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At least 91 records · Page 5Linked to original sources
PubMed2002

Quantitative assessment of surgical decompression of the cervical spine with cine phase contrast magnetic resonance imaging.

OBJECTIVE: We measured cerebrospinal fluid flow velocity by use of cine phase contrast magnetic resonance imaging to quantitate the effectiveness of surgical decompression in patients with cervical myelopathy. METHODS: Forty-seven patients with cervical myelopathy attributable to either spondylosis or ossification of the posterior longitudinal ligament were studied. Thirty-five patients underwent anterior cervical decompression and fusion; 12 others underwent expansive laminoplasty. Patients were examined preoperatively and postoperatively by use of a 1.5-T scanner with a pulse-gated cine phase contrast sequence. Cerebrospinal fluid flow direction and velocity in the ventral subarachnoid space were determined at the C1 and T1 levels. Forty-four healthy control subjects were examined to determine normal flow velocity parameters. Severity of cervical myelopathy was evaluated preoperatively and postoperatively by use of Japan Orthopedic Association scores to calculate the extent of recovery. RESULTS: Preoperatively, cerebrospinal fluid flow velocity in the caudal direction was significantly lower at both C1 and T1 than velocities measured in healthy controls. Both decompressive procedures essentially returned patient velocities to control values. Clinical recovery from myelopathy did not differ between anterior and posterior decompression. Postoperative increase in flow velocity correlated with clinical recovery after posterior (P < 0.0008) but not anterior decompression. CONCLUSION: Cine phase contrast magnetic resonance imaging provides quantitative assessment of cervical spine decompression, with particularly good clinical applicability to posterior procedures.

Adult↗
PubMed1999

New techniques for surgical decompression of thyroid-related orbitopathy.

Certain cases of thyroid-related orbitopathy may require surgical decompression of the orbit. The purpose of this paper is to highlight new techniques of orbital decompression in thyroid-related orbitopathy. We present two illustrative cases selected from our recent surgical experience. The techniques of combined-approach decompression, transcaruncular approach to the medial orbital wall, drilling reduction of the greater wing of sphenoid and lateral wall lag-screw fixation after lateralization by greenstick fracture are presented. The relative utility of each technique is examined. These techniques expand the surgical repertoire for this condition and allow individualization of treatment for a specific patient's needs.

Adult↗
PubMed2006

Surgical decompression and coil removal for the recovery of vision after coiling and proximal occlusion of a clinoidal segment aneurysm: technical case report.

OBJECTIVE: We present the case of a patient with continued deterioration of vision after endovascular treatment of an unruptured clinoidal segment aneurysm. In conjunction with a review of the literature, the findings in this case highlight the need for further refinements in our understanding of pathophysiological changes induced by coiling of cerebral aneurysms, especially those in aneurysms producing signs and symptoms relating to mass effect. CLINICAL PRESENTATION: The patient is a 45-year-old man who presented with progressive vision loss. Imaging studies revealed a large, clinoidal segment aneurysm. The patient continued to experience progressive vision loss despite treatment with endovascular coiling, proximal occlusion, and high-dose steroid medication. INTERVENTION: The patient underwent a craniotomy for decompression of the optic nerve and for salvage of vision. Clipping of the distal vessel was performed, and the coil mass was removed. The patient experienced marked improvement of central vision after the surgical procedure. CONCLUSION: Although endovascular treatment of aneurysms protects most patients from aneurysm rupture, this case illustrates the fact that coiling, followed by proximal occlusion, might fail to alleviate symptoms related to mass effect. Our experience in this case suggests that early surgical decompression may be indicated for patients presenting with progressive visual deterioration.

Carotid Artery Diseases↗
PubMed2002

Observations on the safety and efficacy of surgical decompression for lumbar spinal stenosis in geriatric patients.

This retrospective study examines the results of surgical decompression of the lumbar spinal canal in 122 geriatric patients (age range 75-89 years) treated under general anesthesia by the same surgeon between the years 1990 and 1999. Patient demographics, perioperative complications, pain profiles before surgery and at the time of data collection (December 2000), as well as overall mortality were recorded. One hundred and twenty-two patients were studied. The average age at the time of surgery was 78.8 years (range 75-89 years). No perioperative deaths were recorded. The mean time elapsed from surgery until patient follow-up was 45.7 months (range 12-119 months). Fourteen patients had died at the time of patient follow-up (December 2000). When compared to pain experienced before surgery, at the time of the interview a significant (P<0.0001) improvement in low-back and radicular pain as well as in the ability to perform daily activities (dressing, washing, getting out of bed and walking) was described. We conclude that, for geriatric patients rated as physical status I-II (>75 years) under the American Society of Anesthesiologists (ASA) classification, surgical release of lumbar spinal stenosis is a safe and effective treatment option. However, the suitability of ASA III patients requires further investigation.

Age Factors↗
PubMed1995

Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression.

Entrapment of the lateral femoral cutaneous (LFC) nerve as a source of anterolateral thigh dysesthesias has been recognized for 100 years. Despite this historic recognition, its diagnosis today is often delayed, and definitive treatment of refractory cases by surgical decompression rarely reported. This study describes 26 LFC entrapments in 23 patients whose etiologies include iliac crest bone graft harvesting, seat belt injury associated with motor vehicle accident, and diabetes. Twenty-two of the 23 patients (25 of the 26 entrapments) achieved good to excellent outcomes following surgical decompression of the LFC nerve.

Adolescent↗
PubMed2001

Failure of surgical decompression for a presumed case of piriformis syndrome. Case report.

Diagnosis of piriformis syndrome is difficult and its precise definition is highly controversial. In this article, the authors present the case of a patient who had clinical features suggestive of piriformis syndrome. During surgery the patient was found to have a rare variation in anatomical structures, in which the peroneal nerve was displaced by the piriformis muscle. Surgical decompression did not alleviate the patient's symptoms.

Adult↗
PubMed1992

Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves.

Symptomatic diabetic sensorimotor polyneuropathy is considered progressive and irreversible. The hypothesis that symptoms of diabetic neuropathy may be due to entrapment of peripheral nerves was investigated in a prospective study from 1982 to 1988 in which diabetics (38 type I, 22 type II) had surgical decompression of 154 peripheral nerves in 51 upper extremities and 31 lower extremities. Mean postoperative follow-up was 30 months (range 6 to 83 months). Considering the entire series, an excellent final result was noted for motor function in 44 percent and for sensory function in 67 percent of the decompressed nerves. Ten percent of the patients were not improved, and 2 percent were worse in sensorimotor function. Upper extremity nerve decompressions achieved better results than lower extremity nerve decompressions. Improvement in postoperative electrodiagnostic studies varied in relationship to the preoperative electrodiagnosis. Improvement was noted in 100 percent of those nerves with the preoperative diagnosis of "localized entrapment," 80 percent for "peripheral neuropathy with superimposed entrapment," and 50 percent for "peripheral neuropathy." Progressive neuropathy occurred in a nontreated limb of 50 percent of those patients whose surgically treated limb maintained improvement. The results of this study suggest that symptoms of sensorimotor diabetic neuropathy may be due partly to compression of multiple peripheral nerves. The results further suggest that surgical decompression of such nerves may result in symptomatic improvement.

Adult↗
PubMed1980

Cervical spondylosis: natural history and rare indications for surgical decompression.

Degenerative disc disease may be considered a normal process of aging which occurs in virtually the entire population that reaches middle age. Pain problems associated with it should be approached with the greatest reluctance by the surgeon since intermittent flare-ups with subsidence and ultimate overall improvement can be expected in most cases. The clearest indications for surgery have to do with neurologic deficit. The simplest and most obvious example is herniated nucleus pulposus with acute monoradicular or myelopathic symptoms. This situation requires an aggressive approach. More chronic neurologic changes must be approached more cautiously. When unequivocal progression is identified, surgical decompression is in order. Finally, narrowing of the canal from either congenital or acquired processes may in some instances justify prophylactic surgical decompression, but requires the greatest caution. The radiologic findings often do not correlate with the signs and symptoms. The patient's input and his or her full awareness of the possibilities of serious complication is an essential part of good surgical management.

Cervical Vertebrae↗
PubMed1997

[Surgical decompression of bilateral, compression-induced damage to the posterior interosseous nerve. A case report].

Bilateral posterior interosseous nerve palsy is a rare case of radial nerve entrapment. The patient is unable to extend the fingers in the metacarpophalangeal joints. Extension of the interphalangeal joints is preserved due to the intrinsic muscles. Neither the extensor carpi radialis longus and brevis muscles are affected nor the brachioradialis muscle. However, extension of the wrist may be weak. There is no sensory loss. The neurophysiological examination underlines the clinical findings. In our case compression is caused by the arcade of Frohse and the vessels of the recurrent radial artery. A good recovery of nerve function is seen after surgical decompression.

Decompression, Surgical↗
PubMed1998

Recovery of sensory nerve fibres after surgical decompression in lumbar radiculopathy: use of quantitative sensory testing in the exploration of different populations of nerve fibres.

Thirty nine patients with unilateral lumbar nerve root compression at one level were examined with quantitative sensory testing immediately before microdiscectomy and at six weeks, four months, and 12 months after surgery. Twenty one healthy volunteers were used as controls. The patients were classified as having a good or a poor result at the one year follow up. The improvement of function in small unmyelinated nerve fibres came within six weeks in the patients with a good result. By contrast the improvement of function in small myelinated fibres was not found before 12 months after surgery. The function in large myelinated fibres did not improve during the observation period. The difference in the time course of the recovery between large and small nerve fibres is assumed to reflect differing severity in the damage to the fibres before surgical decompression. The preoperative warmth detection threshold reflecting the function in small unmyelinated C fibres was significantly higher in the patients with a poor result and this may indicate that damage to C fibres before surgery is a negative prognostic factor.

Adult↗
PubMed2002

Functional outcome study of patients after surgical decompression for lumbar spinal stenosis: effects of concomitant pathology.

The aim of this study is to identify factors associated with poor outcome in the medium (2-5 years) postoperative period following lumbar stenosis surgery. Fifty-six consecutive patients who underwent decompression for lumbar spinal stenosis were retrospectively analyzed using chart and radiologic review, questionnaire using American Association of Orthopaedic Surgeon's MODEM questionnaire containing disability, symptoms, and illness rating, as well as Short Form-36 questionnaires. Postoperatively, there was 98% partial or total relief in leg pain, 85% had partial or total relief in back pain, and 69% had partial or total recovery of neurologic deficit. Functional outcome according to the Short Form-36 was comparable with the age-adjusted population when other comorbidities were taken into account. We found a direct relationship between poor outcome and coexisting medical conditions (p <0.001). Accompanying comorbid conditions have a significant impact on outcome after surgical decompression for lumbar spinal stenosis.

Activities of Daily Living↗
PubMed1994

The carpal tunnel syndrome: clinical evaluation and results of surgical decompression.

We reviewed 357 patients with carpal tunnel syndrome who had surgical decompression of the carpal tunnel between January 1989 and April 1991. The male to female ratio was 1:6. In 40 patients, there was bilateral involvement. Only 38.5% of the patients complained of numbness or sensory disturbance in the median nerve distribution of the hand. Tinel and Phalen sign tests were positive in about two-thirds of the patients. Electromyographic studies were performed in 329 patients. The commonest surgical procedure was a simple release of the flexor retinaculum at the wrist. Nearly all the patients reported improved symptoms.

Adult↗
PubMed1999

Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomy: a prospective review of 15 cases.

BACKGROUND: Branch retinal vein occlusion (BRVO), the second most common vascular disorder of the retina, typically occurs at arteriovenous (A/V) crossings where the arteriole and venule share a common adventitial sheath. Mechanical narrowing of the venous lumen at these intersections is thought to play a pathoetiologic role in BRVO. METHODS: We performed surgical decompression of BRVO via A/V crossing sheathotomy in 15 patients with decreased visual acuity due to macular hemorrhage, edema, and ischemia. Reperfusion of the retina was achieved by surgically separating the overlying retinal arteriole from the venule via vitrectomy and adventitial sheathotomy techniques. RESULTS: Intraoperative decompression of the A/V crossing was achieved in all 15 patients. All patients showed clinical improvement as determined by fundus examination, photography, and fluorescein angiography. Postoperative visual acuities were equal or improved in 80% of patients. Ten of the 15 subjects (67%) had improved visual acuity with an average gain of four lines of vision. CONCLUSION: Surgical decompression of BRVO via A/V crossing sheathotomy is a technically feasible procedure that can result in rapid reperfusion of the retina. Resolution of macular hemorrhage, edema, and ischemia may improve visual prognosis in patients with this common retinal vascular disorder.

Aged↗
PubMed2004

Recurrence of thoracolumbar intervertebral disk extrusion in chondrodystrophic dogs after surgical decompression with or without prophylactic fenestration: 265 cases (1995-1999).

OBJECTIVES: To evaluate a population of chondrodystrophic dogs treated for Hansen type 1 intervertebral disk (IVD) disease by surgical decompression with or without prophylactic fenestration and determine the rate and location of surgically confirmed recurrence of intervertebral disk extrusion. ANIMALS: 265 dogs. STUDY DESIGN: Retrospective study. PROCEDURES: Medical records of dogs that underwent spinal decompression between 1995 and 1999 were reviewed. RESULTS: 3 (4.9%) dogs were euthanatized or died prior to discharge. Fenestration was performed in 252 dogs, including 37 (14.7%) at the site of decompression only, 48 (19%) at 3 to 4 disk spaces, and 167 (66%) at 5 to 7 disk spaces. There were 12 instances of recurrent disk extrusion confirmed by removal of disk at a second surgery 3.5 to 33 months after the first surgery. Recurrence was always at a new disk space, and rates did not significantly differ between dogs that underwent single or multiple fenestrations. Two recurrences were at a previously fenestrated disk space. Seven recurrences were at a site immediately adjacent to a fenestrated disk space, and 5 recurrences were at L4-5. CONCLUSIONS AND CLINICAL RELEVANCE: Prophylactic fenestration is generally successful in preventing future disk extrusions at fenestrated disk spaces. Prospective evaluation is still required to determine whether fenestration decreases the overall rate of recurrence. Prophylactic fenestration could promote disk extrusion at adjacent, nonfenestrated disk spaces. This could have a substantial clinical impact if recurrence develops at L4-5.

Animals↗
PubMedDate not supplied

[The role of surgical decompression of cauda equina in lumbar disc herniation and recovery of bladder function].

INTRODUCTION: Cauda equina syvndrome from lumbar disc herniation accounts for up to 2-3% of all disc herniations. The aim of this study was to investigate whether recovery of bladder function after surgery depends on preoperative duration of desease. PATIENTS AND METHODS: This retrospective study included 47 patients who underwent surgery for cauda equina syndrome due to a herniated disc in the period between 1997 and 2002. Eleven patients were female and 36 male, with a mean age of 43 years (range 23-67). All presented with sciatica and saddle hypoesthesia, whereas 13 presented with motor weakness of legs. All patients had been catheterized at the time of admission to the Neurosurgical unit. Levels of herniation were L4-L5 in 27 (57%), L5-S1 in 14 (30%), and L3-L4 in 6 (13%) patients. In 7 (15%) patients, surgery was performed within 48 hours of the cauda equina syndrome onset. None underwent surgery within 24 hours. 13 (28%) patients were operated between the 2nd and 7th day and 27 (57%) after 7th day of the cauda equina onset. The role of preoperative duration of symtoms in recovery of bladder function was examined (chi 2 analysis). RESULTS: The follow-up ranged from 15 to 74 months (mean 24.2 months). In 33 patients (70%) excellent result were achieved, in 9 (19%) patients good results and 5 (11%) patients presented with poor results. There was no statistically significant difference concerning the time between the onset of symptoms and surgical decompression and subsequent recovery of bladder function (p>0.05). CONCLUSION: After accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome due to lumbar disc herniation appear satisfactory regardless of the timing of surgery.

Adult↗
PubMed1996

Timing of surgical decompression and fixation of acute spinal fractures.

A retrospective evaluation of 138 patients requiring operative decompression, reduction and fixation of spinal injuries between January 1986 and April 1989 was conducted. The variables of timing and method of operative intervention, level and classification of fracture, associated injuries, injury severity score (ISS), associated neurologic deficits, length of intensive care unit and hospital stays, and projected costs were analyzed for correlation with postoperative complications (pulmonary, skin, urinary, other). Four subgroups were identified: group IA patients underwent surgery within 72 h of injury and had an ISS of < 18; group IB patients underwent surgery after 72 h and had an ISS of < 18; group IIA patients underwent surgery within 72 h and had an ISS of > or = 18; and group IIB underwent surgery after 72 h and had an ISS of > or = 18. There was no statistically significant difference in the incidence of medical complications in patients comparing groups IA and IB. Group IIB patients had a statistically significant higher rate of morbidity than did group IIA. A separate group of patients with cervical spine injuries with neurologic deficit was analyzed by the same statistical analysis. Irrespective of associated injuries, all had fewer complications if they underwent surgery within 72 h. Morbidity was higher in patients with a neurological deficit compared with neurologically intact patients. Surgical decompression, reduction, and/or fixation of spinal fractures within the first 72 h is indicated in patients with multiple trauma (ISS > or = 18) and cervical injuries with a neurological deficit.

Adolescent↗
PubMed1997

Radial tunnel syndrome: long-term results of surgical decompression.

Between 1980 and 1990, 31 patients (33 extremities) underwent decompression of the radial tunnel. All procedures were performed at the same institution by the senior author using a brachioradialis muscle-splitting approach. Twenty-three patients (24 extremities) were available for follow-up evaluation at an average of 8 years after surgery. The outcome was determined using the original criteria of Roles and Maudsley and Ritts et al. By the criteria of Roles and Maudsley, outcomes for 15 patients (16 extremities; 67%) were rated as excellent/good and for 8 patients (8 extremities; 33%), as fair/poor. By the criteria of Ritts et al., 16 patients (17 extremities; 71%) had good results and 7 patients (7 extremities; 29%), a fair/poor result. Overall, the majority of patients were satisfied and felt helped by the surgery. Five patients changed their occupation because of continued discomfort. Significant differences in outcome were not found for workers' compensation patients. Similarly, no differences in outcome were found for site of compression, patient sex, history of trauma, or associated neuropathies. The results of this study suggest that complete pain relief and return to activities following radial tunnel surgery is not as predictable as previous studies have indicated. Nineteen patients (20 extremities), however, felt satisfied and helped and believed they gained improved function because of surgical decompression of the radial tunnel.

Adolescent↗