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PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: fusion following decompression in patients with stenosis without spondylolisthesis.

Based on the medical evidence derived from the scientific literature on this topic, there does not appear to be evidence to support the hypothesis that fusion (with or without instrumentation) provides any benefit over decompression alone in the treatment of lumbar stenosis in patients in whom there is no evidence of preoperative deformity or instability. A single report provides Class II medical evidence and several papers provide Class III medical evidence suggesting that the addition of fusion to decompression in patients with lumbar stenosis and instability evidenced by movement on preoperative flexion-extension radiographs does improve outcome. There are also reports (Class III medical evidence) indicating that patients with lumbar stenosis, without deformity or instability, treated with wide decompression or facetectomy may suffer iatrogenic lumbar instability. Fusion in these patients may improve outcome. There is conflicting Class III medical evidence regarding the application of instrumentation in addition to PLF in patients treated for lumbar stenosis without deformity or preoperative instability.

Decompression, Surgical↗
PubMed2005

Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy.

OBJECT: Recently, limited decompression procedures have been proposed in the treatment of lumbar stenosis. The authors undertook a prospective study to compare the safety and outcome of unilateral and bilateral laminotomy with laminectomy. METHODS: One hundred twenty consecutive patients with 207 levels of lumbar stenosis without herniated discs or instability were randomized to three treatment groups (bilateral laminotomy [Group 1], unilateral laminotomy [Group 2], and laminectomy [Group 3]). Perioperative parameters and complications were documented. Symptoms and scores, such as visual analog scale (VAS), Roland-Morris Scale, Short Form-36 (SF-36), and patient satisfaction were assessed preoperatively and at 3, 6, and 12 months after surgery. Adequate decompression was achieved in all patients. The overall complication rate was lowest in patients who had undergone bilateral laminotomy (Group 1). The minimum follow up of 12 months was obtained in 94% of patients. Residual pain was lowest in Group 1 (VAS score 2.3 +/- 2.4 and 4 +/- 1 in Group 3; p < 0.05 and 3.6 +/- 2.7 in Group 2; p < 0.05). The Roland-Morris Scale score improved from 17 +/- 4.3 before surgery to 8.1 +/- 7, 8.5 +/- 7.3, and 10.9 +/- 7.5 (Groups 1-3, respectively; p < 0.001 compared with preoperative) corresponding to a dramatic increase in walking distance. Examination of SF-36 scores demonstrated marked improvement, most pronounced in Group 1. The number of repeated operations did not differ among groups. Patient satisfaction was significantly superior in Group 1, with 3, 27, and 26% of patients unsatisfied (in Groups 1, 2, and 3, respectively; p < 0.01). CONCLUSIONS: Bilateral and unilateral laminotomy allowed adequate and safe decompression of lumbar stenosis, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life. Outcome after unilateral laminotomy was comparable with that after laminectomy. In most outcome parameters, bilateral laminotomy was associated with a significant benefit and thus constitutes a promising treatment alternative.

Aged↗
PubMed1996

Intraoperative monitoring of microvascular decompression in hemifacial spasm.

The significance of intraoperative electrophysiologic monitoring during microvascular decompression was evaluated prospectively in 261 patients with the hemifacial spasm from 1985 to 1995. The patients were divided into a monitored group and a non-monitored group. Identification of the offending vessels was facilitated by the monitoring during the surgical procedure and the complication rate of the monitored group was significantly lower than that of the non-monitored group (p < 0.05). In addition, the abnormal muscle response continued to improve during the follow-up period, thus the electrophysiological status of the hemifacial spasm after the microvascular decompression improved significantly with time (p < 0.05). In conclusion, intraoperative monitoring is useful for identifying the exact offender among multiple vessels, and lowering the complication rate of the microvascular decompression for the hemifacial spasm.

Adult↗
PubMed2000

Comparison of arthroscopic and open revision decompression for failed anterior acromioplasty.

Thirty-six consecutive patients who underwent revision decompression for refractory subacromial impingement were studied retrospectively. Average interval from the primary decompression procedure to revision was 29 months. Eighteen patients underwent arthroscopic and 18 underwent open revision. Six (33%) patients in the arthroscopic group and 12 (67%) patients in the open group were workers' compensation cases. At an average follow-up of 26 months, 17 (94%) patients in the arthroscopic group and 8 (44%) in the open group were satisfied with their procedure. Comparing workers' compensation patients, 5 of 6 in the arthroscopic group and 4 of 12 in the open group were satisfied. For nonworkers' compensation patients, all 12 patients in the arthroscopic group and 4 of 6 in the open group were satisfied. Average pain scores and postoperative range of motion was improved in both groups. Dense subacromial scarring with thick, fibrous adhesions was present in all patients. Residual, prominent bone, or an acromial spur was found in 20 (56%) patients. Overall, revision arthroscopic subacromial decompression was superior to open revision. However, there were more workers' compensation patients in the open group. Workers' compensation patients fared worse for both groups, but a significant proportion (83%) of the arthroscopic group was satisfied. Since subacromial scarring may be the most important pathology, arthroscopy is less invasive, allowing earlier, unrestricted postoperative rehabilitation and proving more effective.

Acromion↗
PubMed1992

[Inner ear decompression sickness following a scuba dive].

Inner ear decompression sickness (IEDCS) is one form of Type II decompression sickness. Most cases of IEDCS have been associated with saturation dives, so there are very few reports of occurrence following shallow scuba dives. We present here the case of a diver who suffered from IEDCS following a shallow scuba dive (30m), and was successfully treated by the protocol outlined in U.S. Navy treatment table 6. This case suggests that there is the possibility of occurrence of IEDCS, even following a shallow scuba dive, if proper decompression procedures are not adhered to. In addition, detailed analysis of diving profiles should be used to distinguish the inner ear dysfunction seen in some divers from inner ear barotrauma which may be attributable to IEDCS.

Adult↗
PubMed2006

Brain-stem auditory evoked responses during microvascular decompression for trigeminal neuralgia: predicting post-operative hearing loss.

CONTEXT: The importance of brainstem auditory evoked potential monitoring in reducing hearing loss during microvascular decompression for trigeminal neuralgia is now accepted. However the extent of the changes in the pattern of these potentials and the safe limits to which these changes are relevant in reducing postoperative hearing loss have not been established. AIMS: The aim of this study is to quantify these changes and relate these to the postoperative hearing loss. SETTINGS AND DESIGN: This study was done at the Walton Centre for neurology and neurosurgery, Liverpool, United Kingdom. The study was designed to give a measure of the change in the wave pattern following microvascular decompression and relate it to postoperative hearing loss. MATERIALS AND METHODS: Seventy-five patients undergoing microvascular decompression for trigeminal neuralgia had preoperative and postoperative hearing assessments and intraoperative brainstem auditory evoked potential monitoring. STATISTICAL ANALYSIS USED: Chi-square tests. RESULTS: It was found that the wave V latency was increased by more than 0.9 ms in nine patients, eight of whom suffered significant postoperative hearing loss as demonstrated by audiometry. It was also seen that progressive decrease in amplitude of wave V showed progressive hearing loss with 25% loss when amplitude fell by 50 and 100% loss when wave V was lost completely. However most of the patients did not have a clinically manifest hearing loss. CONCLUSIONS: A per-operative increase in the latency of wave V greater than 0.9 ms and a fall of amplitude of wave V of more than 50% indicates a risk to hearing.

Acoustic Stimulation↗
PubMed2004

Decompressive craniotomy after middle cerebral artery infarction. Retrospective analysis of patients treated in three centres in Switzerland.

QUESTIONS UNDER STUDY / PRINCIPLES: Several studies have reported an improved outcome in patients presenting with complete middle cerebral artery (MCA) infarction treated by decompressive hemicraniectomy. Although this palliative treatment form has gained popularity in Switzerland since 2000, the results of these series have not been reported. The aim of this study is, firstly, to report factors influencing the outcome of our patients, in order to create awareness of the indications and decision-making processes in our departments, and, secondly, to analyse therapeutic strategies which are open to improvement and standardisation. METHODS: This retrospective study included a total of 28 patients (age 51 +/- 12 years) who underwent decompressive craniectomy after MCA between January 2000 and May 2002 at the Departments of Neurosurgery of Aarau (n: 6), Bern (n: 10), and Zurich (n: 12). Demographic characteristics included preoperative clinical condition (NIHSS and GCS), timing of surgery, cause, location, and extension of infarction. Additionally, the time delay from the onset of symptoms to surgery and preoperative signs of herniation and their relation to final outcome was analysed. The final outcome was assessed in terms of mortality and scores such as modified Rankin scale and Barthel index. RESULTS: The preoperative clinical condition according to NIHSS was 20.2 +/- 4.7 and GCS was 10.6 +/- 3.6. The mean time in hours to surgery after onset of symptoms was 35 +/- 24. Twelve patients (42.8%) underwent "early" surgery (within 24 hours) and 21 (75%) suffered non-dominant stroke. The follow-up period was 22 +/- 13 months and 17% of the patients died within this period. Outcome did not differ significantly between institutions. The overall mean Barthel index was 47 +/- 25 and modified Rankin scale was 4 +/- 1.3. CONCLUSIONS: The outcome in patients undergoing decompressive craniectomy after MCA infarction in Switzerland is less favourable than in other series recently reported. Less favourable preoperative clinical condition, inclusion of dominant hemispheric infarction, poorly defined protocols and late involvement of neurosurgeons on these patients' admission may explain the results.

Adult↗
PubMedDate not supplied

Caudal cervical intervertebral disk disease in the small dog: role of distraction and stabilization in ventral slot decompression.

The clinical outcomes in 112 dogs weighing less than 35 pounds that were presented with cervical intervertebral disk protrusions were retrospectively evaluated. Although the second to third cervical (C2 to C3) intervertebral space was the most common site (27%) of disk protrusion, 57% of disk protrusions presented were caudal to the fourth cervical (C4) vertebra. Dogs with cranial intervertebral disk protrusions, including the C2 to C3 and C3 to C4 intervertebral disk spaces, responded favorably to ventral slot decompression. By comparison, caudal intervertebral disk protrusions (within the C4 to the seventh cervical [C7] intervertebral disk spaces) responded less favorably to ventral slot decompression, demonstrating significantly more severe clinical effects in motor function, comfort, recovery, and long-term outcome following surgery. Significant improvement in clinical results was seen in caudal disk protrusions when additional surgical distraction and stabilization were provided following ventral slot decompression.

Animals↗
PubMed1986

Does non-clinical decompression stress lead to brain damage in abalone divers?

Abalone divers are subject to considerable decompression stresses and could be at risk of progressive cognitive impairment. A sample of abalone divers was compared with a sample of fishermen, by means of a battery of neuropsychological tests. No evidence of cognitive impairment was found in the divers, in spite of evidence of their exposure to decompression stress. The implications for other professional divers and for recreational underwater divers who follow standard decompression protocols are reassuring.

Adult↗
PubMed2006

[Clinical value of primary decompression operation for unilateral ureterocele with complete duplex system].

PURPOSE: To assess a value of decompression operation for a unilateral ureterocele with a complete duplex system as an initial procedure. METHODS: We reviewed records of 33 pediatric patients with a unilateral ureterocele in a complete duplex system who underwent decompression operation between 1987 and 2000. We checked the patient operative age, followup period, position of the ureterocele, type of decompression operation, and additional operation. Furthermore we also checked postoperative vesicoureteral reflux (VUR) in patients who underwent transurethral incision (TUI). RESULTS: Mean operative age and followup period were 6 months old and 82 months. Of the patients, 22 underwent TUI and 11 underwent upper moiety operation (UMO). In the TUI group, 14 (63.6%) had postoperative VUR and 13 (59.0%) underwent additional operations. These rates were higher in the patients with ectopic ureteroceles than with intravesical ureteroceles. Most additional operations were undergone for the patients with postoperative VUR in TUI group by lower complete reconstructions without UMO. All patients with non-functioning upper moiety underwent heminephrectomy at the additional operations. In the other hand, in the UMO group, 3 (27.3%) had additional operation because of persistent VUR which was found preoperatively in lower moiety or contralateral renal unit. CONCLUSION: TUI was useful approach as an initial procedure for intravesical ureteroceles because of low additional operation rate. For ectopic ureteroceles with functioning upper moiety, TUI was high additional operation rate, but it was more useful initial operation of two-staged operation than UMO because of avoiding UMO, like heminephrectomy, at additional operation. UMO was low additional operation rate for ectopic ureteroceles without preoperative VUR of renal unit excluding upper moiety. Especially heminephrectomy was a useful approach as an initial procedure if upper moiety was non-functioning.

Child↗
PubMedDate not supplied

Surgical decompression in lower-extremity diabetic peripheral neuropathy.

Peripheral neuropathy can be a devastating complication of diabetes mellitus. This article describes surgical decompression as a means of restoring sensation and relieving painful neuropathy symptoms. A prospective study was performed involving patients diagnosed as having type 1 or type 2 diabetes with lower-extremity peripheral neuropathy. The neuropathy diagnosis was confirmed using quantitative sensory testing. Visual analog scales were used for subjective assessment before and after surgery. Treatment consisted of external and as-needed internal neurolysis of the common peroneal, deep peroneal, tibial, medial plantar, lateral plantar, and calcaneal nerves. Subjective pain perception and objective sensibility were significantly improved in most patients who underwent the described decompression. Surgical decompression of multiple peripheral nerves in the lower extremities is a valid and effective method of providing symptomatic relief of neuropathy pain and restoring sensation.

Adult↗
PubMedDate not supplied

Surgical treatment of peripheral neuropathy: outcomes from 100 consecutive decompressions.

Since 1992 it has been reported that patients with diabetes mellitus recover sensibility and obtain relief of pain from neuropathy symptoms by decompression of lower-extremity peripheral nerves. None of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of the results of this approach in patients with nondiabetic neuropathy. No previous report has described a change in balance related to restoration of sensibility. A prospective study was conducted of 100 consecutive patients (60 with diabetes and 40 with idiopathic neuropathy) operated on by a single surgeon, other than the originator of this approach, and with the postoperative results reviewed by someone other than these two surgeons. Each patient had neurolysis of the peroneal nerve at the knee and the dorsum of the foot, and the tibial nerve released in the four medial ankle tunnels. After at least 1 year of follow-up, 87% of patients with preoperative numbness reported improved sensation, 92% with preoperative balance problems reported improved balance, and 86% whose pain level was 5 or greater on a visual analog scale from 0 (no pain) to 10 (the most severe pain) before surgery reported an improvement in pain. Decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment.

Adult↗
PubMedDate not supplied

Endoscopic decompression of intermetatarsal nerve entrapment: a retrospective study.

Sixty-nine patients who had 96 interspaces decompressed were retrospectively reviewed to assess the efficacy of the endoscopic decompression of the intermetatarsal nerve procedure. Cases were evaluated between October 1, 1993, and December 31, 1999. Of the 69 patients, 14 were men and 55 were women, and their average age was 50.6 years. Of the 96 interspaces released, 39 were second interspaces and 57 were third interspaces. Nine interspaces were lost to follow-up. There were 75 interspaces with excellent or good results (86%) and 12 with poor results (14%). Of the interspaces with poor results, five required further surgery. Those five interspaces, in five patients, were treated with traditional neurectomy. The other patients, accounting for seven interspaces, who classified their result as poor declined any further surgery. Evaluation of these cases was by means of medical chart review only, where the patient's success or failure was based on the patient's subjective assessment. None of the patients who underwent decompression developed a true amputation neuroma.

Decompression, Surgical↗
PubMedDate not supplied

A modified technique for Morton's neuroma. Decompression with relocation.

Interdigital nerve decompression with relocation was performed on 82 feet in 78 patients. The primary indication for surgery was chronic neuritic symptoms that did not resolve with conservative treatment. All but four patients (95%) achieved complete resolution of preoperative symptoms within an average of 7 days following surgery, with full sensation restored at an average of 5 weeks. All of the patients could tolerate a shoe with a wide toe box within 8 days postoperatively. Interdigital nerve decompression with relocation provides for rapid resolution of neuritic symptoms and early return to normal activities. It is also a relatively easy surgical technique. As such, nerve decompression with relocation should be the procedure of choice for the treatment of Morton's neuroma or interdigital nerve compression syndrome.

Adult↗
PubMed2005

[Acute decompression illness following hyperbaric exposure: clinical features of central nervous system involvement].

Decompression illness (DCI) is a general term encompassing all pathological changes secondary to reduction of environmental pressure. This condition has two forms: decompression sickness (DCS) and arterial gas embolism (AGE) secondary to pulmonary barotrauma. Moreover, DCS is categorized as minor, such as limb and/or joint pains or skin rash (Type I), and serious, as in cardiopulmonary and/or central nervous system involvements (Type II). Cerebral and spinal injuries have been symptomatically classified into AGE and DCS. Brain scans of patients with AGE or DCS showed multiple cerebral infarctions in the terminal and/or border zones of the cerebral arteries. Brain involvements of patients in both AGE and DCS show no differences in neurological or neuro-radiological findings. From the neurological and radiological standpoint, it is therefore impossible to distinguish these two conditions. Despite established treatments for neurological DCI (both AGE and DCS), it is unclear whether US Navy treatment Table 6 is preferable to standard hyperbaric oxygen therapy such as 2.4 atmospheres pressure for 90 minutes. Japanese laws and regulations have peculiarities that permit air diving to 90 meters depth, but with explicit prohibition of the use of oxygen for decompression, albeit a limited use of mixed gas is permissible. Moreover, currently the health screening for hyperbaric workers does not include detailed examination of the cardiopulmonary or the central nervous system.

Adult↗
PubMed2006

Subacromial decompression for shoulder impingement syndrome.

OBJECTIVE: To evaluate the results in a consecutive series of patients who underwent subacromial decompression for shoulder impingement syndrome. DESIGN: Interventional quasi experimental study. PLACE AND DURATION OF STUDY: Orthopaedic Department at St Mary s Hospital, Isle of Wight Healthcare England from May 1999 to August 2001. PATIENTS AND METHODS: Twenty-five consecutive shoulders from 22 patients who underwent subacromial decompression for shoulder impingement syndrome were studied. Nineteen out of 25 shoulders were in stage I or II and 6 had stage III disease, having rotator cuff tear. All patients had a median 10 months course of conservative treatment before surgery. Patients were followed-up for 6 to 24 months postoperatively and assessed by clinical examination and the University of California at Los Angeles (UCLA) shoulder rating scale. Results were analysed by Wilcoxon s non-parametric test for internal comparison. RESULTS: The differences in pre- and postoperative scores for pain, function, active forward flexion, strength of forward flexion and overall patient satisfaction were improved with p-values < 0.01 in for each. This was an overall improvement in 88% cases. CONCLUSION: Subacromial decompression is an effective treatment for shoulder impingement syndrome. Accurate diagnosis, careful patient selection and appropriate surgical intervention results in a successful outcome and return to normal activities in majority of patients.

Adult↗
PubMedDate not supplied

Incidence of decompression illness in amateur scuba divers.

This paper reports changes in the incidence and manifestations of decompression illness in amateur scuba divers in the United Kingdom (UK) between 1981 and 1993, a period during which the popularity of the sport increased. Since 1981, there has been a trend to increased annual incidence of decompression illness, but the large yearly fluctuations reflect a considerable annual variation in the numbers of dives. The need for recompression facilities to treat decompression illness in amateur scuba divers in the UK should take account of this greater public participation in the sport, and should also allow for large annual fluctuations related to meteorological and financial factors.

Data Collection↗
PubMed1999

Electroencephalography and magnetic resonance imaging after diving and decompression incidents: a controlled study.

Electroencephalography and magnetic resonance imaging after diving and decompression incidents: a controlled study. Undersea Hyper Med 1999.; 26(2):61-65.--Diving incidents with symptoms of decompression sickness (DCS) and/or arterial gas emboli (AGE) might increase the degree of pathologic change in the electroencephalogram (EEG) or magnetic resonance imaging (MRI) of the supraspinal central nervous system (CNS). Diving itself, even without known symptoms of DCS and/or AGE, has been proposed to increase the number of CNS lesions using either EEG or MRI. In the first part of a two-part study we examined the effects of recompression treatment on EEG in decompression incidents in a group of sport and professional divers compared with a control group of healthy naval divers. In the second part we recorded brain MRI from three groups of volunteers: 1) divers who were treated for DCS in pressure chamber, 2) divers who had never had symptoms of DCS (and/or AGE), and 3) healthy normal controls who were not divers. Our results indicate that DCS increases the incidence of pathologic EEG recordings, whereas recompression treatment decreases them. The results of MRI do not verify evidence of increased numbers of CNS lesions in normal divers as compared to non-diving, healthy control subjects, whereas some of the divers treated for DCS in a pressure chamber had hyperintense lesions in brain white matter. None of them had any abnormalities in EEG, neurologic performance, or psychologic behavior. Both EEG and MRI are sensitive and non-specific methods for judging suspected evidence of brain lesions from diving or diving accidents.

Adult↗