective review of children admitted with complications of acute sinusitis from January 1995 to July 2002 to a tertiary care children's hospital. RESULTS: One hundred four patients were reviewed with the following complications: orbital cellullitis (51), orbital abscesses (44), epidural empyemas (7), subdural empyemas (6), intracerebral abscesses (2), meningitis (2), cavernous sinus thrombosis (1), and Pott's puffy tumors (3). Sixty-six percent were males ( P < 0.001), and 64.4% presented from November to March ( P < 0.001). Patients with isolated orbital complications were younger than patients with intracranial complications (mean, 6.5 versus 12.3 years), had a shorter stay (mean, 4.2 versus 16.6 days), and had shorter duration of symptoms (mean, 5.4 versus 14.3 days; all P < 0.0001). Complete resolution was documented for 54/55 patients with restricted ocular motility, 7/8 with visual loss, 3/3 patients with a nonreactive pupil, 7/7 with neurological deficits, and 2/4 with seizures. The most common organism isolated was Streptococcus milleri (11/36 patients with surgical cultures). No mortalities occurred, and persistent morbidity occurred in 4 patients (3.8%). CONCLUSIONS: Despite significant deficits on presentation, permanent morbidity was low. Streptococcus milleri is a common pathogen with complications of sinusitis in children.

scholarly journals Transabdominal Pre-peritoneal Mesh Repair versus Lichtenstein’s Hernioplasty

2017 ◽  
Vol 15 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Rajan Koju ◽  
Ram Bhakta Koju ◽  
Balaram Malla ◽  
Yashad Dongol ◽  
Lok Bikram Thapa
Keyword(s):  
Quality Of Life ◽  
Minimal Invasive ◽  
Laparoscopic Technique ◽  
P Value ◽  
Early Return ◽  
Post Operative Pain ◽  
Study Results ◽  
Ethical Committee Approval ◽  
Duration Of Operation

Background: In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. However, superiority of laparoscopic repair over open repair is still controversial. Available literatures have shown laparoscopic technique to be better in term of post-operative pain and early return to work.Methods: In this prospective study, a total of 102 patients aged 21-78 years with inguinal hernia were recruited and enrolled into two comparative groups, namely Lichtenstein’s and Transabdominal pre-peritoneal, and each group containing 51 participants. Hospital ethical committee approval and written informed consent from patients was obtained. Primarily, the duration of operation, post-operative pain and complication, and quality of life after surgery was compared between the two different approaches of hernia repair.Results: The study results demonstrated a statistically significant superiority of trans abdominal pre-peritoneal repair over Lichtenstein’s hernioplasty in terms of post operative pain (2.00±0.63 vs 3.90±0.74 VAS score, P value<0.001), hospital stay (2.33±0.62 vs 2.96±0.20 days, P value <0.001) and quality of life with early return to normal work (13.39±0.60 vs 17.88±0.86 days, P value <0.001); whereas a prolonged operative time was seen in transabdominal pre-peritoneal repair (96.08±27.08 vs 42.55±5.95 mins, P value <0.001). Conclusions: This study has shown that transabdominal pre-peritoneal repair is better than Lichtenstein’s in respect to post-operative pain, quality of life and post-operative complication. However, it has prolonged operative duration than conventional method.

Sign in / Sign up

Export Citation Format

Share Document