Clinical Outcomes between Stand-Alone Zero-Profile Spacers and Cervical Plate with Cage Fixation for Anterior Cervical Discectomy and Fusion: A Retrospective Analysis of 166 Patients

Stand-alone (SA) zero-profile implants are an alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF). In this study, we investigate differences in surgical outcomes between SA and CP in ACDF. We conducted a retrospective analysis of 166 patients with myelopathy and/or radiculopathy who had ACDF with SA or CP from Jan 2013–Dec 2016. We measured surgical outcomes including Bazaz dysphagia score at 3 months, Nurick grade at last follow-up, and length of hospital stay. 166 patients (92F/74M) were reviewed. 92 presented with radiculopathy (55%), 37 with myelopathy (22%), and 37 with myeloradiculopathy (22%). The average operative time with CP was longer than SA (194 ± 69 vs. 126 ± 46 min) (p < 0.001), as was the average length of hospital stay (2.1 ± 2 vs. 1.5 ± 1 days) (p = 0.006). At 3 months, 82 patients (49.4%) had a follow-up for dysphagia, with 3 patients reporting mild dysphagia and none reporting moderate or severe dysphagia. Nurick grade at last follow-up for the myelopathy and myeloradiculopathy cohorts improved in 63 patients (85%). Prolonged length of stay was associated with reduced odds of having an optimal outcome by 0.50 (CI = 0.35–0.85, p = 0.003). Overall, we demonstrate that there is no significant difference in neurological outcome or rates of dysphagia between SA and CP, and that both lead to overall improvement of symptoms based on Nurick grading. However, we also show that the SA group has shorter length of hospital stay and operative time compared to CP.

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Multilevel anterior cervical discectomy and fusion with and without rhBMP-2: a comparison of dysphagia rates and outcomes in 150 patients

Journal of Neurosurgery Spine ◽

10.3171/2012.10.spine10231 ◽

2013 ◽

Vol 18 (1) ◽

pp. 43-49 ◽

Cited By ~ 45

Author(s):

Daniel C. Lu ◽

Luis M. Tumialán ◽

Dean Chou

Keyword(s):

Group Versus ◽

Anterior Cervical Discectomy ◽

Bone Morphogenetic Protein 2 ◽

Cervical Discectomy ◽

Dysphagia Score ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Group 1

Object Reported complications of recombinant human bone morphogenetic protein–2 (rhBMP-2) use in anterior cervical discectomy and fusion (ACDF) cases include dysphagia and cervical swelling. However, dysphagia often occurs after multilevel ACDF procedures performed with allograft (without BMP) as well. To date, there has been no large study comparing the dysphagia rates of patients who have undergone multilevel ACDF using allograft spacers with those who underwent ACDF using polyetheretherketone (PEEK) cages filled with rhBMP2. The authors report one of the first such comparisons between these 2 patient cohorts. Methods The authors retrospectively reviewed 150 patient records. Group 1 (BMP group) consisted of 100 patients who underwent multilevel ACDF with PEEK cages filled with rhBMP-2 and instrumented with a cervical plate. Group 2 (allograft group) included a matched control cohort of 50 patients who underwent multilevel ACDF with allograft spacers and anterior plate fixation (without rhBMP-2). Patient demographics were not significantly different between the groups. Fusion was assessed by means of dynamic radiographs and/or CT at routine intervals. Complications, dysphagia incidence, standardized dysphagia score, Nurick grades, and fusion rates were assessed. Results The mean follow-up for the BMP group (Group 1) was 35 months while the mean follow-up for the allograft group (Group 2) was 25 months. There was a complication rate of 13% in the BMP group compared with 8% in the allograft group (p < 0.005). There was no significant difference in overall dysphagia incidence between the BMP group and the allograft group (40% vs 44%, respectively; p > 0.05). However, there was a significant difference in the severity of dysphagia (using the SWAL-QOL dysphagia scoring system) between the 2 groups: 0.757 for the BMP group versus 0.596 for the allograft group (p < 0.005). In subgroup analysis, the use of rhBMP-2 significantly increased the severity of dysphagia in patients undergoing 2-level ACDF (p < 0.005). However, the severity of dysphagia did not differ significantly between groups when 3- or 4-level ACDF cases were compared. There was no pseudarthrosis in Group 1 (the BMP group) compared with a 16% pseudarthrosis rate in Group 2 (the allograft group) (p < 0.05). There was a weak correlation between the total rhBMP-2 dose and the dysphagia score (Kendall tau rank correlation coefficient 0.166, p = 0.046). Conclusions The use of rhBMP-2 in patients undergoing 2-level ACDF significantly increases the severity of dysphagia (dysphagia score) without affecting the overall incidence of dysphagia. However, there is no statistically significant difference in the incidence or severity of dysphagia between patients undergoing 3-level or 4-level ACDF treated with PEEK/rhBMP-2 and those treated with only allograft. The use of rhBMP-2 appears to reduce the risk of pseudarthrosis. This benefit is most pronounced in patients who undergo 4-level ACDF and are smokers.

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Clinical efficacy of autogenous vertebrae-filled polyetheretherketone cage in anterior cervical discectomy and fusion with instrumentation

10.21203/rs.3.rs-411395/v1 ◽

2021 ◽

Author(s):

Xusheng Li ◽

Xuehua Zhan ◽

Long Chang ◽

Yongdong Qiao ◽

Huiqiang Ding ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Clinical Efficacy ◽

Operative Time ◽

Neck Disability Index ◽

Anterior Cervical Discectomy ◽

Peek Cage ◽

Cervical Discectomy ◽

Significant Difference

Abstract Background. Anterior cervical discectomy and fusion with instrumentation (ACDFI) have been widely used in the treatment of the degenerative disease or traumatic instability of the cervical spine. This study aimed to investigate the clinical efficacy of the autologous vertebral-filled polyetheretherketone (PEEK) cage in anterior cervical discectomy and fusion with instrumentation (ACDFI).Material and Methods. The clinical data of 368 patients who received ACDFI from September 2015 to September 2020 were retrospectively analyzed. According to the material that filled PEEK cage during the surgery, the patients were divided into two groups, the autologous vertebrate group (n = 185) and the autologous iliac group (n = 183). The operative time, operative blood loss, postoperative complications in two groups were recorded and analyzed. The bone graft fusion and postoperative functional outcomes, including scores of modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and visual analog scale (VAS) were compared.Results. Patients were followed-up for 14.04 ± 0.98 months. At a 6-months follow-up, the rate of spinal fusion was 96.29% (178/185) in the vertebral group and 95.94% (176/183) in the iliac group, there was no statistically significant difference between the two groups (P>0.05). The postoperative VAS, mJOA, and NDI scores were not significantly different between two groups during the follow-up (P>0.05). The operative time and blood loss in the vertebral group were significantly less than that of the iliac group (P<0.01). In the iliac group, all patients suffered pain in the iliac donor site, 65 patients suffered numbness, 12 patients had fat liquefaction in donor incision, while all patients in the vertebral group had no postoperative complications. Conclusion. The autologous vertebrae-filled PEEK cage can achieve the same clinical outcome as the autologous iliac, but the autologous vertebrae filled PEEK cage have the advantage of shorter operative time, less intraoperative blood loss, and postoperative complications.

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Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2019.9.spine19879 ◽

2020 ◽

Vol 32 (4) ◽

pp. 562-569

Author(s):

Minghao Wang ◽

Dean Chou ◽

Chih-Chang Chang ◽

Ankit Hirpara ◽

Yilin Liu ◽

...

Keyword(s):

Revision Surgery ◽

Plate Fixation ◽

Anterior Cervical Discectomy ◽

Anterior Plate ◽

Cervical Discectomy ◽

Posterior Surgery ◽

Structural Allograft ◽

Significant Difference ◽

Surgery Rates

OBJECTIVEBoth structural allograft and PEEK have been used for anterior cervical discectomy and fusion (ACDF). There are reports that PEEK has a higher pseudarthrosis rate than structural allograft. The authors compared pseudarthrosis, revision, subsidence, and loss of lordosis rates in patients with PEEK and structural allograft.METHODSThe authors performed a retrospective review of patients who were treated with ACDF at their hospital between 2005 and 2017. Inclusion criteria were adult patients with either PEEK or structural allograft, anterior plate fixation, and a minimum 2-year follow-up. Exclusion criteria were hybrid PEEK and allograft cases, additional posterior surgery, adjacent corpectomies, infection, tumor, stand-alone or integrated screw and cage devices, bone morphogenetic protein use, or lack of a minimum 2-year follow-up. Demographic variables, number of treated levels, interbody type (PEEK cage vs structural allograft), graft packing material, pseudarthrosis rates, revision surgery rates, subsidence, and cervical lordosis changes were collected. These data were analyzed by Pearson’s chi-square test (or Fisher’s exact test, according to the sample size and expected value) and Student t-test.RESULTSA total of 168 patients (264 levels total, mean follow-up time 39.5 ± 24.0 months) were analyzed. Sixty-one patients had PEEK, and 107 patients had structural allograft. Pseudarthrosis rates for 1-level fusions were 5.4% (PEEK) and 3.4% (allograft) (p > 0.05); 2-level fusions were 7.1% (PEEK) and 8.1% (allograft) (p > 0.05); and ≥ 3-level fusions were 10% (PEEK) and 11.1% (allograft) (p > 0.05). There was no statistical difference in the subsidence magnitude between PEEK and allograft in 1-, 2-, and ≥ 3-level ACDF (p > 0.05). Postoperative lordosis loss was not different between cohorts for 1- and 2-level surgeries.CONCLUSIONSIn 1- and 2-level ACDF with plating involving the same number of fusion levels, there was no statistically significant difference in the pseudarthrosis rate, revision surgery rate, subsidence, and lordosis loss between PEEK cages and structural allograft.

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Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

Urologia Internationalis ◽

10.1159/000506716 ◽

2020 ◽

pp. 1-7

Author(s):

Zhenhua Gu ◽

Yucheng Yang ◽

Rui Ding ◽

Meili Wang ◽

Jianming Pu ◽

...

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Kidney Stones ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Clinical Results ◽

Retrograde Intrarenal Surgery ◽

Alternative Approach ◽

Significant Difference

Background: Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. Objectives: The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. Methods: A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. Results: Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, p = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, p = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, p = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, p < 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, p = 0.04) when comparing RIRS with micro-PCNL. Conclusions: Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

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Impact of radiation (RT) regimen on palliative procedures (PP) for patients with resectable locally advanced esophageal cancer treated with exclusive chemoradiation (CRT) or preoperative chemoradiation (CRT+S): results from a phase III trial of the Federation Francophone de Cancerologie Digestive (FFCD 9102)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4531 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4531-4531

Author(s):

G. Crehange ◽

F. Bonnetain ◽

S. Seng ◽

T. N'guyen ◽

X. Mirabel ◽

...

Keyword(s):

Hospital Stay ◽

Locally Advanced ◽

Length Of Hospital Stay ◽

Local Relapse ◽

Phase Iii ◽

Dysphagia Score ◽

Cancérologie Digestive ◽

The Impact ◽

Locally Advanced Esophageal Cancer

4531 Background: The FFCD 9102 trial demonstrated that CRT is an alternative to CRT+S for responding patients. We investigated the type of PP in the follow-up (FU) period, according to the RT scheme: protracted (P-RT) vs. split course (SC-RT). Methods: Resectable T3 N0–1 M0 thoracic esophageal carcinoma were included. First sequence : 2 cycles of cisplatin and 5-FU (day (d)1 - d22) combined with RT. Two schemes of RT were allowed: P-RT (46 Gy / 4.5 weeks (w), 2 Gy / f) or SC-RT (2 one-week courses of 15 Gy, 3 Gy / f). For CRT, the same chemotherapy was given on d43, d64 and d92 combined with 20 Gy / 2w (P-RT) or 15 Gy / 1w (SC-RT). Responding patients after the first sequence were randomized between CRT and CRT+S. The impact of SC-RT vs. P-RT on PP in the FU period was explored using a Mann-Whitney test. Results: From February 1993 to December 2000, 451 pts were registered and 446 were eligible. P-RT: 161 pts, SC-RT: 285 pts. After a median FU of 47.4 months, 2-year overall survival and local relapse-free survival were for P-RT vs. SC-RT: 37.1% vs. 30.5% (p = 0.25) and 76.7% vs. 56.8% (p = 0.002), respectively. P-RT vs. SC-RT: mean length of hospital stay: 48 d vs. 60.5 d (p= 0.0003). Mean number of dilatation sessions: 0.56 vs. 0.66 (p= 0.43). Mean number of stents: 0.21 vs. 0.34 (p= 0.03). Mean number of any PP: 1.01 vs. 1.50 (p= 0.001). Mean dysphagia grade: 2.99 vs. 3.12 (p= 0.21). In the CRT+S-group, P-RT vs. SC-RT: mean length of hospital stay 55.0d vs. 68.7d (p =0.051). Mean number of dilatation sessions: 0.74 vs. 0.74 (p= 0.77). Mean number of stents: 0.09 vs. 0.18 (p= 0.44). Mean number of PP: 1.00 vs. 1.37 (p= 0.054). In the CRT-group, P-RT vs. SC-RT, mean length of hospital stay: 42.6d vs 54.0d (p= 0.053). Mean number of dilatation sessions : 0.38 vs. 0.67 (p= 0.12). Mean number of stents: 0.31 vs. 0.50 (p= 0.03). Mean number of PP: 0.83 vs. 1.86 (p= 0.0005). Conclusions: Stents, rate of PP and length of hospital stay were significantly increased with SC-RT. Dysphagia score was similar between SC-RT and P-RT at last FU. No significant financial relationships to disclose.

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Delayed appendicectomy in patients with non-perforated acute appendicitis

International Surgery Journal ◽

10.18203/10.18203/2349-2902.isj20173415 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2766

Author(s):

Anandaravi B. N. ◽

Krishna S. R. ◽

Pradeep Kumar H. D. ◽

Mayank Garg

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Readmission Rate ◽

Operative Time ◽

Perforated Appendicitis ◽

Length Of Hospital Stay ◽

Perforation Rate ◽

Significant Difference ◽

Emergency Group ◽

Delayed Group

Background: Appendicitis remains one of the most common diseases encountered by the surgeon in practice. Appendicectomy is the most common urgent or emergency general surgical operation performed. Emergency appendicectomy is believed to be the standard treatment protocol for patients with acute appendicitis. This study was conducted to verify whether acute non-perforated appendicitis requires immediate surgery or can be delayed to be taken up on elective basis.Methods: This is a retrospective study of all the cases undergoing appendicectomy for acute appendicitis over the period of January 2016 to December 2016 in K. R. hospital, Mysuru, Karnataka, India. The cases were divided into two comparison groups: emergency group (operated within 12 hours of admission) and delayed group (operated between 12-72 hours). Parameters like age, sex, duration of symptoms, total leucocytes count, temperature, haemoglobin, radiological investigations, operative procedure, operative time, length of hospital stay, length of post-operative stay were collected and the end points for comparison were: Operative time, perforation rate, post-operative complication, length of hospital stay, readmission rate. Cases of perforated appendicitis in preoperative diagnosis, interval appendicectomy and appendicectomy done in association with other abdominal conditions were excluded from the study.Results: During this one-year period 283 patients have undergone appendicectomy. Out of this 189 (66.8%) patients have undergone surgery within 12 hours of admission and 94 (33.2%) have undergone surgery between 12 to 72 hours of admission. There was no significant difference between the two groups in operative time, per operative perforation rate, post-operative complication rate, readmission rate. Length of the hospital stay was greater in delayed group as compared to emergency group. But there was no significant difference between the post-operative length of hospital stay.Conclusions: Acute appendicitis can be treated surgically in a delayed elective basis without increasing morbidity.

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Uniportal video-assisted thoracoscopic drainless sympathectomy for palmar and palmo-plantar hyperhidrosis: an institutional experience

The Cardiothoracic Surgeon ◽

10.1186/s43057-020-00030-3 ◽

2020 ◽

Vol 28 (1) ◽

Author(s):

Mohammed Ahmed El-Hag-Aly ◽

Rafik Fekry Soliman ◽

Nehad Abdo Zaid ◽

Mahmoud Said Eldesouky ◽

Mohamed Mordy Bakoush ◽

...

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Compensatory Hyperhidrosis ◽

Thoracic Sympathectomy ◽

Significant Difference ◽

Institutional Experience ◽

Primary Hyperhidrosis ◽

Disease Severity Scale

Abstract Background Primary hyperhidrosis (PH) still impacts negatively the patient’s quality of life (QoL). Progressively, it leads to poorer QoL regardless of gender. The endoscopic thoracic sympathectomy has been used safely and effectively for control of palmar hyperhidrosis, but it is still questionable in palmo-plantar type. We assessed the benefits of uniportal drainless thoracoscopic sympathectomy (UDTS) for palmo-plantar hyperhidrosis patients compared to palmar ones. This prospective study comprised 213 consecutive patients with PH. They underwent bilateral simultaneous UDTS. We used the Hyperhidrosis Disease Severity Scale (HDSS) scoring system for assessment of QoL pre- and postoperatively. Follow-up was continued for 1-year that was aiming to detect the QoL improvement, recurrence, and compensatory hyperhidrosis (CH). Results All patients experienced immediate complete resolution of hyperhidrosis postoperatively. Recurrence was encountered in one patient during the first 6 months. All patients had improved QoL postoperatively, but at the end of 1-year follow-up, 2.8% of patients were still suffering moderate to severe impaired QoL. Mean hospital stay was 31.79 ± 17.5 h. We found significant longer hospital stay in palmar group than palmo-plantar group. There was no significant difference between both groups in neither operative time, recurrence, nor CH. Conclusions UDTS offers better QoL for patients with PH even the palmo-plantar type. The palmo-plantar type benefits similarly to the palmar type in terms of comparable postoperative QoL and CH incidence.

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816 Managing Acute Appendicitis During the First Wave of the COVID-19 Pandemic: A Single-Centre Retrospective Study

British Journal of Surgery ◽

10.1093/bjs/znab259.478 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Lotfallah ◽

A Aamery ◽

G Moussa

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Statistical Significance ◽

Length Of Hospital Stay ◽

Interquartile Range ◽

Secondary Outcome ◽

Complication Rates ◽

Alvarado Score ◽

Significant Difference

Abstract Introduction The COVID-19 pandemic provoked a change to normal surgical practice and led to a higher proportion of acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse patients presenting with AA during the first wave of the pandemic, comparing surgically and conservatively managed patients. Method All patients presenting to our centre with AA between March and July 2020 were included. Six-month follow-up data was collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcome was length of hospital stay. Results Fifty-seven patients (n = 57) were admitted with AA, 45.6% (n = 26) managed conservatively compared to 54.4% (n = 31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not statistically significant (16% vs 35%; p = 0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p = 0.012 and p = 0.028 respectively). Conclusions Stratification criteria, such as Alvarado score and WCC may identify patients more suitable for conservative management. Longer term follow-up will be carried out, which may alter complication rates in either group. We suggest all patients treated conservatively should undergo computerised tomography (CT) to exclude complicated appendicitis. Further UK-based studies will add to the evidence-base surrounding management of AA during the COVID-19 pandemic.

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Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity

Journal of Neurosurgery Spine ◽

10.3171/2019.7.spine19437 ◽

2020 ◽

Vol 32 (1) ◽

pp. 23-30 ◽

Cited By ~ 2

Author(s):

Darryl Lau ◽

Anthony M. DiGiorgio ◽

Andrew K. Chan ◽

Cecilia L. Dalle Ore ◽

Michael S. Virk ◽

...

Keyword(s):

Vertical Axis ◽

Anterior Cervical Discectomy ◽

Cervical Lordosis ◽

Sagittal Vertical Axis ◽

Significant Linear Trend ◽

Cervical Discectomy ◽

T1 Slope ◽

Significant Difference ◽

Vas Scores

OBJECTIVEUnderstanding what influences pain and disability following anterior cervical discectomy and fusion (ACDF) in patients with degenerative cervical spine disease is critical. This study examines the timing of clinical improvement and identifies factors (including spinal alignment) associated with worse outcomes.METHODSConsecutive adult patients were enrolled in a prospective outcomes database from two academic centers participating in the Quality Outcomes Database from 2013 to 2016. Demographics, surgical details, radiographic data, arm and neck pain (visual analog scale [VAS] scores), and disability (Neck Disability Index [NDI] and EQ-5D scores) were reviewed. Multivariate analysis was used.RESULTSA total of 186 patients were included, and 48.4% were male. Their mean age was 55.4 years, and 45.7% had myelopathy. Preoperative cervical sagittal vertical axis (cSVA), cervical lordosis (CL), and T1 slope values were 24.9 mm (range 0–55 mm), 10.4° (range −6.0° to 44°), and 28.3° (range 14.0°–51.0°), respectively. ACDF was performed at 1, 2, and 3 levels in 47.8%, 42.0%, and 10.2% of patients, respectively. Preoperative neck and arm VAS scores were 5.7 and 5.4, respectively. NDI and EQ-5D scores were 22.1 and 0.5, respectively. There was significant improvement in all outcomes at 3 months (p < 0.001) and 12 months (p < 0.001). At 3 months, neck VAS (3.0), arm VAS (2.2), NDI (12.7), and EQ-5D (0.7) scores were improved, and at 12 months, neck VAS (2.8), arm VAS (2.3), NDI (11.7), and EQ-5D (0.8) score improvements were sustained. Improvements occurred within the first 3-month period; there was no significant difference in outcomes between the 3-month and 12-month mark. There was no correlation among cSVA, CL, or T1 slope with any outcome endpoint. The most consistent independent preoperative factors associated with worse outcomes were high neck and arm VAS scores and a severe NDI result (p < 0.001). Similar findings were seen with worse NDI and EQ-5D scores (p < 0.001). A significant linear trend of worse NDI and EQ-5D scores at 3 and 12 months was associated with worse baseline scores. Of the 186 patients, 171 (91.9%) had 3-month follow-up data, and 162 (87.1%) had 12-month follow-up data.CONCLUSIONSACDF is effective in improving pain and disability, and improvement occurs within 3 months of surgery. cSVA, CL, and T1 slope do not appear to influence outcomes following ACDF surgery in the population with degenerative cervical disease. Therefore, in patients with relatively normal cervical parameters, augmenting alignment or lordosis is likely unnecessary. Worse preoperative pain and disability were independently associated with worse outcomes.

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Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis

Neurosurgical FOCUS ◽

10.3171/2011.6.focus1198 ◽

2011 ◽

Vol 31 (2) ◽

pp. E5 ◽

Cited By ~ 64

Author(s):

John Berry-Candelario ◽

Emily B. Ridgway ◽

Ronald T. Grondin ◽

Gary F. Rogers ◽

Mark R. Proctor

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Average Length ◽

A Priori ◽

Length Of Hospital Stay ◽

Blood Transfusions ◽

Helmet Therapy ◽

Age At Surgery ◽

Strip Craniectomy

Object The primary goals of treatment in the infant with craniosynostosis are to correct the deformity and allow for adequate brain growth in as safe and effective a manner as possible. Herein, the authors present the results of treating craniosynostosis using an endoscope-assisted strip craniectomy and postoperative helmet therapy (EASC + PHT) in the hopes of providing further evidence of its role in the treatment of multiple different forms of craniosynostosis. This is a retrospective review of the patients treated with this technique at Children's Hospital Boston. Methods The electronic medical records of all children with craniosynostosis treated using this technique were reviewed retrospectively. A priori, data were collected for deformity type, patient age at surgery, number of transfusions, operative time, length of hospital stay, and anthropometric measurements. Results One hundred seventy-three patients (61 females and 112 males) were treated at our institution between July 2004 and March 2011 with EASC + PHT. The mean operative time was 46.30 minutes. Eight (4.6%) of the 173 patients received blood transfusions. The average length of hospital stay was 1.35 days, with the majority of patients being discharged the day after surgery. All complications and any patient who required additional craniofacial reconstructions are discussed. In addition, a subgroup analysis was done for patients who had undergone surgery and had longer than 1 year of follow-up. Conclusions The authors' growing database of patients supports the experiences described by others that early treatment of craniosynostosis with an EASC + PHT is a safe and efficacious technique. In addition, cost reduction due to decreased hospital stay and limitation of blood transfusions are demonstrable benefits associated with the use of this technique.

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