Bilateral evacuation of bilateral non-acute subdural hematomas - evaluation of postoperative outcomes and complications.

INTRODUCTION: Bilateral finding of non-acute subdural hematomas (NASH) is less common compared to unilateral occurrence. The aim of this study was to evaluate results of surgical treatment of bilaterally treated bilateral NASH. METHODS: Retrospective analysis of patients, who underwent bilateral surgical evacuation of NASH (2014-2020). This study was conducted to determine the association between the incidence of postoperative complications and outcome, hematoma recurrence and selected risk factors (including volumetric parameters). Correlations between variables were assessed by using Spearman's correlation. Chi-squared test, Student's t-test (unpaired and paired) and one-way ANOVA were used for univariate analysis. RESULTS: Our study included 29 patients with bilateral NASH who underwent bilateral surgical hematoma evacuation. The laminar hematoma type was associated with higher hematoma recurrence rate (p=0.032) and worse clinical outcome (p=0.043). Larger PHV was significantly associated with larger PV after surgery and worse neurological outcome. Larger PHV, PHCV and PV were significantly associated with higher incidence of NASH recurrence (p=0.0008, p=0.0007 and p=0.00006). CONCLUSION: The laminar hematoma type and larger PHV were significant risk factors for the recurrence of bilateral NASH and worse neurological outcome. Larger PHCV and PV were significantly associated with hematoma recurrence (Tab. 7, Fig. 3, Ref. 24).

Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

INTRODUCTION: The occurrence of symptomatic spinal epidural hematoma after spine surgery is a rare, but serious major complication whose incidence usually requires urgent surgical intervention. Obesity is currently considered to be one of the most common metabolic diseases. METHODS: Prospective analysis of patients who underwent surgical treatment of degenerative lumbar spine disease from January 2016 to February 2018 with one-year follow-up. All patients underwent decompression of spinal cord and nerve roots. This study was conducted to determine an association between the incidence of spinal epidural hematoma (SEDH) requiring surgical treatment and obesity/body mass index (BMI). RESULTS: In our study, data from 371 patients were assessed. SEDH requiring surgical intervention occurred totally in seven patients (1.89 %). An average BMI in patients with presence of SEDH was 30.67 kg/m2. Our work showed a statistically significant difference between BMI in patients with SEDH compared to patients without SEDH (p = 0.0044). This study also showed a significant difference in incidence of symptomatic SEDH in obese patients compared to non-obese patients (p=0.0158). CONCLUSION: In our study, we found out that obesity is a significant risk factor for the incidence of postoperative SEDH after degenerative lumbar spine surgery (Tab. 1, Fig. 2, Ref. 18).

Unintended durotomy during degenerative lumbar spine surgery in patients aged 60 years and older - incidence and risk factors.

ntroduction: Unintended perioperative dural tear is a common complication in spine surgery. Methods: Retrospective analysis of patients over 60 years of age who underwent surgery for degenerative disease of the lumbar spine at the Department of Neurosurgery (University Hospital in Martin) from January 2016 to December 2017. Incidence of incidental perioperative durotomy was analyzed. We analyzed selected risk factors gender, ASA (American Society of Anesthesiologists), surgical diagnosis, type of surgical performance, range of surgical procedure, revision surgery and comorbidities. The results were statistically evaluated using descriptive statistics and Fisher›s test. Results with p.

Dysphagia after anterior cervical discectomy and interbody fusion - prospective study with 1-year follow-up.

INTRODUCTION: Dysphagia is a common finding after anterior cervical discectomy. The incidence and severity of swallowing disorders are variable and depend on many factors. METHODS: 73 patients after 1- or 2-level anterior cervical discectomy and fusion /ACDF/ were enrolled in prospective, single-center study. The severity of dysphagia was evaluated by the Bazaz-Yoo dysphagia score before surgery and 6 weeks, 3, 6 and 12 months after surgery. The impact of factors such as sex, age, number of operated segments, smoking, gastroesophageal reflux disease, hypertension, duration of surgery and pre-existing dysphagia on the incidence of dysphagia after surgery was verified. The correlation between the duration of surgery and severity of postoperative dysphagia, and similarly between the age and severity of preoperative and postoperative dysphagia was studied. RESULTS: Dysphagia was present in 22% patients within 12 months after surgery. No patient reported severe dysphagia. No significant relationship was demonstrated between sex, age, number of operated segments, pre-existing dysphagia, gastroesophageal reflux disease, hypertension and the incidence of dysphagia after surgery. Smokers showed a significantly lower incidence of dysphagia before surgery and within 12 months after ACDF (p.

[Dynamic intraligamentary stabilization of acute anterior femoral cruciate ligament rupture : Preliminary and intermediate clinical results]. / Dynamische intraligamentäre Stabilisierung der akuten vorderen femoralen Kreuzbandruptur : Erste und mittelfristige klinische Ergebnisse.

BACKGROUND: The results of anterior cruciate ligament (ACL) reconstruction demonstrate excellent short and mid-term results; however, long-term follow-up results are compromized by high rates of osteoarthritis. Dynamic intraligamentary stabilization (DIS) focuses on preserving the cruciate ligament. The short and mid-term results of the dynamic ligamentary cruciate ligament suture from a nondevelopmental hospital are presented. MATERIAL AND METHODS: A total of 73 consecutive patients with an acute rupture of the ACL were included in this prospective study. Patients were surgically treated between July 2014 and October 2017 with DIS within 21 days after ACL rupture. All patients were reviewed before the operation, 60 patients reached a 3­month follow-up , 51 patients reached a 6­month follow-up and 38 patients a 12-month follow-up. The perioperative and postoperative complication spectrum was recorded. RESULTS: The positive results of the developmental clinics were confirmed. The Tegner, Lysholm and International knee documentation Committee (IKDC) scores showed very good results 12 months after surgery. The intraoperative and postoperative complication rates were low at 1.4% and 6.8%, respectively. Postoperative restrictions on movement required re-arthroscopy in 3 patients, 66% of the patients had concomitant damage to the knee joint, which could be treated simultaneously. CONCLUSION: The dynamic intraligamentary cruciate liament suture (Ligamys) is a successful additional option in the sugical treatment of acute femoral ACL rupture. A high proportion of collateral damage and injuries of the knee joint can be detected and simultaneously treated.

[Urinary incontinence in degenerative spinal disease]. / Kontinencné poruchy pri degeneratívnych ochoreniach chrbtice.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the presence of urinary incontinence in patients with chronic degenerative spinal disease and to identify factors affecting the occurrence and changes in urinary incontinence after surgery. MATERIAL: The group evaluated comprised 214 patients undergoing surgery for degenerative spinal disease at our department between January 1 and December 31, 2008. The patients were categorised according to the type of their degenerative disease (cervical disc herniation, lumbar disc herniation, spinal stenosis, spinal instability or olisthesis) and the spine level involved (cervical or lumbar spine). The symptoms of urinary incontinence included leakage of urine and non-obstructive chronic urinary retention developing in association with the manifestation of vertebrogenic disorder. Patients with diseases known to increase the risk of incontinence were not included in the study. METHODS: Based on a retrospective analysis of the patients' clinical notes, the occurrence of urinary incontinence in each type of degenerative spinal disease was assessed. The effect of gender, age, body mass index (BMI), neurological status and spinal disease type on the development of incontinence was statistically evaluated. The efficacy of surgical treatment was assessed on the basis of the patients' subjective complaints at the first follow-up one month after surgery. The data were evaluated by the statistical programme InSTAT (analysis of variance ANOVA, t-test). All tests were two-sided; a 0.05 level of statistical significance was used. RESULTS: Of the 214 patients with degenerative spinal disease, 27 (12.6%) had urinary incontinence. A higher risk of developing incontinence was found in women (p = 0.008) and in patients with radicular weakness (p = 0.023). The patients with urinary incontinence had their BMI significantly lower than patients without this disorder (p = 0.019). Age had no effect. The differences in the occurrence of urinary incontinence amongst the different types of degenerative disease were regarded as approaching statistical significance (p = 0.09). The surgical treatment resulted in incontinence control in 15 (55.5 %) affected patients. DISCUSSION: A comparison of the factors leading to the development of urinary incontinence in degenerative spinal disease and those associated with the development of incontinence in the general population suggests that the aetiology in each case is different. The relationship between low back pain and urinary incontinence remains unknown. CONCLUSIONS: Degenerative spinal disease can result in acute or chronic urinary incontinence. Factors associated with its development include gender, BMI, radicular weakness and the type of degenerative disease. Surgical treatment improved or eliminated the symptoms of urinary incontinence in more than half of the patients affected.