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PubMed1996

Outcome of anterior decompression and stabilization for thoracolumbar unstable burst fractures in the absence of neurologic deficits.

STUDY DESIGN: This study investigated the outcome of anterior decompression and stabilization for "unstable" burst fractures without initial neurologic deficits in the thoracolumbar spine. OBJECTIVE: To determine the pain and work status of the patients, who underwent the anterior decompression and stabilization, to evaluate the relationship between residual back pain and the degree of kyphosis, and to analyze the advantages and disadvantages of surgery for burst fractures without initial neurologic deficits in the thoracolumbar spine. SUMMARY OF BACKGROUND DATA: A retrospective review was conducted on 45 patients with unstable burst fractures in the thoracolumbar spine treated by anterior decompression and stabilization in our institutions from 1982 to 1993. Nineteen patients were available for this study. Ten patients were men and 9 were women. Their age at surgery ranged from 15 to 76 years (average, 46 years). The duration of follow-up ranged from 24 to 84 months (average follow-up, 54 months). METHODS: All clinical charts and radiologic data of these patients were reviewed by the first author. Their pain, work, and employment statuses were assessed by the scales proposed by Denis in 1984. RESULTS: Nine patients were rated P1, 7 were rated P2, 2 were rated P3, 1 was rated P5, 11 were rated W1, 3 were W2, 1 was W3, and 4 were rated W5. Even the physical laborers' return to work averaged 5 months after surgery (range, 3-12 months). The postoperative kyphotic angle ranged from -6 degrees to 45 degrees (average, 11 degrees), and it remained -5 degrees to 45 degrees (average, 12 degrees) at final follow-up. There was no statistical correlation between the kyphotic angle and the pain scale. CONCLUSIONS: Anterior decompression and stabilization for unstable burst fracture without initial neurologic deficits in the thoracolumbar spine has some advantages in the view of anatomical reduction and rigid stability that allows patients an early rehabilitation, return to work, and gainful employment.

Adolescent↗
PubMed2002

Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression.

STUDY DESIGN: Reconstruction techniques after multilevel anterior cervical decompression were retrospectively compared. OBJECTIVE: To compare radiographic and clinical outcomes of multiple interbody grafting with strut grafting. SUMMARY OF BACKGROUND DATA: Previous studies have reported lower fusion rates for anterior cervical decompressions reconstructed with multiple interbody grafts as opposed to a single strut graft, although these techniques have never been directly compared in a consecutive series of patients who underwent surgery by a single surgeon. METHODS: Over a 20-year period, 190 patients underwent anterior cervical decompression and autogenous grafting without internal fixation and were followed for an average of 68 months. There were 98 two-level and 33 three-level discectomies with interbody grafting. These were compared with 16 one-level, 21 two-level, 20 three-level, and 2 four-level corpectomies with strut grafting. Radiographic and clinical outcomes were compared between the groups by chi2 and rank-sum analysis, respectively. RESULTS: Of the 59 patients who underwent strut grafting, 55 achieved a solid arthrodesis (93%), as compared with 87 of the 131 patients who underwent multiple interbody grafting (66%) (P = 0.0002). There were six cases of graft displacement or extrusion among the 59 patients who had strut grafts, as compared with no graft-related complications among the 131 patients who had interbody grafts (P < 0.0001). More "good" and "excellent" clinical outcomes were found among patients who underwent strut-grafting (88% vs 84%), although the difference was not statistically significant (P = 0.73). However, patients with a pseudarthrosis had significantly poorer clinical outcomes (P < 0.0001). CONCLUSIONS: A much higher fusion rate was achieved after corpectomy and strut grafting than after multilevel discectomy and interbody grafting. Although there were strut graft-related complications, four of these six complications occurred among patients who had a postlaminectomy kyphosis. Because pseudarthrosis resulted in poorer clinical outcomes, strut grafting should be considered after multilevel anterior cervical decompression to increase the likelihood of successful fusion.

Adult↗
PubMedDate not supplied

Evaluation of the maximal excretion rate of indocyanin green as a prognostic indicator in patients undergoing biliary decompression for obstructive jaundice.

To assess the postoperative outcome of jaundiced patients and to select the optimal timing for surgical intervention, indocyanin green (ICG) concentrations in the bile were measured after biliary decompression in patients with obstructive jaundice. The maximal excretion rate of ICG in the bile was calculated as a function of time (ICG Bmax). Among 59 patients with positive ICG Bmax values, morbidity was 15.2% and postoperative hospital mortality was 3.3%. However, the morbidity and mortality in nine patients with values between -0.5 and 0 were 88.8 and 44.4%, respectively. The 13 patients with in ICG Bmax below -0.5 had a 76.9% morbidity and a 61.5% mortality. The patients with ICG Bmax values below 0 showed a significantly higher morbidity and mortality than positive ICG Bmax patients. In patients showing ICG Bmax values below -0.5, surgery is contraindicated despite intensive postoperative care. The ICG Bmax value improved according to the increasing effect of biliary decompression. The index is useful not only as a prognostic index in the early phase of biliary decompression but also as an index of bile secretory capacity at a given time. By means of time course measurement of this index, the suitable time for operation can be determined. The ICG Bmax is a useful and reliable indicator in the assessment of hepatobiliary functional reserve in jaundiced patients after biliary decompression and prior to further surgical intervention.

Adult↗
PubMed1991

Results of ulnar neuropathy at the elbow treated by decompression or anterior transposition.

A retrospective study was conducted on 148 patients with ulnar neuropathy at the elbow, who underwent surgical treatment between 1981 and 1989. Of the 178 nerves operated on, 105 underwent subcutaneous anterior transposition, and 73 were decompressed without transposition. We compared the surgical results of these two groups, and factors influencing prognosis. Overall, 92% of patients improved postoperatively. Pre-operatively, electrophysiological assessment corresponded well to clinical findings, and to macroscopic findings at operation in 95% of cases. The severity of pre-operative clinical findings, advancing age, duration of symptoms and the presence of intraneural fibrosis did not predict an adverse outcome. A satisfactory outcome in 72% of those decompressed compared with 60% of those who were transposed was not statistically significant. However, there was a lower percentage of those with unsatisfactory results in the decompressed series. Thus, we advise that, except where there is persistent deformity or a mass lesion in the region of the ulnar groove, decompression is the operation of choice.

Adult↗
PubMed1991

Ultrastructural changes in an obligately barophilic marine bacterium after decompression.

The bacterial isolate MT-41 from 10,476 m, nearly the greatest ocean depth, is obligately barophilic. The purpose of this study was to describe the morphological changes in MT-41 due to nearly isothermal decompression followed by incubation at atmospheric pressure. Two cultures were grown at 103.5 MPa and 2 degrees C and then decompressed to atmospheric pressure (0.101 MPa). One of the cultures was fixed just before decompression. The other culture, kept at 0 degrees C, was sampled immediately and four more times over 168 h. The number of CFU (assayed at 103.5 MPa and 2 degrees C) declined with incubation time at atmospheric pressure. Decompression itself did not lead to immediate morphological changes. The ultrastructure, however, was altered with increasing time at atmospheric pressure. The first aberrations were intracellular vesicles and membrane fragments in the medium. After these changes were plasmolysis, cell lysis, the formation of extracellular vesicles, and the formation of ghost cells. Intact cells in the longest incubation at atmospheric pressure had the normal cytoplasmic granularity suggestive of ribosomes but had few and poorly stained fibrils in the bacterial nucleoids. From the practical standpoint, samples of hadal deep-sea regions need to be fixed either in situ or shortly after arrival at the sea surface even when recovered in insulated sampling gear. This should prevent drastic structural degradation of sampled cells, thus allowing both accurate estimates of deep-sea benthic standing stock and realistic morphological descriptions.

Journal Article↗
PubMed1991

Bleeding gastroesophageal varices: gastric vein embolization after partial portal decompression.

Shunts that decompress the portal vein are effective in the treatment of bleeding esophageal varices. Use of large-caliber portacaval shunts, however, results in the complete decompression of the portal system and the risk of subsequent development of hepatic encephalopathy. Use of small-caliber portacaval shunts results in mild portal hypertension and less frequent hepatic encephalopathy but may increase the risk of recurrent bleeding. Thirty-three patients underwent angiography after partial decompression portacaval shunting (median trans-shunt pressures, 8 mm Hg). Embolization of residual varices, noted in 13 patients, was performed. Results included one complication with no sequelae and no bleeding a mean of 13 months after the procedure was performed. Trans-shunt embolization of esophageal varices effectively prevents bleeding varices after partial portal decompression.

Embolization, Therapeutic↗
PubMed1990

Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy.

Hypopituitarism is a major manifestation of pituitary adenoma apoplexy. We postulated that the acute deterioration in pituitary function may be caused by compression of portal vessels and the pituitary stalk, secondary to a sudden increase in intrasellar contents. If this were the case, one would predict improvement in pituitary function to occur after surgical decompression. We studied pituitary function in eight patients presenting with the clinical syndrome of pituitary adenoma apoplexy before and on multiple occasions after urgent surgical decompression. Partial or complete hypopituitarism was seen in all subjects at the time of presentation. Serum cortisol levels were inappropriately low (5.9 +/- 1.4 micrograms/dL; 162.8 +/- 38 nmol/L) for the degree of stress in seven patients and appropriately elevated in only one subject (55.3 micrograms/dL; 1525.7 nmol/L). High normal increments in cortisol levels were noted in three subjects given test doses of cosyntropin. Patients were given glucocorticoids before, during, and for 2 days after surgery. Serum cortisol concentrations measured on or after the third day when glucocorticoids had already been stopped were normal in seven subjects and consistently low in one. These seven subjects were discharged on no replacement and were subsequently documented by dynamic testing to have normal pituitary-adrenal function. Gonadal function improved in two of four men and in one of two women who had hypogonadism on presentation. Improvement in thyroid function was documented in two of three subjects with preoperative hypothyroidism. Gradual improvement and almost complete resolution of the neuroophthalmological abnormalities occurred days to weeks after decompression. These observations demonstrate that urgent surgical decompression after pituitary tumor apoplexy was associated with improvement not only in neurological defects but also in pituitary function. The rapid improvement in pituitary function indicates not only that the hypopituitarism was reversible, but also that it might be caused by compression of the portal circulation and pituitary stalk by the sudden increase in intrasellar contents.

Adrenocorticotropic Hormone↗
PubMed2005

Continuous gastric decompression for postoperative nausea and vomiting after coronary revascularization surgery.

Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel's risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.

Aged↗
PubMed1989

Effects of hydrocephalus and surgical decompression on cortical norepinephrine levels in neonatal cats.

Norepinephrine (NE) changes during hydrocephalus, and the effects of surgical decompression on these changes, were studied using a new model of neonatal hydrocephalus. Kittens 4 to 10 days old received intracisternal injections of a sterile solution of 25% kaolin. Control kittens were injected similarly with sterile injectable saline. Ultrasonography was used to follow the progression of ventriculomegaly and the initial effects of the shunts. A subgroup of hydrocephalic animals was shunted using a cerebrospinal fluid lumbar-peritoneal catheter. Hydrocephalic animals were killed at approximately 25 days of age (16-21 days after kaolin injection). Surgical decompression was performed at 12, 16, and 17 days after kaolin injection; these animals were killed 30 days after the shunts were inserted. Control animals were killed at 29 and 53 days of age, to correlate with the ages of the hydrocephalic and shunted animals, respectively. Cortical samples equivalent to Brodmann's areas 4, 22, and 17 were measured for NE using high-performance liquid chromatography. Hydrocephalus caused NE levels to decrease significantly in all cortical areas. These alterations followed a rostrocaudal gradient in severity, with mean reductions of 65.8, 83.9, and 95.8% in areas 4, 22, and 17, respectively. Partial recovery occurred in animals that received shunts 16 and 17 days after kaolin injection, such that NE reductions of 75.7, 56.2, and 81.6% were noted in areas 4, 22, and 17, respectively. Shunting at 12 days after kaolin injection produced complete recovery in areas 4 and 22, with only a 67.7% decrease in area 17. These results suggest that the projection fibers from the locus ceruleus are damaged by the direct effects of hydrocephalus. Axotomy or neuropraxia of these fibers could result in decreases in NE throughout the cerebral cortex. In addition, there appears to be a period of time during which surgical decompression will allow neuropraxic fibers to recover with partial restoration of NE levels. Earlier insertion of a shunt appears to allow for more recovery than later decompression.

Animals↗
PubMed1992

Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients.

The results of the treatment of trigeminal neuralgia by neurovascular decompression or partial sensory rhizotomy in a personal series of 220 patients are presented. Microvascular decompression was performed in 178 patients and partial sensory rhizotomy in 42. The mean follow-up was 5.2 years. Immediate pain relief was achieved in 94% of all patients, but the rate dropped to 84% during the follow-up period. The recurrence rate in the microvascular decompression group was 6% and in the PSR 49%. Permanent sequelae occurred in 4 patients (loss of hearing, 1; loss of corneal reflex, 1; lesion of the portio minor, 2), but transitory complications (impaired hearing caused by hematotympanum and diplopia) were more frequent, especially in the beginning of the series. Elderly patients tolerated the procedure very well and the percentage of complications was evenly distributed in all age groups. Three patients died. No patient developed painful dysesthesias or anesthesia dolorosa. There were no differences in the outcome, considering sex and age. The duration of symptoms did not influence the prognosis. Patients with severe compression did better than those with a mild one, and patients with an arterial compression did better than those with a venous one. Trigeminal neuralgia in multiple sclerosis is seldom relieved by microvascular decompression. The experience of the surgeon reduces the number of negative findings considerably.

Adult↗
PubMed1994

Total craniospinal decompression in achondroplastic stenosis.

We describe our experience with total craniospinal decompression along the entire neuraxis, extending from the brain stem to the cauda equina, in seven patients with achondroplasia. These patients presented with clinically significant compression at multiple levels. In these patients, there were focal areas of complete myelographic block, typically at the cervicothoracic or thoracolumbar junction, as well as diffuse narrowing of the entire spinal subarachnoid space. In some, there were further complications of basilar impression, Arnold-Chiari malformation, or syringomyelia. Total craniospinal decompression was completed in either one or two stages. Only a small minority of our patients with achondroplasia had critical stenosis over this many levels, requiring total craniospinal decompression. However, with proper preparation and technique, we found that patients can tolerate even such an extensive decompressive procedure and benefit from surgery without suffering postoperative spinal instability.

Achondroplasia↗
PubMed1998

Outcome after external decompression for massive cerebral infarction.

Acute ischemic stroke involving the entire vascular distribution of a carotid or middle cerebral artery can cause massive cerebral edema. This study evaluated external decompression for the treatment of massive stroke and analyzed possible prognostic factors. Twenty-four patients with acute massive cerebral infarction, which had progressed to tentorial herniation and impending death, underwent external decompression after medical therapy failed to achieve an effective response. The neurological outcome 2 months after surgery using the Glasgow Outcome Scale was severe disability in 14 patients, vegetative state in two, and death in eight. The overall mortality was 33%. Various characteristics (age, sex, etiology, side of hemispheric infarction, pupillary asymmetry, Japan Coma Scale, distribution of infarction, hemorrhagic infarction, midline shift, tentorial herniation) were evaluated to determine the factors associated with high mortality after surgical intervention. There was no statistically significant relationship between any variable and mortality. Mortality was especially high in the patients with preoperative consciousness level of 200, anterior, middle, and posterior cerebral artery territory infarction, and stage III of tentorial herniation. Postoperatively, all patients with severe disability returned to a clear level of consciousness. Six patients with dominant hemisphere stroke had some measure of communicative skills in spite of aphasia. External decompression is a life-saving treatment for patients with massive cerebral infarction and can provide a reasonable quality of life even for those with dominant hemisphere strokes. Decompressive surgery should be considered and performed as soon as possible if computed tomography demonstrates signs of descending tentorial herniation.

Acute Disease↗
PubMed1987

Subtemporal decompression: radiological observations and current surgical experience.

Subtemporal decompression, although seldom used today for the management of hydrocephalus, pseudotumour cerebri, or premature closure of cranial sutures, is still used in many centres to alleviate intracranial hypertension caused by tumour, trauma, or severe intracranial haemorrhage. The charts of 50 patients undergoing subtemporal decompression for either severe head trauma or severe intracranial haemorrhage were reviewed. Preoperative and postoperative computed axial tomographic scans were available in 15 patients for analysis of the effects of decompression on the underlying temporal lobe. Calculation of the additional space provided by subtemporal decompression ranged from 26 to 33 cm3.

Adult↗
PubMed1987

Neurovascular decompression for cranial rhizopathies.

For some cranial rhizopathies, such as hemifacial spasm and glossopharyngeal neuralgia, treatment has been unsatisfactory. Neurovascular decompression now offers a cure in almost 90% of these cases. In spite of the availability of alternative minor surgical procedures for trigeminal neuralgia, neurovascular decompression, being non-destructive, is a superior method of treatment. Vascular compression may also play a role in atypical facial pain and decompression may offer relief in this intractable condition. Vascular compression was not observed on exploration for nervus intermedius neuralgia, spasmodic torticollis and Meniere's disease. However, microsurgical techniques for selective section of nerves have been beneficial in Meniere's disease and nervus intermedius neuralgia. Neurovascular decompression is a relatively major procedure and is associated with a complication rate of 15%, deafness being most significant. Surgical expertise, a familiar operating team and possibly intraoperative monitoring facilities can reduce these complications.

Adult↗
PubMed1998

Decompression of the labyrinthine segment of the facial nerve in acoustic neuroma surgery: a consideration for minimizing postoperative delayed facial nerve dysfunction.

Delayed facial nerve palsy, a condition characterized by spontaneous deterioration of facial nerve function in patients who had otherwise normal or near-normal facial function in the immediate postoperative period, has been reported in 15 to 29% of patients undergoing microsurgical resection of vestibular schwannomas. One putative mechanism for its occurrence suggests that edematous entrapment of the facial nerve in the meatal foramen (the narrowest segment of the internal auditory canal) may lead to nerve ischemia or necrosis and subsequent facial nerve dysfunction. To assess whether meatal decompression may help reduce the incidence of delayed facial nerve palsy during microsurgical resection of acoustic tumors, we compared 25 patients undergoing translabyrinthine removal of acoustic neuromas who received prophylactic decompression of the labyrinthine segment of the facial nerve (Group 1) with 40 patients who did not receive facial nerve decompression (Group 2). No patients in Group 1 had a delayed progressive facial paralysis with degeneration. In contrast, when Group 2 patients with larger, average-sized tumors were reviewed, eight patients (20%) developed delayed degeneration. These findings suggest that decompression of the labyrinthine segment may be of value in acoustic tumor surgery in reducing delayed facial nerve dysfunction. Further study is indicated in this important area.

Journal Article↗
PubMed1982

Radical orbital decompression for severe dysthyroid exophthalmos.

A surgical technique is described for radical decompression of the orbit for dysthyroid exophthalmopathy. The operation should be considered in a patient with proptosis greater than 30 mm bilaterally or one with unilateral proptosis of 10 mm or more greater than the opposite eye. Such exophthalmos is frequently associated wih corneal exposure and ulceration, extreme cosmetic disfigurement, and optic neuropathy. The surgical procedure is performed through a 35-mm lateral skin incision and a lateral canthotomy with subconjunctival dissection. All four walls of the orbit are partially removed. This panorbital decompression procedure has been performed on five patients, with reduction of preoperative proptosis by as much as 17 mm. Complications were minimal. A review of the effectiveness of other orbital decompressive procedures is presented. It appears that the four-wall decompressive procedure offers the maximum degree of orbital reduction.

Adult↗
PubMed1984

Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine.

Metastatic lesions involving the spine may cause vertebral body collapse, resulting in either spinal instability or neural compression, or both. Progressive destruction of the vertebral body by the tumor may cause increasing spinal instability, leading to a kyphotic deformity and further neural deficit. Anterior decompression allows direct excision of the tumor focus and direct neural decompression. Because of postoperative irradiation, conventional bone grafts are rarely incorporated. Over an 8-year period, 52 patients with spinal instability secondary to metastatic pathological fractures of one or more vertebrae underwent anterior decompression and stabilization by replacement of the affected vertebral bodies with methyl methacrylate, polymerizing in situ. No postoperative external support was required, and the acrylic fixation achieved by this method was not affected adversely by subsequent irradiation to a mean of 4020 rads. Forty patients had major neurological impairment preoperatively and required anterior spinal cord and/or nerve root decompression prior to fixation. Of these, 21 had complete neurological recovery postoperatively, 13 others were improved significantly, five remain unchanged, and one patient deteriorated neurologically. There were three cases with failure of fixation. Seven other patients did not benefit from the procedure because of specific complications or the advanced state of their disease. The remaining 42 patients had good relief of pain and restoration of spinal stability, which did not deteriorate during the follow-up period, ranging from 6 to 100 months postoperatively.

Adult↗
PubMed1987

Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm.

Facial electromyographic (EMG) responses were monitored intraoperatively in 67 patients with hemifacial spasm who were operated on consecutively by microvascular decompression of the facial nerve near its exit from the brain stem. At the beginning of the operation, electrical stimulation of the temporal or the zygomatic branch of the facial nerve gave rise to a burst of EMG activity (autoexcitation) and spontaneous EMG activity (spasm) that could be recorded from the mentalis muscle in all patients. In some patients, the spontaneous activity and the autoexcitation disappeared after the dura was incised or when the arachnoid was opened, but stimulation of the temporal branch of the facial nerve caused electrically recordable activity in the mentalis muscle (lateral spread) with a latency of about 10 msec that lasted until the facial nerve was decompressed in all but one patient, in whom it disappeared when the arachnoidal membrane was opened. When the facial nerve was decompressed, this lateral spread of antidromic activity disappeared totally in 44 cases, in 16 it was much reduced, and in seven it was present at the end of the operation at about the same strength as before craniectomy. In four of these last seven patients there was still very little improvement of the spasm 2 to 6 months after the operation; these four patients underwent reoperation. In two of the remaining three patients, the spasm was absent at the 3- and 7-month follow-up examination, respectively, and one had mild spasm. Of the 16 patients in whom the lateral spread response was decreased as a result of the decompression but was still present at the end of the operation, 14 had no spasm and two underwent reoperation and had mild spasm at the last examination. Of the 44 patients in whom the lateral spread response disappeared totally, 42 were free from spasm and two had occasional mild spasm at 6 and 13 months, respectively, after the operation. Monitoring of facial EMG responses is now used routinely by the authors during operations to relieve hemifacial spasm, and is performed simultaneously with monitoring of auditory function for the purpose of preserving hearing. The usefulness of monitoring both brain-stem auditory evoked potentials recorded from electrodes placed on the scalp and compound action potentials recorded directly from the eighth cranial nerve is evaluated.

Electromyography↗