Q112433201
Dotaz
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PURPOSE OF THE STUDY: The original aim of this prospective semi-randomised study was to determine associations between segmental sagittal alignment after Anterior Cervical Discectomy and Fusion (ACDF) and subjective and clinical results. Two types of cages, cage P with parallel end-plates and cage A with 5-degree angulations, were used in the patients treated for degenerative conditions. MATERIAL AND METHODS: A total of 94 consecutive patients, 56 treated by single-level ACDF and 38 undergoing a two-level procedure, completed 8 years of follow-up. The patients in equally-sized A and P subgroups were examined at 6 weeks and 1, 2 and 8 years after surgery. The follow-up included X-ray in a neutral lateral position, a questionnaire assessing pain in neck and shoulder regions and JOA scores. The results including the cumulative incidence of surgical procedures indicated for adjacent segment diseases were statistically evaluated. RESULTS: An average increase in the lordotic angle at 6 weeks after surgery was 2.32° for the implant P and 2.02° for the implant A subgroup. During 8 years of follow-up the average values decreased to 1.51° and 1.36°, respectively. The proportion of patients with no or minimal neck and shoulder pain decreased, in subgroup P, from the initial 85% at 6 weeks to 59% at 8 years after the surgery and, in subgroup A, from 89% to 40 %. The average JOA score of 16 at 6 weeks in both subgroups, at 8 years, had a value of 15.9 in subgroup P and 16.0 in subgroup A. The cumulative incidence of surgery for adjacent segment disease 8 years was 8.3% for subgroup P and 6.3% for subgroup A. No statistically significant differences between the subgroups at any follow-up period were recorded in either morphological characteristics or clinical outcomes. CONCLUSIONS: The ability to lordotize a segment by stand-alone ACDF is below the angular resolution of current radiographic methods, irrespective of the sagittal profile of the implant used. Comparable morphological results haven´t been reflected by significant difference in subjective and clinical outcome and also in the incidence of surgery for adjacent segment disease. Such results were not expected and therefore post-operative sagittal alignment mechanisms in stand-alone cage assisted ACDF will require further investigation. Key words:cervical vertebrae, surgical technique, spinal fusion, sagittal alignment, clinical outcome.
- MeSH
- analýza selhání vybavení MeSH
- degenerace meziobratlové ploténky radiografie chirurgie MeSH
- design vybavení MeSH
- diskektomie přístrojové vybavení MeSH
- dospělí MeSH
- fúze páteře přístrojové vybavení MeSH
- interní fixátory MeSH
- krční obratle radiografie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- prospektivní studie MeSH
- protézy a implantáty MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- klinické zkoušky MeSH
Cíl: Hlavní výzkumný problém studie je možnost validního posouzení poklesu kognitivní výkonnosti u pacientů po chirurgické či endovaskulární intervenci na mozkovém aneuryzmatu. Soubor a metodika: Autoři se zaměřují na rutinní klinický přístup v ČR – využití výsledků Wechslerovy inteligenční škály (WAIS-R) – porovnání celkové výše IQ s referenční normou, a dále na rozdíl mezi verbálním a neverbálním IQ. Celkem bylo neuropsychologicky vyšetřeno 80 pacientů z původních 168 přeživších subarachnoidální krvácení (SAK), s průměrným odstupem 1,7 roku od neurochirurgického zákroku. Výsledky: Průměrné celkové, verbální i neverbální IQ bylo statisticky významně sníženo vzhledem k referenční normě (o 6,6 a 5 bodů). Průměrný rozdíl mezi verbálním a neverbálním intelektem nebyl statisticky významný (0,5 bodu IQ, p = 0,92). Závěr: Autoři upozorňují na některé nedostatky v používání Wechslerovy inteligenční škály u této skupiny pacientů, především na absenci rozdílů mezi verbálním a neverbálním intelektovým výkonem, způsobenou možným vlivem difuzního poškození mozku; na stárnutí norem jako možnou příčinu absence kognitivního deficitu u části pacientů; na nedostatek informací o premorbidním stavu pacientů (vzhledem k nemožnosti provedení předoperačního vyšetření). Autoři doporučují využívání zkoušek premorbidního intelektu pro pacienty po neurochirurgických výkonech.
This study focuses on an assessment of cognitive functions in patients after cerebral artery aneurysm surgery. The main research problem is to obtain a valid assessment pertaining to the decrease of cognitive performance. Authors discuss routine clinical techniques which are applied in day to day practice in the Czech Republic – comparison of Full-Scale IQ with a reference norm and difference between verbal and performance IQ. Eighty out of the 168 patients were neuropsychologically evaluated for 1.7 years after the operation. The mean Full-Scale, Verbal and Performance IQ significantly decreased in comparison to the norm: 6.6 and 5 points, respectively. The mean difference between verbal and performance IQ was 0.5 points, p = 0.92. The authors point out some disadvantages of using WAIS-R in this group of patients: lack of difference between verbal and performance intellect, probably caused by diffuse brain injury; old norms as a probable reason for absence of cognitive deficit in some patients, insufficient information about premorbid intelligence level (pre-surgery testing not possible). The authors recommend using a premorbid intelligence test in patients after neurosurgery interventions.
- Klíčová slova
- kognitivní deficit, premorbidní intelekt,
- MeSH
- chronické poškození mozku komplikace psychologie MeSH
- dospělí MeSH
- financování organizované MeSH
- intrakraniální aneurysma komplikace MeSH
- kognitivní poruchy diagnóza epidemiologie psychologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- neverbální komunikace MeSH
- pooperační komplikace MeSH
- prasklé aneurysma chirurgie komplikace MeSH
- prospektivní studie MeSH
- psychometrie MeSH
- referenční hodnoty MeSH
- senioři MeSH
- stupeň vzdělání MeSH
- subarachnoidální krvácení chirurgie komplikace psychologie MeSH
- verbální chování MeSH
- Wechslerovy škály statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
To present a new technique of minimally invasive decompression of the cervical spinal canal using elastic and plastic deformation of the laminae. MATERIAL AND METHODS: Short midline vertical incision provides an access to the superior aspect of the target spinous processes. Cranial edge of the lamina is located by a midline, muscle-sparing interspinous dissection. The spinous process is cut in mid-sagittal plane using a thin blade of an ultrasonic bone scalpel down to epidural space. The created sagittal cleavage of the spinous process is subjected to tension and elastic distraction by a custom-designed distractor (Aesculap, Germany). Gradual increase of the distraction force leads to a significant plastic deformation. This reduces the distraction force and allows for a wider exposure which, in turn, facilitates dural visualization, resection of the yellow ligament and undercutting of approximately a half of the adjacent intact laminae. After completion of decompression, the plastic arch expansion can be maintained either by interposed bone-graft or appropriately shaped cage secured by a circumferential suture to the spinous process. Soft tissue resection and permanent expansion of the laminae provide sufficient decompression of the cervical spinal cord. In multilevel stenosis, the desired laminae can be expanded using this technique. To achieve the same degree of canal expansion as that by a classic laminoplasty (C3-7), a skip technique can be utilized. This involves combining expansive laminoplasty of C4 and C6 with bilateral undercutting of C5 and partial undercutting of C3 and C7. This can be achieved through two short vertical incisions. Based on data and experience gained from testing on 11 cadavers, we applied this method in 7 patients requiring posterior cervical decompression. RESULTS: The spinous process or laminae fractured during expansion in the initial 4 patients and the procedure required conversion to a minimally invasive laminectomy. Further modification of the distractor and spinous process splitting technique resulted in elimination of this complication in subsequent cases. In all remaining patients, sufficient canal expansion was achieved by soft tissue resection and distraction of laminae, typically reaching 5 - 8 mm. Minimally-invasive muscle-sparing midline approach provided very positive functional results in terms of postoperative pain and range of motion allowing for immediate mobilization without external bracing. CONCLUSION: Minimally invasive, muscle sparing, expansive laminoplasty provides adequate spinal canal expansion. Use of this technique and its muscle-sparing nature potentially result in improvement of early functional outcomes when compared to standard laminoplasty techniques requiring lateral lamina-facet border exposure. However, the theoretical superiority of this technique will need to be clinically scrutinized in a well designed surgical outcome study.
Implantace stimulačního systému SureScan umožňuje u pacienta s mnohočetnou kavernózní malformací mozku dlouhodobé sledování pomocí NMR, a tím správné načasování terapie
- Klíčová slova
- SureScan,
- MeSH
- kardiostimulátor škodlivé účinky MeSH
- lidé MeSH
- nemoci centrálního nervového systému MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Spinal navigation has substantially advanced during the past ten years. Surgeons have gained sufficient skills and confidence, and have introduced this technology to the anatomically challenging region of the upper cervical spine and craniocervical junction. The detailed evaluation of individual anatomy, rational pre-operative planning and final intraoperative control improve the safety and precision of classical surgical procedures. As methods technologically evolve, indication criteria change accordingly, but the basic principles of a relevatn choice remain; these are to reduce morbidity due to its three main causes, i.e., mechanical, neurological and vascular. We present an overview of current techniques and discuss their applicability in the region of the upper cervical spine and craniocervical junction. The systems allowing us to obtain live images intra-operatively, such as fluoroscopy or intra.operative CT, seem to be most versatile and accurate, especially when combined with traditional virtual navigation systems. Based on case histories, the authors suggest trends in the development of this field, with a focus on minimally invasive techniques. Key words: navigation, upper cervical spine, craniocervical junction.
- MeSH
- atlas (obratel) chirurgie MeSH
- axis chirurgie MeSH
- chirurgie s pomocí počítače MeSH
- fluoroskopie MeSH
- intervenční radiografie MeSH
- krční obratle chirurgie radiografie MeSH
- lidé MeSH
- magnetická rezonance intervenční MeSH
- počítačová rentgenová tomografie MeSH
- uživatelské rozhraní počítače MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
