Minimally Invasive Scoliosis Correction in Parkinson Disease: Retrospective Case Series

2020 ◽  
Author(s):  
Ravi S Nunna ◽  
Richard G Fessler
Keyword(s):  
Minimally Invasive ◽  
Parkinson Disease ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The United States ◽  
Invasive Technique ◽  
Radiographic Findings ◽  
Presenting Symptoms ◽  
Scoliosis Correction

Abstract BACKGROUND Parkinson disease (PD) is the second most common neurodegenerative disease in the United States. In the context of the disability inherent to PD, the additional physical challenges and pain from scoliosis can be debilitating for these patients. However, the magnitude of surgery required to correct the deformity combined with the medical co-morbidities and frailty in this population of patients makes surgery very risky. OBJECTIVE To investigate clinical presentations and outcomes of patients with PD that underwent minimally invasive long-segment fusion for scoliosis correction. METHODS A retrospective chart review was performed over the years 2007 to 2017 for patients diagnosed with PD undergoing long-segment spinal fusion (5 or more levels) with the use of circumferential minimally invasive spine surgery techniques. Data including age, sex, race, medical co-morbidities, presenting symptoms, radiographic findings, surgical procedure, case history, and complications were collected from the medical record. RESULTS Retrospective chart review revealed three patients that met the inclusion criteria. They included 2 males and 1 female, with a mean age of 68.7 yr (range 63-75 yr). Ability to maintain upright posture, return to activities of daily living, and visual analog scale (VAS)-back improved in all patients at 1-yr follow-up. Results were durable at 2-yr follow-up. No medical complications were observed. CONCLUSION The generally positive results suggest that minimally invasive technique could have significant benefits in this high-risk group of patients.

scholarly journals P.138 Minimally invasive treatment of syringomyelia using tubular retractors

2018 ◽  
Vol 45 (s2) ◽  
pp. S53-S53
Author(s):  
K Yang ◽  
M Sourour ◽  
N Zagzoog ◽  
K Reddy
Keyword(s):  
Minimally Invasive ◽  
Chart Review ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Senior Author ◽  
Invasive Technique ◽  
Single Center ◽  
Invasive Treatment ◽  
Multiple Modalities ◽  
Subarachnoid Spaces

Background: Multiple modalities have been used in the treatment of syringomyelia, including direct drainage, shunting into peritoneal, pleural and subarachnoid spaces. The authors report their experience of surgical treatment of syringomyelia in a minimally invasive fashion. Methods: We conducted a single-center retrospective chart review on our syringomyelia cases treated with minimally invasively using Metrx Quadrant retractor system since January 2011. Lateral fluoroscopy was used to guide the placement of the retractor onto the lamina of the corresponding level. This was followed by laminectomy and a small durotomy. Once the syrinx cavity was identified and the proximal end of the tubing was inserted into the syrinx cavity, the tubing was tunneled into the pleural incision subcutaneously. Insertion of the pleural end of the shunt was performed under the microscope, with removal of a small amount of the rib at its upper edge. Results: 10 procedures were performed in 7 patients by the senior author. Etiologies of syringomyelia included Chiari malformation, trauma, diastematomyelia and kyphoscoliosis. All patients improved neurologically. No patients had immediate postoperative complications. One patient underwent two revisions of syringopleural shunts due to multilobulated nature of syringomyelia. Conclusions: Our case series presents a novel, minimally invasive technique for shunting of syringomyelia with results comparable to open procedures.

scholarly journals Keyhole retrosigmoid approach for large vestibular schwannomas: strategies to improve outcomes

2018 ◽  
Vol 44 (3) ◽  
pp. E2 ◽  
Author(s):  
Reid Hoshide ◽  
Harrison Faulkner ◽  
Mario Teo ◽  
Charles Teo
Keyword(s):  
Minimally Invasive ◽  
Facial Nerve ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Retrosigmoid Approach ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

OBJECTIVEThere are numerous treatment strategies in the management for large vestibular schwannomas, including resection only, staged resections, resections followed by radiosurgery, and radiosurgery only. Recent evidence has pointed toward maximal resection as being the optimum strategy to prevent tumor recurrence; however, durable tumor control through aggressive resection has been shown to occur at the expense of facial nerve function and to risk other approach-related complications. Through a retrospective analysis of their single-institution series of keyhole neurosurgical approaches for large vestibular schwannomas, the authors aim to report and justify key techniques to maximize tumor resection and reduce surgical morbidity.METHODSA retrospective chart review was performed at the Centre for Minimally Invasive Neurosurgery. All patients who had undergone a keyhole retrosigmoid approach for the resection of large vestibular schwannomas, defined as having a tumor diameter of ≥ 3.0 cm, were included in this review. Patient demographics, preoperative cranial nerve status, perioperative data, and postoperative follow-up were obtained. A review of the literature for resections of large vestibular schwannomas was also performed. The authors’ institutional data were compared with the historical data from the literature.RESULTSBetween 2004 and 2017, 45 patients met the inclusion criteria for this retrospective chart review. When compared with findings in a historical cohort in the literature, the authors’ minimally invasive, keyhole retrosigmoid technique for the resection of large vestibular schwannomas achieved higher rates of gross-total or near-total resection (100% vs 83%). Moreover, these results compare favorably with the literature in facial nerve preservation (House-Brackmann I–II) at follow-up after gross-total resections (81% vs 47%, p < 0.001) and near-total resections (88% vs 75%, p = 0.028). There were no approach-related complications in this series.CONCLUSIONSIt is the experience of the senior author that complete or near-complete resection of large vestibular schwannomas can be successfully achieved via a keyhole approach. In this series of 45 large vestibular schwannomas, a greater extent of resection was achieved while demonstrating high rates of facial nerve preservation and low approach-related and postoperative complications compared with the literature.

P3674Patient characteristics and treatment patterns in the multicentre, retrospective chart review of first-time Opsumit (macitentan) users in the United States (OrPHeUS)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V McLaughlin ◽  
R Channick ◽  
K Chin ◽  
P Leary ◽  
C Miller ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Exposure Period ◽  
The United States ◽  
Treatment Patterns ◽  
Functional Class ◽  
Kaplan Meier ◽  
Real World Evidence

Abstract Introduction The OPsumit® Historical USers cohort (OrPHeUS) is a multicentre, US, retrospective medical chart review conducted to supplement the OPsumit® USers (OPUS) Registry to fulfil the FDA request to characterise the safety of macitentan in clinical practice. Purpose To describe patient characteristics, treatment patterns, hepatic safety and survival in patients with pulmonary hypertension (PH) newly treated with macitentan. Methods OrPHeUS (NCT03197688) aimed to include 2200 new users of macitentan, between October 2013 and March 2017, who were not enrolled in OPUS. Here we present patients with follow-up data, including characteristics and treatment patterns at macitentan initiation, hepatic adverse events (HAEs) identified using preferred terms in chart entries and pharmacovigilance reporting, hospitalisations and survival. Results OrPHeUS included 2982 patients newly treated with macitentan and with follow-up data; the reason for macitentan prescription was pulmonary arterial hypertension (PAH) in 2362 (79.3%) patients, other PH aetiologies in 612 (20.6%) patients and 8 patients with other/unknown reasons. At macitentan initiation, the median (Q1, Q3) age of the patients was 62 (51, 72) years and 73.9% were female. WHO functional class (FC) was documented in 654 (21.9%) patients, 35.6% of patients were in FC I/II and 64.4% in FC III/IV; median (Q1, Q3) 6-minute walk distance, documented in 411 (13.8%) patients, was 293 (200, 383) metres. At macitentan initiation, 41.5% (n=1239) of patients were not receiving PAH therapy, 46.3% (n=1382) were already receiving one PAH therapy and 11.9% (n=356) were already receiving two PAH therapies. The median (Q1, Q3) exposure to macitentan was 14.9 (5.6, 27.1) months; 57% and 43% of patients had exposures of >12 and >18 months. During the exposure period, 933 (31.3%) patients discontinued treatment, including 474 (15.9%) patients who discontinued due to an adverse event (AE), 6 (0.2%) due to a HAE, 449 (15.1%) for reasons other than an AE/HAE, and 4 (0.1%) for unknown reasons. There were 275 (9.2%) patients who experienced ≥1 HAE (incidence rate [IR]: 0.07 [95% CI, 0.06, 0.08] per 1 person-year); alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥3x upper limit of normal (ULN) were experienced by 113 (3.8%) patients (IR: 0.028 [95% CI, 0.023, 0.033] per 1 person-year); ALT/AST ≥x3 ULN and bilirubin ≥2x ULN was experienced by 33 (1.1%) patients (IR: 0.008 [95% CI, 0.006, 0.011] per 1 person-year). There were 1148 (38.5%) patients who experienced at least one hospitalisation (IR: 0.36 [95% CI, 0.34, 0.39] per 1 person-year). The 12-month Kaplan-Meier survival estimate was 92% (95% CI, 91, 93). Conclusion OrPHeUS provides additional real-world evidence in patients newly treated with macitentan, confirming the hepatic safety profile of macitentan. Acknowledgement/Funding Actelion Pharmaceuticals Ltd

scholarly journals Neonatal Follow Up Study: A Retrospective Chart Review of Developmental Outcomes

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Heather Wolfe, MD ◽  
Denise Gilham, NP ◽  
Susan Stace, RN, CPN ◽  
Uchechukwu Emili, BS
Keyword(s):  
Preterm Birth ◽  
Infant Development ◽  
Chart Review ◽  
Turning Point ◽  
Retrospective Chart Review ◽  
The United States ◽  
Ages And Stages Questionnaire ◽  
Preterm Group ◽  
Preterm Babies

Background and Hypothesis: According to the CDC, Preterm birth is defined as a baby born before 37 weeks of gestation. 1 In 2016 preterm birth affected 1 in every 10 infant born in the United States.1 Preterm birth has been known to cause many birth defects along with developmental delays and has attributed to 17% of all infant death. Neonatal Follow Up clinics or programs have been instrumental in helping infants catch up developmentally.3 We believe that with the NFC, we will be able to develop a standard for preterm babies and the normalization of their development. Experimental Design or Project Methods: A retrospective chart review was conducted to determine the developmental outcome of infants that were born prior to 37 weeks’ gestation. Infants were divided into extreme, very, and moderate preterm cohorts. Test of Infant Motor Performance (TIMP), Ages and Stages Questionnaire (ASQ), Bayley Scales of Infant Development (BSID) and Modified Checklist for Autism in Toddlers (M-CHAT) scores were used to determine a standard for when preterm babies in each cohort normalize developmentally. Results: Analysis of the data showed that the developmental turning point for each cohort varies. Within the extreme preterm cohort, one can see that there was no clear turning point for development. For the very preterm group, by TIMP 2, one could see a turning point and a decrease in delays. Lastly, moderately preterm cohort, the number of delays was seen tot decrease from the administration of TIMP 2 and continue in this trend. Conclusion and Potential Impact: Through the administration of these developmental tests, physicians are able to track the development of preterm babies. We concluded that with the proper follow up, one can see an improvement in development as early as the administration of TIMP 2. 1) Preterm Birth https://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PretermBirth.htm 2) Suave, R., & Lee, S. K. (2006). Neonatal follow-up programs and follow-up studies: Historical and current perspectives. Paediatrics and Child Health. http://doi.org/10.1093/pch/11.5.267 3) Voller, S. M. B. (2018). Follow-Up Care for High-Risk Preterm Infants. Pediatric Annals, 47(4). http://doi.org/10.3928/19382359-20180325-03

scholarly journals Translaminar Osseous Channel–Assisted FullEndoscopic Flavectomy Decompression of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Surgical Technique and Results

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E475-E485
Author(s):  
Wenbo Liao
Keyword(s):  
Minimally Invasive ◽  
Study Design ◽  
Spine Surgery ◽  
Ligamentum Flavum ◽  
Japanese Orthopaedic Association ◽  
Invasive Technique ◽  
Control Group ◽  
Thoracic Myelopathy ◽  
Radiographic Findings

Background: Previous surgical procedures for the treatment of thoracic myelopathy (TM) due to ossification of the ligamentum flavum (OLF) were accompanied by significant trauma and risk. Objectives: Report a novel minimally invasive technique, translaminar osseous channel–assisted posterior percutaneous full-endoscopic flavectomy (p-PEF), as an alternative surgical strategy for the treatment of OLF-related TM. Study Design: A retrospective cohort study. Setting: A center for spine surgery and pain medicine. Methods: Thirteen patients with TM caused by isolated OLF who underwent translaminar osseous channel–assisted p-PEF were retrospectively analyzed. Preoperative and postoperative radiographic findings and clinical results were compared to confirm the efficacy of the procedure and perioperative complications were investigated to evaluate the technical safety. Results: All 13 patients with 23 isolated ossified sites were successfully treated with the translaminar osseous channel–assisted p-PEF technique and no additional internal fixation was needed. With an average follow-up of 29.2 months (range, 24–36 months), no local instability was detected. The preoperative and final follow-up cross-sectional area of the stenotic dural sac was 47.87 ± 8.98 mm2 and 130.47± 19.07 mm2 , respectively (P < 0.0001). The mean modified Japanese Orthopaedic Association score was significantly improved from 3.54 ± 1.26 points preoperatively to 9.07 ± 1.48 points at final follow-up (P < 0.0001). The Visual Analog Scale scores of thoracolumbar backaches were 5.3 ± 1.2 before surgery and 0.69 ± 0.75 at final follow-up (P = 0.001). No serious complications ensued. Limitations: This was a retrospective study with several limitations, including the lack of a control group, small number of included samples and unavoidable nature of the single-center study design. Conclusions: Translaminar osseous channel–assisted p-PEF technique, with less tissue trauma and impact on the stability of the spine, can provide adequate decompression and satisfying outcomes in the treatment of OLF-related TM and should be considered as an alternative procedure for isolated OLF. Key words: Translaminar osseous channel, percutaneous full-endoscopic flavectomy, thoracic myelopathy, ossification of ligamentum flavum, minimally invasive spine surgery

scholarly journals 689 Silac (Sinus Laser-Assisted Closure) For Pilonidal Sinus: Our NHS Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Kalaskar ◽  
J Adamek
Keyword(s):  
Minimally Invasive ◽  
Success Rate ◽  
Pilonidal Disease ◽  
Surgical Excision ◽  
Pilot Project ◽  
Invasive Technique ◽  
Recurrence Rates ◽  
Pilonidal Cyst ◽  
Primary Wound Closure

Abstract Introduction The accepted treatment of pilonidal disease still consists of surgical excision with primary wound closure. This treatment has complications such as excessive pain, delayed wound healing, and recurrence. We introduced this technique using a radial laser probe (SiLaCTM, Biolitec, Germany). Previous studies have shown encouraging results with respect to safety, patient satisfaction, and minimal recurrence rates. Method The pilot project was planned with the objectives to assess postoperative complications and reoperation rates. All operations were performed as day case procedures under general anaesthesia. We studied the data of our first 25patients operated with this technique between January 2019 and December 2019 using a prospective database and outpatient clinic follow up. Results The median follow up duration was 13 months. The initial success rate was 64%(16/25), reoperation was required in 32%(8/25) and one patient was lost to follow up. one patient returned with abscess formation in the postoperative period. Conclusions SiLaC is a safe and minimally invasive technique for the destruction of the pilonidal cyst and sinus. The success rate is modest, making this new therapy a minimally invasive option for the majority of the patients with pilonidal disease but it should be offered with caution.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

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