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PubMed1989

L4-5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion.

The results of the treatment of L4-5 degenerative spondylolisthesis by decompressive laminectomy and partial facetectomy without fusion are presented. Patients who met the following criteria were studied: 1) A slip of at least 10%; 2) No compensation/litigation issues involved; 3) No prior surgery; and 4) Follow-up of at least 18 months. Twenty-four patients with an average follow-up of 34 months (range, 18 to 71 months) are reported. The average preoperative slip measured 7 mm (17%; range, 4-12 mm). Sixteen patients, including all patients less than 60 years of age, underwent preoperative supine lateral flexion-extension radiographs for evaluation of instability. No patient had greater than 2 mm of increase in slip on flexion-extension testing. During decompression, the structural integrity of the pars interarticularis and facet joints are preserved. There were 20 good, three fair, and one poor results. The average postoperative slip measured 8 mm (20%; range, 4-11 mm), and no patient had an increase in slip of greater than 4 mm. In the absence of objective instability on preoperative flexion-extension lateral radiographs in L4-5 degenerative spondylolisthesis, decompressive laminectomy with preservation of the structural integrity of the pars interarticularis and articular processes does not require routine spinal fusion and produced satisfactory clinical results.

Aged↗
PubMed1989

Decompression after gastric surgery. Gastrostomy versus nasogastric tube.

The efficacy and associated morbidity and mortality of gastrostomy (G) versus nasogastric (NG) tube decompression after gastric surgery were analyzed in a review of 100 patients. Age, sex, and risk factors were homogeneously distributed between the two groups, while perforated ulcers and emergency operations were more common in the G group. A gastrostomy did not completely eliminate the need for NG tube decompression in the G group. Postoperative morbidity was similar in the two groups, with the exception of an increased incidence of atelectasis in the elective NG group and increased mortality in the emergency G group. There was also a significant increase in length and cost of hospitalization in the emergency G group compared with emergency NG patients. Gastrostomy does not appear to offer any significant advantage over nasogastric decompression after gastric surgery and should be limited to special cases.

Adult↗
PubMed1989

Somatosensory-evoked potentials in lumbar nerve root decompression.

The adequacy of decompression of nerve roots is determined by direct visual observations and by correlation with roentgenograms of the pathological lesion. The usefulness of additional evidence of adequate neural decompression from intraoperative somatosensory-evoked potential (SEP) data was tested in 41 cases of a herniated intervertebral disc (27 patients) or spinal stenosis (14 patients). Postoperative observations at three weeks and three months were evaluated by intraoperative observation of decreased latency and/or increased amplitude of SEP recordings. In patients with unilateral or asymmetrical bilateral radiculopathy, the asymptomatic or less-affected leg acted as a control in the study. Successful function correlated significantly with intraoperative changes in latency toward normal in the more-affected leg, whether the lesion was herniated nucleus pulposus or spinal stenosis. Intraoperative physiological testing (SEP) is valuable for determining the adequacy of lumbar nerve root decompression and for the prediction of the successful relief of symptoms.

Evoked Potentials, Somatosensory↗
PubMed1989

Changes in noradrenaline and histamine in monkey spinal cords traumatised by weight drop, compression and subsequent decompression.

Levels of noradrenaline (NA) and histamine (H) in the spinal cord of monkeys at 8, 24 and 48 hr following 200 g/cm contusion injury, 50 g of compression injury at 8 hr and decompression for 16 and 40 hr following 8 hr of compression were studied in the traumatised and in an adjacent non-traumatised segment. The NA level doubled in the traumatised and non-traumatised segments at 8 hr contusion injury followed by a slow decline to control values at 24 and 48 hr of contusion injury. There was no change in NA content of the spinal cord segments at 8 hr of compression injury. Decompression for 16 hr following 8 hr of compression increased NA content of the traumatised segment. H levels decreased in the traumatised and non-traumatised segments at 24 and 48 hr of contusion injury. Compression for 8 hr elevated H in the traumatised and non-traumatised segments. On decompression H level was further increased in the traumatised segment.

Animals↗
PubMed1989

Colonoscopic decompression for pseudo-obstruction of the colon.

The purpose of this report was to review the authors' experience with colonoscopy as a method of treating patients with acute colonic distention. For the period 1981-1987, 19 patients at two teaching hospitals met the selection criteria for this study. In terms of measurable decompression of a colon distention, colonoscopy was successful in 89 per cent of patients, although 41 per cent required repeat endoscopic decompression during their hospital stay. The procedure failed in two patients (11%) and operative decompression was necessary. The authors have found that colonoscopy is a useful procedure for determining the cause of progressive colon distention and for providing safe and effective treatment.

Adult↗
PubMed1988

[Experimental study on therapeutic plasmapheresis with the biliary decompression in the treatment of obstructive jaundice].

The effectiveness of therapeutic plasmapheresis with the biliary decompression was evaluated using animal model in the treatment of obstructive jaundice. Plasma exchange (PE) using fresh frozen plasma was carried out with biliary decompression on canine jaundice model made by means of ligation and resection of bile duct. Routine biochemical analysis was performed following the PE and biliary drainage and the result was compared with the external biliary drainage group. Plasma level of total bilirubin decreased after PE and kept lower level while plasma level of bilirubin in external biliary drainage group decreased slowly. M-GOT and GOT level, those are the indicators of liver cell injury, was lower in PE group. Mitochondrial function of liver cell was evaluated following partial hepatectomy carried out two days after PE with biliary decompression on jaundiced rat. Mitochondrial respiratory control ratio and ADP/O ratio was improved in PE group. The effectiveness of PE is speculated as the combined mechanism of the removal of hepatotoxic factors in the jaundiced plasma and the addition of hepatotrophic factors within the fresh frozen plasma. These results support the effectiveness of PE to shorten the biliary drainage period and to improve the hepatic function for perioperative management.

Animals↗
PubMed1988

[Surgical orbital decompression in Basedowian optic neuropathy. Apropos of 5 cases].

Surgical orbital decompression in 5 patients with basedowian optic neuropathy restored the visual acuity and visual field in all cases. The place of surgery among the different therapeutic options proposed for this serious complication of Basedow's disease is discussed, as well as the advantages over other decompression techniques of the procedure used : the cutaneous approach to a trans-ethmoidonasal decompression.

Adrenal Cortex Hormones↗
PubMed1988

Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy.

During a ten-year period, 77 patients with spinal instability caused by metastatic pathologic fractures of one or more vertebrae were treated with anterior decompression and stabilization by replacement of the affected vertebral bodies with methylmethacrylate, polymerizing in situ, augmented by Knodt distraction rods positioned anteriorly. No postoperative external support was required, and the fixation achieved by this method was not affected adversely by subsequent irradiation at a mean of 4020 rads. Sixty-two patients had major neurologic impairments preoperatively and required spinal cord and/or nerve root decompression anteriorly prior to fixation. Of these, 26 had complete neurologic recovery postoperatively, 16 others improved significantly, 20 remained unchanged, and one patient deteriorated neurologically. Five patients suffered failures of fixation, although two were successfully restabilized after a second operation. The remaining 72 patients enjoyed good or excellent resolution of spine pain postoperatively, and, in patients surviving their underlying malignancies, stability did not deteriorate during the follow-up period ranging from 42 to 146 months. Six patients developed spinal instability from tumor lysis at a different level between five and 95 months postoperatively. All were treated with successful decompression and stabilization. There was one wound infection among the 83 anterior stabilization procedures. However, three of the six patients requiring secondary posterior stabilization suffered wound dehiscences, and three of these became infected.

Adult↗
PubMed1988

Ischemic necrosis of the femoral head. Treatment by core decompression.

Since 1977, we have performed twenty-one core decompressions in seventeen patients who had stage-I or II ischemic necrosis of the femoral head. The diagnosis was confirmed histologically in all but one patient. After a mean length of follow-up of thirty-nine months, healing was evident in eight hips (40 per cent) but not in the other twelve. All twelve hips required additional surgical treatment; the average length of time before the additional treatment was required was 9.2 months. The results of two intraoperative diagnostic tests (intramedullary pressure and saline stress tests) did not correlate with the results of biopsy. A perioperative fracture through the site of the decompression occurred in one of the twenty-one hips. Given the relatively poor long-term results and the considerable morbidity that was associated with core decompression, this treatment cannot be recommended.

Adult↗
PubMed1987

Cervical spondylotic myelopathy and myeloradiculopathy. Anterior decompression and stabilization with autogenous fibula strut graft.

Operative treatment for cervical spondylotic myelopathy and myeloradiculopathy by anterior decompression produced functional improvement of one grade (Nurick's rating system) in 16 of 21 patients evaluated at 32 months average follow-up period. The best results occurred in patients with symptoms for less than one year and classified as grades I-III. The anterior approach for decompression is preferred because it is directed toward the degenerative structures responsible for cord and root compression. The autogeneic fibula dove-tailed strut graft is favored over an iliac crest bone graft because with multilevel decompression in the cervical spine, it provided structural stability and a high union rate. There were no neurologic complications in this series of 21 cases.

Cervical Vertebrae↗
PubMed1986

Core decompression of the femoral head for osteonecrosis.

The results of forty core-decompression procedures that were performed for ischemic necrosis of the femoral head in thirty-one patients over a four-year period were retrospectively reviewed to ascertain the effectiveness of the procedure. The data did not support the published rates of success of the procedure for Stage-1 and Stage-2 lesions. With a mean length of follow-up of eighteen months, 60 per cent of the hips that had a decompression prior to collapse of the femoral head demonstrated progression of the lesion and were judged to be a failure by clinical or radiographic criteria. Computerized tomographic scans and magnetic resonance imaging proved to be 100 per cent sensitive for diagnosis in preoperative testing; isotopic bone-scanning was less sensitive (80 per cent). Functional intraoperative testing by the method of Ficat did not provide added sensitivity or specificity to the results of the preoperative bone scan. A postoperative or intraoperative fracture occurred in four hips, for an incidence that exceeded any in previously published reports. We concluded that core decompression should be considered a relatively ineffective procedure with significant morbidity.

Adult↗
PubMedDate not supplied

[Surgical decompression of neuritis of Hansen's disease].

The recent progress were focused on: the identification of the general immunological mechanism of the hansenian neuritis, demonstrated by endoneural biopsies; the different pathology of the two categories of neuritis; the pathophysiologic derangements, inducing hypoxia or anoxia in the truncular involved segment. The adjuvant role of the canals is important; the clinical differences of the two categories of neuritis and the cases we shall treat by emergency; the importance of antireactionnal treatment and of the notation by tests for the study of the results. The goals are the hemodynamic decompression, useful in the first stage of ENL neuritis, the mechanical decompression of neural fasciculus and the urgent exeresis of necroses or evacuation of febrile abscess. Three technics a re studied: Extraneural and epineural decompression fascicular endoneural necrosis, neurolysis and complex neurolysis for evaluated ENL neuritis and for endoneural necrosis. The different indication according to the two categories: medico-surgical treatment for ENL neuritis, and according the precocity and the delay of the antireactional treatment, and also the absolute emergency of the necrosis and febrile abscess. The results of the treatment of 258 cases of recent neuritis are presented.

Acute Disease↗
PubMed1985

Brain stem auditory evoked potentials in Arnold-Chiari malformation: possible prognostic value and changes with surgical decompression.

Symptomatic Arnold-Chiari malformation (Chiari II) is a recently described clinical entity, the natural history and surgical management of which remain controversial. The brain stem auditory evoked potentials (BAEPs) have been described as abnormal in 50 to 86% of children with myelomeningocele. We present the case of a full-term infant with myelomeningocele, shunted hydrocephalus, and Chiari II malformation who was surgically treated by decompression when she was 3 weeks old. BAEPs recorded immediately after decompression showed dramatic improvement over BAEPs recorded immediately before decompression, an improvement that could not be attributed to maturation of the central nervous system. It is postulated that in further large series the degree of abnormality in BAEPs may be of value in predicting the clinical course of these patients. The current status of BAEPs as they apply to the evaluation of posterior fossa anomalies is reviewed.

Arnold-Chiari Malformation↗
PubMed1985

[Surgical treatment of trigeminal neuralgia--neurovascular decompression established by Jannetta].

The etiology of trigeminal neuralgia has been unknown. However, recently, trigeminal neuralgia is believed to be caused by vascular cross compression at the root entry zone of the trigeminal nerve. Posterior cranial fossa approach for the neurovascular decompression was enhanced by Jannetta et al. They emphasized that the pain was relieved by surgery. In this report, we will discuss the operative findings and results in a series of 8 patients who have undergone neurovascular decompression. The postoperative progress in all of these patients was excellent and relieved of the pain. There was neither mortality nor any significant complication. We stress that the neurovascular decompression surgery is now well justified as the definite treatment for the trigeminal neuralgia.

Adult↗
PubMed1985

Intestinal decompression: preliminary study in the horse.

A technique of nasoduodenal (N-D) intubation and intestinal decompression was developed and used in the horse to explore the prevention of gastric and intestinal distention after abdominal surgical operation. Three styles of tubes (2 single-lumen tubes and 1 double-lumen tube) were positioned in the duodenum of 12 mature horses (10 experimental and 2 clinical) during laparotomy (without enterotomy), and an iatrogenic occlusion at the small intestine was created and later released in the 10 experimental horses. The 2 clinical horses had an exploratory laparotomy to correct a natural obstruction of the small intestine. After each horse recovered from surgical manipulation, suction was used to keep fluids from accumulating in the cranial part of the gastrointestinal tract. In 5 of the 12 horses, the most simple N-D tube was positioned successfully and functioned properly. Three of the 5 horses which were fasted before surgical manipulation (to obtain an empty stomach) survived without postsurgical complications. Volume of reflux material was measured. Clinical data, such as periods of comfort during decompression without giving analgesics, were recorded. Necropsies were done on 10 of the 12 horses (9 experimental and 1 clinical). Although already tested in 2 clinical horses, use of the N-D tube remains experimental, and the N-D tube functioned only in horses which were fasted before surgical manipulation. Perfection of a safe and dependable means of emptying the equine stomach of its solid ingesta before gastrointestinal intubation is done, is the next step in affording greater clinical application of the N-D tube for gastrointestinal decompression.

Animals↗
PubMed1985

Intramedullary decompression with condylectomy for intractable plantar keratoma.

A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated. This method has proved less traumatic than previous procedures, permitting immediate ambulation with little postoperative pain or edema. In a series of cases, I have compared this method with control studies on the same patient in which intramedullary metatarsal decompression was performed on one foot and a neck osteotomy on the opposite foot. Results with intramedullary metatarsal decompression have been comparable but have fewer postoperative sequelae. Exuberant bone callus formation dorsally and at the osteotomy site, lateral displacement of bone segments, frequency of transfer lesions, delayed healing or nonunion of the osteotomy site, and the possibility of synostosis when two adjacent bones were osteotomized are all decreased. A short review of the rationale, selection of cases, and criteria for orthotics is presented. The concept and simplified method of treatment applied in a series of cases is described.

Anesthesia, Local↗
PubMed1985

A simplified technique for gastric and duodenal decompression for duodenal injuries.

A simplified effective method of the decompression for use after repair of duodenal injuries is described. A Moss esophagogastric decompression tube is inserted as a gastrostomy to provide decompression of stomach and duodenum through a single tube. In addition, the complications associated with long-term nasogastric tube drainage are avoided.

Drainage↗
PubMed1982

Ventral decompression for caudal cervical disk herniation in large- and giant-breed dogs.

Ventral decompression was evaluated as a treatment for cervical disk protrusion in large- and giant-breed dogs. All of the dogs improved after ventral decompression. After a follow-up period averaging 16 months, half of the dogs were clinically normal and the other half were functional pets despite minor residual proprioceptive deficits. Ventral decompression alone appeared to be acceptable treatment for dogs not having other radiographic signs of caudal cervical spondylopathy.

Animals↗