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PubMed2006

High patient satisfaction after arthroscopic subacromial decompression for shoulder impingement: a prospective study of 50 patients.

BACKGROUND: Arthroscopic subacromial decompression (ASD) for shoulder impingement has gained popularity. We evaluated the result of this common procedure prospectively, from a patient perspective. METHOD: We used the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Visual Analogue Scale (VAS) to evaluate 50 patients with a mean age of 49 (27-72) years. All patients had undergone 6 months of failed nonoperative treatment prior to surgery. Exclusion criteria were total rotator cuff rupture, shoulder instability, clinically verified acromioclavicular joint osteoarthritis, calcifying tendonitis or neurological symptoms. All the decompressions were done by experienced shoulder arthroscopists. RESULTS: A significant improvement in both the median DASH score and the VAS had occurred 6 months after surgery. INTERPRETATION: ASD for impingement in properly selected patients performed by experienced surgeons gives a high degree of patient satisfaction 6 months after surgery.

Activities of Daily Living↗
PubMed2003

Effect of decompression craniotomy on increase of contusion volume and functional outcome after controlled cortical impact in mice.

If, how, and when decompressive craniotomy should be used for the treatment of increased intracranial pressure after traumatic brain injury are widely discussed clinical subjects. Despite the large number of clinical studies addressing this issue, experimental evidence of a beneficial or detrimental role of decompressive craniotomy after brain trauma is sparse. Therefore, we investigated the influence of craniotomy on intracranial pressure, contusion volume, and functional outcome in a model of traumatic brain injury in mice. Male C57/Bl6 mice were craniotomized above the right parietal cortex and were subjected to controlled cortical impact injury. In control mice, the craniotomy was closed immediately after trauma, whereas in treated animals the craniotomy was left open. In control mice intracranial pressure (ICP) increased to a maximum of 23.7 +/- 3.1 mm Hg 6 h after trauma (p < 0.001), while in craniotomized animals, no ICP increase was observed. Twenty-four hours after trauma, the point in time of maximal lesion expansion, contusion volume in craniotomized mice was 40% smaller as compared to controls (18.3 +/- 2.0 vs. 30.2 +/- 3.5 mm(3), p < 0.04). Furthermore, craniotomized mice showed significantly improved motor function in a beam walking task (p < 0.04) and faster recovery of body weight after trauma (p < 0.02). Our results demonstrate that craniotomy blunts post-traumatic ICP increase, significantly reduces secondary brain damage and improves functional outcome after experimental TBI. Careful clinical evaluation of craniotomy as a therapeutic option after TBI in man may therefore be indicated.

Animals↗
PubMed2001

Cervical percutaneous laser disc decompression: preliminary results of an ongoing prospective outcome study.

OBJECTIVE: This study identifies the efficacy of laser disc ablation and compares the relative efficacy of Holmium2100; YAG and KTP532 laser wavelengths in the treatment of broad-based cervical disc protrusions presenting with cervical axial pain with compressive or noncompressive radicular symptoms. BACKGROUND: A preliminary report on a prospective outcome study of cervical laser disc ablation and decompression in the management of cervical disc prolapse and discographically confirmed discogenic pain in association with radicular pain. METHODS: Patients with chronic cervical pain and radicular symptoms unresponsive to conservative treatment were assessed with magnetic resonance (MR) scans. Those with broad-based disc bulge or discal degeneration were assessed with provocative discography to isolate the source of pain. Percutaneous laser disc decompression was performed as a day case procedure on 105 patients at 108 levels under X-ray control via the anterior approach with side-firing probes in patients. RESULTS: At a minimum follow up of 24 months, 51% of patients demonstrated a sustained significant clinical benefit with an additional 25% in whom functional improvement was noted. No difference in outcome was identified either with the wavelengths used or with laser annealing or painful discal tears. The cohort integrity of the study was 80%. CONCLUSION: The sustained nature of the benefit (mean 3.5 years at final follow up) after long-term preoperative symptoms (mean 3.9 years) in 76% patients rules out placebo effect. Benefits occurred independently of the wavelength of laser used.

Adult↗
PubMed2004

The effects of decompression and exogenous NGF on compressed cerebral cortex.

Using a rat epidural bead implantation model, we found that compression alone could reduce the overall and individual layer thicknesses of cerebral cortex with no apparent cell death. The dendritic lengths and spine densities of layer II/III and V pyramidal neurons started to decrease within 3 days of compression. Decompression for 14 days resulted in near complete to partial recovery of the cortical thickness and of the dendritic lengths of layer II/III and V pyramidal neurons, depending on the duration of the preceding compression. The recoverability was better following short (3-day) than long (1- or 3-month) periods of compression. The loss of dendritic spines nevertheless persisted. An intraventricular infusion of NGF was performed after decompressing the lesions following 3 days of cortical compression, and this increased the recovery of the spines but not the dendritic length of the cortical pyramidal neurons, nor did it alter the recovery of the cortical thickness. NGF also promoted the increase of the dendritic spines, but not the dendritic length of the cortical pyramidal neurons of normal animals. In short, the data show that a few days of compression alone can cause permanent cortical damage. Exogenous NGF, if applied topically, may restore the dendritic spine density of cortical neurons subjected to compression.

Animals↗
PubMed2005

Role of decompressive surgery in the management of severe head injuries: prognostic factors and patient selection.

Decompressive surgery or craniectomy (DC) is a treatment option, which should be considered when the intracranial pressure (ICP) cannot be treated by conservative methods. The purpose of this study was to evaluate the benefits of decompressive craniectomy in patients with intractable posttraumatic intracranial hypertension and to evaluate the patient selection criteria for this management protocol. In this study, 100 patients with severe head injuries were involved. All patients were treated according to the European Brain Injury Consortium (EBIC) guidelines for severe head injuries and were assessed based on individual initial Glasgow Coma Scores (GCS), age, Glasgow Outcome Score (GOS), presence of systemic injury, changes in ICP, presence of mass lesion and the right timing for DC. All patients presented with a GCS of 8 or below. Based on their initial GCS, the patients were divided in two groups of 60 (group I with GCS 4-5) and 40 (group II with GCS 6-8) in each, respectively. Prognosis was evaluated according to the (GOS). After treatment with DC, 84 of the patients (84%) showed unfavorable and 16 (16%) showed favorable outcomes. In group I, 58 patients (96.6%) showed unfavorable and two (3.4%) showed favorable outcomes. In group II, 26 (65%) patients showed unfavorable and 14 (25%) showed favorable outcomes. The importance of initial GCS and age in patient outcomes were statistically significant. The presence of systemic injuries or mass lesions in outcomes were not statistically significant. Based on our findings, we conclude that patients with Glasgow Coma Scores of 6-8 are the best candidates for DC treatment.

Adolescent↗
PubMed1985

Is routine postoperative nasogastric decompression really necessary?

Controversy exists regarding the need for nasogastric tube decompression and the incidence of complications resulting from its use following major intra-abdominal surgery. To determine the value of such tubes, 100 patients were managed after surgery with a nasogastric tube in situ until the passage of flatus per rectum (Group I). In a second group of 100 patients, no nasogastric tube was placed after surgery unless vomiting, gross distention, or overt obstruction occurred (Group II). In Group I, the nasogastric tube remained in place an average of 6 days and five patients required replacement of the tube after its initial removal. In Group II, nasogastric intubation was required at some point after surgery in six patients. No aspiration pneumonia, nasal septum necrosis, anastomotic leak, or wound dehiscence was seen in either group. There were three wound infections in Group I and two in Group II. The most obvious difference was the increased comfort and mobility of the group of patients treated without routine nasogastric decompression (Group II). Routine use of the nasogastric tube adjunct to patient care following gastrointestinal tract surgery may be safely eliminated.

Cholecystectomy↗
PubMed1998

Ruptured globe during orbital decompression surgery.

A 74-year-old patient sought treatment for visual obscuration and clinically had signs of Graves orbitopathy. Past medical history was unremarkable except for the use of antihypertensive medication. During the hospital admission, a fluorescent treponemal antibody absorption test was reactive, indicating infection with syphilis at some time in the past. Visual deterioration despite oral corticosteroid therapy prompted orbital decompression. At the time of surgery, she sustained a globe rupture. Presumably, syphilitic scleritis was responsible, in part, for scleral thinning and weakening, predisposing her to this complication. To the authors' knowledge, globe rupture has not been previously reported during orbital decompression.

Aged↗
PubMedDate not supplied

Microvascular decompression.

Microvascular decompression (MVD) remains the only treatment of trigeminal neuralgia that directly addresses the presumed pathogenesis. It is a proven therapy, associated with the longest duration of pain relief while preserving facial sensation. The authors' premise for advocating early MVD is the belief that the disease's natural progression, in the absence of treatment, is toward the development of more atypical features that are refractory to treatment, signifying ongoing neuropathic injury. In an effort to more successfully select candidates for MVD, the authors have incorporated high-resolution magnetic resonance imaging into our preoperative algorithm, since it has proven extremely accurate in defining the neurovascular relations at the trigminal nerve complex. Microvascular decompression can only be recommended when it is performed with low rates of morbidity.

Decompression, Surgical↗
PubMed2001

Decompressive surgery for typical lumbar spinal stenosis.

Between 1991 and 1992, 103 consecutive patients (average age, 65 years) underwent decompressive surgery for treatment of typical lumbar spinal stenosis. Clinical results at 1-year followup revealed that four patients had revision surgery. At 2- to 5-years followup, there were no additional revision surgeries. Two patients underwent revision surgery for a deep infection, and two underwent revision surgery for a superficial infection. Outcome results showed that 77 patients completed the questionnaire, 15 were lost to followup and 11 died. Postoperative results showed that 64 of 77 patients had no or mild pain, 72 of 77 patients stated that they were satisfied or somewhat satisfied with their overall results of surgery, and 73 of 77 were satisfied with pain relief. Younger patients had greater improvement in function and a greater reduction in severity scores. However, satisfaction was similar in both groups. Survivorship results (failure was revision surgery) showed at the end of 4 years, a patient had a 95% chance of not having revision surgery. Statistically, there was no association between outcome and cofactors such as scoliosis, spondylolisthesis, number of levels decompressed, discectomy, or smoking. Satisfaction rates for older patients were similar to patients younger than 65 years although physical function scores and severity scores were less.

Aged↗
PubMed2001

Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis.

Between 1990 and 1993, 54 consecutive patients were treated with decompression, fusion and instrumentation surgery for complex lumbar spinal stenosis. The mean age of the patients was 60 years. The average followup was 39 months. Clinically, there was one deep wound infection, and three mechanical failures. There were two staged operations. There were three revision surgeries performed for mechanical reasons. Of the 47 patients who completed the questionnaire, 96% of patients were very satisfied or somewhat satisfied with the operation, 98% were satisfied with relief of pain, 94% were satisfied with their ability to walk, 89% were satisfied with their strength, and 94% were satisfied with balance. Survivorship analysis (failure endpoint was revision surgery) revealed that at the end of 4 years, the patient had a 92% chance of not undergoing revision surgery for any reason (mechanical and infectious), and a 94% chance of not undergoing revision surgery for mechanical reasons. Lumbar decompression, fusion, and instrumentation surgery seems to be efficacious in patients with complex lumbar spinal stenosis (associated previous lumbar spine operations with evidence of radiographic instability, radiographic evidence of junctional stenosis after surgery, radiographic evidence of instability, degenerative spondylolisthesis greater than Grade I with instability, if present, and degenerative scoliosis with a curve greater than 20 degrees).

Decompression, Surgical↗
PubMed2001

Distraction laminoplasty for decompression of lumbar spinal stenosis.

Distraction laminoplasty is a technical modification of routine laminectomy that allows decompression of the lumbar spinal canal with maximal bone preservation. The technique involves the application of a distraction force, in conjunction with an undercutting laminoplasty technique. It is safe, easily applied, and allows excellent canal visualization and decompression with minimal bone resection. The purpose of the current study is to describe the technical aspects of the technique.

Decompression, Surgical↗
PubMed2001

Predicting complications in elderly patients undergoing lumbar decompression.

A retrospective chart review of 68 patients 70 years of age or older who underwent decompressive procedures of the lumbar spine with or without fusion for benign conditions was performed to determine the ability of preoperative assessment of medical comorbidities to predict early postoperative complications. Patients 70 years of age or older who underwent decompressive procedures on the lumbar spine with or without fusion from January 1, 1990 to June 30, 1996 were identified. A chart review focused on preoperative comorbid diseases and early postoperative complications. A telephone survey was performed to assess patient satisfaction. Thirty-four women and 34 men with an average of 76.5 years averaged 1.6 comorbidities. Thirteen patients did not have comorbidities. The weighted comorbidity index resulted in an average score of 1.9. Eighty-five percent of the patients underwent posterolateral fusion. The total complication rate was 40%. Serious complications potentially affecting quality of life occurred in 12% of patients. The early mortality rate was 1.4%. The authors were unable to show a significant relationship between comorbidities and postoperative complications. Seventy-one percent of the 44 patients who were contacted at an average 42 months postoperatively were satisfied with their outcome. Elderly patients can safely undergo lumbar spinal procedures with an outcome similar to younger patients.

Aged↗
PubMed2001

Minimal medial epicondylectomy and decompression for cubital tunnel syndrome.

Sixty-four patients (66 elbows) treated for refractory cubital tunnel syndrome had minimal medial epicondylectomy and in situ decompression to minimize the potential disadvantages of classic medial epicondylectomy. After a mean followup of 27 months results were excellent in 27 patients (44%), good in 23 patients (35%), fair in 10 patients (15%), and poor in four patients (6%). No ulnar nerve palsy, ulnar nerve subluxation, or medial elbow instability were seen. The main complaint of patients regarding the procedure was tenderness at the osteotomy site. The results show that minimal medial epicondylectomy and in situ decompression of the ulnar nerve is a safe and effective method to treat patients with cubital tunnel syndrome. This procedure minimizes the disadvantage of medial instability and recurrent symptoms attributable to nerve trauma after a classic medial epicondylectomy.

Adolescent↗
PubMed1988

Is there a role for the autochthonous bubble in the pathogenesis of spinal cord decompression sickness?

Histological examination by light and electron microscopy of the spinal cords of four dogs rapidly perfusion-fixed after the onset of decompression sickness revealed the presence of numerous non-staining, space-occupying lesions that were absent in similarly prepared sections of control or ischemic spinal cords. We propose the hypothesis that these lesions are caused by the liberation of a gas phase. The possible significance of these lesions in the evolution of spinal cord dysfunction is discussed with reference to the principal theories of the pathogenesis of spinal cord decompression sickness.

Animals↗
PubMed1996

Timing of surgical decompression and fixation of acute spinal fractures.

A retrospective evaluation of 138 patients requiring operative decompression, reduction and fixation of spinal injuries between January 1986 and April 1989 was conducted. The variables of timing and method of operative intervention, level and classification of fracture, associated injuries, injury severity score (ISS), associated neurologic deficits, length of intensive care unit and hospital stays, and projected costs were analyzed for correlation with postoperative complications (pulmonary, skin, urinary, other). Four subgroups were identified: group IA patients underwent surgery within 72 h of injury and had an ISS of < 18; group IB patients underwent surgery after 72 h and had an ISS of < 18; group IIA patients underwent surgery within 72 h and had an ISS of > or = 18; and group IIB underwent surgery after 72 h and had an ISS of > or = 18. There was no statistically significant difference in the incidence of medical complications in patients comparing groups IA and IB. Group IIB patients had a statistically significant higher rate of morbidity than did group IIA. A separate group of patients with cervical spine injuries with neurologic deficit was analyzed by the same statistical analysis. Irrespective of associated injuries, all had fewer complications if they underwent surgery within 72 h. Morbidity was higher in patients with a neurological deficit compared with neurologically intact patients. Surgical decompression, reduction, and/or fixation of spinal fractures within the first 72 h is indicated in patients with multiple trauma (ISS > or = 18) and cervical injuries with a neurological deficit.

Adolescent↗
PubMed1999

Decompressive surgery in acute head injuries: where should it be performed?

BACKGROUND: In Norway, most patients with severe head injuries are transported to, and operated in, the neurosurgical unit of the regional university hospital. However, some patients are still occasionally operated on in county central hospitals by orthopedic or general surgeons who do not have neurosurgical expertise. The aim was to analyze this surgical activity outside the neurosurgical units. METHODS: Data were collected from two sources: a nation-wide survey and the records of all patients with a severe head injury occurring within Vestfold county (1987-1996). RESULTS: The Norwegian county central hospitals perform each only 2.5 to 3 surgical evacuations of intracranial hematomas per year. In Vestfold county, a total of 161 patients were hospitalized alive with an acute severe head injury. One third of the patients (54 patients) underwent decompressive surgery, mostly evacuations of intracranial hematomas. The patients operated on in the central hospital had a significantly worse outcome than the patients who were transferred to and operated on in the neurosurgical unit of the regional hospital. Only patients with extracerebral hematomas were operated on in the central hospital. Patients with an extradural (epidural) hematoma had a better outcome than patients with an acute subdural hematoma. Based on the surgery records and preoperative and postoperative computed tomographic scans, one third of the operations (10 operations) in the central hospital were classified retrospectively as inadequate, because the hematoma was not evacuated or found or because the surgeons did not achieve control of the perioperative bleeding. The overall mortality rate was 29.8%. CONCLUSION: The present study indicates that, in Norway and countries with a similar hospital system, it must be difficult for general and orthopedic surgeons to achieve and maintain the skills required for emergency operations in patients with acute severe head injuries. Thus, it is probably to the patients' benefit to improve the general hospitals' competency and speed in the detection of candidates for surgical decompression, and stress the importance of these patients being transferred without unnecessary delay to a neurosurgical unit.

Acute Disease↗
PubMed1997

Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm.

OBJECTIVE: We evaluated the follow-up results of microvascular decompression in 1032 patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS), who underwent operations between 1976 and 1991 and were followed for more than 5 years. METHOD: Patients were divided into two groups, and their follow-up results were compared and studied. The early series, Group A (1976-1986), comprised 588 patients (127 with TN and 461 with HFS) followed from 10 to 20 years (mean, 12.6 +/- 2.1 yr), and the recent series, Group B (1987-1991), comprised 444 patients (154 with TN and 290 with HFS) followed from 5 to 9 years (mean, 7.0 +/- 1.4 yr). RESULTS: The immediate postoperative cure rates were 92.9% in Group A and 96.7% in Group B for TN and 97.4% in Group A and 98.3% in Group B for HFS. Satisfactory results obtained by the follow-up study were 80.3% in Group A and 82.5% in Group B for TN and 84.2% in Group A and 89.0% in Group B for HFS. Incomplete cure rates were 7.1% in Group A and 3.3% in Group B for TN and 2.6% in Group A and 1.7% in Group B for HFS. Recurrence rates were 10.2% in Group A and 6.5% in Group B for TN and 8.9% in Group A and 6.9% in Group B for HFS. Postoperative hearing dysfunction occurred in 7.1% of patients with TN in Group A and 4.5% in Group B and 9.1% of patients with HFS in Group A and 3.7% in Group B. CONCLUSION: Improved methods of repositioning the affected vessels and of straightening the axis of the trigeminal nerve are important to obtain satisfactory follow-up results after microvascular decompression.

Adult↗
PubMed1997

One-year outcome after decompressive surgery for massive nondominant hemispheric infarction.

OBJECTIVE: Massive cerebral infarction is often accompanied by early death secondary to transtentorial herniation. We have tested the hypothesis that decompressive hemicraniectomy for massive nondominant cerebral infarction is lifesaving in a series of 14 patients presenting with right hemispheric infarction and clinical signs of uncal herniation and impending death. We have further analyzed, in prospective follow-up examinations, the levels of physical, psychiatric, and social disabilities in these patients. METHODS: The methods used included retrospective analysis to determine rates of immediate mortality and morbidity after surgical intervention. Prospective follow-up data were obtained to determine the level of recovery in surviving patients after 1 year. Standardized measures of outcome to assess physical, psychiatric, and social recovery included the Barthel Index, Zung Depression Scale, and Reintegration to Normal Living Index. RESULTS: With decompressive hemicraniectomy, we were able to prevent death secondary to transtentorial herniation in all cases; 11 patients experienced long-term survival after the procedure, and three deaths were related to non-neurological causes. We observed that 8 of the 11 surviving patients were at home, were functioning with minimal to moderate assistance, and had Barthel scores greater than 60. The remaining three patients were severely disabled. Seven of the 11 survivors were able to walk at 1 year after undergoing the procedure. Depression and failure to reintegrate socially were experienced by most patients. CONCLUSION: This series confirms the lifesaving nature of hemicraniectomy in patients deteriorating because of cerebral edema after infarction. In patients younger than 50 years, recovery to a state of near-independence is possible.

Activities of Daily Living↗