ABSTRACT
The aim of the present study was to improve the feasibility of anterior decompression and stabilization of the cervico-thoracic junction with transmanubrial transclavicular approach and also to study the problems encountered in anterior reconstruction of the cervico-thoracic junction [CTJ]. Nine patients [mean age 32 +/- 7.33, range 13-60 years; mean duration of symptoms 6.06 +/- 3.07, range 1.5 -12 months; male to female ratio of 4:5] of various pathologies involving the CTJ who were operated by transmanubrial transclavicular approach were analyzed. Preoperative disability was scored using Harsh myelopathic grading system. Eight cases belonged to grade 3 and 4, one to grade 1. On radiology there was mean involvement of 2.2 +/- 0.97 vertebral levels [range 1 - 4]. Eight patients were operated from the left side with an average decompression of 2.11 +/- 0.93 [range 1 - 4] vertebral bodies. Clavicular graft was used in 8 .patients and iliac tricorticate graft in one with plating [instrumentation] done in 8 cases. All the patients showed improvement in immediate postoperative period with significant improvements in their Harsh grades and no major complication. The mean follow-up duration was 9.22 +/- 4.60 [range 1-16 months]. Transmanubrial transclavicular approach provides an excellent exposure of vertebrae and paravertebral spaces of CTJ [lower 2 cervical and upper 2 thoracic vertebrae] allowing anterior spinal cord decompression, grafting and instrumentation without any increase in morbidity and mortality as compared to the conventional approaches
ABSTRACT
The development of neurosciences has made the understanding and management of intracranial aneurysms better. It has been realized over the years that there may be a subgroup of patients who fare differently from the rest. The identification of factors which make the aneurysm different or complex may help in prognosticating patients. The aim of the current study was to identify such factors to assess how well they correlated with the outcome. Three-hundred-fourteen consecutive cases of spontaneous subarachnoid haemorrhage with intracranial aneurysms were retrospectively analyzed. Sixteen independent factors broadly categorized into three categories viz., patient related, radiological factors and surgery related factors were analyzed and their correlation with outcome studied. Univariate and multivariate analysis was done using logistic regression analysis and P values, and predictive values were determined. Five factors viz, WFNS grade 4-5, clinical vasospasm, smoking >/= 30 years, Fisher grade 3-4 and posterior circulation aneurysms were found to have highly significant association with poor outcome both using univariate and multivariate analysis. The clinical factors predominate and have more significant association with the outcome. The presence of factors viz, WFNS grade 4- 5, clinical vasospasm [DIND], smoking >/= 30 years, Fisher grade 3-4 and posterior circulation aneurysms were found to correlate with poor outcome and any of these factors could lead to poor outcome and are sufficient to label the patient as having a complex aneurysm
Subject(s)
Humans , Male , Female , Subarachnoid Hemorrhage , Retrospective StudiesABSTRACT
Over the years it has been found that multiple factors may influence the surgical outcome for lumbar disc hemiation. There are various series available studying the role of clinical factors in outcome, however, it may be that a multitude of patient related and clinico radiological factors may help predict a better outcome. A prospective analysis of 97 cases operated during the past 10 years was made excluding those with previous back surgery, with osseous stenosis and those operated on an emergency basis. A set of 17 independent factors related to patient particulars and clinico radiological parameters were included and outcome was analyzed in their relation. Multivariate analysis was done to form an outcome prediction model based on the analyzed factors. Modified Stauffer-Coventry criteria was used to assess outcome and it was found that for multivariate analysis factors found suitable were presence of backache and radicular pain, positive family history, hypertension, disc degeneration grade, crossed straight leg raising [CSLR] test and duration of symptoms. It was found on applying logistic regression using stepwise forward selection, a 97.5% correct predictability of good outcome and 75% correct predictability of poor outcome was obtained with an overall correct predictability of 93.8% with this model. All the factors showed a negative correlating value except the duration of symptoms. The mean follow-up was 47.96 + 28.52 [12 - 116] months. Accurate estimation of outcome may be possible using the standard patient related and clinico radiological parameters. Using them in combination, an outcome prediction model can be formulated which can help in prognosticating patients. The spectrum of patients may vary significantly in different series; however, if multiple factors are considered together, the prognosis can be predicted with reasonable accuracy. The prolonged duration of symptoms have a positive influence on prognosis whereas the presence of backache, hypertension, radicular pain, positive family history, CSLR and degeneration of disc had a negative influence on outcome