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PubMed1996

Acute carpal tunnel syndrome in a diver: evidence of peripheral nervous system involvement in decompression illness.

Conclusive evidence for involvement of the peripheral nervous system in decompression illness is lacking. We report a case of decompression illness associated with shoulder pain and the clinical features of median nerve injury at the wrist. Initial recompression and hyperbaric oxygen treatment produced prompt relief of all symptoms and signs, but carpal tunnel syndrome subsequently recurred. Nerve conduction studies confirmed median nerve conduction delay at the wrist. Repeat measurements after treatment with hyperbaric oxygen showed electrophysiologic improvement that was consistent with improvement in symptoms. We believe this is the first objectively substantiated case of injury to the peripheral nervous system caused by decompression illness.

Acute Disease↗
PubMed1997

Carpal tunnel decompression under local anaesthetic and tourniquet control.

A postal survey within the North West Region (UK) revealed that 66% of the consultant orthopaedic surgeons did not use local anaesthesia routinely for carpal tunnel decompression. This prospective study was set up to assess the effectiveness, safety and patient tolerance of performing this procedure using local anaesthesia and upper arm tourniquet control. Eight-six carpal tunnel decompressions were performed on 75 consecutive and unselected patients with confirmed carpal tunnel syndrome over a 6-month period. Completed questionnaires were obtained before discharge. None or only slight discomfort was experienced for all aspects of the operation in at least 94%. None of the patients reported severe and unbearable discomfort. At review, 3 months postoperatively, all patients with the exception of two reported complete resolution of preoperative symptoms. The use of local anaesthesia and a tourniquet is safe, effective and well-tolerated in carpal tunnel decompressions.

Adult↗
PubMed2002

Ultrasound-guided decompression of the spinal canal in traumatic stenosis.

The purpose of this study was to examine the efficacy of ultrasound (US)-guided decompression of the myelon in the surgical treatment of spinal fractures. Intraoperative ultrasonography was performed in 22 patients with traumatic stenosis of the spinal canal during spinal cord surgery with removal of retropulsed bony fragments. US imaging requires a posterior approach and an enlarged foramen interarcuale. The posterior vertebral facet and the myelon can accurately be distinguished from small bony fragments by ultrasonography. Pre- and postoperative computed tomography was compared with intraoperative US imaging. Complete decompression of the spinal canal was controlled by US imaging of the restored ventral epidural space, as seen after repositioning of displaced fragments. Thus, the required extent of the surgical procedure was determined by intraoperative ultrasonography. We conclude that intraoperative US imaging is an important tool to monitor the restoration of the spinal canal and decompression of the spinal cord in case of fracture. The repositioning of stenosing bony fragments using surgical instruments can be monitored. US imaging as a real-time method intraoperatively provides the surgeon with additional information and significantly influences treatment options.

Decompression, Surgical↗
PubMed1998

Cognitive improvement despite minimal arachnoid cyst decompression.

There are relatively few reports that evaluate the cognitive functions of patients with arachnoid cysts. Presumably, these 'silent cysts' are regarded as incidental findings with no functional significance. Although postoperative clinical improvement is well documented in patients with significant reduction in cystic volume, the current report describes a patient who underwent cystoperitoneal shunting due to mass effect, with minimal postoperative decompression. Neuropsychological testing indicated significant cognitive improvement in verbal learning, memory, visual-perceptual abilities, constructional skills, conceptual shifting, and psychomotor speed after shunt placement, despite marginal evidence of decompression. These findings suggest that (1) significant cognitive changes can occur in these patients, despite minimal postoperative regression of the lesion, (2) cognitive measures may provide an alternative, functional index of outcome efficacy, and (3) reliance on traditional outcome measures (i.e. anatomical decompression or resolution of clinical symptoms) may underestimate the efficacy of surgical intervention for these patients.

Adult↗
PubMed2003

Long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression.

PURPOSE: The goal of the study was to evaluate the long-term outcome of combined arthroscopic distal clavicle excision and subacromial decompression. TYPE OF STUDY: Retrospective, long-term cohort evaluation. METHODS: Twenty patients with an average follow-up of 6 years (range, 3.9 to 9 years) were reviewed. All patients had ipsilateral impingement syndrome and acromioclavicular joint disease at the time of surgery and underwent arthroscopic subacromial decompression combined with arthroscopic distal clavicle excision. All patients returned for evaluation in person, in addition to filling out a questionnaire incorporating the University of California, Los Angeles (UCLA), and Constant scoring systems. Preoperative and postoperative radiographs were available for all patients. RESULTS: Postoperatively, all patients had pain relief and were satisfied with the result. The average postoperative UCLA Shoulder score was 29.8 +/- 0.6, compared with 17.5 +/- 3.0 before surgery (P =.001). The Constant Shoulder score averaged 98.5 +/- 2.1 postoperatively, compared with 70.5 +/- 11.2 preoperatively (P =.001). There was 100% good to excellent results using both scoring systems. Individual components of the UCLA scoring system (pain, function, and power) all showed significant postoperative improvement (P =.001). Constant categories of pain, activities of daily living, range of motion, and power also improved. Follow-up radiographs showed maintenance of the resected distal clavicle in 19 patients. Five patients (25%) had radiographic evidence of calcific density distal to the resected clavicle but were asymptomatic. CONCLUSIONS: The long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression are uniformly good or excellent. Impingement and acromioclavicular joint disease frequently coexist and should be identified and treated concurrently.

Acromioclavicular Joint↗
PubMedDate not supplied

Arthroscopic subacromial decompression: results and factors affecting outcome.

Arthroscopic subacromial decompression was performed on 114 patients with rotator cuff impingement who had not responded to nonoperative measures. None of the patients had a full-thickness cuff tear. Patients with associated instability, symptomatic acromioclavicular joint disease, or ruptures of the long head of biceps were not included. Results were determined by questioning patients about their satisfaction with the outcome of surgery and by functional assessment of the shoulder with the parameters of pain, ability to perform daily activities, and range of motion according to the Constant scoring system. When reviewed at a mean interval of 19 months after surgery, 85 patients (75%) were satisfied with the outcome. Pain scores improved by an average of 8.6 points; "activities of daily living" scores improved by an average of 5.8 points; range-of-motion scores improved by an average of 3.6 points. The improvements in all 3 parameters scored were significant (P < .05). The following variables were statistically analyzed to assess their influence on final outcome: age, sex, occupation, duration of symptoms before surgery, dominance of the affected shoulder, outcome of the impingement test, state of the cuff, and experience of the surgeon performing the operation. The duration of symptoms before surgery was the most significant predictor of outcome. Symptoms of prolonged duration were associated with an unsatisfactory subjective results (P < .01) and with smaller improvements in the parameters of the Constant score (P < .001). Recovery after arthroscopic subacromial decompression and eventual outcome were related to the extent of cuff damage. Patients with partial thickness tears or fraying of the cuff had a delayed return to work (P < .001) and were found to have smaller increases in the pain and range-of-motion scores (P < .05). A satisfactory subjective result was most often associated with a positive impingement test (P < .05). Unsatisfactory outcomes were associated with a questionable diagnosis and lack of clear evidence of impingement at arthroscopy, inadequate decompression of the subacromial space, or the presence of calcium deposits in the rotator cuff.

Adult↗
PubMed2004

[Decompressive craniectomy in malignant infarction of the middle cerebral artery].

INTRODUCTION: Medically managed malignant infarction of the middle cerebral artery (MCA) is associated with an 80% mortality rate. However, several studies report a 40-50% increase in survival rates when decompressive craniectomy is performed. We present our experience with such surgical treatment and a literature review. PATIENTS AND METHODS: Seven decompressive craniectomies were performed on five patients for spaceoccupying MCA infarctions. Age ranged from 33 to 57 years-old (three males and two females). Preoperative GCS score was 9-13. Cranial CT was performed within the first 12 hours. Intracranial pressure (ICP) was continuously measured in four patients. Two infarcts occurred in the dominant hemisphere and three in the non-dominant side. Wide fronto-parieto-temporal craniectomies were performed. The duramater was opened and a large heterologous dura graft was placed. RESULTS: Surgery was performed on the second day after the onset of symptoms (median: 47 hours). Preoperative ICP ranged from 27 to 50 mmHg (median: 30.5 mmHg), with immediate postoperative ICP under 15 mmHg in all patients. Two patients (both non-dominant side) survived with good (after reoperation) and excellent functional outcome. They remain stable after ten and five months of follow-up. Three patients died five, five and thirteen days after admission due to uncontrollable high ICP. In our experience, bone removal itself was more relevant than dural opening for ICP control. Initial wide craniectomies may spare reoperations. CONCLUSION: The significant mortality rate reduction, a wide therapeutic window (2-3 days) and a low incidence of intraoperative complications make decompressive craniectomy a relevant treatment in malignant cerebral MCA infarction.

Adult↗
PubMed1997

Endoscopic orbital decompression for dysthyroid eye disease.

Orbital decompression for dysthyroid eye disease is traditionally performed either through an external approach or transantrally. The introduction of endoscopic sinus surgery over the last decade has led to a better understanding of the intranasal surgical landmarks of orbital walls and the development of endoscopic orbital decompression. We have adopted the endoscopic technique as the treatment of choice for orbital decompression in dysthyroid eye disease for the last two years. The surgical technique is described and illustrated, and the results of our first series of 15 patients (30 orbits) are presented.

Adult↗
PubMed2000

Results of transantral orbital decompression in patients with thyroid-associated ophthalmopathy.

PURPOSE: To present the results of orbital decompression in patients with thyroid-associated ophthalmopathy (TAO). METHODS: Transantral orbital decompression was performed in 63 patients with TAO. In 40 patients (63%) the operation was made because of progressive ophthalmopathy not responding to medical therapy, and in 23 patients (37%) the operation was made for rehabilitative reasons. The long-term hypesthesia engaging the infraorbital nerve was assessed with a questionnaire using a Visual Analogue Scale (VAS). RESULTS: The mean proptosis reduction was 3.2 mm (range 0-8 mm). Twenty-one patients had impaired visual acuity preoperatively, and 20 improved. Altogether 30 patients (40%) had worsened ocular motility postoperatively. Forty-three patients did not have diplopia in the primary position preoperatively, and new diplopia developed in 22 of these (51%). Hypesthesia in the infraorbital nerve area was reported for half of the operated sides, but was a major cause of distress (VAS-scoring >5) to eleven patients. CONCLUSIONS: Transantral orbital decompression is indicated in patients with progressive TAO or in patients with prominent exophthalmos, and results in a good proptosis reduction, but the risk of postoperative diplopia is significant. Postoperative hypesthesia is common but often not a major problem.

Adolescent↗
PubMed2001

Results of a neurosurgical two-wall orbital decompression in the treatment of severe thyroid associated ophthalmopathy.

PURPOSE: Follow-up of patients with severe thyroid associated ophthalmopathy treated with a transcranial two-wall orbital decompression and reconstruction. METHODS: A two-wall transcranial orbital decompression was performed in 30 such patients (50 eyes). The patients were evaluated one month postoperatively, and long-term evaluation (median 14 months, range 2-54 months) was carried out. The main outcome measures were visual acuity, proptosis measured by Hertel ophthalmometry, soft tissue involvement, and restriction of eye motility. RESULT: Visual acuity improved rapidly in 28 of 32 affected eyes with normalization in 19 eyes (p<0.001). Worsening was not seen. Median proptosis was reduced by 4.0 mm, range 0-10.0 (p<0.001). Double vision was present in 24 patients before operation 14 of whom achieved binocular vision (p<0.001). Three patients had unchanged complaints and the double vision worsened in one patient. Seventeen of 20 patients on preoperative corticosteroid treatment discontinued this medication in relation to surgery. Complications included one case of perioperative minor stroke and two cases of facial nerve frontal branch palsy. CONCLUSION: The transcranial two-wall decompression is a simple, an efficient and a low-risk procedure for treatment of patients with severe thyroid associated ophthalmopathy.

Adult↗
PubMed2002

Surgical decompression in traumatic optic neuropathy.

BACKGROUND: The management of traumatic optic neuropathy remains controversial. This retrospective study presents the results of 19 cases of indirect optic neuropathy where surgical decompression represented the primary mode of treatment. METHODS: Nineteen patients (20 optic nerves) with traumatic optic neuropathy underwent primary surgical decompression. The surgery was performed using the transethmoidal technique. RESULTS: The extent of bony optic canal injury documented during surgery indicated that this had been underestimated in this series by CT findings. Vision improved in eight patients, five of whom had had no light perception preoperatively. CONCLUSION: Primary surgical decompression of the optic nerve within 48 h of injury produces beneficial results. Testing of visual acuity 6 weeks after surgery does not serve as a reliable predictor of final outcome.

Adolescent↗
PubMed1998

Endoscopic orbital decompression for thyroid eye disease.

BACKGROUND: Thyroid eye disease is a disorder of immune function resulting in extraocular myopathy and an increase in retrobulbar fat. These changes lead to the clinical features found in thyroid eye disease including proptosis, eyelid retraction, restrictive myopathy and sometimes compressive optic neuropathy. Orbital decompression is undertaken for optic nerve compression, exposure keratopathy or cosmesis. Previously this involved an external approach with the removal of the medial orbital wall along with the floor. An intranasal endoscopic approach with the removal of the medial orbital wall and part of the floor has recently been advocated as an alternative procedure. METHODS: We present the results of 7 patients who underwent endoscopic orbital decompression. The effects on optic nerve function, proptosis and ocular motility were assessed. Symptoms before and after surgery were monitored. RESULTS: The surgery was found to be successful in all cases with a reduction in proptosis and minimal effect on ocular motility. The surgery was also associated with a low post-operative morbidity. CONCLUSION: We suggest endoscopic orbital decompression is an effective and safe treatment for dysthyroid eye disease.

Adult↗
PubMed1986

Urinary problems in decompression sickness.

The records of 25 patients with type II decompression sickness and urinary problems have been reviewed. Seventeen patients were professionals and 8 were above the age of 40. The disease appeared within the 1st hour of emergence from the water in 70% of the cases and within the first 4 hours in the remaining 30%. Nine patients were diagnosed as paraplegic and two as tetraplegic. All patients had urinary disturbances and 14 were on Foley-catheter drainage during the decompression while 11 were on intermittent catheterisation. Fifteen patients had improved urinary function after recompression, 8 had some difficulty, 2 underwent a sphincterotomy and one a transurethral prostatectomy. The low percentage of complete recovery was due to the delayed arrival at the decompression chamber.

Adult↗
PubMed2001

Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine.

STUDY DESIGN: To evaluate the role of single stage decompression with anterior interbody fusion with posterior instrumentation and deformity correction of tuberculous kyphosis of the dorso-lumbar spine in patients with/without neurological deficit. OBJECTIVES: (1) To evaluate the amount of kyphosis correction with single stage surgery and its progression with time. (2) To evaluate the neurological recovery. (3) To evaluate the bony anterior interbody fusion. SETTING: King Edward Memorial Hospital, Bombay, India. METHODS: Twenty-eight patients with post-tuberculous kyphosis deformity averaging 64.3 degrees (range 17 to 105) were treated by a single stage posterolateral decompression, correction of kyphosis, anterior interbody fusion and posterior instrumentation. RESULTS: The mean kyphosis correction obtained was 62.5% with the mean post-operative kyphosis angle reducing to 24.1 (range 5-60). At a mean follow-up of 5.8 years (4-7 years) the mean kyphosis angle loss was 3.2 degrees (range 0-5 degrees ). Of the 23 patients with neurological deficit, recovery was seen in 21 cases (91.3%) while deterioration was seen in one case (4.3%). The remaining five patients were neurologically intact pre-operatively. Bony fusion was seen in all cases at 9 months. One patient with subpulmonary function died post-operatively (mortality 3.5%). CONCLUSION: The results of our series are encouraging. However single stage decompression with fusion and kyphosis correction is a very demanding surgery and should be performed after taking into account the risks and benefits involved. This surgery perhaps prevents progression of neurological deficit and recurrence of late onset paraplegia in these complex cases in developing countries.

Adolescent↗
PubMed2005

Foramen magnum decompression for the treatment of Arnold Chiari malformation type I with associated syringomyelia in an elderly patient.

STUDY DESIGN: Report of a rare case of an elderly patient with late onset of Arnold Chiari malformation type I with associated syringomyelia that was successfully treated with foramen magnum decompression. OBJECTIVE: To report this rare case along with a literature review. SETTING: Gifu, Japan. METHODS: A 69-year-old woman with a 4-year history of dull pain in her right arm was referred to the clinic. After physical and radiographical examinations, she was diagnosed with Arnold Chiari malformation type I with associated syringomyelia. A foramen magnum decompression by the removal of the outer layer of the dura mater was performed. RESULTS: At 2 years postoperatively, MRI revealed a decrease in the size of the syringomyelia. Her symptoms had also remarkably improved. CONCLUSIONS: A rare case of symptomatic Arnold Chiari malformation type I with associated syringomyelia in an elderly woman was successfully treated with foramen magnum decompression by the removal of the outer layer of the dura mater.

Aged↗
PubMed2006

Transoral anterior approach for extensive anterior decompression at the C3 vertebra level in a patient with severe atlantoaxial vertical subluxation and rheumatoid arthritis.

STUDY DESIGN: We report a successful extensive transoral anterior decompression for an elderly patient with myelopathy and occipitalgia due to severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with rheumatoid arthritis (RA). OBJECTIVE: To describe the treatment of an exceptional pathological condition involving severe vertical subluxation. SETTING: University-affiliated hospital in Gifu, Japan. METHODS: A 73-year-old woman was referred to our clinic because of myelopathy and occipitalgia due to severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with RA. Plain radiographs revealed severe atlantoaxial vertical subluxation and sagittal magnetic resonance (MR) imaging revealed severe compression of the spinal cord at the level of the C2/3 disc space due to both posterior subluxation of C2 and rheumatoid pannus at the C2/3 disc space. As MR images demonstrated that the C2/3 disc space was located just behind the retropharyngeal wall, we performed successful anterior decompression from C2 to C3 via the standard transoral approach without mandibular osteotomy. RESULTS: The patient has been followed for 4 years and her symptoms are currently much improved without further surgical treatment. CONCLUSIONS: The present case illustrates that severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with RA can be treated successfully by anterior decompression of C2 and C3 via the standard transoral approach.

Aged↗
PubMed2003

Outcomes of emergency common bile duct exploration: impact of preoperative endoscopic decompression.

BACKGROUND: Emergency common bile duct exploration (CBDE) is still required in patients acutely ill with complicated biliary tract stone disease when endoscopic decompression fails to reverse their condition. This study looks at the clinical profile of patients requiring emergency CBDE and examines the various factors influencing the postoperative outcome. METHODS: Clinical records of patients with emergency CBDE in Singapore General Hospital from January 1991 to December 1998 were reviewed. Factors influencing postoperative outcomes, for example, pre-existing medical problems, hepatic parameters, the impact of endoscopic procedures (if any) and indications for surgery, were correlated with postoperative morbidity and 30-day mortality. RESULTS: The records of 100 patients were available for review. Major indications for emergency CBDE were cholangitis (51%) and intraoperative findings of common bile duct obstruction during emergency laparotomy (23%). Six patients had emergency CBDE because of iatrogenic complication of attempted therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) for biliary stones. Overall mortality was 14.0% and 8.0% had retained stones. Mortality was significantly influenced by age, prior biliary disease, preoperative endoscopic biliary decompression in acute cholangitis (33.3%vs 9.4%, P = 0.035) and endoscopic complications. CONCLUSIONS: Among patients requiring emergency CBDE, uncomplicated preoperative endoscopic biliary decompression benefits patients with acute cholangitis.

Adult↗
PubMedDate not supplied

Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients.

The surgical options for hallux rigidus in the presence of painful but moderate degenerative metatarsophalangeal joint disease are limited to either joint-destructive or joint-preserving procedures. The following study compared the effectiveness of 2 joint-preservation procedures. Forty-nine patients, with a mean age of 53 years, underwent phalangeal osteotomy and were reviewed at an average 29 months postoperatively. A subsequent group of 59 patients, with a mean age of 51 years, underwent first metatarsal decompression osteotomy and were reviewed at an average 15 months postoperatively. In the phalangeal osteotomy group, 65% of patients were completely satisfied, 24% were satisfied with reservation, and 11% were dissatisfied. Three patients suffered continued metatarsophalangeal joint pain, 3 developed hallux interphalangeal joint pain, and 4 patients developed transfer metatarsalgia. The postoperative decrease from 36 degrees to 35 degrees in mean peak hallux dorsiflexion on walking was not significant. In the first metatarsal decompression osteotomy group, 54% were completely satisfied, 13.5% were satisfied with reservations, and 32% were dissatisfied. Continued metatarsophalangeal joint pain occurred in 2 patients, 18 developed transfer metatarsalgia, and 6 of these patients required lesser metatarsal osteotomy. Peak hallux dorsiflexion during walking increased from 36 degrees to 42 degrees (P < .001). First metatarsal decompression osteotomy will increase joint range of motion but the risk of complication and patient dissatisfaction is less after phalangeal osteotomy. Neither procedure could be considered definitive for hallux rigidus.

Decompression, Surgical↗