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PubMed2006

Prognostic ability of a good outcome to carpal tunnel release for decompression surgery in the lower extremity.

For years, patients who were treated successfully with carpal tunnel release were told there was nothing that could be done about their lower extremity symptoms. Now that lower extremity nerve decompression has been accepted as an option to treat appropriate patients, the authors looked for correlations between a successful outcome with carpal tunnel syndrome and its predictive value of success for lower extremity nerve decompression. Data from a recent study demonstrate that a good result from upper extremity peripheral nerve surgery predicts the outcome for lower extremity peripheral nerve surgery in 88% of patients, and is, therefore, information valuable for prognosis and clinical decision-making.

Animals↗
PubMed2006

Endoscopic nerve decompression.

Endoscopic decompression for forefoot nerve entrapments is discussed in this article from not only the perspective of preoperative indications, intraoperative technique, and postoperative management, but with reference to the changing paradigm for management of this condition. Surgical results are discussed and compared with other published reports. Complications of the surgical technique are also discussed, which will give the operating surgeon a frame of reference when comparing decompression procedures to those techniques involving nerve resection. There is also a valuable discussion of current methods of diagnosis that may help the practitioner improve patient outcomes.

Decompression, Surgical↗
PubMed2005

Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation.

BACKGROUND: We assess that pudendal neuralgia is a tunnel syndrome due to a ligamentous entrapment of the pudendal nerve and have treated 400 patients surgically since 1987. We have had no major complication. We conducted a randomized controlled trial to evaluate our procedure. METHODS: A sequential, randomized controlled trial to compare decompression of the pudendal nerve with non-surgical treatment. Patients aged 18-70, had chronic, uni/bilateral perineal pain, positive temporary response to blocks at the ischial spine and in Alcock's canal. They were randomly assigned to surgery (n=16) and control (n=16) groups. Primary end point was improvement at 3 months following surgery or assignment to the non-surgery group. Secondary end points were improvement at 12 months and at 4 years following surgical intervention. RESULTS: A significantly higher proportion of the surgery group was improved at 3 months. On intention-to-treat analysis 50% of the surgery group reported improvement in pain at 3 months versus 6.2% of the non-surgery group (p=.0155); in the analysis by treatment protocol the figures were 57.1% versus 6.7% (p=.0052). At 12 months, 71.4% of the surgery group compared with 13.3% of the non-surgery group were improved, analyzing by treatment protocol (p=.0025). Only those randomized to surgery were evaluated at 4 years: 8 remained improved at 4 years. No complications were encountered. CONCLUSIONS: In this study we demonstrate that decompression of the pudendal nerve is an effective and safe treatment for cases of chronic pudendal neuralgia that have been unresponsive to analgesia and nerve blocks. Following surgery, other medical interventions may be necessary.

Adolescent↗
PubMed2006

Outcome after surgical decompression of severe traumatic brain injury.

One of the factors that affects outcome following severe traumatic brain injury is development and progression of cerebral oedema with associated increase in intracranial pressure (ICP). Uncontrolled elevations of ICP may compromise energy metabolism of the injured brain and lead to secondary injury, affecting neurological outcome of the patient. Decompressive craniectomy has been used for over a century as a treatment of refractory brain swelling in a variety of neurological conditions. However, conclusive evidence of whether it has a beneficial or adverse affect on outcome is lacking. This article reviews the existing evidence on the role of decompressive craniectomy in management of patients with traumatic brain injury and stresses the need for randomised controlled trials.

Brain Injuries↗
PubMed2004

Reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression.

This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium bicarbonate for reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. Twenty-one patients undergoing bilateral open carpal tunnel decompression received, in a randomized manner, lidocaine 1% with adrenaline (1:200,000) in one hand and the same local anaesthetic buffered with 8.4% NaHCO3 at a 5:1 ratio in the other hand. Pain, especially its burning element, was evaluated on a visual analogue scale and was significantly reduced with the buffered solution. The buffering was effective for all patients and no adverse effects were noted. This is a safe, easy and quick method for making open carpal tunnel surgery less uncomfortable to patients.

Adult↗
PubMed2004

Carpal tunnel decompression. Is lengthening of the flexor retinaculum better than simple division?

This prospective randomized double-blind control trial compared lengthening and simple division of the flexor retinaculum in carpal tunnel decompression. Twenty-six patients with bilateral carpal tunnel syndrome were randomly allocated to have the flexor retinaculum divided on one side and lengthened on the other. All 52 hands were reviewed at regular intervals up to 25 weeks. The patients, therapists and the final reviewer were unaware of treatment allocation. The Levine symptom and function scores were used to assess the severity of the carpal tunnel syndrome and showed that the two treatments were comparable for relief of carpal tunnel symptoms. The two treatments were also similar for function measured with the Jebsen-Taylor test. There is no identifiable benefit in lengthening the flexor retinaculum when decompressing the carpal tunnel. Moderate or severe pillar and scar pain is common, occurring in 13 of 52 hands after surgery, but only in four by the 12th week and two by the 25th week.

Adult↗
PubMed2005

The use of a fine-gauge needle to reduce pain in open carpal tunnel decompression: a randomized controlled trial.

This randomized controlled study on 86 patients compared the level of pain experienced by patients on instillation of local anaesthetic into the palm with a 23-gauge and a 27-gauge (dental) needle in open carpal tunnel decompression. Patients were asked to score the amount of pain they experienced during the injection of the local anaesthetic and their level of anxiety about future injections using a visual analogue scale (VAS) and a four-point verbal response scale (VRS). The mean pain and anxiety scores on the VAS were significantly lower in the dental needle group. There was significant correlation between the pain and anxiety VAS scores. When infiltrating local anaesthetic into the palm for open carpal tunnel decompression, the use of a fine (dental) needle can reduce the pain on that occasion and the anxiety concerning future injections likely to be experienced by the patient.

Adult↗
PubMed2004

Progressive symptomatic kyphotic deformity after decompressive surgery for lumbar destructive spondyloarthropathy.

Destructive spondyloarthropathy (DSA) is a serious complication of haemodialysis for end stage renal failure. We present a case of a patient who complained of back pain and cruralgia due to L2-3 disc degeneration with instability, and was treated with posterior decompression and bone grafting. Soon after surgery, the kyphotic deformity progressed and the symptoms deteriorated. A correction of the deformity and posterior fusion was required six years after initial surgery. Pathological findings showed characteristic findings of DSA. Our findings indicate that in some cases with unstable DSA, spinal decompression as well as spinal fixation may be necessary.

Decompression, Surgical↗
PubMed2005

The role of decompressive craniectomy in the management of traumatic brain injury: a critical review.

Brain swelling and intracranial hypertension following severe head injury are known to contribute to secondary brain damage, and have been shown to adversely affect patient outcome. The use of unilateral craniectomy following the evacuation of a mass lesion, such as acute subdural haematoma or traumatic intracerebral haematoma, is accepted practice. The following review focuses on a bi-fronto-temporal decompressive craniectomy, used as an isolated operation for the control of intracranial hypertension, secondary to diffuse brain swelling refractory to medical management. Though the operation is being increasingly used, current opinion is still divided regarding its overall effects on outcome. This review examines the experimental and clinical evidence for and against the use of decompressive craniectomy, highlights the lack of class I evidence relevant to this topic and emphasises the necessity for well-designed prospective randomised controlled trials.

Animals↗
PubMed2006

Lintene granuloma following microvascular decompression mimicking a cerebellopontine angle tumour.

We describe a case of foreign body granuloma caused by lintene (cotton gauze), placed during microvascular decompression of the fifth nerve for trigeminal neuralgia. At presentation, the clinical and radiological findings were suggestive of a tumor. This is only the second case in the literature of a foreign body granuloma occurring owing to the placement of a lintene pledget during microvascular decompression.

Brain Stem Neoplasms↗
PubMed2005

Microvascular decompression for trigeminal neuralgia: recurrences and complications.

BACKGROUND: The purpose of this study was to review the complications and pain recurrences after microvascular decompression (MVD) for trigeminal neuralgia. METHODS: This is a retrospective review of 156 patients undergoing MVD in the last 25 years at Princess Alexandra Hospital, Brisbane, Australia. Patients were contacted by telephone and a questionnaire was used for the interview. RESULTS: The probability of becoming pain free after MVD in our study was 0.93. There were no deaths and the incidence of serious complication was 2%. Our complication profile is similar to other authors. Pain recurrences occurred in 18% of patients over a 25 year period. This was most likely within two years of surgery and thereafter occurred at a rate of 2-3.5% a year. Seventy-four percent of patients were still pain free at 10 years. In half of the patients the recurrence was not as severe as the initial occurrence of pain. Thirty percent of recurrences occurred on the opposite side. Eighteen percent of patients were not pain free despite any intervention. CONCLUSIONS: Microvascular decompression in experienced hands has an excellent pain outcome in the majority of patients. Major complications are uncommon.

Decompression, Surgical↗
PubMedDate not supplied

Can the impingement test predict outcome after arthroscopic subacromial decompression?

The impingement test, placement of local anesthetic in the subacromial space, is considered a useful tool in diagnosing impingement syndrome. The purpose of this study was to examine the predictive value of the impingement test with respect to outcome after arthroscopic subacromial decompression. Fifty-five patients who had a preoperative impingement test were evaluated at 3 and 12 months postoperatively. We noted 88% satisfactory results in patients in whom the impingement test was positive, with only 63% satisfactory results at 3 months and 60% satisfactory results at 12 months in patients in whom the impingement test was negative. Although workers' compensation patients tended to have lower scores than others, the impingement test result was more predictive of outcome than was compensation status. Impingement test results and preoperative American Shoulder and Elbow Surgeons scores were independent predictors of postoperative American Shoulder and Elbow Surgeons scores. Our evidence indicates that the impingement test can be used as a predictor of outcome for patients with impingement syndrome treated by arthroscopic subacromial decompression.

Adult↗
PubMed2006

Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review.

Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients. While a wide variety of opinions exist medical personnel on the scene require guidance in situations when tension pneumothorax or progressive pneumothorax is suspected. To ensure evidence based decisions we performed a systematic review of the current literature with respect to the diagnostic accuracy in the pre-hospital setting to identify patients with (tension) pneumothorax, the efficacy and safety of performing pleural decompression in the field and the choice of method and technique for the procedure. The evidence found is presented and discussed and recommendations are drawn from the authors' perspective.

Chest Tubes↗
PubMedDate not supplied

Decompression for cervical myelopathy.

BACKGROUND CONTEXT: Cervical spondylotic myelopathy is a degenerative condition of the cervical spine. Surgical decompression is considered the gold standard of treatment, yet multiple published studies failed to yield consistent clinical results. Properly designed clinical outcomes studies using physiological, functional, and self-reported measures have the ability to define the best intervention for this disease entity. Many validated outcomes measures for cervical spondylotic myelopathy already exist, ranging from the disease-specific Nurick grading scale to the generalized Short Form 36-item (SF-36) questionnaire. PURPOSE: To review the literature concerning outcome measurements for cervical spondylotic myelopathy. CONCLUSION: Future research must consistently use a broad array of outcome assessments to elucidate the correct utilization of surgical decompression for this disease entity.

Cervical Vertebrae↗
PubMed2006

True hemicranial decompression for severe pediatric cranial trauma: a short series of 4 cases and literature review.

BACKGROUND: Traumatic acute SDH in pediatric patients is a life-threatening situation. There is a severe increase in ICP caused by acute SDH or diffuse brain swelling or secondary to ischemic brain damage. In certain situations, conventional measures may fail to control such a rapid increase in ICP. CASE DESCRIPTION: The cases of 4 pediatric patients with cranial trauma with raised ICP, in whom hemicranial decompression was performed, are described. All patients had acute SDH with diffuse brain injury; in addition, 2 of them had associated massive infarcts. Three of them survived and had a favorable outcome. CONCLUSIONS: In certain situations, pediatric patients with cranial trauma may be offered hemicranial decompression as a surgical option. These children may have a better long-term outcome despite massive infarcts.

Accidental Falls↗
PubMed1999

Use of decompressive craniectomy after severe head trauma.

Ten percent of head injuries quality as "severe," requiring prompt diagnosis and treatment. This level I trauma center uses an aggressive approach to treatment of severe head injuries and, when indicated, intervenes with decompressive craniectomy. This article explains decompressive craniectomy, including indications, procedures, and protocols. The case studies presented highlight two patients with profound head injuries. Additionally, cranioplasty replacement of autograft flap is explained and discussed.

Adolescent↗
PubMed2005

Resolution of periodic alternating nystagmus after decompression for Chiari malformation.

CASE REPORT: A 20-year-old female presented with horizontal jerk nystagmus, blurred vision, severe headaches, unsteady gait, and paresthesia. Magnetic resonance imaging revealed Chiari malformation I. Symptoms resolved after decompression of the posterior cranial fossa and removal of the right cerebellar tonsil. COMMENTS: Conditions associated with acquired periodic alternating nystagmus and ocular disorders associated with Chiari malformation are discussed. To our knowledge, this case is the first to report the resolution of periodic alternating nystagmus after neurosurgical decompression.

Adult↗
PubMed2003

Ganglion cysts of the shoulder: technique of arthroscopic decompression and fixation of associated type II superior labral anterior to posterior lesions.

Ganglion cysts of the shoulder and concomitant suprascapular nerve compression should be considered in the differential diagnosis of shoulder pain. They are associated commonly with labral tears, most commonly SLAP lesions. MRI has become commonplace in evaluating shoulder pain and has led to the increased awareness of shoulder cysts. MRI accurately demonstrates the size and location of ganglions, which is critical when planning surgical intervention. It also has shown the frequent association of intra-articular pathology with these cysts. Despite that MRI can detect atrophy, the diagnosis of suprascapular nerve compression can be confirmed only by EMG/NCS, because the presence of a cyst does not necessarily mean the nerve is compressed. Likewise, a positive EMG does not confirm that the compression is caused by a ganglion cyst. EMG/NCVs are necessary for confirming the diagnosis and evaluating nerve and muscle function. A trial of nonoperative management is warranted; however, this is associated with a high failure rate. Aspiration techniques are successful for decompression of the cysts and initial pain relief; however, the intra-articular pathology is not addressed and there is a higher rate of recurrence. Open resection of the ganglion cyst is successful; however, the intra-articular labral tears are not addressed, which can lead to recurrence and the morbidity of the cyst excision is not warranted. Shoulder arthroscopy has led to the identification of associated intra-articular pathology such as SLAP lesions. These were not appreciated previously with open surgery and therefore were not addressed. Arthroscopic techniques have evolved to allow decompression of the ganglion cysts and repair of the labral lesions. This should decrease the possibility of recurrence of the cyst by eliminating the cyst and the pathologic lesion that created it. Arthroscopic excision also avoids much of the morbidity of the open approach and allows intra-articular pathology to be addressed concomitantly. This point has been emphasized by other investigators also. Furthermore, because of the limited surgical dissection, rehabilitation is able to begin earlier, with less patient discomfort and more prompt return to normal activities.

Arthroscopy↗