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Results for “Decompression, Surgical”

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PubMed2005

[Paraparesis following stable L4 burst fracture Possible correlation with preexisting degenerative stenosis of the spinal canal].

A patient with degenerative stenosis of the lumbar spinal canal developed paraparesis of both legs following a stable L4 burst fracture. However, neither the stenosis nor the fracture have caused a significant narrowing of the spinal canal. Surgical decompression and dorsal stabilization has led to relief of the neurological deficit. This case demonstrates that even a stable burst fracture may cause paraparesis and that a degenerative spinal canal stenosis is a predisposing factor.

Aged↗

PubMed2006

Doppler Adson's test: predictor of outcome of surgery in non-specific thoracic outlet syndrome.

INTRODUCTION: Outcome of surgery in non-specific thoracic outlet syndrome (TOS) is variable. Duplex imaging of the subclavian artery during Adson's maneuvre may help predict outcome. PATIENTS AND METHODS: A retrospective study of 16 cases of non-specific TOS who had pre-operative duplex imaging of the subclavian artery during Adson's maneuvre was done and their outcomes following surgical decompression of the thoracic outlet studied. RESULTS: Of the eight cases with a positive Adson's test, seven (87.5%) had a complete response of symptoms following surgery while in the eight cases with a negative test, only four (50%) had a favorable response to surgery. CONCLUSION: Duplex scanning of the thoracic outlet during Adson's maneuvre may help predict outcome of thoracic outlet decompression surgery in cases of non-specific TOS.

Decompression, Surgical↗

PubMed2001

Acute paraplegia revealing an intraspinal neurenteric cyst in a child.

The authors report a case of intraspinal neurenteric cyst in a 22-month-old child, who presented with acute paraplegia following a vesicourethrogram. Despite 8 days' delay in surgical decompression, he made a complete neurological recovery. Neurenteric cysts are rare congenital lesions of the spinal canal lined with an epithelium of endodermal origin. They are usually located at the cervicothoracic junction and present with progressive mild to moderate signs of myelopathy. This is a unique case in regard both to its clinical presentation and to the excellent outcome after 8 days of complete paraplegia.

Acute Disease↗

PubMed2005

Results of posterior surgery with intraoperative radiotherapy for spinal metastases.

OBJECT: Spinal cord compression from spinal metastasis represents a substantial clinical problem. Complete resection of spinal metastases is difficult in many cases, and conventional surgical decompression of the spinal cord with or without instrumentation often results in unsatisfactory neurological recovery and local recurrence, even if combined with external radiotherapy. To increase rates of local control and improve neurological recovery in such cases, we introduced decompressive surgery combined with intraoperative radiotherapy (IORT) for the treatment of spinal metastasis in 1992. We report the results of neurological recovery and local control in cases that received surgery with IORT. METHODS: Between November 1992 and December 2001, 133 cases (117 patients) were treated using IORT at Tokyo Metropolitan Komagome Hospital. The 79 cases (74 patients) that received posterior spine surgery only for spinal paresis due to spinal metastasis were reviewed. RESULTS: Improvement of at least one level according to Frankel's classification was attained in 68 cases (86%). Of the 58 patients unable to walk preoperatively, 45 patients (78%) regained walking ability postoperatively. Rate of local recurrence was 2.5%. CONCLUSIONS: IORT, combined with posterior surgery and FERT, might be one of the effective methods for local control of spinal metastasis and neurological improvement, especially in cases with progressive and multi-level lesions.

Adult↗

PubMed2000

Infection as a cause of spinal cord compression: a review of 36 spinal epidural abscess cases.

A retrospective survey of 36 cases treated in the Department of Neurosurgery, Hacettepe University Hospitals since 1970 was performed. Clinical presentation, aetiology and outcome of this rare disease compared to recently published series. All cases were admitted with signs of neural compression. Clinical and laboratory data suggesting an infectious origin were present only in 4 cases. Radiological investigation including magnetic resonance imaging in 10 patients, were not confirmative for an epidural abscess except for two cases. All cases underwent urgent surgical decompression and tuberculous abscess either in granulation or pus form was found in the majority. Overall mortality rate was 5.8%. Outcome was closely related to the neurological condition on admission rather than the underlying infectious origin. When compared with recently reported series, our cases demonstrated a significant divergence in terms of clinical presentation, pathogenesis and outcome. The most probable reason for this discrepancy is that risk factors for compromised immunity or systemic infection were much less than the other series and mycobacterium tuberculosis is the responsible agent in the majority which has a much more favourable outcome than non-spesific infections.

Adolescent↗

PubMed2004

Bath ankylosing spondylitis functional index (BASFI) evaluation of postoperative patients with OPLL.

Although surgical decompression of the involved spinal cord achieves a good recovery of neurological conditions, one of the most important complaints of patients with ossification of the posterior longitudinal ligament (OPLL) is disability as a result of spinal immobility. The activities of daily living (ADL) of postoperative patients with OPLL were examined. To evaluate the ADL of postoperative patients with OPLL in the cervical spine, we utilized the Bath Ankylosing Spondylitis Functional Index (BASFI), one of the most widely used functional indexes for ankylosing spondylitis. We investigated consecutive cases that underwent surgery for OPLL of the cervical spine in our department from 1978 to 1998. The latest and postoperative scores were compared to the preoperative Japanese Orthopaedic Association (JOA) scores (range, 0-17) to assess neurological recovery. We also evaluated ADL at the latest follow-up, using BASFI scores. Significant recoveries of JOA scores were confirmed; however, 77% of patients complained of disability. In BASFI, questions that seemed to reflect spinal condition received low scores in the present study. BASFI scoring was not sufficient in the present form; however, it is one of the candidate functional indexes for evaluating ADL in postoperative patients with OPLL. Establishment of an ideal functional index for such evaluation is needed.

Activities of Daily Living↗

PubMed2001

Gait analysis of spastic walking in patients with cervical compressive myelopathy.

To assess neurological status and to evaluate the effect of surgical decompression in patients with cervical myelopathy, we performed computerized gait analysis in 24 patients with cervical compressive myelopathy who showed spastic walking. Gait analysis was repeated during neurological follow-up that averaged 32.4 months. The gait pattern in patients with severe myelopathy was characterized by hyperextension of the knee in the stance phase without plantar flexion of the ankle in the swing phase, significantly reduced walking speed and step length, prolonged stance phase duration and decreased single-stance phase duration, and increased step width. The angle of flexion of the knee joint in the stance phase was significantly correlated with the Japanese Orthopaedic Association (JOA) score. Postoperative neurological improvement was associated with increased walking speed and decreased extension angle of the knee joint (single-stance phase and swing phase). Postoperatively, 12 patients had normalized extension of the knee in stance phase and their walking speed, cadence, stance phase duration, and single-stance phase duration, as well as step length and width, showed nonsignificant differences from these parameters in healthy controls. Our results show that kinesiological gait analysis is clinically useful for the functional assessment of the severity of spastic walking in cervical myelopathy.

Adult↗

PubMed2000

Therapeutic effectiveness of acetazolamide in hindbrain hernia headache.

A 43-year-old man had been suffering from exertional headache for 10 years. Sagittal sections on magnetic resonance imaging showed a Chiari type 1 malformation and a cerebellar arachnoid cyst. This syndrome, named hindbrain hernia headache, disappeared with oral acetazolamide. This treatment should be tried in patients with hindbrain hernia headache prior to considering surgical decompression of the foramen magnum.

Acetazolamide↗

PubMed2007

Delayed traumatic thoracic spinal epidural hematoma: a case report and literature review.

Spinal epidural hematoma is a relatively uncommon disease, but an important cause leading to cord compression. Posttraumatic spinal epidural hematoma is a rare entity and remains a challenge for clinical physicians. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression with evacuation of hematoma could improve some neurologic deficits, especially vital cord functions. We presented a 77-year-old woman who sustained back pain after a fall 1 month before admission, complaining of progressive weakness and sensory loss in bilateral lower extremities since 2 weeks before admission. Radiography of the thoracic spine revealed decreased body height at T10 and compression fracture. Magnetic resonance imaging of the thoracic spine revealed epidural hematomas at the level of T11 to T12. An urgent decompressive laminectomy with evacuation of hematoma was performed immediately. Postoperatively, her previous neurologic deficits improved except for an underactive neurogenic bladder and fecal incontinence.

Aged↗

PubMed2004

A subclinical impairment of ventilatory function in cervical spondylotic myelopathy.

OBJECTIVE: To evaluate the ventilatory function in patients with cervical spondylotic myelopathy (CSM). DESIGN: Prospective cohort study. SETTING: Medical school in Japan. PARTICIPANTS: Thirty-seven consecutive patients with CSM. INTERVENTIONS: All the patients had surgical intervention for mild to moderate spastic limb paresis. MAIN OUTCOME MEASURES: Analysis of the maximum voluntary ventilation (MVV) in addition to routine spirometry before and after surgical decompression. Functional assessment was made by using the Japanese Orthopaedic Association (JOA) Scale. RESULTS: The MVV (% predicted) increased significantly (P<.002) from 77%+/-19% preoperatively to 84%+/-20% postoperatively. None of the other routine spirometric data (ie, vital capacity, forced vital capacity, forced expired volume in 1 second, peak expiratory flow rate) increased significantly. According to the JOA score, tetraparesis improved significantly (P<.0001) from 8.3+/-3.2 preoperatively to 11.4+/-3.0 postoperatively. The ratio of postoperative to preoperative MVV showed a significant correlation (r=.538, P<.002) with that of the JOA score. CONCLUSIONS: MVV provides a useful measure for monitoring ventilatory impairment in patients with myelopathy.

Aged↗

PubMed2006

From there to here: a personal viewpoint after three decades of neuropathy research.

Currently there is unprecedented interest in research, writing, and clinical experience related to lower extremity peripheral nerve surgery. Its time is here, now. Application of the concepts for diagnosis and treatment of nerve compression, painful neuroma, and neuropathy has been a direct extension from the upper extremity to the lower extremity. By the end of 2005, there were more than a dozen studies demonstrating that the basic neuropathy causes metabolic changes that render the peripheral nerve susceptible to chronic nerve compressions. My hypothesis continues to assert that surgical decompression of known sites of compression can relieve symptoms of neuropathy that are caused by superimposed nerve compressions.

Decompression, Surgical↗

PubMed2006

Anterior tarsal tunnel syndrome.

Compression of the deep peroneal nerve is commonly referred to as anterior tarsal tunnel syndrome. Although rare, this syndrome remains poorly diagnosed. The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle. Non-operative measures should be attempted to reduce or remove the external compression along the anterior aspect of the foot and ankle. Other options include shoe modifications, cortisone injections,and physical therapy. If conservative management fails to relieve the symptoms, surgical decompression of the entrapped nerve can be performed. The deep peroneal nerve is released from compressive forces in the entrapment site. This can be performed at the more proximal level at the extensor retinaculum or more distally at the level of the tarsal metatarsal site.

Decompression, Surgical↗

PubMed2004

Nerve injuries in the throwing elbow.

The unique anatomy of the elbow combined with the angular velocity and stresses placed across this hinge joint while throwing can cause a large number of pathologic changes associated with nerves. Although the ulnar nerve is the most commonly injured, neuropathies are also seen with the branches of the median and radial nerves. These neuropathies are typically responsive to rest, activity modification, ice, splinting, and anti-inflammatories. A graduated return to throwing is then needed before returning to play. When conservative measures fail, surgical decompression is warranted, but results have been less than perfect.

Athletic Injuries↗

PubMed2006

Otitic hydrocephalus associated with lateral sinus thrombosis and acute mastoiditis in children.

The incidence of intracranial complications of acute otitis media (AOM) has decreased and the need for operative and medical treatment is declined during the antibiotic era. To describe pathognomonic signs, evaluation management, operative findings, clinical course and outcome of otitic hydrocephalus and lateral sinus thrombosis as complications of AOM and mastoiditis in pediatric patients. Two children, 9 and 13 years old, with the diagnosis of OH and TK and MRI findings are presented. Intracranial complications in children resulted from unsuccessful treatment of AOM, which led to acute mastoiditis and lateral sinus thrombosis. Both of the presented children had thrombus in their sigmoid sinus preoperatively, demonstrated by MRI, causing decreased blood flow. Both patients underwent a mastoidectomy and delamination of sigmoid sinus with puncture of sinuses. After medical and surgical treatment, blood flow through the sinus increased significantly. In both cases signs of increased intracranial pressure ceased. The clinical presentation of otogenic lateral sinus thrombosis (LST) as a complication of acute otitis media (AOM) can be masked by antibiotic treatment. The episodes of vomiting, headache, visual impairment and a history of AOM seem to be indicative for otitic hydrocephalus. MRI scans of patients with similar symptoms should be carefully studied to facilitate the early diagnosis of dural sinus thrombosis with increased intracranial pressure. Contrast-enhanced computed tomography scan and magnetic resonance imaging play a major role in determining diagnosis and treatment plans in this intracranial complications. Management included systemic antibiotics, short-term heparin anticoagulation and surgical decompression. In our patients intensive i.v. antibiotic treatment, steroids, anticoagulants and surgery led to a significant improvement in the clinical condition.

Acute Disease↗

PubMedDate not supplied

Central cord injury: pathophysiology, management, and outcomes.

BACKGROUND CONTEXT: Cervical spinal trauma can result in a heterogeneous collection of spinal cord injury syndromes. Acute traumatic central cord syndrome is a common category of which no uniform consensus on the etiology, pathophysiology, and treatment exists. PURPOSE: To evaluate and review potential pathophysiology, current treatment options, and management of central cord injuries. STUDY DESIGN: Comprehensive literature review and clinical experience. METHODS: A systematic review of Medline for articles related to central cord and spinal cord injury was conducted up to and including journal articles published in September 2005. CONCLUSIONS: Central cord injuries is a clinical definition which is composed of a heterogeneous population for which medical management and surgical decompression and stabilization provide improved neurologic recovery.

Central Cord Syndrome↗

PubMed2006

Anesthesia following overfilling of a root canal sealer into the mandibular canal: a case report.

The surgical treatment of a case of anesthesia that occurred with the extrusion of Endomethasone root canal sealer into the mandibular canal is presented. Endomethasone is a neurotoxic root canal sealer containing paraformaldehyde and eugenol. The literature indicates immediate surgical decompression on the extrusion of Endomethasone into the mandibular canal. In our case, the decompression surgery was done 3 weeks after the endodontic mishap. The nearly complete resolution of anesthesia 4 months following the decompression surgery suggests that the neurotoxic effects of Endomethasone are still reversible after 3 weeks.

Adult↗

PubMed2003

[Evaluation of electroneurography as a prognostic method in the development of peripheral facial paralysis].

Electroneurography (EnoG) is a prognostic test used in the assessment of the peripheral facial nerve paralysis. We believe that when performed in standard conditions and together with the clinical evolutive parameters, it is very useful to reveal the critical time for a more radical treatment. We studied 44 patients; 13 patients had greater than 90% neural degeneration on EnoG. 5 of them underwent facial nerve surgical decompression due to a poor clinical outcome and up to three of these patients had a normal facial function after this.

Adolescent↗

PubMed2003

Surgical treatment of thoracic outlet syndrome: effect and results of surgery.

BACKGROUND: Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience. METHODS: Forty-seven patients with thoracic outlet syndrome were operated on between 1985 and 2000. Mean age was 37.9 years (range, 17 to 58 years); female/male ratio was 41/6. The most frequent symptom was paresthesia (72.3%). Seventeen patients (36%) had bilateral symptoms. Of all, 89.3% (42 cases) were neurologic thoracic outlet syndrome, and 10.7% (five cases) were vascular. Lower plexus (C8-T1/ulnar nerve) compression was present in 36 patients and upper plexus (C5-C7/median nerve) compression in 6 patients. Doppler ultrasonography in 11 patients, angiography in 8, and lymph node scintigraphy in 1 patient were also performed. Main operative indications were persistence of symptoms after conservative therapy and reduced (< 60 m/s) ulnar nerve conduction velocity. RESULTS: Fifty-five operations were performed on the 47 patients. First (59.6%) and cervical costae (21.3%) resections were the most frequent operations. Mean ulnar nerve conduction velocity was 54.8 m/s (range, 43 to 68 m/s) preoperatively and 69.4 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05). The morbidity rate was 17% (8 of 47). No difference was observed between transaxillary and supraclavicular incisions. No brachial plexus injuries occurred. The most frequent cause of morbidity was incisional pain. Two reoperations were performed for recurrences. Follow-up was 4.6 years, and 75% of lower plexus and 50% of upper plexus compressions remained asymptomatic. Severe and long-term pain occurred in 1 patient. CONCLUSIONS: Surgical decompression for thoracic outlet syndrome is efficient and dependable, but results deteriorate over time.

Adolescent↗