scholarly journals Translaminar Osseous Channel–Assisted FullEndoscopic Flavectomy Decompression of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Surgical Technique and Results

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E475-E485
Author(s):  
Wenbo Liao
Keyword(s):  
Minimally Invasive ◽  
Study Design ◽  
Spine Surgery ◽  
Ligamentum Flavum ◽  
Japanese Orthopaedic Association ◽  
Invasive Technique ◽  
Control Group ◽  
Thoracic Myelopathy ◽  
Radiographic Findings

Background: Previous surgical procedures for the treatment of thoracic myelopathy (TM) due to ossification of the ligamentum flavum (OLF) were accompanied by significant trauma and risk. Objectives: Report a novel minimally invasive technique, translaminar osseous channel–assisted posterior percutaneous full-endoscopic flavectomy (p-PEF), as an alternative surgical strategy for the treatment of OLF-related TM. Study Design: A retrospective cohort study. Setting: A center for spine surgery and pain medicine. Methods: Thirteen patients with TM caused by isolated OLF who underwent translaminar osseous channel–assisted p-PEF were retrospectively analyzed. Preoperative and postoperative radiographic findings and clinical results were compared to confirm the efficacy of the procedure and perioperative complications were investigated to evaluate the technical safety. Results: All 13 patients with 23 isolated ossified sites were successfully treated with the translaminar osseous channel–assisted p-PEF technique and no additional internal fixation was needed. With an average follow-up of 29.2 months (range, 24–36 months), no local instability was detected. The preoperative and final follow-up cross-sectional area of the stenotic dural sac was 47.87 ± 8.98 mm2 and 130.47± 19.07 mm2 , respectively (P < 0.0001). The mean modified Japanese Orthopaedic Association score was significantly improved from 3.54 ± 1.26 points preoperatively to 9.07 ± 1.48 points at final follow-up (P < 0.0001). The Visual Analog Scale scores of thoracolumbar backaches were 5.3 ± 1.2 before surgery and 0.69 ± 0.75 at final follow-up (P = 0.001). No serious complications ensued. Limitations: This was a retrospective study with several limitations, including the lack of a control group, small number of included samples and unavoidable nature of the single-center study design. Conclusions: Translaminar osseous channel–assisted p-PEF technique, with less tissue trauma and impact on the stability of the spine, can provide adequate decompression and satisfying outcomes in the treatment of OLF-related TM and should be considered as an alternative procedure for isolated OLF. Key words: Translaminar osseous channel, percutaneous full-endoscopic flavectomy, thoracic myelopathy, ossification of ligamentum flavum, minimally invasive spine surgery

scholarly journals Distal Chevron Osteotomy vs The Simple, Effective, Rapid, Inexpensive Technique (SERI) for Mild to Moderate Isolated Hallux Valgus: A Randomized Controlled Study

2020 ◽  
Author(s):  
Ezequiel Palmanovich ◽  
Nissiom Ohana* - equal first author contribution ◽  
Ilan Small ◽  
Iftach Hetsroni ◽  
Eyal Amar ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Controlled Study ◽  
Wound Complications ◽  
Invasive Technique ◽  
Control Group ◽  
Chevron Osteotomy ◽  
The Mean ◽  
One Year

Abstract Background Hallux valgus is a common foot deformity that leads to functional disability with serious sequelae. Minimally invasive surgery is often used to treat hallux valgus in order to reduce wound complications and improve recovery time. The objective of this study was to compare a Simple, Effective, Rapid, Inexpensive (SERI) technique with a simple Chevron technique in patients with minimum of one-year follow. Methods and Materials Between the years 2014-2015 we performed a prospective study comparing the SERI minimally invasive technique to treat symptomatic hallux valgus with a standard chevron osteotomy technique. All procedures were performed by a single fellowship trained foot and ankle surgeon. Twenty-one patients were randomized to the SERI cohort and 15 to the standard Chevron technique. Results The mean pre-operative intermetatarsal angle (IMA) of the SERI group was 14.8 ± 1.9 (11.9 - 22.9). The mean pre-operative IMA of the Chevron control group was 13.3 ± 2.3 (10.4 -18.2) (p = 0.038). The mean IMA two weeks after surgery was 6.0 ± 2.3 (2.4-12) in the SERI group, and 6.1 ± 3 (2.6-13.1) in the control group. At the two week and one year follow up, there was no significant difference found in the IMA between the two groups (p = 0.871). Neither groups reported symptomatic transfer metatarsalgia throughout the follow up period. The SERI group had increased metatarsophalangeal joint (MTPJ) motion (p < 0.001) however, all other parameters with similar. Conclusion The SERI technique provided comparable outcomes at up to one year follow up when compared to a standard Chevron osteotomy for moderate hallux valgus. This study demonstrated good reproducible results using the SERI technique for moderate hallux valgus.

Minimally Invasive Scoliosis Correction in Parkinson Disease: Retrospective Case Series

2020 ◽  
Author(s):  
Ravi S Nunna ◽  
Richard G Fessler
Keyword(s):  
Minimally Invasive ◽  
Parkinson Disease ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The United States ◽  
Invasive Technique ◽  
Radiographic Findings ◽  
Presenting Symptoms ◽  
Scoliosis Correction

Abstract BACKGROUND Parkinson disease (PD) is the second most common neurodegenerative disease in the United States. In the context of the disability inherent to PD, the additional physical challenges and pain from scoliosis can be debilitating for these patients. However, the magnitude of surgery required to correct the deformity combined with the medical co-morbidities and frailty in this population of patients makes surgery very risky. OBJECTIVE To investigate clinical presentations and outcomes of patients with PD that underwent minimally invasive long-segment fusion for scoliosis correction. METHODS A retrospective chart review was performed over the years 2007 to 2017 for patients diagnosed with PD undergoing long-segment spinal fusion (5 or more levels) with the use of circumferential minimally invasive spine surgery techniques. Data including age, sex, race, medical co-morbidities, presenting symptoms, radiographic findings, surgical procedure, case history, and complications were collected from the medical record. RESULTS Retrospective chart review revealed three patients that met the inclusion criteria. They included 2 males and 1 female, with a mean age of 68.7 yr (range 63-75 yr). Ability to maintain upright posture, return to activities of daily living, and visual analog scale (VAS)-back improved in all patients at 1-yr follow-up. Results were durable at 2-yr follow-up. No medical complications were observed. CONCLUSION The generally positive results suggest that minimally invasive technique could have significant benefits in this high-risk group of patients.

scholarly journals Full-Endoscopic Decompression with the Application of an Endoscopic-Matched Ultrasonic Osteotome for Removal of Ossification of the Thoracic Ligamentum Flavum

2021 ◽  
pp. 275-281
Author(s):  
Yuan-Ting Zhao
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Surgery ◽  
Ligamentum Flavum ◽  
Japanese Orthopaedic Association ◽  
Thoracic Myelopathy ◽  
Improvement Rate ◽  
Cord Injury ◽  
Endoscopic Spinal Surgery

Background: Resection of the ossification of the thoracic ligamentum flavum (OTLF) with a high-speed burr may cause a high rate of perioperative complications, such as dural laceration and/or iatrogenic spinal cord injury. Objectives: The aim of this study was to investigate the safety and feasibility of the endoscopicmatched ultrasonic osteotome in full-endoscopic spinal surgery for direct removal of OTLF. Study Design: Retrospective study. Setting: All data were from Honghui Hospital in Xi’an. Methods: This study conducted between December 2017 and December 2018, included 27 consecutive patients who met the study criteria, had single-level OTLF, and underwent fullendoscopic decompression under local anesthesia. The postoperative follow-up was scheduled at 1, 3, 6, and 12 months postoperatively. Outcomes evaluations included the Visual Analog Scale (VAS) score for lower extremity pain and the modified Japanese Orthopaedic Association (mJOA) score and improvement rate for the assessment of thoracic myelopathy. Removal of OTLF was measured by comparing the pre- and postoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans. Results: The operation was completed in all patients without conversion to open surgery. The operation time ranged from 65 to 125 minutes (average, 83.7 ± 12.3 minutes). All patients were followed up for 12 to 18 months, with an average follow-up of 14.3 ± 1.3 months. Satisfactory neurologic decompression was confirmed by postoperative CT and MRI, and no revision surgery was required. The VAS and mJOA scores showed statistically higher improvement at the 1-month follow-up and the last follow-up compared with the preoperative assessment (P < 0.05). According to the improvement rate at the final follow-up, 20 cases were classified as good, 6 cases were fair, and 1 case remained unchanged. Limitations: A single-center, noncontrol study. Conclusions: The endoscopic-matched ultrasonic osteotome can be considered quite safe and feasible for direct removal of OTLF during full-endoscopic spinal surgery in strictly selected patients, as this allows for effective direct decompression of OTLF while minimizing trauma and instability. In addition, because of the design characteristics of the ultrasonic osteotome, surgical complications, especially dural tears and spinal cord injury, can also be effectively controlled. Key words: Percutaneous endoscopic spinal surgery, ultrasonic osteotome, ossification of thoracic ligamentum flavum, microsurgery, thoracic myelopathy, minimally invasive procedures

scholarly journals Comparison of Surgical Results of the Bridge Crane Technique Versus Laminectomy for the Treatment of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

2021 ◽  
pp. 219256822199668
Author(s):  
Kaiqiang Sun ◽  
Xiaofei Sun ◽  
Jian Zhu ◽  
Fei Huang ◽  
Le Huan ◽  
...  
Keyword(s):  
Ligamentum Flavum ◽  
Demographic Data ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Bridge Crane ◽  
Thoracic Myelopathy ◽  
Duration Of Symptoms ◽  
Postoperative Hematoma ◽  
Csf Leakage

Study Design: A retrospective study. Objectives: This study aimed to evaluate the safety and effectiveness of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). Methods: Totally 41 patients who underwent surgical decompression due to thoracic OLF from May 2017 to June 2018 in our institution were enrolled in this study and were divided into group BG (bridge crane technique, n = 19) and group L (laminoectomy, n = 22). Demographic data was collected from medical records and the modified Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological outcomes during the follow-up. Surgery-related complications were analyzed. Results: The mean duration of follow-up was comparable between group BG (19.4 ± 1.5 months) and group L (19.6 ± 1.4 months). No statistical differences were observed between two groups in terms of gender, age, duration of symptoms, preoperative occupying rate, involved levels, operation time, intraoperative blood loss, and complications. The JOA score significantly increased at the final follow-up in both groups. However, patients in group BG had higher JOA score and recovery rate ( P < 0.05). Four patients in group L experienced complications, including 3 cerebrospinal fluid (CSF) leakage and one postoperative hematoma. Only one patient in group BG had CSF leakage. Conclusion: The results of this study suggested that bridge crane technique may be relatively safe and effective for patients with symptomatic thoracic OLF with more satisfactory clinical improvement. However, high-quality studies are still required to validate the results of this study.

Early outcomes of mitral valvuloplasty by minimally invasive surgery or sternotomy

2020 ◽  
Vol 28 (7) ◽  
pp. 398-403
Author(s):  
Huan-lei Huang ◽  
Qian Yan ◽  
Xu-jing Xie ◽  
Kan Zhou ◽  
Biao-chuan He ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Median Sternotomy ◽  
Invasive Technique ◽  
Control Group ◽  
Study Group ◽  
Transfusion Rate ◽  
Invasive Approach ◽  
Thoracoscopic Approach ◽  
Mitral Valvuloplasty

Background Disagreement exists regarding methods for repair of the mitral valve. We compared early outcomes of mitral valvuloplasty by a minimally invasive technique and by a median sternotomy. Methods The data of 507 patients (mean age 47.9 ± 15.2 years) undergoing mitral valvuloplasty from January 2015 to June 2018 were analyzed retrospectively. In the study group ( n = 225), mitral valvuloplasty via a totally thoracoscopic approach was performed by a single surgeon. In the control group ( n = 282), mitral valvuloplasty via the traditional median sternotomy was carried out by other cardiac surgeons in our hospital. Clinical data, surgical results, and follow-up findings in the two groups were comparatively analyzed. Results In the study group, the blood transfusion rate (5.3% vs. 20.9%, p < 0.05) and incidences of poor wound healing (0 vs. 5.3%, p < 0.05) and respiratory tract infection (4.4% vs. 16.3%, p < 0.05) were lower, and postoperative hospitalization was shorter (5.9 ± 4.0 vs. 10.7 ± 8.4 days, p < 0.05). Within 30 days after surgery, no patient died in the study group while one died in the control group. The duration of follow-up was 12–36 months (mean 22.9 ± 8.8 months). During follow-up, there were 1 and 0 cases of redo surgery and 1 and 3 deaths in the study group and control group, respectively. Conclusion Mitral valvuloplasty via a minimally invasive approach is superior to the traditional median sternotomy in terms of early outcomes, especially when performed by experienced surgeons.

Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level

2010 ◽  
Vol 13 (1) ◽  
pp. 116-122 ◽  
Author(s):  
Hong-Qi Zhang ◽  
Ling-Qiang Chen ◽  
Shao-Hua Liu ◽  
Di Zhao ◽  
Chao-Feng Guo
Keyword(s):  
Thoracic Kyphosis ◽  
Ligamentum Flavum ◽  
Posterior Instrumentation ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Thoracic Myelopathy ◽  
Posterior Decompression ◽  
Decompressive Laminectomy ◽  
Kyphosis Correction

Object The object of this study was to evaluate the efficacy and safety of posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. Methods Between January 2003 and December 2005, 11 patients (8 men and 3 women) with thoracic myelopathy due to OLF and OPLL at the same level underwent posterior decompressive laminectomy and excision of OLF. Posterior instrumentation was also performed for stabilization of the spine and reducing the thoracic kyphosis angle by approximately 5–15° (kyphosis correction), and spinal fusion was performed in all cases. The follow-up period ranged from 2 to 4 years (mean 2.8 years). The outcomes were evaluated using a recovery scale based on the Japanese Orthopaedic Association classification. The score of each patient was calculated before surgery, 1 year after surgery, and at the final follow-up visit. Results After surgery, the thoracic kyphosis in the stabilization area was reduced from 30.0 ± 4.02° to 20.8 ± 2.14° on average. The mean score on the Japanese Orthopaedic Association scale improved from 3.5 ± 1.69 preoperatively to 8.5 ± 1.63 at the final follow-up, with a recovery rate of 68.0%. The results were good in 9 patients and fair in 2 patients. Postoperative MR imaging showed that the spinal cord was shifted posteriorly and decompressed completely in all cases. Myelopathy was not aggravated in any case after surgery. Conclusions A considerable degree of neurological recovery was observed after posterior decompression and kyphosis correction. The procedure is easy to perform with a low risk of postoperative paralysis. The authors therefore suggest that the procedure is useful for patients whose spinal cords are severely impinged by OLF and OPLL at the same level.

The effect of dry needling of myofascial trigger points on muscle stiffness and motoneuron excitability in healthy subjects

2021 ◽  
pp. 096452842110275
Author(s):  
Carolina Jiménez-Sánchez ◽  
Julio Gómez-Soriano ◽  
Elisabeth Bravo-Esteban ◽  
Orlando Mayoral-del Moral ◽  
Pablo Herrero-Gállego ◽  
...  
Keyword(s):  
Muscle Tone ◽  
Intervention Group ◽  
Trigger Points ◽  
Muscle Stiffness ◽  
Invasive Technique ◽  
Control Group ◽  
Dry Needling ◽  
Myofascial Trigger Points ◽  
Motoneuron Excitability

Background: Myofascial trigger points (MTrPs) are hypersensitive nodules in a taut band (TB) of skeletal muscle. Dry needling (DN) is an invasive technique recommended for the treatment of MTrPs. However, to our knowledge, no studies have investigated the influence of the DN technique on modification of muscle stiffness and neurophysiological properties of MTrPs. Objective: The objective was to examine the effect of DN on muscle stiffness and motoneuron excitability of a latent medial MTrP (nodule and TB) of the soleus muscle in non-injured subjects. Methods: A double-blinded randomised controlled trial of 46 subjects with latent medial MTrPs of the soleus was conducted, in which all received one session of DN. The intervention group (n = 23) were subjected to DN into the MTrP (the nodule), while the control group (n = 23) were subjected to DN into the TB. Assessment was carried out at baseline (pre-test), after the intervention (post-test) and 1 week after the intervention (follow-up). Biomechanical variables (muscle resistive force at 10°/s and 180°/s, muscle extensibility and strength), as measured with an isokinetic dynamometer, and neurophysiological variables (H-reflex), were recorded. Results: There were no statistically significant differences in biomechanical or neurophysiological assessments between groups. Considering the intra-group analysis, subjects in the intervention group exhibited increased maximal isometric voluntary force to ankle plantarflexion (MIVFp) at both post-intervention and follow-up assessment (p < 0.0125; 0.2 < d < 0.5), while no changes were found in the control group. Conclusion: One session of DN targeting latent MTrPs did not change muscle stiffness, muscle extensibility or motoneuron excitability. Further research on subjects with muscle tone disorders should be considered to better address the impact of DN on muscle tone. Trial registration number: NCT02575586 (ClinicalTrials.gov).

scholarly journals 689 Silac (Sinus Laser-Assisted Closure) For Pilonidal Sinus: Our NHS Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Kalaskar ◽  
J Adamek
Keyword(s):  
Minimally Invasive ◽  
Success Rate ◽  
Pilonidal Disease ◽  
Surgical Excision ◽  
Pilot Project ◽  
Invasive Technique ◽  
Recurrence Rates ◽  
Pilonidal Cyst ◽  
Primary Wound Closure

Abstract Introduction The accepted treatment of pilonidal disease still consists of surgical excision with primary wound closure. This treatment has complications such as excessive pain, delayed wound healing, and recurrence. We introduced this technique using a radial laser probe (SiLaCTM, Biolitec, Germany). Previous studies have shown encouraging results with respect to safety, patient satisfaction, and minimal recurrence rates. Method The pilot project was planned with the objectives to assess postoperative complications and reoperation rates. All operations were performed as day case procedures under general anaesthesia. We studied the data of our first 25patients operated with this technique between January 2019 and December 2019 using a prospective database and outpatient clinic follow up. Results The median follow up duration was 13 months. The initial success rate was 64%(16/25), reoperation was required in 32%(8/25) and one patient was lost to follow up. one patient returned with abscess formation in the postoperative period. Conclusions SiLaC is a safe and minimally invasive technique for the destruction of the pilonidal cyst and sinus. The success rate is modest, making this new therapy a minimally invasive option for the majority of the patients with pilonidal disease but it should be offered with caution.

Sign in / Sign up

Export Citation Format

Share Document