Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy

Background Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide on surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD + VP) can be simultaneously attempted. This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR. Methods This retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability and patients who have not been followed for more than 6 months, were excluded from this study. All patients underwent BEPLD + VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores. Results Most of the patients had DVC affecting level L4, with the deformation being a flat type or concave type rather than a wedge type. The VAS score (back and leg) significantly decreased from 7.78 ± 1.17 and 6.89 ± 1.13 preoperatively to 2.94 ± 0.64 and 2.67 ± 1.08 within 2 postoperative days (p < 0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p < 0.001). The mean recovery rate (RR) in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment, and no re-operation was required. Conclusions BELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.

Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy

Background: Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD+VP) can be simultaneously attempted. In particular, in high-risk elderly patients, BEPLD+VP can be performed under regional anesthesia, can reduce the need for spinal fusion, and can provide good clinical results such as rapid functional recovery. This study aimed to assess clinical outcomes of BEPLD+VP for the treatment of DVC-related LSR. Methods: This retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability, and patients who have not been followed for more than 6 months were excluded from this study. All patients underwent BEPLD+VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores. Results: Most of the patients had DVC affecting level L4, with the deformation being flat type or concave type rather than wedge type. The VAS score decreased from 8.1 preoperatively to 3.1 postoperatively (p<0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p<0.001). The mean RR in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment and no re-operation was required.Conclusions: BELPD+VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia, and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.

Clinical Follow-Up in Orofacial Clefts—Why Multidisciplinary Care Is the Key

(1) Background: Although most clinicians involved in the treatment of cleft patients agree upon the major importance of interdisciplinary cooperation and many protocols and concepts have been discussed in the literature, there is little evidence of the relevance of continuous interdisciplinary care. We aimed to objectify the type and number of therapeutic decisions resulting from an annual multidisciplinary follow-up. (2) Methods: We retrospectively analyzed the data of all 1126 patients followed up in the weekly consultation hours for cleft patients at university clinics in Leipzig for the years 2005–2020. We assessed the clinical data of every patient and specifically evaluated the treatment decisions taken at different points in time by the participating experts of different specialties. (3) Results: In total, 3470 consultations were included in the evaluation, and in 70% of those, a therapeutic recommendation was given. Each specialty showed certain time frames with intense treatment demand, which partially overlapped. Nearly all therapy recommendations were statistically attached to a certain age (p < 0.001). (4) Conclusions: There is an exceptionally high need for the interdisciplinary assessment of patients with cleft formation. Some developmental phases are of particular importance with regard to regular follow-up and initiation of different treatment protocols. The therapy and checkup of cleft patients should be concentrated in specialized centers.

Prospective Clinical Investigation of Orthodontic Relapse from Gingival Clefts

Background: Orthodontic space closure following premolar extraction may result in gingival cleft formation. This may contribute to orthodontic relapse due to reopening of extraction spaces. Purpose: 1) To see the effects gingival clefts have on relapse and opening of closed extraction spaces after orthodontic treatment. 2) To record any changes in cleft severity that may occur. 3) To evaluate any relationship between gingival phenotype and cleft severity. Methods: Subjects recruited from previous study in which gingival clefts were measured during space closure. The clinical measures included the occurrence and severity of clefts and their relationship to gingival phenotype. Results: Sites with a cleft (N=42) had 42.86% relapse and those without (N=19) had 36.84% relapse. Conclusions: As gingival cleft severity increases, the amount of relapse distance is likely to increase. Patients with a thick gingival phenotype who obtain gingival clefts in extraction sites during orthodontic treatment are more likely to have relapse post-treatment compared to sites which did not develop a gingival cleft.

Pancreatic Adenocarcinoma in a Young Woman

Despite significant improvement in the management strategy, pancreatic cancer continues to be a great challenge for surgeons and oncologists. Length of survival largely depends upon stage at diagnosis and a completeness of resection. Distal pancreatectomy with RO resection has been reported as a favorable method in selected pancreatic body and tail tumors. Additional organ resections are rarely required. A young woman was diagnosed with a tumor in the body and tail of the pancreas that required splenectomy in addition to dista1 pancreatectomy. Postoperative course was uneventful. Histopathology revealed the tumor as moderately differentiated adenocarcinoma with extensive areas of necrosis, haemorrhage and cholesterol cleft formation. Resected end of pancreas was free of tumor. She has completed a course of chemotherapy and is doing well after 8 months of surgery. Journal of Surgical Sciences (2014) Vol. 18 (2) : 78-82

Cholesteatoma and hydrocephalus associated to a third ventricle meningioma in a cat

ABSTRACT: Meningiomas are neoplasms that commonly involve the central nervous system of cats, while cholesteatomas are nodular granulomatous chronic lesions within the choroid plexus that are rarely reported in cats. This study described a case of cholesteatoma and non-communicating hydrocephalus associated to a third ventricle meningioma in a cat. Clinically, the cat had a 2-year history of behavioral changes, photophobia and motor incoordination. At the necropsy, a tan-brown mass totally occluded the third ventricle, causing a severe dilation of the lateral ventricles (non-communicating hydrocephalus). Microscopically, the mass was composed by a neoplastic proliferation of spindle cells arranged in bundles, containing in the center psammomatous bodies (meningioma), while in the adjacent areas a cholesteatoma was observed, which was characterized by multiple cholesterol cleft formation, hemosiderosis and associated granulomatous inflammation. At immunohistochemistry (IHC), neoplastic cells had a marked immunostaining for vimentin, while were negative for cytokeratin and S100. The diagnosis of transitional meningioma occurring in association to cholesteatoma and non-communicating hydrocephalus in a cat was obtained mainly by the histological and IHC features. These are important methods to distinguish this condition from other neurological disorders in cats.

Coupling of Ultrasonic and Photometric Techniques for Synchronous Measurements of Unconfined Turbidity Currents

By synchronizing data collection, such as photometric and ultrasonic Doppler profiling (UVP) measurement techniques, new insights can be obtained into environmental flows, such as highly dynamic turbidity currents. We introduce a combined experimental setup, which ultimately allows a time reduction in testing programmes, and discuss the measurement advances with the help of four surface conditions we tested for unconfined turbidity currents: (a) a smooth surface; (b) a smooth surface with an obstacle present; (c) a rough surface; and (d) a rough surface with an obstacle present. We show that data from both measurement techniques indicate that a rough surface reduces global current velocities and the magnitude of turbidity current phenomena, including Kelvin-Helmholtz instabilities and lobe-and-cleft formation. However, by coupling the techniques, photometric data give valuable insight into the spatial development of instabilities, such as the grouping of lobe and cleft formations. The presence of an obstacle causes local regions of an increased and decreased velocity, but does not affect the global current velocity. Additionally, the obstacle created three local intensity maxima upstream, dissipating to two maxima downstream, supporting the presence of local eddies. The study shows that the combination of UVP and photometry is an effective way forward for obtaining detailed qualitative and quantitative insights into turbulent flow characteristics and we highlight the potential for future research.