Curb the pain of spondylolisthesis; comparing posterolateral fusion with posterior lumbar interbody fusion

Background and Aim: the purpose of this study was to evaluate and compare the pain of patients with spondylolisthesis who had undergone either of the surgery techniques: posterolateral fusion [PLF] or posterior lumbar interbody fusion [PLIF]

Methods and Materials/Patients: in a prospective observational study, 102 surgical candidates with low grade degenerative and isthmic spondylolisthesis were enrolled from 2012 to 2014. The observed patients were into two groups: PLF and PLIF. Assessing of pain has been done by a questionnaire using Visual Analogue Scale [VAS] scores. The questionnaire was completed by all patients before surgery, the day after surgery, after six months and after one year

Results: there were no statistically significant differences in terms of age and sex distribution, type of spondylolisthesis and pre-operation pain between groups [p>0.05]. Comparison of the mean VAS scores of two groups over the whole study period showed a significant statistical difference [p-value<0.05], although comparison of VAS at three points in time showed a mixed result. VAS scores showed no significant differences between two groups before surgery, the day after surgery and one year after surgery [p>0.05], but the difference of mean VAS scores between groups 6 months after surgery was statistically significant [p<0.05]. Analyzing the course of VAS scores over the study period showed a descending pattern for either of the groups [p<0.0001]

Conclusion: both surgical fusion techniques [PLF and PLIF] showed to be effective in treating low grade degenerative and isthmic spondylolisthesis, but PLIF was related to better outcome with respect to pain control

Relationship of the P angle with stereotactic Arc in intraoperative outcome of patients with Parkinson's disease undergoing deep brains stimulation

Background and Aim: DBS [deep brain stimulation] is a new and successful technique in treatment of symptoms of Parkinsonism especially after drug resistance. Research in this field is mostly designed for evolution of this technique. The present study aimed at evaluating the relationship between the angle formed in midsagittal and STN [sub-thalamic nucleus] axis line and recording length in the final electrode p lacement

Methods and Materials/Patients: 46 patient candidates for DBS operation were studied in terms of demographic variables, STN nucleus length, the angle between midsagittal line and STN axis [p angle], the number of tested electrodes, force and length of final electrode registration and final coordinates of the placed electrode. The primary information was obtained from patients records and other technical information based on MRI imaging using Stereonata software and during surgery. The information were analyzed using SPSS [version 16] and descriptive analysis and linear relationship

Results: the mean force of the recording from trial microelectrodes implanted in the right side ranged from 1.49 +/- 1.45 to 2.65 +/- 1.42 and in the left side from 1.53 +/- 1.35 to 2.65 +/- 2.30. In comparative analysis, no significant statistical relationship was found between P angle of the right side and degree registered in the final electrode of the right side [Pearson correlation: 0.314, P value= 0.049]

Conclusion: not only accurate electrodes positioning in the STN can lead to improved outcome within bilateral STN DBS, but also optimizing defined P angle can have beneficial effects on intraoperative outcome after STN DBS

single posterior approach for vertebral column resection in adults with severe rigid kyphosis

Correction of severe kyphosis is a challenging operation in spinal surgery. A two stage operation has been commonly used: anterior release and decompression followed by posterior correction and fusion. We describe the posterior vertebral osteotomy technique for eorrecticfn of severe and rigid kyphosis through posterior-only approach. Twelve patients [six male and six female] with severe and rigid kyphotic deformity of the thoracic spine were treated by posterior vertebral column resection using a single posterior approach. The apex level of kyphosis was at the upper thoracic in five patients, the lower thoracic in four patients and mid thoracic in three patients. There was old fracture in one patient, congenital deformity in six, tumor in three and neurofibromatosis in two patients. After posterior vertebral column resection, segmental posterior instrumentation was used for correction of the kyphotic deformity. Complications and radiographic findings were analyzed to evaluate clinical outcomes and radiologic changes of posterior vertebral column resection in patients with angulated kyphotic deformity. The major curve correction was averaged 31.66 ° [SD=15.69] [45%]. The resection was performed at the involve level in every patient. Posterior segmental fusion was achieved in average 8.9 [SD=1.7] segments. Anterior reconstruction was with titanium mesh cage in two and with cancellous chip packing in other patients. There were no neurologic complications after six month. Bony fusion achieved in all patients, and there was no correction loss. Satisfactory correction is safely performed by posterior vertebral column resection with a direct visualization of the circumferentially decompressed spinal cord. Although the performance is technically laborious, it offers good correction without jeopardizing the integrity of the spinal cord

Long term effects of Gamma knife Radiosurgery for treatment of cerebral arteriovenous malformations

The Gamma Knife Radiosurgery [GKR] is an established management option for Cerebral Arteriovenous Malformations [AVMS]. Therapeutic benefits of radiosurgery for arteriovenous malformations are complete obliteration of nidus with minimal neurological deficit. Radiosurgery was performed between February 2003 and April 2010 at Kamraniye day clinic, Tehran, Iran, using the Leksell gamma knife model B [Elektra Instruments AB, Stockholm, Sweden] on 82 consecutive patients with AVMs. The male-to-female ratio was 1.4:1 [48M, 34F]. The age of the patients ranged from 9 to 70 years [mean, 28.5 +/- 12 years]. The marginal dose to the AVM nidus was 45 to 85% [median, 60%] isodose and ranged from 14 to 30 Gy [mean, 20.57 +/- 13Gy].The maximum dose ranged between 20 to 60 Gy [mean, 37.5 Gy +/- 10.17Gy]. Follow up of patients for complete AVM obliteration and in the case of complications MRI were performed. Complete obliteration of AVM was achieved in 56 cases [68.29%]. It was marked in average 3.62 [SD=3.19] years [from 1 to 5 years] after GKR. Partial obliteration [>50% reduction of the nidus volume] was marked in 24 cases [31%], and less than 50% reduction of the nidus volume was marked in 2 cases [2.4%] with a follow-up of 5 years. Complete obliteration of AVM had statistically significant associations with smaller score of Spetzler-Martin arteriovenous malformation grading system for AVMs. [p< 0.05]. The Gamma Knife Radiosurgery can offer total and partial obliteration to acceptable percent of treated AVM with a low risk of morbidity. Higher success observed in patients with Spetzler-Martin Grade I and II AVMs, which was attributed to smaller volume of AVMs in this group

Managing prolactinoma during pregnancy

Prolactinomas are the most common pituitary tumors in pregnant women. We conducted this study on pregnant women with prolactinoma to determine their clinical symptoms and signs and eventual necessity to medical therapy. A descriptive study was performed on 85 pregnant women with prolactinoma. Patients were followed up by physical examination, imaging, and perimetry for diagnosis of visual field defect. If tumor was increased in size perimetry was performedin order to determine eventual visual field defect [VFD]. Patients with progressive visual field defect had absolute indication for trans sphenoidal surgery [TSS]. In other cases with progressive enlargement of adenoma size but without VFD bromocriptine was administered. Patients without increasing adenoma size were just followed up. In this study 72 patients [84%] had microadenomas, 7 patients [8%] had macroadenomas without previous medical or surgical therapy and 6 patients [7%] had macroadenomas with previous medical therapy with bromocriptine. Totally 20 patients [23%] had tumor enlargement during pregnancy and was symptomatic in 7 patients [8.2%]. There was significant difference between 3 groups according to incidence of symptomatic tumor enlargement [p<0.05]. Macroprolactinomas are more likely to enlarge during pregnancy than microprolactinomas. In our study conservative management was successfully done in all patients without surgery or medical therapy

Modified methylmethacrylate cranioplasty in 127 cases of war casualities

We report 127 cases who have had elective operation on cranium because of skull bone defect during 1984-1989. Usually repair of skull bone defect and preserving normal anatomy were the major therapeutic goals. In these cases a new surgical technique is described which can successfully accomplish these goals in a single but staged operative procedure

Progressive neurological deficit due to neglected dural repair in war casualties

One hundred patients underwent elective cranioplasty for high velocity missile injury of the head during a 30-month-period study and investigation in Amiralmomenin Hospital affiliated to Iran University of Medical Sciences. Deep penetrating wounds were the most frequent injuries seen during this study. Three patients presented with massive bone defects and progressive neurological deficit and during the operation it was noted that dural repair had not been done. It was suggested that intermittent brain herniation was the probable cause of progressive brain damage