Predictors of Successful Outcome for Lumbar Chemonucleolysis: Analysis of 3000 Cases during the Past 14 Years

Neurosurgery ◽  
2002 ◽  
Vol 51 (suppl_2) ◽  
pp. S2-123-S2-128 ◽  
Author(s):  
Young-Soo Kim ◽  
Dong-Kyu Chin ◽  
Yong-Eun Cho ◽  
Byung-Ho Jin ◽  
Do-Heum Yoon
Keyword(s):  
Back Pain ◽  
Clinical Outcome ◽  
Patient Group ◽  
Chief Complaint ◽  
Leg Pain ◽  
Successful Outcome ◽  
Duration Of Symptoms ◽  
Straight Leg Raising ◽  
Selection Of Patients ◽  
Selection Of

Abstract OBJECTIVE Among numerous minimally invasive procedures for the treatment of herniated lumbar disc disease (HLD), chymopapain chemonucleolysis has the longest history of clinical usage. Long-term studies indicated good clinical results with a low risk for patients. However, much confusion still remains about the indications. This study was conducted to evaluate the predictors of successful outcome for chemonucleolysis and to firmly establish the proper indications for this procedure. METHODS Three thousand patients with HLD were treated with chemonucleolysis between 1984 and 1999. The clinical success rate in our series was 85%. The medical history and physical and radiological findings, including the type and direction of disc herniation, were analyzed retrospectively. RESULTS The patient group with the chief complaint of leg pain achieved a better clinical outcome than the patient group with low back pain (88% versus 59%, P < 0.05). A positive straight-leg-raising test was strongly correlated with good clinical outcome (< P < 0.05). Patients manifesting a soft, protruded disc had a better outcome than those manifesting diffuse bulging disc (< P < 0.05). Other prognostic factors favoring a good outcome were as follows: young age, short duration of symptoms, and no bony spur or calcification on radiological study. CONCLUSION Chymopapain chemonucleolysis is a safe and effective procedure. Proper selection of patients is important for the success of treatment. We propose the following three clinical criteria (Kim's triad) for selection of patients: chief complaint of leg pain rather than back pain, positive straight-leg-raising test, and soft protruded disc.

Cardioversion of Atrial Fibrillation: How Important is a Long Arrhythmia Duration?

1994 ◽  
Vol 39 (3) ◽  
pp. 78-79
Author(s):  
G.Y.H. Lip ◽  
K.J. Hogg
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Successful Outcome ◽  
Proper Selection ◽  
Long Duration ◽  
Selection Of Patients ◽  
Selection Of

A long duration of atrial fibrillation is usually considered as an adverse feature for successful cardioversion of atrial fibrillation and the maintenance of sinus rhythm. This often leads to the exclusion of such patients from being considered for this procedure. We report three patients in whom atrial fibrillation was present for a long duration (one for 2 years, two for 10 years), and successful cardioversion to sinus rhythm was achieved. Proper selection of patients with atrial fibrillation with an understanding of all features predicting a successful outcome will often allow a good result.

scholarly journals Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome

2020 ◽  
pp. 219256822094251
Author(s):  
Freyr Gauti Sigmundsson ◽  
Anders Möller ◽  
Fredrik Strömqvist
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Rating Scale ◽  
Leg Pain ◽  
Successful Outcome ◽  
Neurogenic Claudication ◽  
Lumbar Spinal ◽  
Outcome Of Surgery

Study Design: Prospective register cohort study. Objectives: The indication for surgery in patients with lumbar spinal stenosis (LSS) is considered to be leg pain and neurogenic claudication (NC). Nevertheless, a significant part of patients operated for LSS have mild leg pain levels defined as leg pain ≤minimally important clinical difference (MICD). Information is lacking on how to inform these patients about the probable outcome of surgery. The objective was to report the outcome of surgery for LSS in patients with a mild preoperative level of leg pain. Methods: A total of 2559 patients operated upon for LSS with preoperative leg pain ≤3 NRS (Numerical Rating Scale) were evaluated for outcome at the 1-year follow-up. NRS for back pain, the Oswestry Disability Index (ODI), and the EuroQol (EQ-5D) were used. Results: In the period 2007 to 2017, we identified 3239 patients (14%) who had mild leg pain (≤3 on the NRS). In this cohort, leg pain increased 0.40 (0.56-0.37) and back pain decreased 1.0 (0.95-1.2) at the 1-year follow up. ODI decreased 11.1 (10.2-11.4) and the EQ-5D increased 0.15 (0.17-0.14). A total of 31% reached successful outcome in terms of back pain, 43% in terms of ODI and 48% in terms of EQ-5D. 63% of the patients were satisfied with the outcome. Conclusion: A minority of patients with mild leg pain levels operated upon for LSS attain MICD for back pain, ODI, and EQ-5D. The results from this study can aid the surgeon in the shared decision-making process before surgery.

Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and back pain

2014 ◽  
Vol 20 (6) ◽  
pp. 617-622 ◽  
Author(s):  
Michiel B. Lequin ◽  
Dagmar Verbaan ◽  
Gerrit J. Bouma
Keyword(s):  
Back Pain ◽  
Patient Group ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Good Recovery ◽  
Trabecular Metal ◽  
The Mean

Object Patients with recurrent sciatica due to repeated reherniation of the intervertebral disc carry a poor prognosis for recovery and create a large burden on society. There is no consensus about the best treatment for this patient group. The goal of this study was to evaluate the 12-month results of the placement of stand-alone Trabecular Metal cages in these patients. Methods The authors performed a retrospective analysis of 26 patients with recurrent disc herniations treated with stand-alone posterior lumbar interbody fusion (PLIF) with Trabecular Metal cages. At 1 year patients were evaluated using the Roland Morris Disability Questionnaire (RMDQ) and a visual analog scale (VAS) for back and leg pain. Furthermore, Likert scores of perceived recovery and satisfaction with the treatment were recorded. Lumbar spine radiographs after 1 year were compared with postoperative radiographs to measure subsidence. Stability of the operated segment was assessed using dynamic radiography. Results The patient group consisted of 26 patients (62% male) with a mean age of 45.7 ± 11.4 years (± SD). Patients had a history of 1 (31%), 2 (42%), or more (27%) discectomies at the same level. The mean follow-up period was 15.3 ± 7.3 months. At follow-up the mean VAS score for pain in the affected leg was 36.7 ± 27.9. The mean VAS score for back pain was 42.5 ± 30.2. The mean RMDQ score at follow-up was 9.8 ± 6.2. Twelve (46%) of the 26 patients had a global perceived good recovery. With respect to treatment satisfaction, 18 patients (69%) were content or very content with the operation and would recommend it. Disc height was increased immediately postoperatively, and at the 1-year follow-up it was still significantly higher compared with the preoperative height (mean 41% ± 38.7%, range −25.7 to 126.8, paired t-test, both p < 0.001), although a mean of 7.52% ± 11.6% subsidence occurred (median 2.0% [interquartile range 0.0%–10.9%], p < 0.003). No significant correlation between subsidence and postoperative back pain was found (Spearman's rho −0.2, p = 0.459). Flexion-extension radiographs showed instability in 1 patient. Conclusions Although only 46% of patients reported a good recovery with significant reductions in back and leg pain, 85% of patients reported at least some benefit from the operation, and a marked improvement in working status at follow-up was noted. In view of previously published poor results of instrumented lumbar fusion for patients with failed back surgery syndrome, the present data indicate that Trabecular Metal interbody fusion cages can be used in a stand-alone fashion and should not always need supplemental posterior fixation in patients with recurrent disc herniation without spinal instability, although a long-term follow-up study is warranted.

scholarly journals The Effect of Symptom Duration on Outcomes After Fusion for Degenerative Spondylolisthesis

2018 ◽  
Vol 9 (5) ◽  
pp. 487-491 ◽  
Author(s):  
John Fleming ◽  
Steven D. Glassman ◽  
Adam Miller ◽  
John R. Dimar ◽  
Mladen Djurasovic ◽  
...  
Keyword(s):  
Back Pain ◽  
Statistical Significance ◽  
Degenerative Spondylolisthesis ◽  
Leg Pain ◽  
Symptom Duration ◽  
Positive Trend ◽  
Duration Of Symptoms ◽  
Preoperative Symptom ◽  
Primary Surgery ◽  
Patient Reported

Study Design: Longitudinal comparative cohort. Objectives: To determine if the duration of symptoms in patients with degenerative spondylolisthesis affects postoperative outcomes after 1- or 2-level decompression and fusion. Methods: Patients undergoing primary surgery for grade 1 degenerative spondylolisthesis at a single Quality Outcomes Database (QOD) participating site were identified. Demographic, surgical and patient-reported outcomes (PROs) data, including baseline and 12-month postoperative Oswestry Disability Index (ODI), back pain (BP, 0-10), leg pain (LP, 0-10), and EuroQOL-5D (EQ-5D) scores were collected. Individual medical records were reviewed for data on duration of symptoms prior to surgery. Patients were stratified into 3 cohorts—those with preoperative symptom duration of less than 1 year, 1 to 2 years, or greater than 2 years. Results: Complete data was available in 123 patients. Significant improvement in ODI, BP, and LP scores were observed in all groups. At 12-month follow-up improvement in ODI, BP, or LP was similar among the cohorts; with a trend toward significance with better improvement in LP scores in patients with a symptom duration of less than 1 year to those with symptom duration greater than 2 years ( P = .058). Conclusions: The duration of symptoms up to 2 years prior to surgery may not be a useful predictor of improvement of back pain or disability scores in patients with spondylolisthesis requiring decompression and fusion. Although there was a positive trend for improvement in leg pain for those with a shorter duration of symptoms, this did not reach statistical significance in our study.

The Backed-Up Bed Blocker

2020 ◽  
pp. 49-54
Author(s):  
Pat Croskerry
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Urinary Retention ◽  
Emergency Physician ◽  
Chief Complaint ◽  
Middle Aged ◽  
Sphincter Tone ◽  
Straight Leg Raising ◽  
Middle Aged Male

In this case, a middle-aged male presents to a busy community emergency department with a chief complaint of constipation. The emergency physician cannot see him immediately and gives an order to a nurse for a saline enema. It proves ineffective (fortuitously). When the physician later assesses the patient, the patient is complaining of back pain and found to have weakness on straight leg raising, reduced sphincter tone, and urinary retention. His problems turn out to be more complicated than constipation.

Role of Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

2013 ◽  
Vol 8 (2) ◽  
pp. 110-112
Author(s):  
ATM Iqbal Hasan ◽  
SA Ahsan ◽  
AKM F Rahman ◽  
CM Ahmed ◽  
M Safiuddin ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Therapeutic Option ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Successful Outcome ◽  
Outflow Obstruction ◽  
Septal Thickness ◽  
Percutaneous Septal Ablation ◽  
Selection Of Patients ◽  
Selection Of

HCM is a relatively common genetic mediated primary cardiac disease which may cause sudden death in the young including competative athlets.PTSMA is an alternative therapeutic option for surgical septal myomectomy who are high risk for surgery and presented with severe disabling symptoms due to marked LV outflow obstruction. PTSMA is performed by injection of 1 to 4 ml of 96% to 98% ethanol into the target artery in 0.5 to 1.0 ml aliquots at 1 ml/min. Selection of patients for PTSMA includes those with severe symptoms refractory to maximum medical management associated with LV outflow gradient > 50 mm Hg and basal septal thickness > 18 mm. Successful outcome following septal ablation by LV outflow gradient often reduced to < 20 mm of Hg and improved from symptomatic standpoint. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16083 University Heart Journal Vol. 8, No. 2, July 2012

scholarly journals Outcome of Endoscopic Discectomy in Patients with Lumbar Prolapsed Intervertebral Disc

2019 ◽  
Vol 23 (3) ◽  
pp. 228-233
Author(s):  
FAIQ SHEIKH ◽  
FAHEEM AHMAD USMANI ◽  
HAMMAD MALIK
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Case Series ◽  
Leg Pain ◽  
Low Back ◽  
Duration Of Symptoms ◽  
Endoscopic Discectomy ◽  
Before And After ◽  
Prolapsed Intervertebral Disc

Objective: To determine the outcome of endoscopic discectomyin patients with lumbar prolapsed intervertebral disc in terms of back pain and leg pain using the visual analogue scale.Material and Methods: Descriptive case series, was conducted at, PINS, LGH Lahore for 6 months. 15 patients were included through non probability consecutive sampling that fulfilled inclusion criteria. All patients’ low back pain and leg pain was documented using visual analogue scale before and after 2 months of surgery.On the basis of VAS we calculated % age improvement of low back pain and leg pain after endoscopic discectomy, while ≥ 5 scale improvement was considered clinically significant.Results: Patients mean age was 44.46 years. Among them, 9 (60%) were males and 6(40%) were females. On average, the basal metabolic index (Kg/m2) was 29.29 However, the BMI of females was 31.76 and male was 27.65 Kg/m2. On average, the duration of symptoms was 8.05 months. On average, the Straight Leg Raise was 24.7o at the time of treatment. A decreased sensation was observed in L5 of 3 (20%) and in S1 of 4 (26.67%) participants. Whereas Absent sensation was observed in L5 of 3(20%) and in S1 of 5 (33.33%). Mean preoperative back pain and as well as leg pain was 7.05 that improved to 0.41 and 0.86 4 weeks post operatively.Conclusion: Endoscopic discectomy is equally effective in alleviating the symptoms without notable difference in surgical outcome.

Speech Therapy and Language Recovery in Severe Aphasia

1970 ◽  
Vol 13 (3) ◽  
pp. 607-623 ◽  
Author(s):  
Martha Taylor Sarno ◽  
Marla Silverman ◽  
Elaine Sands
Keyword(s):  
Speech Therapy ◽  
Programmed Instruction ◽  
Sex Distribution ◽  
Duration Of Symptoms ◽  
Treatment Groups ◽  
Treatment Conditions ◽  
Language Recovery ◽  
Terminal Behavior ◽  
Selection Of Patients ◽  
Selection Of

This study was designed to investigate whether speech therapy enhances language recovery in severe aphasia and whether or not the method of speech therapy used affects recovery if it occurs. Thirty-one post CVA, severe expressive-receptive aphasics were assigned to one of three groups: programmed instruction, nonprogrammed instruction, and no treatment. All groups were comparable with respect to age, duration of symptoms, sex distribution, and education. Patients were initially tested to establish their level of functional language skills and ability to perform the terminal behaviors to be taught. Patients in the treatment groups received up to 40 hours of therapy. Posttests were administered individually after each terminal behavior was taught. All posttests were readministered at the termination of treatment and again one month after termination to determine the degree to which a behavior had been retained. There were no significant differences in outcome under the three treatment conditions Results strongly suggest that current speech therapy does not modify verbal behavior in this population. A more realistic approach to the overall rehabilitation management of the severe aphasic, and more careful selection of patients who will receive speech therapy is suggested.

Selection of patients for portal-systemic shunts

JAMA ◽  
1966 ◽  
Vol 196 (12) ◽  
pp. 1039-1044 ◽  
Author(s):  
R. E. Hermann
Keyword(s):  
Selection Of Patients ◽  
Selection Of
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