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PubMed1999

Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondylolisthesis.

STUDY DESIGN: A retrospective study of patient outcomes after decompression and fusion for degenerative spondylolisthesis, using the SF-36 survey and a functional questionnaire. SUMMARY OF BACKGROUND DATA: In recent studies, patient outcomes have been examined more specifically; however, detailed functional outcomes are not available nor have widely used outcomes instruments been administered. METHODS: Thirty patients aged more than 40 years (average, 60.1 years) who had degenerative spondylolisthesis were evaluated after decompression and instrumented posterior fusion. Charts and radiographs were also reviewed. Questionnaires were administered by telephone, and consisted of the Medical Outcomes Study short form (SF-36) and 27 questions designed to evaluate function, quality of life, medication usage, and satisfaction with surgical results. RESULTS: Ninety-three percent of patient's were satisfied with their outcomes. Patients improved significantly in their ability to perform heavy and light activities, participate in social activities, sit, and sleep (P < 0.001) and also improved in pain, depression, and medication usage (P < 0.0001). SF-36 data showed significantly better overall assessment of health in all categories than that in a published cohort of patients with low back pain. The current study group also showed no difference in seven of eight categories when compared with the general population. Fusion rate was 93% at an average of 128 days. Three patients required reoperation: two for pseudarthrosis and one for a deep infection. A poorer outcome, scored by the SF-36, was associated with greater preoperative stenosis (P < 0.05) or occurrence of a complication (P < 0.05). CONCLUSIONS: Patients treated with decompression and fusion for degenerative spondylolisthesis had improved functional outcomes, when measured by a disease-specific questionnaire and by widely used instruments.

Activities of Daily Living↗
PubMed1999

Strain on intervertebral discs after anterior cervical decompression and fusion.

STUDY DESIGN: An analysis of the change in strain distribution of intervertebral discs present after anterior cervical decompression and fusion by an original method. The analytical results were compared to occurrence of herniation of the intervertebral disc on magnetic resonance imaging. OBJECTIVES: To elucidate the influence of anterior cervical decompression and fusion on the unfused segments of the spine. SUMMARY OF BACKGROUND DATA: There is no consensus regarding the exact significance of the biomechanical change in the unfused segment present after surgery. METHODS: Ninety-six patients subjected to anterior cervical decompression and fusion for herniation of intervertebral discs were examined. Shear strain and longitudinal strain of intervertebral discs were analyzed on pre- and postoperative lateral dynamic routine radiography of the cervical spine. Thirty of the 96 patients were examined by magnetic resonance imaging before and after surgery, and the relation between alteration in strains and postsurgical occurrence of disc herniation was examined. RESULTS: In the cases of double- or triple-level fusion, shear strain of adjacent segments had increased 20% on average 1 year after surgery. Thirteen intervertebral discs that had an abnormally high degree of strain showed an increase in longitudinal strain after surgery. Eleven (85%) of the 13 discs that showed an abnormal increase in longitudinal strain had herniation in the same intervertebral discs with compression of the spinal cord during the follow-up period. Relief of symptoms was significantly poor in the patients with recent herniation. CONCLUSIONS: Close attention should be paid to long-term biomechanical changes in the unfused segment.

Adult↗
PubMed2002

Anterior decompression for myelopathy resulting from thoracic ossification of the posterior longitudinal ligament.

STUDY DESIGN: A retrospective study was conducted to investigate the anterior decompression and fusion of 12 patients with thoracic ossification of the posterior longitudinal ligament. OBJECTIVE: To evaluate the effect of myelopathy management in which the thoracic ossification of the posterior longitudinal ligament is removed. SUMMARY AND BACKGROUND DATA: Very few reports have described operative treatments for thoracic ossification of the posterior longitudinal ligament. The condition is extremely rare, even in Japan. Consequently, operative procedures for myelopathy resulting this disorder have not been established. METHODS: This study involved 12 patients with thoracic ossification of the posterior longitudinal ligament. All the patients underwent direct removal of the ossification and spinal fusion using an anterior approach. A scapula-releasing technique was used in five patients who had major ossification of the posterior longitudinal ligament at Th4. The follow-up period ranged from 2.5 to 10 years (mean, 6.5 years). The clinical effect of the decompression was evaluated with a Japanese Orthopedic Association score for cervical myelopathy. The efficacy of the decompression was determined by postoperative computed tomography scan. RESULTS: Complete removal of the ossification was achieved in eight patients. In four patients, however, residual ossification was noted. The Japanese Orthopedic Association score before the operation ranged from 4 to 7 points (mean, 5.3 +/- 0.4 points). It showed a change 3 months after the operation, ranging from 1 to 8 points (mean, 6.9 +/- 0.5 points). At 1 year after the operation, it had changed to a range of 1 to 10 points (mean, 7.2 +/- 0.6 points). At the final consultation, it had changed further to a range of 1 to 10 points (mean, 6.9 +/- 0.5 points). Patients whose ossification was not completely removed showed severe or minor postoperative deterioration. CONCLUSIONS: Total removal of the ossification might be required to manage severe myelopathy in patients with thoracic ossification of the posterior longitudinal ligament. Complete removal of the ossification gave good results in eight patients. Patients whose ossification of the posterior longitudinal ligament had not been completely removed, however, had a poor outcome.

Adult↗
PubMed2002

Managing chronic pain of spinal origin after lumbar surgery: the role of decompressive surgery.

STUDY DESIGN: A literature review was conducted. OBJECTIVE: To provide an evidence-based approach for patients with neurogenic symptoms after lumbar surgery. SUMMARY OF BACKGROUND DATA: Patients may present with chronic pain of spinal origin after lumbar surgery. Failure to decompress the involved neural structures adequately or progression of the underlying degenerative condition may lead to neurologic symptoms. METHODS: A literature search of peer-reviewed publications that investigate etiologies and treatments for neurogenic pain in patients who have undergone previous spinal surgery was conducted. RESULTS: In the absence of profound or progressive neurologic deficits, most patients with chronic back and leg pain who have undergone previous spinal surgery should be treated nonoperatively. Additional decompressive surgical intervention may be justified in patients with well-defined, discrete pathology amenable to surgical correction who have been refractory to conservative care. The surgery typically will include meticulous decompression of the affected neural structures and may include arthrodesis to address any deformity or instability. CONCLUSIONS: In a patient presenting with neurogenic symptoms after lumbar surgery, a meticulous workup is required to elucidate the source of these symptoms. Surgical indications are similar to those for primary lumbar spinal surgery and include a well-defined anatomic source of neural compression that is amenable to a surgical solution.

Back Pain↗
PubMed2003

A prospective study on CT scan outcomes after conservative decompression surgery for lumbar spinal stenosis.

This is a prospective study analyzing CT scan imaging outcomes after conservative decompression in patients with lumbar spinal stenosis. Forty patients (18 males and 22 females) initially underwent a laminarthrectomy surgical procedure to decompress the central canal as well as the neuroforamina and nerve root canals while respecting the integrity of the neural arches, facet joints, and most muscle attachments. Morphologic features of preoperative CT scan images were compared with postoperative CT scans of the operative levels, obtained for 36 patients (17 males and 19 females) after a minimum follow-up of 1 year (mean 1.7 years). Successful surgical outcome was defined as an improvement in at least three of the following four criteria: self-reported pain on a visual analog scale, self-reported functional status measured by LBOS, reduction of pain while walking, and reduction of leg pain. Fifty-five percent of patients met the successful surgical outcome criteria, including 14 subjects who met all four success criteria. Overall, there was a statistically significant increase in the interfacet bony canal diameter of the operated levels (3.9 mm, p < 001). However, patients categorized as successful surgical outcomes had a substantially, but not significantly, lower interfacet canal diameter increase postsurgically (mean 3.41 mm) in comparison with patients categorized as failures (mean postoperative increase 4.52 mm). Midsagittal canal diameters remained unchanged in the failure group but increased in the success group. The CT scan canal measures used in this study cannot be advocated for evaluation of outcome in conservative lumbar spinal canal decompression.

Adolescent↗
PubMed2006

"Normal" prevertebral soft tissue swelling following elective anterior cervical decompression and fusion.

INTRODUCTION: Prevertebral soft tissue swelling (PSTS) has been evaluated in the setting of traumatic cervical spine injuries. However, no study to date has quantified the PSTS following elective anterior cervical decompression and fusion or the time course to resolution of that swelling. METHODS: From May 2002 to May 2005 the senior author performed 193 elective 1- or 2-level anterior cervical decompression and fusions. Patients who underwent corpectomies and anterior cervical fusions for trauma or tumor were excluded. Preoperative, 2-week postoperative and 6-week postoperative radiographs were available on 100 patients. The prevertebral soft tissue stripe was measured on the neutral lateral radiographs for the 3 time points. The mean swelling (mm) for each time point was calculated and stratified by cervical level. Repeated measures analysis of variance with the Tukey-Kramer multiple comparisons test was used to compare the measured swelling at the various time points. RESULTS: The average PSTS was calculated for each cervical level, for each of the 3 time points, preoperative, 2- and 6-week postoperative. There was a significant increase in PSTS between the preoperative and 2-week postoperative measurements at all levels. There is a significant decrease in PSTS between 2- and 6-week postoperatively at all cervical levels. There is no significant change in PSTS at C2, C3, and C5, when comparing the preoperative and 6-week postoperative measurements. There is significant PSTS at C4, C6, and C7, when comparing preoperative and 6-week postoperative measurements. CONCLUSIONS: The "normal" range for PSTS at 2 weeks and at 6 weeks after elective 1- and 2- level anterior cervical decompression and fusions is described. Our data demonstrates that edema persists at the 2-week follow-up. By 6 weeks postoperative, the increased PSTS has greatly dissipated.

Cervical Vertebrae↗
PubMed2002

Decompressive surgery in the treatment of traumatic brain injury.

According to European Brain Injury Consortium (EBIC) and American Brain Injury Consortium (ABIC) guidelines for severe head injuries, decompressive craniectomy is one therapeutic option for brain edema that does not respond to conventional therapeutic measures. As a result of the failure of all recently developed drugs to improve outcome in this patient group, decompressive craniectomy has experienced a revival during the last decade. Although class I studies of this subject are still lacking, there is strong evidence from prospective, uncontrolled trials that such an operation improves outcome in general and also has beneficial effects on various physiologic parameters that are known to be independent predictors for poor outcome. Whether this operation should be performed in a protocol-driven or in a prophylactic manner remains unclear. Decompressive craniectomy may, however, be the only method available in developing countries with limited ICU and monitoring resources. Prospectively controlled and randomized studies to definitively evaluate the effect of this old neurosurgical method on outcome in patients with traumatic brain injury (TBI) are forthcoming.

Brain Edema↗
PubMed2001

Microvascular decompression of the vestibulocochlear nerve for disabling positional vertigo: the House Ear Clinic experience.

OBJECTIVE: To review characteristics of and outcome in patients undergoing microvascular decompression of the vestibulocochlear nerve. Patients studied had a diagnosis of disabling positional vertigo caused by a vascular loop compressing the VIIIth cranial nerve. STUDY DESIGN: Retrospective chart review and telephone interview. SETTING: Private practice tertiary neurotologic referral center. PATIENTS: Twenty patients with disabling positional vertigo underwent 25 retrosigmoid craniotomies for microvascular decompression between November 1990 and June 1999. The 4 men and 16 women ranged in age from 30 to 71 years (mean age, 46 yr). MAIN OUTCOME MEASURES: Charts were reviewed and patients were contacted by telephone and asked to rate severity of symptoms (tinnitus and dizziness) on a 4-point scale (none = 1, mild = 2, moderate = 3, and severe = 4) before and after surgery. They were also asked to rate their overall disability from their symptoms on the six-point scale established by the American Academy of Otolaryngology-Head and Neck Surgery. Preoperative and postoperative four-frequency (500 Hz, 1 kHz, 2 kHz, and 4 kHz) pure-tone average and speech discrimination scores were calculated and compared. Complications of surgery are also reported. RESULTS: Postoperative tinnitus score and dizziness score showed significant improvement from preoperative scores (p < or = 0.047 and p < or = 0.001, respectively), with 80% of patients improved in dizziness rating; 85% improved in their overall disability rating, and the difference from preoperative to postoperative was significant (p < or = 0.001). The mean postoperative pure-tone averages (15.4 dB) and speech discrimination scores (99%) did not differ from preoperative scores (11.9 dB and 98%). One patient lost all vestibular function in the operated ear (hearing remained intact) as the only complication of surgery. When asked, 83% of patients responded that they would have the surgery again. CONCLUSIONS: Diagnosing disabling positional vertigo secondary to vascular compression of the VIIIth cranial nerve remains the clinical challenge; a clear history plus air-contrast computed tomographic or magnetic resonance imaging make the diagnosis. Microvascular decompression of the vestibulocochlear nerve is a safe and effective operation for these carefully selected patients.

Adult↗
PubMed2007

Results of multiple drilling compared with those of conventional methods of core decompression.

We performed multiple drilling as a femoral head-preserving procedure for osteonecrosis of the femoral head thinking the therapeutic effects of core decompression could be achieved by this simpler procedure than core decompression. We retrospectively reviewed 136 patients (163 hips) who had multiple drilling using 9/64-inch Steinmann pins for treatment of nontraumatic osteonecrosis of the femoral head. The mean followup for patients who did not require additional surgery (113 hips) was 87 months (range, 60-134 months). We defined failure as the need for additional surgery or a Harris hip score less than 75. After a minimum 5-year followup, 79% (31/39) of patients with Stage I disease and 77% (62/81) of patients with Stage II disease had no additional surgery. All (15/15) small lesions (<25% involvement) and 84% (37/44) of medium-sized lesions (25-50% involvement) were considered successful. Survival rates of patients with Ficat Stages I or II lesions were greater than survival rates for patients with Stage III lesions. Hips with a large necrotic area had poor results. We had one instance of subtrochanteric fracture through drill entry holes. Multiple drilling is straightforward with few complications and produces results comparable to results of other core decompression techniques.

Adult↗
PubMedDate not supplied

Percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate pellets for unicameral bone cysts in children: a new minimally invasive technique.

Several treatment options exist for unicameral bone cysts (UBCs), including observation, steroid injection, bone marrow injection, and curettage and bone grafting. These are all associated with high recurrence rates, persistence, and occasional complications. Newer techniques have been described, most with variable success and only short follow-up reported. Because of these factors, a new minimally invasive percutaneous technique was developed for the treatment of UBCs in children. Twenty-eight children with UBCs who underwent percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate (MGCS) pellets by the senior author (J.P.D.) between April 2000 and April 2003 were analyzed as part of a pediatric musculoskeletal tumor registry at a large tertiary children's hospital. Four patients were lost to follow-up, and the remaining 24 patients had an average follow-up of 21.9 months (range 4-48 months). Twelve patients were followed for at least 24 months. Six of the 24 children had received previous treatment of their UBC, most often at an outside institution. Follow-up was performed through clinical evaluation and radiographic review. Postoperative radiographs at most recent follow-up showed complete healing, defined as more than 95% opacification, in 22 of 24 patients (91.7%). One patient (4.2%) demonstrated partial healing, defined as 80% to 95% opacification. One patient had less than 80% radiographic healing (4.2%). All 24 patients returned to full activities and were asymptomatic at most recent follow-up. The only complication noted was a superficial suture abscess that occurred in one patient; this resolved with local treatment measures. The new minimally invasive technique of percutaneous intramedullary decompression, curettage, and grafting with MGCS pellets demonstrates favorable results with low complication and recurrence rates compared with conventional techniques. The role of intramedullary decompression as a part of this percutaneous technique is discussed.

Administration, Cutaneous↗
PubMed2003

Intradiscal pressure study of percutaneous disc decompression with nucleoplasty in human cadavers.

STUDY DESIGN: Intradiscal pressure was measured after percutaneous disc decompression by nucleoplasty in human cadavers with different degrees of disc degeneration. OBJECTIVES: To assess intradiscal pressure change after disc decompression, and to analyze the influence of degeneration on the intradiscal pressure change. SUMMARY OF BACKGROUND DATA: Partial removal of the nucleus has been shown to decompress herniated discs, relieving pressure on nerve roots and, in some cases, offering relief from disc pain. Nucleoplasty, a new minimally invasive procedure using patented Coblation technology, combines coagulation and ablation for partial removal of the nucleus. Coblated channels remove the tissue volume and may decrease the disc pressure. METHODS: Three fresh human cadaver spinal specimens (T8-L5; age, 54-84 years; mean age, 70.7 years) were used in this investigation. The intradiscal pressure was measured at three points: before treatment, after each channel was created, and after treatment using a 25-guage 6-inch needle connected to a Merit Medical Systems Intellisystem Inflation Monitor. The needles were calibrated initially to approximately 30 pounds per square inch. For the control, the change in disc pressure was recorded by the same procedure without using Coblation energy. To evaluate the effectiveness of nucleoplasty, disc pressure changes were compared between treatment with and without Coblation energy. RESULTS: Intradiscal pressure was markedly reduced in the younger, healthy disc cadaver. In the older, degenerative disc cadavers, the change in intradiscal pressure after nucleoplasty was very small. There was an inverse correlation between the degree of disc degeneration and the change in intradiscal pressure. CONCLUSIONS: Pressure reduction through nucleoplasty is highly dependent on the degree of spine degeneration. Nucleoplasty markedly reduced intradiscal pressure in nondegenerative discs, but had a negligible effect on highly degenerative discs.

Aged↗
PubMed2003

One-stage posterior decompression-stabilization and trans-sacral interbody fusion after partial reduction for severe L5-S1 spondylolisthesis.

STUDY DESIGN: A retrospective clinical study was conducted. OBJECTIVES: To evaluate the clinical and radiologic outcomes of one-stage posterior decompression-stabilization after partial reduction and trans-sacral interbody fusion with a titanium cage for severe L5-S1 spondylolisthesis. SUMMARY OF THE BACKGROUND DATA: Trans-sacral interbody fusion for the management of severe L5-S1 spondylolisthesis with or without partial reduction and pedicular fixation has been previously described. The use of a trans-sacral titanium cage has not been previously reported. METHODS: Fifteen patients with severe L5-S1 spondylolisthesis were treated consecutively with posterior decompression, partial reduction, pedicular fixation, and posterior lumbar interbody fusion using a trans-sacral titanium cage. The mean age at the time of surgery was 22.4 years (range, 11-37 years). The mean follow-up period was 31.4 months (range, 12-58 months). Nine patients had severe back pain and six patients radicular pain. Three patients had a partial unilateral L5 motor deficit and two an L5 sensory deficit. Five patients had extremely tight hamstrings. The mean preoperative percentage of slipping was 69.3% (range, 53-91%). Patients were evaluated for complications and fusions, and outcomes were collected using the modified Scoliosis Research Society Outcomes Instrument. RESULTS: At follow-up, all patients, except one with major vascular complications, were extremely or reasonably satisfied with the surgery. All patients showed improvements in radiologic indexes and stable fusion at the final follow-up examination. CONCLUSIONS: Posterior decompression and partial reduction followed by circumferential stabilization performed in one stage combining pedicle fixation with trans-sacral titanium cage interbody fusion is an effective and safe technique for the management of severe spondylolisthesis.

Adolescent↗
PubMed2005

Proprioceptive recovery of patients with cervical myelopathy after surgical decompression.

STUDY DESIGN: A prospective observational study. OBJECTIVES: To determine whether proprioceptive deficit recovers after surgery and whether proprioceptive evaluation can predict functional outcome in cervical myelopathy patients. SUMMARY OF BACKGROUND DATA: Proprioceptive sensation plays an important role in smooth, coordinated movement of the limbs. Information about proprioception ascends through the dorsal columns in the spinal cord. In severe compressive myelopathy, proprioceptive ability would be reduced and could be improved after surgical decompression. However, there have been few studies concerning proprioceptive impairment in cervical myelopathy. MATERIALS AND METHODS: The study group included 26 cervical myelopathy patients who underwent posterior surgical decompression. Knee proprioception was assessed by joint position sense, which was evaluated by measuring the error angle when the subjects tried to reproduce the predetermined angle by extension and by flexion. Proprioceptive deficit in the study group was evaluated, compared with age-matched normal subjects. Postoperative recovery and correlation to functional status was analyzed in the study group. The Japanese Orthopedic Association (JOA) scores were used for functional evaluation. RESULTS: The error angles were significantly higher in the study group than those in the control group before surgery. All patients in the study group finally had improvement of the error angles by a year after surgery. The average of error angles in the study group was improved 2 weeks after surgery; however, no changes were observed later. There was significant correlation between the improvement rate of the error angles 2 weeks after surgery and that of the JOA scores 2 years after surgery. There were 9 patients who had worsened proprioception 2 weeks after surgery either by extension or by flexion, all of whom had poor functional outcome. CONCLUSIONS: Knee proprioception was impaired in cervical myelopathy and recovered after surgical posterior decompression. Proprioceptive improvement at 2 weeks correlates with the degree of improvement in JOA scores at 2 years after surgery.

Adult↗
PubMed2005

A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results.

STUDY DESIGN: A randomized, controlled, prospective multicenter trial comparing the outcomes of neurogenic intermittent claudication (NIC) patients treated with the interspinous process decompression system (X STOP) with patients treated nonoperatively. OBJECTIVE: To determine the safety and efficacy of the X STOP interspinous implant. SUMMARY OF BACKGROUND DATA: Patients suffering from NIC secondary to lumbar spinal stenosis have been limited to a choice between nonoperative therapies and decompressive surgical procedures, with or without fusion. The X STOP was developed to provide an alternative therapeutic treatment. METHODS.: 191 patients were treated, 100 in the X STOP group and 91 in the control group. The primary outcomes measure was the Zurich Claudication Questionnaire, a patient-completed, validated instrument for NIC. RESULTS: At every follow-up visit, X STOP patients had significantly better outcomes in each domain of the Zurich Claudication Questionnaire. At 2 years, the X STOP patients improved by 45.4% over the mean baseline Symptom Severity score compared with 7.4% in the control group; the mean improvement in the Physical Function domain was 44.3% in the X STOP group and -0.4% in the control group. In the X STOP group, 73.1% patients were satisfied with their treatment compared with 35.9% of control patients. CONCLUSIONS: The X STOP provides a conservative yet effective treatment for patients suffering from lumbar spinal stenosis. In the continuum of treatment options, the X STOP offers an attractive alternative to both conservative care and decompressive surgery.

Aged↗
PubMed2005

Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy?

STUDY DESIGN: Posterior cervical spinal cord shifting after selective single laminectomy associated with partial laminotomies was compared with that after bilateral open-door laminoplasty between the C3 and C7 levels in relation to the clinical results of each procedure. OBJECTIVES: To investigate the clinical significance of posterior spinal cord shifting after extensive cervical laminoplasty. SUMMARY OF BACKGROUND DATA: Current techniques used for cervical laminoplasty for multisegmental cervical spondylotic myelopathy (CSM) are consecutively performed between the C3 and C6 or C7 levels with expectation that the spinal cord will shift backward to keep it clear of anterior compression. However, the clinical significance of the posterior spinal cord shifting remains controversial, and there has been no report verifying it by comparing limited posterior decompression procedures with conventional extensive ones. METHODS: Twenty-six patients with consecutive 2- to 3-level CSM who underwent selective laminoplasty (Group A) were enrolled in the study, and among 56 CSM patients who underwent bilateral open-door laminoplasty between the C3 and C7 levels, 25 who had consecutive 2- or 3- level stenosis identified by preoperative magnetic resonance imaging were used as controls (Group B). The recovery rate was calculated using preoperative and postoperative Japanese Orthopedic Association (JOA) scores for each patient, and for each patient's magnetic resonance imaging, the postoperative cervical curvature index was obtained according to Ishihara's method and the magnitude of postoperative backward shifting of the spinal cord was measured. RESULTS: There was no significant difference between the subjects in Groups A and B with respect to the spinal curvature index, preoperative JOA scores, and recovery rate, but the magnitude of the postoperative posterior shifting of the spinal cord was greater for those in Group B than for those in Group A. There was no correlation between the recovery rate and posterior shifting of the spinal cord for each group, and no correlation was also found between the curvature index and posterior shifting of the spinal cord. CONCLUSIONS: The outcome of posterior decompression surgery for multisegmental CSM is not correlated with the magnitude of postoperative backward shifting of the spinal cord. Extensive and consecutive decompression performed in conventional cervical laminoplasties is therefore not always necessary for multisegmental CSM.

Adult↗
PubMed2004

Cerebral vasospasm and ischemia after orbital decompression for graves ophthalmopathy.

PURPOSE: We describe the first reported cases of cerebral vasospasm, ischemia, and infarct after orbital decompression surgery for Graves disease-related ophthalmopathy. METHODS: We present two patients who had inadvertent penetration of the dura mater during orbital decompression surgery. One case was recognized at surgery; the other was not. All patient data were gathered and relayed in accordance with state and U.S. laws. RESULTS: Postoperative cerebrospinal fluid leak, radiographic evidence of subarachnoid hemorrhage, and severe neurologic morbidity occurred in each case. Cerebral ischemia and infarction resulting from subarachnoid hemorrhage-induced cerebral vasospasm occurred in each case. CONCLUSIONS: The risk of dural penetration, cerebral vasospasm, and ischemia should be considered during preoperative evaluation for orbital decompression surgery. The diagnosis, treatment, and prevention of this previously unreported serious complication of this procedure is paramount.

Aged↗
PubMed2004

Orbital decompression for gross proptosis associated with orbital lymphangioma.

A 14-year-old boy with 11 mm of proptosis and exposure keratopathy secondary to an orbital lymphangioma underwent surgical debulking with a carbon dioxide laser through a lateral orbitotomy combined with a 3-wall orbital decompression. The proptosis was reduced by approximately 2 mm as a result of the debulking procedure, but a further 5 mm reduction was achieved with the orbital decompression. No serious adverse effects were encountered. Bony orbital decompression may be a useful alternative treatment in patients with severe proptosis secondary to orbital lymphangioma.

Adolescent↗
PubMed2006

Predictors for emergency biliary decompression in acute cholangitis.

OBJECTIVE: Medical treatment is the first-line management in patients with acute cholangitis but those who fail to respond to antibiotic treatment need urgent biliary decompression. Early prediction of patients with acute cholangitis who require urgent biliary drainage is important because this group of patients has a higher morbidity and mortality from this pathology. This study was undertaken to identify early predictors for emergency biliary decompression in patients with acute cholangitis. METHODS: This is a retrospective analysis of a prospective database of 171 consecutive patients with acute cholangitis managed in a regional hospital in Hong Kong. Emergency biliary drainage was performed when conservative treatment failed. Twenty-four variables that could be assessed upon admission were analyzed for the prediction of the need for emergency biliary decompression. RESULTS: Thirty-one (18.1%) patients needed emergency biliary drainage. Older age (P=0.001), habit of chronic smoking (P=0.04), prolonged prothrombin time (P=0.025), higher blood glucose level (P=0.002), and dilated common bile duct diameter on ultrasonography (P=0.047) predicted the need for urgent biliary drainage. Patients aged older than 75 years had a significantly higher chance of failure of conservative treatment than those aged 75 years or less (26.5% versus 10.2%, P=0.005). CONCLUSIONS: Biliary drainage should be considered early in cholangitic patients aged older than 75 years and/or chronic smoking because they are less likely to respond to conservative treatment. Further studies are required to confirm that the outcome of patients with acute cholangitis can be improved by this selective approach.

Acute Disease↗