Surgical outcome of workman's comp patients undergoing endoscopic foraminal decompression for lumbar herniated disc.

BACKGROUND: Worker's compensation (WC) patients undergoing spine surgery typically experience delayed return to work (RTW) compared with non-WC patients, especially those approved for surgery undergoing traditional open spine surgery. The purpose of this study was to describe the observe RTW rates in WC patients after minimally invasive "selective endoscopic discectomy" (SED™) for a lumbar herniated disc. METHODS: Clinical outcomes using the modified Macnab criteria and RTW data were analyzed in 118 WC patients following the outpatient SED™ procedure in an ambulatory surgery center (ASC) using only local anesthesia with or without sedation. This endoscopic transforaminal decompression was trademarked by Anthony Yeung as SED. RESULTS: Single-level SED™ was performed in 62 patients, a two-level in 48 patients, a three-level decompression in 6, and a four-level decompression in another two patients, respectively. Patient selection was augmented by diagnostic and therapeutic injections performed preoperatively to determine how many levels of spine segments required surgical intervention. At the two-year follow-up, Excellent Macnab outcome in 36 patients, Good in 53, Fair in another 21, and Poor in the remaining eight patients, respectively. Of the 118 WC patients, 89 (75.42%) were released back to their original job within in 6 weeks from the index operation. The average time to work release was 4.2 months. Twenty-one patients who had previous spine surgery were working. Twenty-nine of the 118 study patients (24.58%) were unable to return to their original job. CONCLUSIONS: In the hands of a well-trained endoscopic spine surgeon, RTW rates with SED™ are higher than with traditional open translaminar surgery. Therefore, endoscopic surgery should be considered for WC patients and further be validated as a cost-effective alternative to open spine surgery.

Correlations of Neck/Shoulder Perfusion Characteristics and Pain Symptoms of the Female Office Workers with Sedentary Lifestyle.

AIM: Modern office workers are often impacted by chronic neck/shoulder pain. Most of the previous studies which investigated the relationship of the occupational factors and musculoskeletal symptoms had adopted questionnaire survey. In this study the microcirculatory characteristics and perceived symptoms in neck/shoulder region were compared among office workers with sedentary lifestyle. METHODS: Thirty-seven female office workers were recruited in this study. Microcirculatory flow in neck/shoulder region characterized by the mean blood flow (MMBF value), pulsatile blood flow (PMBF value), and the PMBF/MMBF ratio (perfusion pulsatility, PP) were investigated using Laser Doppler Flowmetry (LDF). A Chinese version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ) were also administered to collect the information of perceived neck/shoulder symptoms. Correlations between the perfusion characteristics and the individual/occupational factors were analyzed using the Spearman test. The difference of the MMBF values between the low-pain group (pain level≤2) and the high-pain group (pain level>2) were compared using the Mann-Whitney U test. RESULTS: There were 81% participants reported neck or shoulder pain symptoms. The duration of shoulder pain was significantly correlated with the workers' age and the duration of employment (p<0.01) (n = 37). While both the MMBF and PMBF values in shoulder region were significantly reduced with the workers' age and the duration of employment (p<0.05) (n = 27). And there was a 54% reduction in the MMBF value of the workers from age of 23 to 47. And the MMBF value of the high-pain group (n = 15) was significantly lower than the value of the low-pain group (n = 15) (p<0.05). The duration of shoulder pain showed a moderately negative correlation with PMBF values (n = 19). Besides, the PP value was moderately correlated with shoulder pain level attributed by the rapid reduction of MMBF values (p = 0.07). CONCLUSION: In this study, the LDF method was used for the first time in the workplace in Taiwan. It was demonstrated that the MMBF in shoulder region were affected by aging effect and towards lower value at higher pain level. Impaired microcirculation caused by age effect, when coupled with sedentary lifestyle, was found to be more likely to evoke ischemia shoulder pain. Further studies are needed to assess current indicator, PP value, and the underlying mechanism of pain caused by sedentary lifestyle.

Intra-extracranial hemangiopericytoma: clinical manifestations, histopathological features, diagnosis, treatment, and outcomes.

BACKGROUND: Intra-extracranial hemangiopericytomas (HPCs) are rare vascular neoplasms. This paper reports the clinical manifestations, histopathological features, diagnosis, treatment, and outcomes of HPCs. METHODS: We reviewed three patients with intracranial HPC and one patient with HPC of the scalp who were surgically treated at Taichung Veterans General Hospital between 1989 and 1999. RESULTS: All four patients underwent surgery and postoperative radiotherapy. After surgery, three patients showed improvement compared with their preoperative neurological function. Two patients had recurrent tumors, one patient was well and free from tumor recurrence, and one patient was lost during follow-up. CONCLUSIONS: Clinical presentation and radiographic appearance of intracranial HPC can be indistinguishable from meningioma. Intracranial HPC is an aggressive neoplasm with malignant potential. Both benign and malignant variations of HPC of the scalp exist. The principal treatment is surgical excision. Survival is influenced by more aggressive primary resection and by postoperative radiotherapy. Recurrences are common. Metastases may be multiple and can develop in many organs and systems.