1,505 results on '"Leg pain"'
Search Results
2. Patent Issued for Systems and methods for orthopedic implants (USPTO 12133803).
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ORTHOPEDIC apparatus ,HUMAN anatomical models ,SPINAL fusion ,ORTHOPEDIC implants ,MEDICAL personnel ,LUMBAR vertebrae diseases ,LEG pain ,MEDICAL software - Abstract
The patent issued for systems and methods for orthopedic implants by Carlsmed Inc. describes patient-specific orthopedic implants and efficient methods for their production. The orthopedic implants aim to replace missing anatomy, correct deformities, and restore compromised anatomical relationships. The process involves creating user accounts, obtaining patient data, generating anatomical models, designing implants, receiving feedback from healthcare providers, and manufacturing the patient-specific orthopedic implants. The use of software throughout the design process is highlighted, emphasizing the importance of patient consent and healthcare provider approval in the creation of these implants. [Extracted from the article]
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- 2024
3. Patent Issued for Medical implant (USPTO 12133664).
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SURGICAL blood loss ,SPINAL nerve roots ,SPINAL cord diseases ,SPINAL cord compression ,SURGICAL technology ,SPINAL surgery ,LEG pain - Abstract
A patent has been issued for a medical implant designed by Spinal Simplicity LLC to address spinal stenosis, a condition that causes pain and numbness in the back and legs. The implant aims to stabilize the spine by clamping onto nearby bony tissue or soft tissue, reducing the need for extensive bone or soft tissue removal during surgery. The implant features a single actuation mechanism to simplify the surgical procedure and decrease the complexity of the implant. This innovation may offer a less invasive and more efficient solution for patients undergoing spinal procedures. [Extracted from the article]
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- 2024
4. Patent Issued for Devices and methods for correcting vertebral misalignment (USPTO 12127953).
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SPINE abnormalities ,LUMBAR pain ,HAMSTRING muscle ,SPINAL canal ,SPASMS ,SPONDYLOLYSIS ,LEG pain - Abstract
A patent has been issued to Globus Medical Inc. for devices and methods aimed at correcting vertebral misalignment, particularly conditions like spondylolisthesis. The invention involves vertebral implants that can be used to move dislocated vertebral bodies into proper alignment and maintain stability post-surgery. These devices offer potential solutions for various spinal conditions beyond spondylolisthesis, such as fractures, deformities, degenerative lesions, and post-tumor resection reconstruction. [Extracted from the article]
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- 2024
5. Patent Issued for Implant removal tool (USPTO 12127954).
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SURGICAL equipment ,SURGICAL technology ,MINIMALLY invasive procedures ,SURGICAL instruments ,SPINAL nerve roots ,SPINAL implants ,ARTIFICIAL implants ,LEG pain - Abstract
Spinal Simplicity LLC has been issued a patent for an implant removal tool designed to facilitate the removal of expandable spinal implants. The tool aims to simplify the process of removing implanted surgical devices, particularly in cases where the device needs to be replaced or removed due to failure. This invention provides a combined instrument for preparing and removing the implant, reducing the number of tools required for the surgical procedure and ensuring safe and complete removal from the patient. [Extracted from the article]
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- 2024
6. Patent Issued for Walking cane (USPTO 12108850).
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PARKINSON'S disease ,CENTRAL nervous system ,LEG pain ,BUSHINGS ,BACKACHE ,STAFFS (Sticks, canes, etc.) - Abstract
A patent has been issued for a walking cane designed to provide quick and easy adjustability while offering support and stability to users, particularly the elderly and those with medical conditions. The cane features an expandable and collapsible design with spring-actuated expansion and an internal latch mechanism to lock it at a desired height. The invention aims to address the limitations of standard walking canes by providing a more versatile and user-friendly mobility device. [Extracted from the article]
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- 2024
7. "Methods To Secure An Implant System To A Bone" in Patent Application Approval Process (USPTO 20240325163).
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- 2024
8. Investigators from Medtronic Target Leg Pain (Low-energy Differential Target Multiplexed Scs Derivative Reduces Pain and Improves Quality of Life Through 12 Months In Patients With Chronic Back And/or Leg Pain).
- Abstract
A study conducted by investigators from Medtronic in Minneapolis, Minnesota, evaluated the effectiveness of a low-energy differential target multiplexed (DTM) spinal cord stimulation (SCS) derivative in reducing chronic back and/or leg pain. The study included 57 subjects who experienced a 50.4% mean reduction in overall pain from baseline at the 3-month follow-up, which was sustained through 12 months. The use of DTM endurance SCS therapy demonstrated that energy-reducing stimulation patterns can provide clinical benefit and improve quality of life for patients with chronic pain. The research was supported by Medtronic and has been peer-reviewed. [Extracted from the article]
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- 2024
9. Patent Issued for Systems and methods for vertebral adjustment (USPTO 12076051).
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SPINAL fusion ,INTERVERTEBRAL disk ,SPINAL canal ,SPINAL stenosis ,NUCLEUS pulposus ,SPINAL surgery ,LUMBAR vertebrae diseases ,LEG pain - Abstract
NuVasive Specialized Orthopedics Inc. has been issued a patent for systems and methods for vertebral adjustment. The patent describes a non-invasive adjustable system for changing the curvature of the spine. This system can be used to treat conditions such as degenerative disc disease, back pain, and stenosis. The patent provides detailed information about the design and operation of the adjustable implant, as well as its potential applications in various orthopedic deformities. The patent was filed in January 2023 and published online in September 2024. [Extracted from the article]
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- 2024
10. Patent Issued for Single insertion delivery system for treating embolism and associated systems and methods (USPTO 12016580).
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EMBOLISMS ,THROMBOSIS ,PULMONARY blood vessels ,PATENTS ,VENOUS thrombosis ,MEMBRANE filters ,LEG pain - Abstract
A patent has been issued for a single insertion delivery system for treating embolism and associated systems and methods. Thromboembolic disorders, such as stroke, pulmonary embolism, and heart attack, can have serious consequences and are a major cause of morbidity and mortality. The patent describes a method for intravascular treatment of clot material within a blood vessel, involving the use of an interventional device to engage and remove clot material. The technology aims to improve the effectiveness and efficiency of clot removal procedures while minimizing trauma to the patient. [Extracted from the article]
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- 2024
11. Patent Issued for Adjustable spine distraction implant (USPTO 12011196).
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LEG pain ,SPINAL implants ,MEDICAL personnel ,NEUROLOGICAL disorders ,PATENTS ,SPINAL canal - Abstract
A patent has been issued for an adjustable spine distraction implant developed by Life Spine Inc. The implant is designed to alleviate discomfort associated with spinal stenosis, facet arthropathy, and similar conditions. It works by relieving pressure and restrictions on blood vessels and nerves in the spine. The implant includes an adjustable device that can distract adjacent vertebrae, increasing the volume and cross-sectional area of the spinal canal and neural foramen. The implant can be positioned between spinous processes and is adjustable to meet the specific needs of each patient. [Extracted from the article]
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- 2024
12. Patent Issued for Meditation seat system (USPTO 12004659).
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MEDITATION ,SEATING (Furniture) ,PATENTS ,ORTHOPEDIC apparatus ,ROLLING contact ,LEG pain - Abstract
A patent has been issued for a meditation seat system developed by Ungloo LLC. The seat system is designed to provide support for users sitting in a cross-legged or kneeling position during meditation. It aims to increase comfort by supporting the knees, hips, and back of the user. The seat system includes customizable knee blocks and a crescent-shaped seat. The patent provides detailed descriptions and claims for the portable meditation system. [Extracted from the article]
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- 2024
13. Researchers Submit Patent Application, "Implant System And Methods Of Use", for Approval (USPTO 20240164909).
- Abstract
A patent application has been submitted for an implant system and methods of use in orthopedic surgery. The invention aims to address spinal disorders and degenerative conditions that cause back and leg pain. The implant system can be used to augment the vertebral body, fuse multiple vertebral bodies, and decompress neural elements. It can also be used in other bones or joints. The system includes a cage, a staple, and an anchor frame, which provide better control, conform to the bone surface, and secure the implant device with a compressive force. The implant can be implanted laterally or from other orientations, allowing for surgical benefits. This patent application describes an orthopedic implant device that includes a cage, a staple, a coupling element, and an anchor frame. The staple has a staple head and a staple shaft, and the coupling element is used to adjust the positional relationship between the staple head and the anchor frame without rotating the staple shaft. The device is designed to secure bone portions together and can be used in surgeries for conditions such as leg pain, scoliosis, and spinal curvatures. The patent application was filed by Charlie Barfield, Randal R. Betz, Marc Burel, Dimitri K. Protopsaltis, Michael Sherman, and Dale E. Whipple. [Extracted from the article]
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- 2024
14. Patent Issued for System and method for performing percutaneous spinal interbody fusion (USPTO 11974927).
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SPINAL fusion ,MINIMALLY invasive procedures ,LEG pain ,PATENTS ,SURGICAL technology ,ARTIFICIAL joints ,SURGICAL instruments - Abstract
A patent has been issued to Spineology Inc. for a system and method for performing percutaneous spinal interbody fusion. The patent describes the current challenges and limitations of existing devices used to treat degenerative disc disease and proposes a new approach that enables true percutaneous interbody fusion. The system utilizes indirect x-ray visualization and a posterolateral approach to access the spine, resulting in significantly less soft tissue damage, blood loss, post-operative pain, scar tissue, and vascular injury compared to minimally invasive interbody fusion. The patent also includes details about a discectomy evaluation device and a system for performing percutaneous interbody spinal fusion. [Extracted from the article]
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- 2024
15. Patent Issued for Implantable stent (USPTO 11980555).
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LEG pain ,THROMBOSIS ,PERIPHERAL vascular diseases ,VENOUS thrombosis - Abstract
Vesper Medical Inc. has been issued a patent for an implantable stent designed to treat May-Thurner syndrome and deep venous thrombosis. May-Thurner syndrome is a condition in which the left common iliac vein is compressed by the right common iliac artery, leading to blood clots and other adverse effects. The stent aims to improve blood flow and prevent further compression following angioplasty. The stent design includes obliquely oriented struts and flexible connectors to enhance flexibility and reduce foreshortening. Deep vein thrombosis, a potentially life-threatening complication, can be treated with anticoagulation and other therapies. [Extracted from the article]
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- 2024
16. Patent Issued for Spinal surgery method and related apparatus (USPTO 11950790).
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SPINAL surgery ,LEG pain ,RETRACTORS (Surgery) ,PLASMA jets ,DISCECTOMY ,SPINAL nerve roots ,SURGICAL technology ,JET streams - Abstract
A patent has been issued for a spinal surgery method and related apparatus by Misonix LLC. The invention relates to surgical procedures known as discectomy and nucleotomy, which involve removing part of an intervertebral disc that is putting pressure on a nerve in the spinal column. The patent describes a surgical method using an elongate probe with an outlet port to stream energy, such as a laser beam or plasma jet, into the spinal disc material to vaporize tissue and other organic material. The method also includes aspirating gas and detritus from the surgical site and flowing air into the spinal disc space. [Extracted from the article]
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- 2024
17. Patent Application Titled "Atherectomy Device" Published Online (USPTO 20240108365).
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ATHERECTOMY ,PATENT applications ,INTERNET publishing ,TRANSLUMINAL angioplasty ,MINIMALLY invasive procedures ,LEG pain ,MUCOCUTANEOUS lymph node syndrome - Abstract
The US Patent and Trademark Office has published a patent application for an atherectomy device designed to remove plaque from blood vessels. The device, invented by Israel, Jenna Rose; Leedle, John D.; McGuckin, Jr., James F.; Snyder, Aaron Larry; and Valentis, Colin, features a rotatable tip and an auger to move particles into an outer member. The device aims to improve the removal of small particles during atherectomy procedures. The patent application, filed by Rex Medical L.P., provides detailed descriptions of the device's features and embodiments. [Extracted from the article]
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- 2024
18. Patent Issued for Surgical implant system and method (USPTO 11938042).
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ARTIFICIAL implants ,LEG pain ,SPINAL implants ,END effectors (Robotics) - Abstract
A patent has been issued for a surgical implant system and method by inventors Daniel Paxton Wall and assigned to Warsaw Orthopedic Inc. The patent describes a surgical instrument that includes an outer sleeve, an inner shaft, and an inner sleeve. The instrument is designed to deliver implants for fusion and fixation to provide stability to a treated region during surgical treatment. The patent also mentions the sacro-iliac joint and its susceptibility to disorders and trauma, which can cause pain in the lower back and radiating buttock and leg pain. Non-surgical treatments may be ineffective in relieving symptoms, making surgical treatment necessary. [Extracted from the article]
- Published
- 2024
19. Meeting Patient Expectations or Achieving a Minimum Clinically Important Difference: Predictors of Satisfaction among Lumbar Fusion Patients
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Caroline N. Jadczak, Shruthi Mohan, Conor P. Lynch, Elliot D.K. Cha, Cara E. Geoghegan, and Kern Singh
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medicine.medical_specialty ,Visual analogue scale ,business.industry ,Minimal clinically important difference ,medicine.medical_treatment ,Leg pain ,Retrospective cohort study ,humanities ,Patient satisfaction ,Lumbar ,Pain reduction ,Spinal fusion ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,Surgery ,business - Abstract
Study Design: Retrospective cohort.Purpose: To investigate the impact of meeting a patient’s preoperative expectations for back or leg pain or the achievement of minimum clinically important difference (MCID) on patient satisfaction following lumbar fusion.Overview of Literature: Few studies have compared if MCID achievement or meeting preoperative expectations for pain reduction affects patient satisfaction.Methods: A surgical database was reviewed for eligible patients who underwent lumbar fusion. Patient satisfaction and Visual Analog Scale (VAS) for back and leg pain were the outcomes of interest. Meeting expectations was calculated as a difference of ≤0 between preoperative expectations and postoperative VAS scores. MCID achievement was calculated by comparing changes in VAS scores with established values. Meeting preoperative expectations or MCID achievement as predictors of patient satisfaction was evaluated using regression analysis.Results: A total of 134 patients were included in this study. Patients demonstrated significant improvements in VAS back and VAS leg (pp≤0.024). Meeting VAS leg expectations and MCID achievement both demonstrated a significant association with patient satisfaction at all postoperative timepoints (all, p≤0.02). No differences between MCID achievement and meeting expectations as predictors of satisfaction were noted.Conclusions: The majority of patients achieved MCID and had their back and leg pain expectations met by 1 year. Both measures were significant predictors of patient satisfaction and suggest that MCID achievement may act as a suitable substitute for patient satisfaction.
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- 2022
- Full Text
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20. Patient preferences for treatment of lumbar disc herniation
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Biswadjiet S. Harhangi, Paul R A M Depauw, Pravesh S. Gadjradj, Esther W. de Bekker-Grob, Nicholas V R Smeele, Mandy de Jong, Maurits W. van Tulder, Neurosurgery, Health Technology Assessment (HTA), Health Sciences, Faculty of Behavioural and Movement Sciences, AMS - Musculoskeletal Health, APH - Methodology, and APH - Societal Participation & Health
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Sciatica ,medicine.medical_specialty ,SDG 16 - Peace ,business.industry ,SDG 16 - Peace, Justice and Strong Institutions ,discrete choice experiment ,Leg pain ,Discrete choice experiment ,General Medicine ,Patient preference ,Preference ,Justice and Strong Institutions ,lumbar disc herniation ,Willingness to pay ,medicine ,Performed Procedure ,Physical therapy ,Lumbar disc herniation ,medicine.symptom ,business ,preferences - Abstract
OBJECTIVE Lumbar discectomy is a frequently performed procedure to treat sciatica caused by lumbar disc herniation. Multiple surgical techniques are available, and the popularity of minimally invasive surgical techniques is increasing worldwide. Clinical outcomes between these techniques may not show any substantial differences. As lumbar discectomy is an elective procedure, patients’ own preferences play an important role in determining the procedure they will undergo. The aims of the current study were to determine the relative preference weights patients apply to various attributes of lumbar discectomy, determine if patient preferences change after surgery, identify preference heterogeneity for choosing surgery for sciatica, and calculate patient willingness to pay for other attributes. METHODS A discrete choice experiment (DCE) was conducted among patients with sciatica caused by lumbar disc herniation. A questionnaire was administered to patients before they underwent surgery and to an independent sample of patients who had already undergone surgery. The DCE required patients to choose between two surgical techniques or to opt out from 12 choice sets with alternating characteristic levels: waiting time for surgery, out-of-pocket costs, size of the scar, need of general anesthesia, need for hospitalization, effect on leg pain, and duration of the recovery period. RESULTS A total of 287 patients were included in the DCE analysis. All attributes, except scar size, had a significant influence on the overall preferences of patients. The effect on leg pain was the most important characteristic in the decision for a surgical procedure (by 44.8%). The potential out-of-pocket costs for the procedure (28.8%), the wait time (12.8%), need for general anesthesia (7.5%), need for hospitalization (4.3%), and the recovery period (1.8%) followed. Preferences were independent of the scores on patient-reported outcome measures and baseline characteristics. Three latent classes could be identified with specific preference patterns. Willingness-to-pay was the highest for effectiveness on leg pain, with patients willing to pay €3133 for a treatment that has a 90% effectiveness instead of 70%. CONCLUSIONS Effect on leg pain is the most important factor for patients in deciding to undergo surgery for sciatica. Not all proposed advantages of minimally invasive spine surgery (e.g., size of the scar, no need of general anesthesia) are necessarily perceived as advantages by patients. Spine surgeons should propose surgical techniques for sciatica, not only based on own ability and proposed eligibility, but also based on patient preferences as is part of shared decision making.
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- 2022
- Full Text
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21. Patent Issued for Orthopedic implant system and methods of use (USPTO 11883300).
- Abstract
This document describes a patented orthopedic implant system and its methods of use. The system aims to address orthopedic issues like collapsed vertebral bodies and misaligned facet joints, which can cause back and leg pain. It is designed to stabilize the spine, provide pain relief, and maintain mobility. The system includes a staple that engages the bone and can rotate to position the staple tines correctly. It also includes a coupling device that can adjust the device length by retracting the staple towards the orthopedic implant device. The document provides additional details and patent information for further research. [Extracted from the article]
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- 2024
22. Clinical accuracy and initial experience with augmented reality–assisted pedicle screw placement: the first 205 screws
- Author
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Ethan Cottrill, Yike Jin, Sheng Fu L. Lo, Daniel M. Sciubba, Ann Liu, Jeff Ehresman, Erick M. Westbroek, Zach Pennington, Camilo A. Molina, Majid Khan, and Timothy F. Witham
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Spinal instrumentation ,business.industry ,Thoracic spine ,Leg pain ,General Medicine ,musculoskeletal system ,Surgery ,Spine surgery ,Lumbar ,Medicine ,Median body ,Lumbar spine ,business ,Pedicle screw - Abstract
OBJECTIVE Augmented reality (AR) is a novel technology which, when applied to spine surgery, offers the potential for efficient, safe, and accurate placement of spinal instrumentation. The authors report the accuracy of the first 205 pedicle screws consecutively placed at their institution by using AR assistance with a unique head-mounted display (HMD) navigation system. METHODS A retrospective review was performed of the first 28 consecutive patients who underwent AR-assisted pedicle screw placement in the thoracic, lumbar, and/or sacral spine at the authors’ institution. Clinical accuracy for each pedicle screw was graded using the Gertzbein-Robbins scale by an independent neuroradiologist working in a blinded fashion. RESULTS Twenty-eight consecutive patients underwent thoracic, lumbar, or sacral pedicle screw placement with AR assistance. The median age at the time of surgery was 62.5 (IQR 13.8) years and the median body mass index was 31 (IQR 8.6) kg/m2. Indications for surgery included degenerative disease (n = 12, 43%); deformity correction (n = 12, 43%); tumor (n = 3, 11%); and trauma (n = 1, 4%). The majority of patients (n = 26, 93%) presented with low-back pain, 19 (68%) patients presented with radicular leg pain, and 10 (36%) patients had documented lower extremity weakness. A total of 205 screws were consecutively placed, with 112 (55%) placed in the lumbar spine, 67 (33%) in the thoracic spine, and 26 (13%) at S1. Screw placement accuracy was 98.5% for thoracic screws, 97.8% for lumbar/S1 screws, and 98.0% overall. CONCLUSIONS AR depicted through a unique HMD is a novel and clinically accurate technology for the navigated insertion of pedicle screws. The authors describe the first 205 AR-assisted thoracic, lumbar, and sacral pedicle screws consecutively placed at their institution with an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B.
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- 2022
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23. Endovascular Treatment for Lower-extremity Arterial Thrombosis in a Patient with Congenital Afibrinogenemia and a History of Bleeding Complications
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Tairo Kurita, Akihiro Takasaki, Takeshi Matsumoto, Ryuji Okamoto, Yoshito Ogihara, Kei Sato, Hideo Wada, Daisuke Hiramatsu, and Kaoru Dohi
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Male ,medicine.medical_specialty ,business.industry ,Renal infarction ,Leg pain ,Extremities ,Hemorrhage ,Thrombosis ,General Medicine ,Blood Coagulation Disorders ,Middle Aged ,Afibrinogenemia ,medicine.disease ,Peripheral ,Surgery ,Congenital afibrinogenemia ,Blood Disorder ,Internal Medicine ,medicine ,Back pain ,Humans ,medicine.symptom ,Endovascular treatment ,business - Abstract
Congenital afibrinogenemia is a rare autosomal recessive blood disorder that accompanies thrombotic complications and is associated with bleeding tendency. The management of these opposing complications remains a challenge. Endovascular treatment (EVT) for peripheral arterial thrombosis has not been described in previous studies. A 57-year-old man with congenital afibrinogenemia developed back pain and left lower leg pain. The cause of the pain was confirmed to be renal infarction and lower extremity arterial thrombosis by Doppler ultrasound and contrast-enhanced computed tomography. He was treated with EVT for the lower extremity arterial thrombosis, leading to an excellent short-term improvement without bleeding.
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- 2022
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24. Historic cohort
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Wes O. Zimmermann, Rigo Hoencamp, M. Verschure, Ewan D. Ritchie, M. Van Der Werve, N. Maliko, Roy Maksymiak, and Surgery
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medicine.medical_specialty ,Referral ,Sports medicine ,medicine.medical_treatment ,Compartment Syndromes ,Fasciotomy ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Chronic exertional compartment syndrome ,Leg ,Chronic Exertional Compartment Syndrome ,biology ,Athletes ,business.industry ,Leg pain ,030208 emergency & critical care medicine ,General Medicine ,biology.organism_classification ,medicine.disease ,Cohort ,cardiovascular system ,business ,Cohort study - Abstract
IntroductionExercise-related leg pain (ERLP) may be caused by chronic exertional compartment syndrome (CECS), occurring mainly in athletes and military recruits. In military populations, the effectiveness of surgical treatment in CECS is debated. The purpose of this study is to assess the outcome of surgical treatment for CECS in Alrijne Hospital (the Netherlands), a civilian hospital with supraregional referral function.MethodsA historic cohort study was performed on patients with ERLP who were suspected for CECS and were referred for intracompartmental pressure measurement (ICPM) from 2013 to 2017 (n=160). Patient demographics, ICPM and survey response were analysed.ResultsThe mean delay before visitation was 29.0±30.3 months. When comparing surgical-treated patients with CECS with conservative-treated patients with ERLP, surgical-treated patients were more satisfied, reported better recovery towards former level of performance (2.8±2.0 vs 3.9±1.7 and 2.5±1.6 vs 3.2±1.4 on a 7-point Likert scale, respectively) and better subjective injury status (79.3±22.6 vs 63.5±27.4 using the Single Assessment Numeric Evaluation score). Treatment satisfaction was 75.0% in surgical-treated CECS versus 51.4% in conservative-treated ERLP.ConclusionCivilian patients report improved functional outcomes after fasciotomy for CECS. Future research should focus on non-invasive diagnostic options and methods to determine which treatment is the most appropriate for each individual patient.
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- 2021
25. A Postoperative Phenomenon of Percutaneous Endoscopic Lumbar Discectomy: Rebound Pain
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Yipeng Wang, Keyi Yu, Chang Zhang, and Ziquan Li
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Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Complications ,Lumbar discectomy ,Clinical Outcomes ,Disability Evaluation ,medicine ,Humans ,Diskectomy, Percutaneous ,Orthopedics and Sports Medicine ,Stage (cooking) ,Lumbar Disc Herniation ,Pain Measurement ,Retrospective Studies ,Orthopedic surgery ,Pain, Postoperative ,Postoperative Pain ,Clinical Article ,Lumbar Vertebrae ,business.industry ,Leg pain ,Retrospective cohort study ,Middle Aged ,Surgery ,Oswestry Disability Index ,Clinical Articles ,Female ,Lumbar disc herniation ,High incidence ,business ,Percutaneous Endoscopic Lumbar Discectomy ,Intervertebral Disc Displacement ,RD701-811 - Abstract
Objective After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg pain. However, for a small number of patients, these symptoms are relieved immediately after surgery but aggravated soon after, and then relieved after short‐term full rest or conservative treatment. The aim of the study was to demonstrate this short‐term recurrent phenomenon, termed rebound pain. Methods A retrospective study was conducted on 144 patients who underwent single‐segment PELD from May 2017 to June 2020. Postoperative patients were divided into a rebound pain group and a non‐rebound pain group. For the former group, general information, symptom characteristics and visual analogue score (VAS) changes in rebound pain were summarized. For both groups, postoperative efficacy was evaluated by recent VAS of low back and leg pain in the remission stage, the Oswestry disability index (ODI) and the modified MacNab criteria at the last follow‐up. Logistic regression analysis was used to identify predictors for rebound pain. Results The VAS and ODI exhibited significant improvements at the last follow‐up of average 15.4 months (P 45 days was found as a protective factor for rebound pain (p = 0.031). Conclusion Although rebound pain with multiple characteristics and a short duration had no significant effect on long‐term postoperative efficacy, its high incidence often caused unnecessary concern in both patients and doctors. As a result, careful differentiation of rebound pain from other postoperative complications is needed., For patients with lumbar disc herniation, most received relief from low back and leg pain after percutaneous endoscopic lumbar discectomy (PELD). However, 10.4% of patients had short‐term pain recurrence after PELD, termed rebound pain, which could be alleviated by adequate rest and conservative treatment.
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- 2021
26. Pain Neuroscience Education for Depression: A Pilot Study
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Adriaan Louw, Ellen Wendling, Dustin Hawk, Nicole Sturdevant, Hailey Louw, and Kevin Farrell
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Moderate to severe ,business.industry ,Catastrophization ,General Engineering ,Leg pain ,Low back pain ,Pain rating ,Medicine ,medicine.symptom ,Pain.knowledge ,Physical therapist ,business ,Neuroscience ,Depression (differential diagnoses) - Abstract
Objective: To determine if a brief, one-on-one pain neuroscience education (PNE) session delivered by a physical therapist (PT) can influence depression. Methods: A convenience sample of patients with persistent low back pain (LBP) (n = 23) attending PT with moderate to severe depression (Patient Health Questionnaire-9 [PHQ-9]) participated in the study. Patients received a standardized, one-on-one 30-minute PNE session by a PT with pre- and post-intervention measures of low back and leg pain (Numeric Pain Rating Scale [NPRS]), pain catastrophization (Pain Catastrophization Scale [PCS]), pain knowledge (Revised Neurophysiology of Pain Questionnaire [rNPQ] and depression (PHQ-9). Results: Immediately following PNE, all measures improved, with low back and leg pain not being significant (pback = 0.345 and pleg = 0.633), while pain catastrophization (p = 0.047), pain knowledge (p = 0.001) and depression (p = 0.004) reaching significant improvements. The PNE session shifted various patients to lower levels of depression, with 21.8% of the patients’ improvement in depression meeting or exceeding the minimal clinical important difference. Conclusion: PNE may be a safe, clinically effective way to help a subgroup of patients attending PT with depression. More studies are needed to further explore the results from this pilot study.
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- 2021
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27. A Seldom Cause of Exercise-Related Leg Pain in a Young Soldier-Athlete: A Case Report
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Taoufik Cherrad, Jamal Louaste, Soufiane Belabbes, Larbi Amhajji, Mohamed Sinaa, and Hassan Zejjari
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Orthopedic surgery ,medicine.medical_specialty ,tibial nerve ,business.industry ,Leg pain ,General Medicine ,leg pain ,Physical therapy ,medicine ,Medicine ,business ,schwannoma ,RD701-811 - Abstract
Chronic leg pain is a common problem for young soldier-athletes. Differential diagnosis of this issue is extensive and includes more common entities such as medial tibial stress syndrome and tibial stress fracture and other scarce causes. Therefore, making a correct diagnosis proves to be vital for appropriate care. This topic discusses the case of a 36-year-old soldier who was diagnosed with a schwannoma of the left tibial nerve as a rare cause of leg pain. Its literature is scarce and intends to add further data about recommendations for investigation and management for this kind of lesion.
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- 2021
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28. EFFECTIVENESS OF LUMBAR SYMPATHETIC BLOCK IN PATIENTS OF CHRONIC LEG PAIN PRESENTED TO PAIN CLINIC AT A TERTIARY GOVERNMENT HOSPITAL OVER PAST TWO-YEARS: A RETROSPECTIVE AND OBSERVATIONAL STUDY
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Madhuri A Lokapur and Vinaya R. Kulkarni
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medicine.medical_specialty ,Government ,Pain Clinics ,business.industry ,Physical therapy ,medicine ,Leg pain ,Observational study ,In patient ,Lumbar sympathetic block ,business - Abstract
Background:Lumbar sympathetic block is used in inoperable peripheral vascular disease. The block acts as a vasodilator by decreasing sympathetic tone and improves tissue oxygenation and helps in ulcer healing. No guidelines exist till date for its use in patients with chronic leg pain and ulcers. The management of patients with unreconstructable distal disease with rest pain has always been difficult. Lumbar sympathetic block helps to abolish this rest pain. Aims and Objectives: 1. To study the effectiveness of lumbar sympathetic block 2. To study the ideal level for needle insertion for 100% success rate. 3. To follow up the patients for 1 week, 4 weeks and 12 weeks for relief of symptoms. 4. To study the safety of the block and note the complications. Materials and Methods: After approval of ethical committee, this retrospective study was conducted from Pain Clinic Records over the past two years. Total number of patients studied were 30 over past 2 years. Data Collection: Demographic Data and VAS score was recorded Preblock walking distance was recorded. CT guided lumbar sympathetic block was given. Results and Conclusion: Lumbar sympathetic block was very useful, safe and effective method to decrease the rest pain in patients presented to pain OPD of our hospital. Follow up for 3 months showed healing of ulcers in some of these patients.
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- 2021
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29. Assessment of risk of falls and internal risk factors in elderly patients who need heart pacemarkers
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Guoda Burneikaitė and Lina Spirgienė
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Old patients ,medicine.medical_specialty ,Weakness ,business.industry ,media_common.quotation_subject ,Leg pain ,Internal risk factors ,Fall risk ,Urination ,Leg muscle ,Internal medicine ,Medicine ,In patient ,medicine.symptom ,business ,media_common - Abstract
The aim is to assess the frequency of falls and intrinsic fall risk factors in patients requiring pacemakers. Methodology. The research was conducted from November 2020 to February 2021. Participated patients were hospitalized at the LUHS hospital Kauno Klinikos Department of Cardiology and required heart pacemaker implantation. Total 82 patients participated in the study. The questionnaire was composed by the authors of the research. The study was obtained by the Bioethics Permit of the Medical Academy of LUHS (No. BEC-SL (B) -42). Results. Almost half of the patients fell (45.1%) at least once a year. Elderly patients (65 years and older) are more likely to experience falls than patients under 65 years of age p=0,006. Elderly patients are more often exposed to various internal risk factors of falls: urination at night (82,9 %), weakness (82,9 %), dizziness (76,8 %). Perceived decreased leg muscle strength was found in both women and men (69.6% and 52.8%, respectively, p = 0.002). Patients older than 65 years and therefore
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- 2021
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30. 13-Year-Old Boy Presenting with Bilateral Femur Fractures in the Setting of Severe Vitamin D Deficiency
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Marianne Jacob and Marisa Censani
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education.field_of_study ,Pediatrics ,medicine.medical_specialty ,business.industry ,Population ,Leg pain ,Case Report ,General Medicine ,Primary care ,Case presentation ,medicine.disease ,Bone health ,RJ1-570 ,vitamin D deficiency ,Autism spectrum disorder ,medicine ,Femur ,education ,business - Abstract
Background. Femur fractures in adolescents are rare. Severe vitamin D deficiency has important implications for bone health. We describe the case of a 13-year-old boy with autism spectrum disorder (ASD) who presented with low-impact bilateral femur fractures in the setting of severe vitamin D deficiency. Case Presentation. A 13-year-old boy with ASD presented with bilateral leg pain after an unwitnessed fall. Laboratory investigations revealed severe hypocalcemia (S. calcium 4.9 mg/dL) and severe vitamin D deficiency (25(OH)D
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- 2021
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31. Patent Issued for Intravertebral implant system and methods of use (USPTO 11806247).
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This document is a patent for an intravertebral implant system designed to treat collapse of the vertebral body wedging, which can cause back pain and misaligned facet joints. The implant device corrects the deformity in the vertebral body, reducing back pain and realigning the facet joints. It stabilizes the corrected vertebral body for 12 weeks while it heals and can relieve radiculopathy symptoms. The device includes a wedge, a plate, a coupling device, and a staple, and the patent provides detailed descriptions of the device and methods for its use. This technology has the potential to improve quality of life and reduce the risk of adjacent level accelerated degeneration. [Extracted from the article]
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- 2023
32. "Orthopedic Implant System And Methods Of Use" in Patent Application Approval Process (USPTO 20230346570).
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A patent application has been filed for an orthopedic implant system that aims to address orthopedic issues such as collapsed vertebral bodies and misaligned facet joints. The system can be used as an intervertebral or intravertebral implant device, providing stability and alignment to the spine. It allows for patient-specific sagittal and coronal alignment, preventing misalignment and improving outcomes. The implant device can relieve pain symptoms while maintaining spine mobility and preventing adjacent level disease. The system includes an orthopedic implant device, a staple, and a coupling device, which allows for the positioning and retraction of the staple. It can be used in various applications, such as securing two pieces of a vertebral body or performing osteotomy procedures. [Extracted from the article]
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- 2023
33. Researchers Submit Patent Application, "Implant System And Methods Of Use", for Approval (USPTO 20230310169).
- Abstract
The orientation of the implant device when implanted laterally also provides a lateral platform on the device to anchor additional devices such as tether screws, tulip head screws and rods or tethers or cords to the implant device. The implants may be used as spinal implants configured to augment the vertebral body or fuse multiple vertebral bodies to decompress neural elements and alter the alignment of the spine. In this arthrodesis procedure, adjacent bones of a joint or adjacent bone portions are immobilized by fusing or joining them with an implant device that secures the adjacent bones. The orientation of the implant device when implanted laterally also provides the ability for the implant to be implanted from orientations that take advantage of the surgical benefits of approach orientations such as lateral or oblique. [Extracted from the article]
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- 2023
34. Patent Issued for Interspinous implant insertion instrument with wing actuation tool (USPTO 11766280).
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LEG pain ,MINIMALLY invasive procedures ,SPINAL implants ,PATENTS ,SPINAL nerve roots ,SPINAL cord diseases - Published
- 2023
35. When We Consider Neurolymphomatosis in Patient with Lumbosacral Plexopathy with an Extreme Leg Pain?
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Sang-Hyun Kim, Hyun Seok, Hyun Jung Kim, Seung Yeol Lee, Yeon Hee Cho, Back Min Oh, and Jun Young Ahn
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medicine.medical_specialty ,business.industry ,Medicine ,Leg pain ,In patient ,Radiology ,business ,Lumbosacral plexopathy - Published
- 2021
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36. Platelet Concentrate In Lumbar Interbody Cage Fusion: A New Era of Modality Of Fusion
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Mohammad Baraka, Ahmed H. Omar, Mohamed Gabr, Ahmed Salah Hassan, Mohamed Mohi El din, and Tarek Ahmed Tareef
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030222 orthopedics ,medicine.medical_specialty ,business.industry ,Leg pain ,General Medicine ,Platelet-rich fibrin ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Interbody cage ,Platelet-rich plasma ,Back pain ,Medicine ,Platelet concentrate ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Vas score - Abstract
AIM: This was a prospective double-blinded randomized comparative study. Several authors have reported the efficacy of platelets derivatives for spinal union. However, the use of PRP and PRF for bone fusion with TLIF has not been fully explored. METHODS: Standard open TLIF surgery was performed on 80 patients, randomized in three groups, TLIF and local bone were used in 40 patients (control group) and TLIF, local bone, and PRP were used in 20 patients (PRP group) and PRF was used in 20 patients (PRF group). Radiological parameters were assessed by X-ray after 3 months post-operative to evaluate the position of the screws and cage migration and by CT scans at 6 months and 12 months postoperatively. Patients, surgeons, and post-surgical analysis were blinded. RESULTS: VAS scores for lower back pain and leg pain were statistically significant between the three groups preoperatively. The VAS scores of back pain improved after 12 months and were statistically significant (p < 0.001) and the VAS score of leg pain improved compared with preoperatively in the three groups during the 6- and 12-month follow-up postoperatively, however, the three groups, VAS scores for leg pain were not significantly different. After 1-year follow-up, significantly more patients achieved definite fusion, when implanted platelets derivatives compared with the control group, but with no significance regarding fusion rates. CONCLUSION: We advocated using platelet derivative as a fusion enhancer modality which is cost and time saving. It appears to be a complementary step that ensures better outcome for the patients.
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- 2021
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37. One‐Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double‐Level Contiguous Adolescent Lumbar Disc Herniation
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Xiao-Tao Wu, Lu Mao, and Bin Zhu
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Adult ,Discectomy ,medicine.medical_specialty ,Percutaneous ,Adolescent ,medicine.medical_treatment ,Lumbar discectomy ,Disability Evaluation ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Diskectomy, Percutaneous ,Orthopedics and Sports Medicine ,Clinical efficacy ,Herniation ,Pain Measurement ,Retrospective Studies ,Orthopedic surgery ,030222 orthopedics ,Clinical Article ,Lumbar Vertebrae ,business.industry ,One stage ,Leg pain ,Endoscopy ,Retrospective cohort study ,Surgery ,Endoscopic ,Clinical Articles ,Female ,Lumbar disc herniation ,business ,RD701-811 ,Intervertebral Disc Displacement ,030217 neurology & neurosurgery - Abstract
Objective To assess the clinical efficacy of one‐stage percutaneous endoscopic lumbar discectomy (PELD) for symptomatic double‐level contiguous adolescent lumbar disc herniation (ALDH). Methods This retrospective study included 16 patients who presented with back and/or leg pain due to double‐level disc herniation underwent PELD for symptomatic lumbar disc herniation (0.27%,16/5877) from January 2014 to September 2019. After follow‐up period of 17.3 months in average, numeric rating scale (NRS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Quantitative data were expressed as mean standard deviation (SD) and the data for the variation in the NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Analyses were performed with IBM SPSS Statistics for Windows, version 19.0 (IBM, Armonk, NY, USA). Values of P, Adjustment of working cannula intraoperatively for symptomatic double‐level contiguous adolescent lumbar disc herniation.
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- 2021
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38. Transforaminal Endoscopic Surgical Treatment for Postlaminectomy Lumbar Radiculopathy: Case Series
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Adetokunbo A. Oyelese, Albert E. Telfeian, Joaquin Q. Camara-Quintana, Ziya L. Gokaslan, Tim Niu, and Jared Fridley
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Adult ,Male ,medicine.medical_specialty ,Lumbar radiculopathy ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Foraminotomy ,medicine ,Humans ,Failed Back Surgery Syndrome ,Radiculopathy ,Surgical treatment ,Aged ,Retrospective Studies ,Aged, 80 and over ,Lumbar Vertebrae ,Oswestry disability index score ,business.industry ,Laminectomy ,Leg pain ,Middle Aged ,Decompression, Surgical ,Endoscopic Procedure ,Surgery ,Endoscopic discectomy ,030220 oncology & carcinogenesis ,Neuroendoscopy ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Objective To describe outcomes of awake transforaminal endoscopic surgical treatment for patients presenting with lumbar radiculopathy after laminectomy. Methods Awake endoscopic decompression surgery was performed on 538 patients over a 5-year period (2014–2019). Transforaminal endoscopic discectomy and foraminotomy was performed in 128 patients who had previously undergone laminectomy surgery. Results At 2-year follow-up, preoperative visual analog scale score for leg pain improved from 7.0 ± 1.4 to 2.0 ± 1.3 and Oswestry Disability Index score improved from 41.4% ± 11.9% to 12.4% ± 11.9% in 118 patients. During the 2-year follow-up period, 10 patients (7.8%) required repeat surgery at the treated level. Conclusions The results of a minimally invasive awake endoscopic procedure are presented for the treatment of lumbar radiculopathy after lumbar laminectomy in a series of patients.
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- 2021
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39. Low Back Pain Versus Back-Related Leg Pain: How Do Patient Expectations and Outcomes of Lumbar Spine Surgery Compare?
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Carol A. Mancuso, Alexander P. Hughes, Christopher M. Brusalis, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi, and Roland Duculan
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030222 orthopedics ,medicine.medical_specialty ,business.industry ,Leg pain ,Original Articles ,Low back pain ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,Lumbar spine surgery ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,Surgery ,Lumbar spine ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background: An increasing number of lumbar spine conditions are treated surgically. Such intervention, however, is commonly thought to be more effective in addressing leg pain than low back pain. Patient expectations may also contribute to self-reported surgical outcomes. Questions/Purposes: We sought to compare the expectations of patients in 2 groups undergoing lumbar spine surgery: those with predominantly low back pain and those with predominantly leg pain. We also sought to evaluate how these expectations were fulfilled for each group. Methods: We carried out a retrospective analysis of prospectively collected data from a prior study in which patients scheduled for lumbar spine surgery at a single institution completed validated surveys preoperatively and at 2 years postoperatively, including a 20-item survey on expectations for lumbar spine surgery. The patients were enrolled in the study between February 2010 and August 2012, and were divided into 2 cohorts: a “Back > Leg” group that consisted of patients with back pain that was isolated or greater than leg pain, and a “Leg ≥ Back” group that consisted of patients with leg pain that equaled or exceeded back pain. The primary analysis compared composite expectation scores (range, 0–100) between groups. Results: A total of 366 patients were deemed eligible for the study; of these, 162 patients were allocated to the Back > Leg group and 204 patients were allocated to the Leg ≥ Back group. Patients in the Leg ≥ Back group had a greater mean preoperative expectation score compared with those in the Back > Leg group. Multivariate analysis demonstrated that higher preoperative expectations were associated with leg pain symptoms after controlling for disease diagnosis. Both groups reported similar proportions of fulfilled expectations. Conclusion: Patients with predominantly leg pain hold greater preoperative expectations for lumbar spine surgery than do patients with predominantly back pain. That these patient groups reported similar fulfillment of their expectations at 2 years postoperatively illustrates the greater clinical outcomes achieved among patients who presented with predominantly leg pain.
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- 2021
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40. Iliocaval reconstruction of chronically thrombosed cylindrical inferior vena cava filters with balloon expandable covered stent-grafts
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Andrew R. Lewis, Mohamed Elboraey, Charles Ritchie, Beau Toskich, Gregory T. Frey, and Zlatko Devcic
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medicine.medical_specialty ,RD1-811 ,030204 cardiovascular system & hematology ,Stent patency ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,IVC filters ,03 medical and health sciences ,0302 clinical medicine ,Case report ,medicine ,Back pain ,Diseases of the circulatory (Cardiovascular) system ,Covered stent ,Iliocaval thrombosis ,business.industry ,Ultrasound ,Leg pain ,Surgery ,Balloon expandable stent ,medicine.vein ,Color changes ,RC666-701 ,cardiovascular system ,Covered stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The use of a Viabahn VBX endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) to exclude chronically thrombosed inferior vena cava (IVC) filters refractory to exclusion with self-expanding stents was evaluated. The mean duration of TrapEase IVC (Cordis, Milpitas, Calif) implantation was 7.6 years (range, 2-11 years). Symptoms included leg pain, edema, color changes, and back pain. The mean Villalta score and venous clinical severity score were 17 (range, 13-23) and 13 (range, 11-15), respectively. Indirect ultrasound evidence of stent patency was demonstrated at a mean of 8 months after intervention. The mean Villalta score and venous clinical severity score had decreased by 13 and 10, respectively, at a mean of 9.5 months after intervention. Iliocaval reconstruction with Viabahn VBX balloon expandable stent-graft exclusion of chronically thrombosed TrapEase IVC filters is safe, with favorable short-term results.
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- 2021
41. A 59-year-old man with persistent fever, aphasia and leg pain
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Alexandre Lafleur, Benoit M. Labbé, and Pierre-Luc Harvey-Michaud
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Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Deep vein ,Persistent fever ,Pain ,030204 cardiovascular system & hematology ,Fever of Unknown Origin ,Veins ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Aphasia ,Enterococcus faecalis ,medicine ,Humans ,030212 general & internal medicine ,Ultrasonography, Doppler, Color ,Gram-Positive Bacterial Infections ,Venous Thrombosis ,Practice ,Embolic Stroke ,Leg ,business.industry ,Anticoagulants ,Leg pain ,What Is Your Call?: Sepsis ,Endocarditis, Bacterial ,General Medicine ,Emergency department ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Thrombosis ,Surgery ,medicine.anatomical_structure ,medicine.vein ,Echocardiography ,Chills ,Posterior tibial vein ,medicine.symptom ,business ,Aneurysm, Infected - Abstract
A 59-year-old man presented to the emergency department with fever and chills that began 6 weeks earlier, when a symptomatic deep vein thrombosis (DVT) of the right posterior tibial vein had been diagnosed. The patient had also noticed word-finding difficulties and mild headache for the week before
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- 2021
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42. Cascade Programming for 10 kHz Spinal Cord Stimulation: A Single Center Case Series of 114 Patients With Neuropathic Back and Leg Pain
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Katie Markham, Omar Al-Kaisy, Stefano Palmisani, Adnan Al-Kaisy, David Pang, Jonathan Royds, Stephany Harris, Thomas L. Yearwood, Samuel Wesley, Nick Padfield, and Thomas Smith
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Series (stratigraphy) ,business.industry ,Inadequate Pain Relief ,Chronic pain ,Leg pain ,General Medicine ,Spinal cord stimulation ,medicine.disease ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Neurology ,Cascade ,Anesthesia ,medicine ,Neurology (clinical) ,business ,Lead (electronics) ,030217 neurology & neurosurgery - Abstract
OBJECTIVE Ten kilohertz spinal cord stimulation (SCS) is usually initiated in a single-bipolar configuration over the radiological reference point T9/T10 intervertebral disc space for neuropathic back and leg pain. Cascade is a duty-cycled, multi-bipolar contact configuration across an entire eight-contact lead. Potential advantages by using a broader area of SCS coverage include mitigation against minor lead migration and a reduction in the need for reprogramming. We report here the results of a retrospective case series of 114 patients using Cascade. MATERIALS AND METHODS Retrospective data were collected over two years. We selected patients with neuropathic back with or without/leg pain who had a trial of SCS. Pain assessments using Numerical Rating Scales (NRS) and Patient Global Impression of Change (PGIC) scores were collected at baseline, six months, and last follow-up beyond 12 months (mean 15.1 months). Patients were programmed with 10 kHz SCS using Cascade during the trial, which was continued unless reporting inadequate pain relief. Morbidity and deviations from Cascade programming were also obtained. RESULTS At six months, 87 of 97 (90.6%) patients with active devices were using Cascade and 58 of 72 (81%) patients at the last follow-up >12 months. There was a significant reduction in back NRS (8.3 vs. 3.9 [p 12 months back (8.3 vs. 3.95 [p
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- 2021
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43. Cost-Effectiveness Model Shows Superiority of Wireless Spinal Cord Stimulation Implantation Without a Separate Trial
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Arthur F. Spalding, Shawn D. Spencer, Richard B. North, Jane Shipley, and Harish S. Parihar
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medicine.medical_specialty ,Clinical effectiveness ,Cost effectiveness ,Cost-Benefit Analysis ,Pain relief ,Pain ,Spinal cord stimulation ,modeling study ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Clinical Research ,Cost‐effectiveness ,wireless SCS ,medicine ,Humans ,Pain Management ,Wireless ,Sensitivity analyses ,Spinal Cord Stimulation ,business.industry ,Leg pain ,General Medicine ,Anesthesiology and Pain Medicine ,Spinal Cord ,Neurology ,SCS health economics ,Lower cost ,Quality-Adjusted Life Years ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Objective We evaluated the cost-effectiveness of wireless spinal cord stimulation (Wireless SCS) with single stage "direct to permanent" implantation vs. screening with temporary electrodes and an external pulse generator followed by implantation of a system for long-term use (IPG SCS). Materials and methods We created a cost model that takes a 2019 United States (U.S.) payer perspective and is based on IPG SCS cost models for subjects with chronic back and/or leg pain. Our six-month decision tree includes the screening trial period (success ≥50% relief) and leads to various levels of pain relief with or without complications for IPG SCS and Wireless SCS and without complications for conventional medical management (CMM). Every three months in the follow-on 15-year Markov model (with costs and quality-adjusted life years discounted 3.5% annually), subjects remain stable or transition to deteriorated health or death. Subjects who fail SCS receive CMM. After 60 Markov cycles, a 100,000-sample simulation reveals the impact of maximum willingness-to-pay (WTP) from $10,000 to $100,000 per quality-adjusted life year on net monetary benefit (NMB). Sensitivity analyses considered the impact of the Wireless SCS screening success rate, Wireless SCS device cost, and IPG SCS device longevity. Results Compared with IPG SCS, Wireless SCS offers higher clinical effectiveness at a lower cost and a higher NMB for our WTP thresholds and is, thus, dominant. Wireless SCS is also cost-effective compared with CMM. Results remain robust with 1) Wireless SCS screening success rates as low as 85% (dominant), 2) the cost of the Wireless SCS devices as high as $55,000 (cost-effective), and 3) IPG SCS devices lasting 12 years (dominant). Conclusions In this model, compared with IPG SCS or with CMM, Wireless SCS is a superior strategy.
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- 2021
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44. High-Dose Spinal Cord Stimulation Reduces Long-Term Pain Medication Use in Patients With Failed Back Surgery Syndrome Who Obtained at Least 50% Pain Intensity and Medication Reduction During a Trial Period: A Registry-Based Cohort Study
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Maarten Moens, Patrice Forget, Ann De Smedt, Sam Eldabe, Lisa Goudman, Neurosurgery, Pain in Motion, Supporting clinical sciences, UZB Other, Physical Medicine and Rehabilitation, Clinical sciences, Neuroprotection & Neuromodulation, and Radiology
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medicine.medical_specialty ,Neuroscience(all) ,Pain medication ,Spinal cord stimulation ,surgery ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,In patient ,Registries ,Failed Back Surgery Syndrome ,Pain Measurement ,Spinal Cord Stimulation ,High-dose spinal cord stimulation ,business.industry ,opioids ,Leg pain ,General Medicine ,Intensity (physics) ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Neurology ,registry-based cohort study ,Morphine ,medication ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Cohort study ,medicine.drug ,Failed back surgery - Abstract
OBJECTIVES: High-dose spinal cord stimulation (HD-SCS) revealed positive results for obtaining pain relief in patients with failed back surgery syndrome (FBSS). However, it is less clear whether HD-SCS also is able to reduce pain medication use. The aim of this registry-based cohort study is to explore the impact of HD-SCS on pain medication use in FBSS patients. MATERIALS AND METHODS: Data from the Discover registry was used in which the effectiveness of HD-SCS was explored in neurostimulation-naïve FBSS patients as well as in rescue patients. All neurostimulation-naïve FBSS patients positively responded to a four-week SCS trial period in which at least 50% pain relief and 50% medication reduction were obtained. Medication use was measured with the Medication Quantification Scale III (MQS) in 259 patients at baseline and at 1, 3, and 12 months of HD-SCS. Additionally, defined daily doses (DDD) and morphine milligram equivalents (MME) were calculated as well. RESULTS: One hundred thirty patients reached thevisit at 12 months. In neurostimulation-naïve patients, a statistically significant decrease in MQS (χ2 = 62.92, p
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- 2021
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45. Orthostatic leg pain in neuropathic postural tachycardia syndrome: what does muscle excitability have to do with it?
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Amy C. Arnold and Judith Navarro-Otano
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medicine.medical_specialty ,Orthostatic vital signs ,Neurology ,Physical medicine and rehabilitation ,Postural tachycardia ,Endocrine and Autonomic Systems ,business.industry ,Diabetes mellitus ,medicine ,Leg pain ,Neurology (clinical) ,business ,medicine.disease - Published
- 2021
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46. Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative
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Ilyas S. Aleem, Osama N. Kashlan, Miguelangelo Perez-Cruet, Mark E. Oppenlander, Muwaffak Abdulhak, Jason M. Schwalb, Paul Park, Victor Chang, Richard W Easton, Hsueh-Han Yeh, Nicholas J. Szerlip, David R. Nerenz, Kevin Swong, and Lonni Schultz
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business.industry ,Leg pain ,General Medicine ,Readmission rate ,Opioid prescribing ,Spinal surgery ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Spine surgery ,Opioid ,030220 oncology & carcinogenesis ,Law ,Back pain ,medicine ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.
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- 2021
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47. Pain During Sex Before and After Decompressive Surgery for Lumbar Spinal Stenosis
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Øystein P. Nygaard, Siril T Holmberg, Sasha Gulati, Agnete Malm Gulati, Øyvind Salvesen, Vetle Vangen-Lønne, and Tore Solberg
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medicine.medical_specialty ,Sexual Behavior ,MEDLINE ,Pain ,Disability Evaluation ,Spinal Stenosis ,Decompressive surgery ,Humans ,Medicine ,Orthopedics and Sports Medicine ,In patient ,Prospective Studies ,Pain Measurement ,Lumbar Vertebrae ,business.industry ,Leg pain ,Lumbar spinal stenosis ,Decompression, Surgical ,medicine.disease ,Oswestry Disability Index ,Treatment Outcome ,Physical therapy ,Observational study ,Neurology (clinical) ,business ,Sexual function - Abstract
Study design Observational multicenter study. Objective The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar spinal stenosis (LSS). Summary of background data There are limited data available on sexual function in patients undergoing surgery for LSS. Methods Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at 1 year, assessed by item number eight of the Oswestry disability index questionnaire. Secondary outcome measures included Oswestry Disability Index, EuroQol-5D, and numeric rating scale scores for back and leg pain. Results Among the 12,954 patients included, 9908 (76.5%) completed 1-year follow-up. At baseline 9579 patients (73.9%) provided information about pain during sexual activity, whereas 7424 (74.9%) among those with complete follow-up completed this item. Preoperatively 2528 of 9579 patients (26.4%) reported a normal sex-life without pain compared with 4294 of 7424 patients (57.8%) at 1 year. Preoperatively 1007 (10.5%) patients reported that pain prevented any sex-life, compared with 393 patients (5.3%) at 1 year. At baseline 7051 of 9579 patients (73.6%) reported that sexual activity caused pain, and among these 3145 of 4768 responders (66%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, and working until time of surgery were predictors of improvement in pain during sexual activity. Current tobacco smoking, pain duration >12 months, previous spine surgery, and complications occurring within 3 months were negative predictors. Conclusion This study clearly demonstrates that a large proportion of patients undergoing surgery for LSS experienced an improvement in pain during sexual activity at 1 year.Level of Evidence: 2.
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- 2021
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48. Exercise induced leg pain due to endofibrosis of external iliac artery
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Christoph Thalhammer, Roman Gähwiler, Thorsten Grumann, Andrej Isaak, and Anja Hirschmüller
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Leg ,medicine.medical_specialty ,biology ,medicine.diagnostic_test ,Sports medicine ,Athletes ,business.industry ,Provocation test ,Pain ,Leg pain ,External iliac artery ,Physical examination ,biology.organism_classification ,Fibrosis ,Iliac Artery ,Muscle hypertrophy ,Physical medicine and rehabilitation ,Endurance training ,medicine.artery ,medicine ,Humans ,Aorta, Abdominal ,Cardiology and Cardiovascular Medicine ,business - Abstract
Summary: Due to monotonous movement patterns, muscular hypertrophy, and increased cardiac output peripheral vasculature of athletes are subject to extreme stresses during athletic performance. Individuals suffering from exercise induced non-traumatic lower leg pain may display underlying vascular pathology such as external iliac artery endofibrosis. Therefore, it is essential in the course of to discriminate vascular from non-vascular findings and prime the correct diagnostic path within the course of clinical examination. In this regard, interdisciplinary thinking and profound knowledge in exercise-associated pathologies of the musculoskeletal, nervous and vascular system is indispensable. Consequently, provocation testing displays an indispensable diagnostic tool and has to be continued until symptoms occur, or complete exhaustion is attained. Finally, selective assessment of conservative and surgical treatment options, as well as its ethical evaluation, are of major importance in order to protect, preserve and promote the health and physical integrity of our patients who are keen to perform.
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- 2021
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49. Ependymomas of Filum Terminale: Clinical Characteristics and Surgical Management of 5 Patients
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Hongzhou Duan, Liang Li, Feifan Xu, and Jiayong Zhang
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Adult ,Male ,Ependymoma ,medicine.medical_specialty ,Cauda Equina ,Neurosurgical Procedures ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,medicine ,Humans ,Postoperative outcome ,Neurofibroma ,Spinal Cord Neoplasms ,Aged ,medicine.diagnostic_test ,business.industry ,Laminectomy ,Lumbosacral Region ,Leg pain ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Gross Total Resection ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Neurology (clinical) ,Filum terminale ,Neoplasm Recurrence, Local ,business ,030217 neurology & neurosurgery - Abstract
Objective To retrospective review a series of patients with ependymomas of filum terminale (FTEs) who underwent microsurgical resection and had long-term follow-up. Methods Five adults with FTEs were surgically treated and enrolled in the study. Clinical manifestations, imaging data, intraoperative findings, and postoperative outcome were recorded. Results Six FTEs were discovered on preoperative lumbar magnetic resonance imaging, with 1 rare case of a single FTE accompanied by a neurofibroma. Gross total resection was achieved in all patients; en bloc excision was carried out in 2 patients for 2 FTEs and 1 neurofibroma, while piecemeal resection was done in 3 patients for 4 FTEs. Most preoperative symptoms were relieved soon after surgery; 1 patient with urination difficulty achieved complete recovery 1 year postoperatively. Tumor recurrence was found in 1 patient 54 months after her first surgery. Conclusions FTEs are rare subdural extramedullary tumors. Patients usually present initially with back and leg pain. Elaborate microsurgical manipulations and intraoperative electrophysiologic monitoring are helpful in ensuring satisfactory excision and neurological prognosis. Regular long-term follow-up is recommended for all postoperative patients.
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- 2021
- Full Text
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50. Assessment of Rod Material Types in Spine Surgery Outcomes: A Systematic Review
- Author
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Jean-Marc P. Lucas, Adedayo Adetunji, Alexander B. Becker, Jennifer Z. Mao, Jeffrey P. Mullin, Justice O. Agyei, John Pollina, Timothy E O'Connor, Asham Khan, Bennett R. Levy, Daniel O. Popoola, and Alexander G. Fritz
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medicine.medical_specialty ,genetic structures ,Visual analogue scale ,Bone Screws ,Polyethylene Glycols ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Spine surgery ,Back pain ,Humans ,Medicine ,Lumbar Vertebrae ,Material type ,business.industry ,Leg pain ,Surgery ,Spinal Fusion ,Treatment Outcome ,Back Pain ,030220 oncology & carcinogenesis ,Inclusion and exclusion criteria ,sense organs ,Neurology (clinical) ,Fusion rate ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Lumbar spine fusion surgery is traditionally performed with rigid fixation. Because the rigidity is often supraphysiologic, semirigid rods were developed. To the best of our knowledge, a comprehensive evaluation of rod material type on surgical outcomes has yet to be conducted. Methods A systematic review based on PRISMA guidelines was conducted across 3 electronic databases. After examination for inclusion and exclusion criteria, data were extracted from the studies. Results Seventeen studies, including 1399 patients, were included in this review. The mean rigid rod fusion rate is 92.2% and 95.5% for semirigid rods (P = 0.129). The mean improvement in back pain was 60.6% in rigid rods and 71.6% in semirigid rods. The improvement in leg pain was 81.9% and 77.2%, respectively. There were no differences in visual analog scale back pain score (P = 0.098), visual analog scale leg pain score (P = 0.136), or in functional improvement between rigid and semirigid rods (P = 0.143). There was no difference (P = 0.209) in the reoperation rate between rigid rods (13.1%) and semirigid rods (6.5%). There was a comparable incidence of adjacent segment disease (3%), screw fracture (1.7%), and wound infection (1.9%) between rod material types. Conclusions There is a moderate level of evidence supporting that surgical intervention results in high fusion rates regardless of rod material type. Surgical intervention improves back pain, leg pain, and function, with neither material type showing clear superiority. There are comparable rates of reoperation, development of adjacent segment disease, development of mechanical complications, and incidence of infection in both rigid and semirigid rods. Further studies regarding rod material type are warranted.
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- 2021
- Full Text
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