ABSTRACT
OBJECTIVE: To determine surgical mortality, incidence of surgery-related neurological deterioration and incidence of postoperative infection or hematoma requiring reoperation in a consecutive series of 318 patients surgically treated with laminectomy or laminoplasty for cervical spondylotic myelopathy (CSM). MATERIALS AND METHODS: This is a retrospective study of 318 consecutive patients treated with laminectomy or laminoplasty for CSM at Oslo University Hospital in the time period 2003-2008. The defined neurosurgical catchment area for OUS is the southeast region of Norway with 2.7 mill inhabitants. The patient charts were systematically reviewed, focusing primarily on operative notes, postoperative (po) complications, such as po deterioration of neurological function, po hematoma and po infection and neurological function at most recent follow-up. RESULTS: The mean age was 64 years (range 29-90 years). Laminectomy was performed in 310/318 (97.5%) and laminoplasty in 8/318 (2.5%) of the patients. The incidence of laminectomy/laminoplasty for CSM was 2.0/100,000 inhabitants per year. The surgical mortality was 0%, and 37 (11.6%) patients had a deterioration of neurological function in the immediate postoperative period. Four (1.3%) patients were reoperated because of po hematoma. We found a statistically significant association between po hematoma and previous posterior neck surgery and American Association of Anaesthetists (ASA) score. Five (1.6%) patients were reoperated because of postoperative infection. Univariate logistic regression analysis showed a statistically significant association between po infection and the number of levels decompressed. CONCLUSIONS: The incidence of laminectomy/laminoplasty for CSM is 2.0/100,000 inhabitants per year. Surgical mortality, postoperative hematoma and postoperative infection are rare complications of laminectomy/laminoplasty for CSM. Neurological deterioration is not an uncommon complication after posterior decompression for CSM.
Subject(s)
Cervical Vertebrae/surgery , Laminectomy/mortality , Spondylosis/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Laminectomy/adverse effects , Male , Middle Aged , Norway , Reoperation , Retrospective Studies , Spondylosis/mortality , Treatment OutcomeABSTRACT
The effects of transforming growth factor-beta1 (TGF-beta1) on systemic nitric oxide (NO) production and wound repair were evaluated using a noninflammatory mouse perforated mesentery connective tissue repair model. Urinary nitrates were monitored as a measure of NO production. TGF-beta1 [bovine serum albumin (BSA) carrier and TGF-beta1 BSA carrier free] were administered on days 0 and 1 and were evaluated in mice over a 10-day period. A significant decrease in the average postwounding urinary nitrate levels compared to prewounding levels was observed within the TGF-beta1 treatment group animals (P = 0.001) with an insignificant change for the phosphate-buffered saline control animals (P = 0.10). Additionally, TGF-beta1-treated animals showed significant connective tissue repair compared to controls without a concurrent increase in postwounding urinary nitrate levels, supporting the noninflammatory nature of the perforated mesentery model. Our findings suggest that an unforseen consequence of TGF-beta1 administration is diminished basal nitric oxide production. When using TGF-beta1 in a wound repair or other therapeutic model, the administration of an exogenous NO donor compound may be necessary in order to ensure homeostasis, thereby avoiding undesired physiological consequences due to diminished basal NO production.