Comparative analysis of the anterior decompression and fusion with internal fixation and simple decompression in the treatment of cervical vertebral multilevel degeneration / 局解手术学杂志

Objective To analyze the clinical value of anterior decompression and fusion with internal fixation and simple decompression in the treatment of cervical vertebral multilevel degeneration.Methods Selected 40 patients with cervical degenerative changes in our hospital from 2012 to 2014,and 20 patients of them underwent anterior decompression and fusion with internal fixation while the other 20 cases took simple decompression.All the patients were well followed up,and the clinical therapeutic effect of the two groups were compared and analyzed.Results After operation,the VAS score and JOA score showed that the scores of the patients underwent anterior decompression and fusion with internal fixation were significandy improved compared with the simple decompression group,and the difference was statistically significant(P ＜ 0.05).Compared with the simple decompression group,the cervical curvature and the curvature of the surgerysection in the anterior decompression and fusion with internal fixation group were significantly improved,especially in the first year after surgery (P ＜ 0.05).The cervical spine joint activity of the two group were improved in the first year after surgery,and the difference was significant (P ＜ 0.05),but there was no significant difference in the degree of cervical joint activity at the last follow-up(P ＞ 0.05).The anterior decompression and fusion with internal fixation is better than simple decompression in the degree of cervical joint activity with statistical significance (P ＜ 0.05).Conclusion The clinical effect of anterior decompression and fusion with internal fixation in treatment of multiple segment degeneration of cervical spine is better than that of simple decompression,it can meet the clinical requirements of biomechanics.

Factors Influencing Outcomes after Ulnar Nerve Stability-Based Surgery for Cubital Tunnel Syndrome: A Prospective Cohort Study

PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.

Cubital Tunnel Syndrome / 대한정형외과학회잡지

Cubital tunnel syndrome is compressive neuropathy, entrapment of the ulnar nerve around the medial epicondyle of the elbow joint, and the second most common neuropathy after carpal tunnel syndrome. Patients complain of hypoesthesia or paresthesia in the ulnar half of the ring and small fingers early in the disease. Advanced disease is complicated by irreversible muscle weakness or atrophy and claw hand deformity of the ring and small fingers. Although traditional decompression and anterior transposition of the ulnar nerve is known as standard treatment, according to recent reports only simple decompression has a good outcome. So, variety of surgical treatment options are available. In this paper, we purpose to describe the causes, clinical features and recent surgical treatments of cubital tunnel syndrome.

Comparative Study between the Conventional Method and Small Skin Incision Method for Simple Decompression of Cubital Tunnel Syndrome / 대한신경손상학회지

OBJECTIVE: The purpose of this study is to review the results of two surgical methods of simple decompression for treatment of cubital tunnel syndrome. METHODS: Surgical procedure of simple decompression of the ulnar nerve using the conventional method requires a relatively long incision of 6-8 cm. Later with accumulating experience, we performed simple decompression using a skin incision of 2 cm or less. Between November 2005 and July 2010, simple decompression using the conventional method was performed in 10 elbows (Group 1), and simple decompression using the small skin incision method was performed in 10 elbows (Group 2). The surgical outcome was evaluated and the two groups were compared using a modified Bishop scoring system. We also compared the operation time and hospital stay between the two groups. RESULTS: There were no significant differences in the outcomes between the two groups using the modified Bishop scoring system (p>0.05). Also, there were no significant differences in the postoperative electrodiagnostic study results between the two groups (p>0.05). However, the operation time and hospital stay were significantly shorter in Group 2 (p<0.01). CONCLUSION: Both the methods can be recommended for the treatment of cubital tunnel syndrome due to their advantages including simplicity and safety of the method. However, the small skin incision method is superior to the conventional method due to the shorter operation time and hospital stay.

A Comparison of Clinical Outcomes between Decompressive Laminectomy Alone and with Arthrodesis in Lumbar Single Level Spinal Stenosis

OBJECTIVE: By comparing the data of patients with spinal stenosis who had undergone decompressive laminectomy alone or with arthrodesis, we retrospectively analysed the advantages and disadvantages of the subsequent surgical techniques. METHODS: We analyzed the radiological parameters, surgical techniques, and clinical outcomes of 35 patients, who had undergone operation for spinal stenosis. The patients were divided into two groups, laminectomy alone(15 patients) and laminectomy with arthrodesis(17 patients) and the patients' subjective outcomes and radiological results were compared. RESULTS: Subjective satisfaction was higher in patients who had received decompressive degrees laminectomy alone(80%) than patients who received degrees decompressive laminectomy with arthrodesis(70%). The mean preoperative spinal lordotic angle in the laminectomy alone groups improved from 32.3 degree to 33.9 degree, postoperatively, and 33.1 degree at the last follow up. The mean preoperative spinal lordotic angle in the laminectomy with arthrodesis groups improved from 33.5 degree to 37.8 degree postoperatively, and 37.4 degree at last follow up. The lamine- ctomy with arthordesis group showed better results regarding spinal lordotic angle correction but this was not directly related to the clinical outcomes CONCLUSION: There was no significant correlation in clinical outcome, correction of spinal lordosis angle and patients' subjective satisfaction between decompressive laminectomy alone and with arthrodesis. Therefore, we suggested that decompressive laminectomy alone was achived good outcomes in patients who has single level spinal stenosis with no proven spinal instability at preoperative stage.

Descompresión simple de nervio ulnaren el codo: informe preliminar / Simple decompression of the ulnar nerve at elbow: preliminary report

The purpose of this study was to assess the simple decompression as surgical treatment for ulnar tunnel syndrome at elbow. The review was in eight patients with a total of ten cases. The electromyography and neuroconduction study was altered in all cases. The classification according McGowan was: 40 percent of cases in grade I, 40 percent grade IIA and 20 percent grade IIB. In the 63 percent of cases a concomitant carpal tunnel syndrome was treated surgically. In all cases, a compressive Osborne’s arcade was observed. The follow up are 3,8 months with an 100 percent of excellent (complete relief of symptoms) and good (minimal residual symptoms) results. This review shows that the simple decompression is a proved and reproducible surgical technique. This technique can be the first option for the surgical treatment of the ulnar tunnel syndrome.

Se presenta trabajo prospectivo sobre la descompresión simple como tratamiento quirúrgico del síndrome de compresión del nervio ulnar en el codo. Se revisa una serie de 8 pacientes y 10 codos operados. Hubo electromiografía alterada en todos los casos. Se clasificó preoperatoriamente según McGowan(40 por ciento grado I, 40 por ciento grado IIA y 20 por ciento grado IIB). En el 63 por ciento de los casos hubo un síndrome de túnel del carpo asociado que también se trató. En todos los casos se observó una fascia de Osborne tensa y compresiva sobre el nervio ulnar. El seguimiento promedio fue de 3,8 meses y se obtuvo un 100 por ciento de resultados buenos y excelentes. En este trabajo se confirma que ésta es una técnica quirúrgica reproducible y basada en la simplicidad. Se le puede considerar como primera opción para el tratamiento quirúrgico del síndrome de compresión del nervio ulnar en el codo.

Simple Decompression of the Ulnar Nerve for Cubital Tunnel Syndrome

OBJECTIVE: Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity. Although many different operative techniques have been introduced, none of them have been proven superior to others. Simple cubital tunnel decompression has numerous advantages, including simplicity and safety. We present our experience of treating cubital tunnel syndrome with simple decompression in 15 patients. METHODS: According to Dellon's criteria, one patient was classified as grade 1, eight as grade 2, and six as grade 3. Preoperative electrodiagnostic studies were performed in all patients and 7 of them were rechecked postoperatively. Five patients of 15 underwent simple decompression using a small skin incision (2 cm or less). RESULTS: Preoperative mean value of motor conduction velocity (MCV) within the segment (above the elbowbelow the elbow) was 41.8+/-15.2 m/s and this result showed a decrease compared to the result of MCV in the below the elbow-wrist segment (57.8+/-6.9 m/s) with statistical significance (p<0.05). Postoperative mean values of MCV were improved in 6 of 7 patients from 39.8+/-12.1 m/s to 47.8+/-12.1 m/s (p<0.05). After an average follow-up of 4.8+/-5.3 months, 14 patients of 15 (93%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. Five patients who had been treated using a small skin incision achieved good or excellent outcomes. There were no complications, recurrences, or subluxation of the ulnar nerve. CONCLUSION: Simple decompression of the ulnar nerve is an effective and successful minimally invasive technique for patients with cubital tunnel syndrome.

Comparison of Postoperative Symptomatic Improvement between Simple Decompression and Fusion with Instrumentation in Lumbar Spinal Stenosis without Instability / 대한척추외과학회지

STUDY DESIGN: The difference between the improvement after operation depending on the surgical method on patients with a spinal canal stenosis without instability were examined retrospectively. OBJECTIVES: To determine the difference between the improvement after surgery depending on the operative method on patients with spinal canal stenosis without an instability by using a retrospective study. SUMMARY AND LITERATURE REVIEW: There is a The clinical difference between simple decompression and fusion using instrument after decompression. MATERIAL AND METHODS: Sixty-six patients, who were diagnosed with pure spinal canal stenosis without instability and treated with surgery from October 2002 to April 2004 and were available for a follow up at least for 1 year were examined. There were 22 examples of decompression only and 22 examples of fusion using instruments. The change in postoperative pain was scaled using a visual analogue scale (VAS), and the functional disability in everyday life was clinically compared with the Korean ODI (KODI) and Lower Back Outcome Score for back pain (LBOS). RESULTS: 20 male and 24 females were examined, and the mean age was 61(45~76) years. the Million Visual Analogue Scale (MVAS) showed improvement in 28.3% of group A with decompression, and the everyday life disability scale using the Korean ODI and Lower back outcome score for back pain (LBOS) showed a improvement of 16.1% (KODI) and 18.4% (LBOS). Group B each showed 18.0% improvement using the VAS. The Korean ODI and Lower Back Outcome Score for back pain each improved by 18.0% (KODI) and 17.3% (LBOS) in two groups showing no statistically significant difference. CONCLUSION: There was little difference in the level of improvement in spinal canal stenosis patients without instability, regardless of ehether they had been treated with simple decompression or fusion using instrument after decompression.