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PubMed1982

Internal decompression for multiple levels of lumbar spinal stenosis: a technical note.

In cases of lumbar spinal stenosis, use of the wide decompressive procedure for neural compression without regard for the integrity of facets tends to lead to instability and the chronic pain syndrome. Experience with the posterior lumbar interbody fusion technique indicates that, in cases of multiple levels of spinal canal stenosis, the decompression can be made adequately by inferior and superior marginal laminotomy, mesial facetectomy with an osteotome, and foraminotomy with an angle bone punch and a supersonic curette. Internal thinning of the thickened lamina can be achieved by the shaving action of the supersonic curette done from within the spinal canal. This technique achieves the necessary internal decompression of the multiple levels of spinal stenosis without interruption of the integrity of the motion segment. The spinous processes and the supraspinous ligaments and the lateral half of the facet, with its firm fibrous capsules, are scrupulously preserved. The disc is not removed unless it is overtly extruded.

Female↗
PubMed1980

Small intestinal blood flow after 48 hours ileus, prostigmin and manual decompression.

In eight piglets small intestinal blood flow (IBF) and motility has been measured after 48 hrs mechanical obstruction, prostigmin application and manual decompression using the microspheres method. Intraenteric basic pressure is in a normal range; the number of tonic contraction waves (type 3 waves) is slightly increased. IBF after 48 hrs ileus is markedly increased compared to normal (218%). Prostigmin does not influence IBF significantly. After manual decompression, IBF decreases to 56% of normal and does not recover within 30 minutes. Whereas IBF in the segment proximal to the obstruction is increased, IBF in the distal part is significantly reduced (48%) after 48 hrs of ileus. It is concluded that 48 hrs of ileus have no harmful effect on intestinal blood flow and function. Prostigmin does not increase IBF, whereas motility is stimulated strongly. Mechanical decompression results in a 50% reduction of IBF, which might be in accordance with clinical observation of retarded recovery and reduced motility after this maneuvre.

Animals↗
PubMed1981

Cortisone-induced intrafemoral head pressure change and its response to a drilling decompression method.

Intramedullary head pressure changes were studied in a group of cortisone-treated New Zealand white rabbits. In addition to femoral head pressure measurements, serum cholesterol levels were followed serially and pathologic specimens from cortisone-treated femoral heads were obtained. Surgical decompression by a drilling method was performed and pressures were remeasured at four weeks following decompression. Persistent increases in cholesterol levels and in intrafemoral head pressures were noted, particularly from six to eight weeks after initiation of steroid treatment. Cholesterol levels were elevated to four times control values and femoral head pressures averaged 2 1/2 times the control values (60 cm of water vs 24.6 +/- 5.5 cm of water). Surgical decompression by drilling effectively reduced the once elevated pressures to control values. A relationship between increased fat cell size, increased intramedullary pressure and decreased femoral head blood flow in steroid-treated rabbits is postulated. The applicability of these data to humans with steroid-induced ischemic necrosis of the femoral head has yet to be demonstrated.

Animals↗
PubMedDate not supplied

Surgical techniques of anterior decompression and fusion for spinal cord injuries.

Many patients who have static or only slowly improving neurologic deficits and significant compression of the spinal cord and nerve roots can benefit from anterior decompression. The improvement ranges from partial root recovery to very dramatic improvement in upper as well as lower extremities in the patient with quadriparesis. Intrinsic damage or contusion of the spinal cord cannot be reversed by decompression. Patients with motor sparing preoperatively attain a better functional improvement than those patients who have only slight distal sensory function initially. The same can be said of patients with spinal cord injuries treated with surgery, but we believe the ultimate degree of functional recovery of incomplete cord injuries is greater following anterior than posterior decompression when the operation is indicated. An early accurate diagnosis must be made concerning whether a patient has a complete or an incomplete spinal cord injury. The mechanical compressive lesion must be well documented by myelography, laminography, or CAT scan. The patient should not be neurologically harmed by a posterior laminectomy approach to anterior pathology which additionally removes all posterior stability. An anterior compressive block is best removed through an anterior approach.

Cervical Vertebrae↗
PubMed1995

[A case of a young infant with Chiari II malformation treated by only bony foramen magnum decompression].

A case of a young infant with Chiari II malformation treated by only foramen magnum decompression was reported. The patient was a 3-month-old infant with a one-month history of stridor and respiratory distress. The myelomeningocele was surgically repaired. At the age of two weeks, a ventriculoperitoneal shunt had been inserted. On admission, MRI demonstrated Chiari II malformation. The shunt mechanism was functioning. Suboccipital craniectomy and upper cervical laminectomy from C1 to C5 level was performed. After the removal of the dural band at the foramen magnum level, good pulsation of the dura mater was demonstrated. After surgery, the stridor and respiratory distress disappeared. Foramen magnum decompression carried out by our surgical technique is advantageous because all the procedures are extradural and there are, therefore, fewer postoperative complications than the foramen magnum decompression techniques previously reported.

Arnold-Chiari Malformation↗
PubMed1994

Posterior decompression and fusion in rheumatoid disease of the cervical spine: redressing the balance.

Forty-seven patients with rheumatoid disease of the cervical spine were followed over an 8-year period. Twenty-one patients with isolated atlantoaxial subluxation and four with combined atlantoaxial and subaxial disease had their atlantoaxial instability treated by posterior decompression and fusion. The incidence of surgical mortality was 8%, and clinical improvement was noted in 75%. There was no neurological deterioration in those patients who survived long term. We have found posterior decompression and fusion to be a satisfactory procedure for the treatment of atlantooccipital subluxation. In our experience, anterior decompression has not been found necessary for successful treatment of atlantoaxial subluxation in patients with rheumatoid cervical spine disease.

Adult↗
PubMed1995

[Surgical decompression for massive cerebellar infarction].

The authors report 10 patients with progressive neurological deterioration due to massive cerebellar infarctions. Computerized tomography scans confirmed obstructive hydrocephalus and brain stem compression. All 10 patients (seven men, three women; mean age, 59 years) were treated by external ventricular drainage and decompressive suboccipital craniectomy. After discharge from the hospital, they were followed up (23-101 months) and their functional independence was evaluated by the Barthel Index. The condition of three patients with brain-stem infarction had deteriorated despite decompressive surgery. Two of these died during the acute stage and one because severely disabled. The remaining seven patients showed neurological improvement during the postoperative period. Four patients with preoperative Japan Coma Scale of 100 returned to their previous jobs within the follow-up period and three patients with preoperative Japan Coma Scale of 200 required some assistance in daily activities. It is suggested that decompressive surgery may be beneficial for massive cerebellar infarction. The postoperative prognosis depends mainly on the presence or absence of coexisting brain-stem infarction. It is possible that, without brain-stem infarction, patients who remained in a "dependent" state may have recovered better if they had been operated on earlier.

Aged↗
PubMed1994

[Simple decompression of the ulnar nerve in cubital tunnel syndrome with and without morphologic changes. Report of experiences based on 523 cases].

The transposition of the ulnar nerve has proved to be an effective therapy in ulnar neuritis at the elbow but has also many risks and technical problems. In contrast the simple decompression or release of the nerve within the cubital tunnel which was first described by Osborne and Feindel and Stratford is an operation which is free of complications and postoperative morbidity and can be performed in local anesthesia. According to the results of a former study of 139 cases and this follow-up study of further 523 cases the simple decompression proved to be an efficacious and almost entirely substitute for the more complicated and extensive procedure of volar transposition-not only for the "idiopathic" cubital tunnel syndrome but also for the "symptomatic" forms as tardy ulnar palsy, luxation of the ulnar nerve or other abnormalities i.e. epitrochleoanconeus muscle, ganglia, lipomas, bursitis. Depending on the severity of nerve damage and duration of symptoms but widely independent from etiology the electroneurographic follow-up study indicated a significant improvement of conduction velocity in about 90% of cases and was therefore a good indicator for successful decompression. It is suggested to give up the concept of different etiologies especially the widely used "sulcus-ulnaris-syndrome" and to replace it by the term "cubital tunnel syndrome" (with or without morphological alterations). Most important for the outcome of surgery is an early operation. Once muscle atrophy has developed the prognosis will be poor. This is also true for cases with concomitant polyneuropathy. Anterior transposition may be restricted to very few cases of extreme cubitus valgus.

Adolescent↗
PubMed1993

[Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment].

Through the findings in the literature on the basis of 9 personal cases, we review the indications and value of decompressive hemicraniectomy with plasty of the dura mater in cases of medically uncontrolled and decompensated intracranial hypertension. Seven patients had a pseudo-tumoral brain infarction. Five patients survived and their functional recovery is consistent with an autonomous daily life. Another patient with acute traumatic sub-dural haemorrhage died. The ninth patient had presuppurative encephalitis and recovered with no disability. At the time of surgery, all the patients were comatose with herniation of the mesencephalon (n = 3), uncal transtentorial herniation which was either unilateral (n = 4) or bilateral (n = 2). ICP was between 25 and 60 mmHg before the operation. After flap removal, ICP decreased by 15% and, after opening of the dura, it fell a further 70%. In 6 patients we were able to carry out continued post-operative monitoring of ICP, which stayed below 50% of initial values. Decompressive hemicraniectomy is an effective means of treating ICH caused by carotid cerebrovascular accidents with a high degree of edema, where mortality rises to 70-85% when only medical treatment is administered. No haemorrhagic complications, which can occur during hemispherectomies, were observed during decompression.

Adolescent↗
PubMedDate not supplied

Failed back syndrome: a study on 95 patients submitted to reintervention after lumbar nerve root decompression for the treatment of spondylotic lesions.

The persistence of lumbar and nerve root pain after nerve root decompression surgery may be attributed to one of five causes; 1) progression of the spondylotic disease in the presence of peridural fibrosis; 2) recurrence of disc herniation or new hernia; 3) stenosis of the spinal or nerve root canal; 4) arachnoiditis; 5) vertebral instability. In most patients with peridural fibrosis and worsening of spondylotic lesions regression of nerve root symptoms was obtained after several months of conservative treatment, which continues to constitute essential treatment for most patients with recurrence of lumbar symptoms. The authors report the results obtained with the surgical treatment of 95 patients performed between 1981 and 1991 and divided into the categories listed above. Of these patients, 70 were submitted to further decompression surgery while 25 were submitted to posterolateral vertebral fusion. Reintervention obtained useful results in 83% of the cases where there had been recurrence of disc herniation; nerve root release obtained positive results in 100% of the cases where there was stenosis. Results obtained after wide decompression were poor in all of the cases with arachnoiditis; in these patients conservative treatment with T.E.N.S. can obtain a fair amount of control over pain. Positive results were obtained in 84% of the 25 patients submitted to posterolateral fusion for the treatment of vertebral instability, with fusion obtained in 96% of the cases. Surgical treatment is indicated for psychotic, neurotic patients or those with insurance-related motivations only when the organic cause of the symptoms is clearly evident.

Adolescent↗
PubMed1994

Anterior decompression for late pain and paralysis after fractures of the thoracolumbar spine.

Anterior decompression of the thoracic and lumbar spine is indicated for patients with trauma, infection, or tumor that causes compression of the neural tissues, resulting in an incomplete neurologic deficit. The complication of chronic pain, with or without paralysis, that results from fractures with canal compromise has received little attention. This study involved 45 patients who had anterior decompression for chronic pain or paralysis at an average of 4.5 years after having thoracolumbar fractures. Pain was improved in 41 of 45 patients, with complete relief in 30 and partial relief in 11. In 25 patients with neurologic deficit, 21 noted improvement, 14 of which improved one or more grades of the Eismont classification. No patient had an increase in pain or loss of neurologic function. Complications were few. Anterior decompression of the thoracolumbar spine for chronic pain after thoracolumbar fractures is a safe and effective treatment for patients with this uncommon and difficult problem.

Adolescent↗
PubMed1994

Lumbar decompression to treat foot drop after hip arthroplasty.

Twenty-one patients with spinal stenosis who developed foot drop after total hip arthroplasty were reviewed. Patients with other risk factors for nerve injury, such as dislocation, hematoma, intraoperative limb lengthening, revision surgery, and direct operative trauma, were excluded. Also excluded were patients without symptoms of spinal stenosis. Patients in this series had back and leg pain without weakness before their hip arthroplasty. When foot drop developed and persisted four months after hip arthroplasty, patients were examined with magnetic resonance imaging or myelography and computed tomography. High-grade spinal stenosis was found in each patient. Sixteen patients were treated by lumbar decompression. Twelve patients improved; six had complete recovery of foot drop. None of the five patients who did not have surgery significantly recovered. One patient developed a foot drop in the other leg after undergoing lumbar decompression. Coexisting spinal stenosis may be a risk factor for symptomatic nerve injury during hip arthroplasty. Selected patients may benefit from lumbar decompression surgery.

Aged↗
PubMed1993

Nasogastric decompression following elective colorectal surgery: a prospective randomized study.

A prospective, randomized study was conducted to determine the need for nasogastric decompression following elective colorectal surgery for malignant and premalignant lesions. Seventy-seven consecutive patients were randomly assigned to one of two groups: Group 1--nasogastric decompression was maintained postoperatively until resumption of bowel function; Group 2--the nasogastric tube was removed in the recovery room. Forty patients were assigned to Group 1 (21 males, 19 females) and 37 to Group 2 (22 males and 15 females). Eleven patients in Group 1 (28%) developed nausea postoperatively, with six patients (15%) having an average of less than two emeses and five (12%) requiring nasogastric reintubation. Thirteen patients in Group 2 (35%) developed nausea, with 10 patients (27%) having an average of two emeses and three (8%) requiring nasogastric intubation (P = 0.80). Abdominal distention was observed in 13 patients (32%) in both Group 1 (32%) and Group 2 (35%). Two of the latter patients required nasogastric reintubation. Postoperative fever was noted in 23 patients (58%) in Group 1 and 14 (38%) in Group 2 (P = 0.13); atelectasis was diagnosed in 38 per cent of patients in Group 1 and 14 per cent in Group 2 (P = 0.03). These data support that nasogastric decompression is not necessary following elective colorectal surgery for malignant and premalignant lesions.

Adult↗
PubMed1993

Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters.

Clinical results of arthroscopic rotator cuff debridement and decompression in 25 patients are presented. Additionally, a fluoroscopic study of 14 patients with known massive rotator cuff tears reveals four kinematic patterns in patients with major cuff deficiencies. Biomechanical models are used to support further the clinical impression that certain rotator cuff tears are amenable to arthroscopic debridement and decompression without repair. Specific indications for arthroscopic debridement and decompression are developed and presented.

Aged↗
PubMed1994

Surgical decompression of Chiari I malformation for isolated progressive sensorineural hearing loss.

Progressive sensorineural hearing loss has been associated with Chiari type I malformation. Retrocochlear features on auditory brainstem response testing have been reported; however, debate exists over the exact location of the defect. Surgical decompression may be beneficial if brainstem or vascular compression have played a significant role in the pathophysiology of the hearing loss. Lack of specific audiologic data before and after surgical decompression has kept surgical decision making theoretic. This report presents the case of a 10-year-old boy with a progressive, asymmetric sensorineural hearing loss without other neurologic abnormalities. He underwent a posterior fossa decompression that resulted in stable hearing over the 2 years he was followed postoperatively. Preoperative and postoperative audiologic and evoked response features are described, and the rationale for operating with symptoms limited to hearing loss is discussed.

Arnold-Chiari Malformation↗
PubMed1995

Microvascular decompression in glossopharyngeal neuralgia.

Glossopharyngeal neuralgia is a rare and often controversial cause for odynophagia and otalgia. The otolaryngologist, head and neck surgeon may be the primary physician called upon to diagnose and treat this entity. In this study, vascular decompression, or more specifically, elimination of contact between the ninth cranial nerve and the posterior inferior cerebellar artery, was employed as treatment in three patients. All achieved relief of their symptoms with this intervention. A review of the neurosurgical literature and the experience with vascular decompression in trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia is presented. The authors conclude that vascular decompression is effective in carefully selected patients, and the role of the skull base surgeon in managing this problem is expanding.

Adult↗
PubMed1995

Meatal facial nerve decompression in acoustic neuroma resection.

Delayed facial palsy occurs after approximately 15% of acoustic neuroma resections. Whereas in most cases facial nerve function recovers satisfactorily, in about 12% of cases delayed facial palsy may have a poor functional recovery. The fate of facial nerve function was studied in 55 consecutive translabyrinthine acoustic neuroma resections, 23 of whom underwent meatal facial nerve decompression (MFND) at the time of tumor resection. The facial nerve results also were reviewed in 19 middle cranial fossa resections, of whom 14 underwent MFND. There was a bimodal distribution of the delayed palsies, with one group having the onset of palsy within hours to 2 days after surgery and the second group having onset of palsy up to 17 days after surgery. The poorest recoveries were seen in the first group. Although the effect was not statistically significant due to the small sample size, the chance of facial weakness in patients who underwent MFND after translabyrinthine surgery was about 40% less than in those who did not undergo decompression. The apparent protective effect of MFND was increased when the confounding factors of tumor size and degree of resection were taken into account, although the effect was not statistically significant. The duration of palsy was shorter and ultimate recovery better among the patients who underwent facial nerve decompression than in those who did not. Of the translabyrinthine patients who underwent MFND, 100% had House-Brackmann grade I-II function at 2 years, whereas 87% of patients who did not have MFND had grade I-II function and 13% had grade III-IV function. Without MFND, 57% of translabyrinthine patients whose onset of facial palsy was within 2 days of surgery had grade III-IV facial nerve function.

Facial Nerve↗
PubMed1996

Recurrence of hemifacial spasm after microvascular decompression.

The success of medical and surgical treatment for hemifacial spasm, and involuntary paroxysmal unilateral contraction of the facial muscles, has been mixed. Although microvascular decompression has the greatest reported success, symptom recurrence affects many patients in whom treatment was initially successful. In this study, we report the results of 34 patients who underwent microvascular decompression of the facial nerve from 1976 to 1989 as well as review the literature concerning the incidence and timing of recurrence in more than 600 patients who underwent microvascular decompression. In this series, 94% of 34 patients had continuous relief of spasm after surgical treatment (mean duration, > 6 yr). Of those patients whose spasms were completely initially relieved, 10.3% developed some degree of recurrent spasm; however, no patient developed a recurrence after 24 months without spasm. Our review of the literature discloses that 86% of all recurrences occurred within 2 years of surgery. Patients who have no recurrence of symptoms 2 years after surgical treatment have only a 1% chance of developing recurrent hemifacial spasm. We also comment on possible causes of treatment failure and recurrence of hemifacial spasm after surgical treatment.

Adult↗