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This study analyzed retrospectively the bladder function of patients after early surgery for cauda equina syndrome (CES) performed within 24 or 48 hours, or after 48 hours of the onset of autonomic symptoms.
We retrospectively reviewed the clinical data of 31 patients after decompression surgery for lumbar disc herniation (LDH) who had been diagnosed with CES between January 2001 and December 2014 at Inha University Hospital. The following factors were assessed to evaluate the influence of time to surgery: bladder function, rectal incontinence, sexual dysfunction, LDH level, and degree of spinal canal compression.
After decompression, the outcome group was categorized into normal bladder function and abnormal bladder function. The patients operated on within 48 hours showed an improved postoperative outcome. Among 16 patients operated on within 48 hours, 13 (81%) recovered normal bladder function. In contrast, among 15 patients with decompression after 48 hours, 6 (40%) recovered normal bladder function. Among 21 patients with mild bladder dysfunction at admission, 16 (76%) recovered normal bladder function after decompression.
Our study suggests that patients who have decompression surgery within 48 hours of the onset of bladder dysfunction, improve their chances of recovering bladder function than those who have a late operation (>48 hours). Also, patients with mild bladder dysfunction are more likely to recover bladder function after decompression, than patients with severe bladder dysfunction.
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Surgical drains are commonly used after the spine surgeries for minimizing hematoma formation, which can delay wound healing and may become a source of fibrosis, infection, and pain. The drain, however, may provide a direct route for infection if it is contaminated. Our objective was to survey the relationship between surgical drains and infection.
The 70 patients who had undergone single-level lumbar discectomy from April 2011 to March 2012 were retrospectively analyzed. Each patient's medical chart and magnetic resonance image were thoroughly reviewed after all the patients had been divided into the drainage and the nondrainage groups. The amounts and durations of the surgical drains in the drainage group were analyzed. Additionally, the levels of C-reactive protein, rates of infection, scores of preoperative and postoperative visual analog scale (VAS), and lengths of hospital stay after operation were compared between the 2 groups.
In this study, 70 patients were retrospectively analyzed; out of which, 42 and 28 patients were included in the drainage and the nondrainage groups, respectively. Two of the postoperative infection cases in the nondrainage group required to undergo repeated operations. The frequency of the postoperative infection cases was higher in the nondrainage group than in the drainage group; however, there was no significant statistical difference between the 2 groups (p=0.157).
Surgical drains did not elevate postoperative infection. Furthermore, drain tip cultures allowed us to detect postoperative infection at an early stage, and it led to faster initiation of antibiotics treatment.
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The purpose of this study was to determine whether the status of the hinge gutter affected clinical and radiographic outcomes of cervical open door laminoplasty.
We retrospectively analyzed 43 patients who had undergone cervical open door laminoplasty. 23 CT scans were performed at 2 days post-operation. The number of CT scans at 3, 6, 12 and 24 months were 16, 12, 21 and 11, respectively. We collected perioperative and follow-up data, including clinical and radiographic results.
There were 7 patients without a hinge fracture and 16 patients with one or more hinge fractures at 2 days postoperation. There were 90 hinges, and the rate of ideal greenstick deformation of the hinge was 63% on 2-day-postoperative CT scans. Postoperative VAS scores of neck pain (p=0.012) in patients without a hinge fracture were higher than in patients with hinge fractures. The hinge healing rates were 37% at 3 months, 57.4% at 6 months, 86.4% at 12 months, and 85.4% at 24 months. Among the patients, 14 patients had healed hinges, and 7 patients had one or more hinge(s) that was/were not healed at 12 months post-operation. However, in clinical and radiographic outcomes, there was no difference between these patients.
Cervical open door laminoplasty was safe and provided stable reconstruction of laminar expansion. In radiographs, the difference between hinges that had healed and hinges that had not healed was statistically negligible. Hinge fractures might not influence the clinical and radiographic outcomes of cervical open door laminoplasty.
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The object of this study was to evaluate the clinical and radiological outcomes of minimally invasive lateral lumbar interbody fusion.
This study included 30 patients who underwent minimally invasive lateral lumbar interbody fusion at our hospital between May 2011 and February 2012 for the following diagnoses: degenerative disc disease, adjacent-segment degeneration, degenerative spondylolisthesis and lumbar degenerative scoliosis. Pain assessment was reported from 0 to 10 using a subjective visual analog scale (VAS) upon admission and at every follow-up day. Lumbar X-rays were obtained in the standing position upon admission and the 1st and 5th postoperative day, and at every follow-up day after the operation. The heights of the intervertebral disc space and neural foramen were measured using an electronic caliper with the PACS software. The surgical outcome was assessed as excellent, good, fair or poor using the Odom scale at the last follow-up.
The mean VAS for low back pain were 4.93±1.47 on admission and 2.01±1.35 at last follow-up, respectively, and for leg pain, the scores were 4.87±2.16 on admission and 1.58±1.52 at last follow-up. The mean height of intervertebral disc space increased by 34% (7.93±2.33 preoperatively, and 11.09±4.33 immediately after surgery, p<0.01). The mean height of neural foramen also increased by 6.4% without any statistical significance (19.17±2.84 preoperatively, and 20.49±4.50 immediately after the surgery). Minimally invasive lateral lumbar interbody fusion was successful in 27 patients (90%) at last follow-up. Surgical complications were reported as transient postoperative thigh sensory changes (5 patients, 16.7%), transient psoas muscle weakness (3 patients, 10%), cage migration (2 patients, 6.7%), lumbar plexus injury (1 patient, 3.3%), and pain aggravation (1 patient, 3.3%).
The minimally invasive lateral lumbar interbody fusion is a safe and effective procedure for treating degenerative lumbar disease with good outcomes and moderate complications. Further follow-up is necessary to establish its safety and efficacy.
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