Study Design. A retrospective study with prospectively-collected data. Objective. To determine how type, location, and size of endplate lesions on magnetic resonance imaging (MRI) may be associated with symptoms and clinical outcomes after anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Structural endplate abnormalities are important, yet understudied, phenomena in the cervical spine. ACDF is a common surgical treatment for degenerative disc disease; however, adjacent segment degeneration/disease (ASD) may develop. Methods. Assessed the imaging, symptoms and clinical outcomes of 861 patients who underwent ACDF at a single center. MRI and plain radiographs of the cervical spine were evaluated. Endplate abnormalities on MRI were identified and stratified by type (atypical, typical), location, relation to operative levels, presence at the adjacent level, and size. These strata were assessed for association with presenting symptoms, patient-reported, and postoperative outcomes. Results. Of 861 patients (mean follow-up: 17.4 months), 57.3% had evidence of endplate abnormalities, 39.0% had typical abnormalities, while 18.2% had atypical abnormalities. Patients with any endplate abnormality had greater odds of myelopathy irrespective of location or size, while sensory deficits were associated with atypical lesions (P = 0.016). Typical and atypical abnormalities demonstrated differences in patient-reported outcomes based on location relative to the fused segment. Typical variants were not associated with adverse surgical outcomes, while atypical lesions were associated with ASD (irrespective of size/location; P = 0.004) and reoperations, when a large abnormality was present at the proximal adjacent level (P = 0.025). Conclusion. This is the first study to examine endplate abnormalities on MRI of the cervical spine, demonstrating distinct risk profiles for symptoms, patient-reported, and surgical outcomes after ACDF. Patients with typical lesions reported worsening postoperative pain/disability, while those with atypical abnormalities experienced greater rates of ASD and reoperation. This highlights the relevance of a degenerative spine phenotypic assessment, and suggests endplate abnormalities may prognosticate clinical outcomes after surgery. Level of Evidence: 3
Study Design. The study is designed as a retrospective cohort study. Objective. The aim of this study was to identify modifiable and nonmodifiable risk factors of postoperative urinary retention in spine surgery patients. Summary of Background Data. Postoperative urinary retention is a common complication in patients undergoing operative procedures requiring anesthesia. Current studies have shown significant risk factors for postoperative urinary retention, but most are nonmodifiable and subsequently of limited usefulness in preventing this complication. Several new studies have shown possible modifiable risk factors, but current data are inconsistent in terms of their statistical significance. Methods. A total of 814 consecutive patients who underwent open posterior lumbar laminectomy and fusion were included in the retrospective cohort study. Pre, intra-, and postoperative characteristics were collected in all patients to identify risk factors for postoperative urinary retention. Results. Glycopyrrolate use (odds ratio [OR] 2.60; P = 0.001), decreased body mass index (OR 0.96; P = 0.018), previous diagnosis of benign prostate hyperplasia (OR 3.34; P ≤ 0.001), and postoperative urinary tract infection (OR 5.60, P = 0.005) were associated with postoperative urinary retention. Previous history of lumbar spine surgery (OR 0.55; P = 0.019) was associated with decreased rates of postoperative urinary retention. Conclusion. Glycopyrrolate use, benign prostate hyperplasia, and postoperative urinary tract infection were independent risk factors for postoperative urinary retention. The use of glycopyrrolate is a potentially modifiable risk factor for postoperative urinary retention. Level of Evidence: 3
Background: YouTube has become a popular source of healthcare information in orthopedic surgery. Although quality-based studies of YouTube content have been performed for information concerning many orthopedic pathologies, the quality and accuracy of information on the rotator cuff have yet to be evaluated. The purpose of the current study was to evaluate the reliability and educational content of YouTube videos concerning the rotator cuff.Methods: YouTube was queried for the term “rotator cuff.” The first 50 videos from this search were evaluated. Video reliability was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (range, 0–5). Educational content was assessed using the global quality score (GQS; range, 0–4) and the rotator cuff-specific score (RCSS; range, 0–22). Results: The mean number of views was 317,500.7±538,585.3. The mean JAMA, GQS, and RCSS scores were 2.7±2.0, 3.7±1.0, and 5.6±3.6, respectively. Non-surgical intervention content was independently associated with a lower GQS (=–2.19, p=0.019). Disease-specific video content (=4.01, p=0.045) was the only independent predictor of RCSS.Conclusions: The overall quality and educational content of YouTube videos concerned with the rotator cuff were low. Physicians should caution patients in using such videos as resources for decision-making and should counsel them appropriately.
A fistula is an abnormal communication between two epithelial surfaces (1). A vesicovaginal fistula (VVF) results in a continuous urinary incontinence (2). This condition brings a severe deterioration in middle-aged womens quality of life (3). Its incidence is underestimated given the associated social stigma (4). Our objective is to describe clinical results, incontinence rates and complications in VF repair with a natural orifice transluminal transurethral endoscopic surgical technique (NOTES). This due to the difficulty in the access through the abdominal or vaginal approach sometimes.METHODS: Previously we presented a case in video of a transurethral VF repair with good outcomes ( 5), now we present a series of 24 patients taken to VF repair with NOTES technique from 2013 -2021. Patients taken to VVF, Vesicoperitoneal (VPF) and vesicoenteral (VEF) closure were included. The surgical procedure consists in a transurethral approach, with the use of a resectoscope and Collins loop, the VF hole in the bladder wall is circumcised, then a continuous suture is performed with a bio spiculated suture introduced by the urethral meatus, minor variations between male and female's techniques are exposed. The surgical technique, complications, outcomes, and clinical follow-up of the patients are described.RESULTS: A total of 24 patients were included, 95.8% female. The median age was 42 years. 79.1% had VVF. 54.1% had complex VF. The median surgical time was 55 and 77 minutes for simple and complex fistulas, respectively. The rate of intra-surgical complications was anesthesia related in 4.2%. There were no complications ! III on the Clavien Dindo scale. 41.6% of the procedures were ambulatory. All patients were released with anticholinergics and bladder catheterizing. 9 of 10 patients with simple VVF reported postoperative clinical improvement. 9 of 13 patients with complex VF had complete resolution of incontinence after removal of the catheter. The median follow-up was 10 months.CONCLUSIONS: NOTES is a minimally invasive technique useful for the initial approach of patients with a VF. It is a reproducible, short-time and potentially ambulatory technique. This approach favors the closure of VVF, VPF and even VEF in non-oncological, oncological and irradiated patients, it is a useful option in patients with previous difficult abdominal approaches without the need to perform open bladder or transabdominal surgery. Multicentric prospective studies are needed for further conclusions.
Introduction Penuma®, a penile silicone sleeve implant, first developed in 2004, is the first FDA-approved penile implant for cosmetic enhancement. The company endorses that on average, girth and flaccid length are increased by one to two inches. Given the novelty of the device and the scarcity of surgeons trained in placement, data regarding surgical outcomes as well as patient satisfaction are limited. It is thought that patient selection is a critical contributor to the ultimate success of the surgery. Post-operative complications have previously been described and can include seroma, infection, and explanation. Objective This study aims to characterize the outcomes of two surgeon's experience with the Penuma device and to analyze patient's perspective regarding the effects of the surgery on penile size, perceived appearance and self-esteem. Methods Retrospective chart review was performed on patients that were six months or greater from initial date of surgery. Progress notes from follow up appointments as well as telephone encounters were reviewed to look for patient complaints, post-operative physical exams, and post operative procedures. Subsequent operative reports apart from initial implant were also reviewed. An electronic survey assessing various aspects of penile satisfaction before and after the implant was sent to patients who were six months or greater from surgery and still had the device in place. Results From April 2019 to February 2021, 70 patients underwent insertion of subcutaneous soft silicone penile implant (Penuma ®) with two surgeons. 8 of these patients (11%) subsequently underwent removal of the device, reasons for which included pain, dissatisfaction with the device, and device erosion. 19 patients (27%) experienced postoperative seromas, of which 14 required drainage. Four patients (5.7%) required operative revision. A follow up survey was sent to one surgeon's patient population of 26 patients, for which we received a 100% response rate. With regards to patient satisfaction, 65.4% of patients self-reported being “dissatisfied” or “very dissatisfied” with the appearance of their penis before the implant compared to 96% who reported being “satisfied” or “very satisfied” after the implant. 84.6% of patients reported being “satisfied” or “very satisfied” with how natural their penis looks after the implant, with 3.8% reporting being “very dissatisfied.” 65.4% reported feeling “very dissatisfied” with self-confidence with regards to their penis prior to surgery, while 92.4% felt “satisfied” or “very satisfied” regarding the same after surgery. Overall, 84.6% of responders “agreed” or “somewhat agreed” that they would opt to undergo surgery again. Conclusions The Penuma® penile sleeve implant can improve patient self-satisfaction and self-confidence with regards to the appearance of their penis while maintaining a natural feel. Post operative complications, including need for re-operation, are low but not negligible. The number of surgeons that currently offer the Penuma® implant surgery in the United States is quite small, and this study suggests that it may be a successful potential option for men with penile dysmorphic disorder. Disclosure No
Antibiotic therapy against non-tuberculous mycobacteria (NTM) is prolonged and can be associated with toxicity. We sought to evaluate whether chest physical therapy (PT) was associated with clinical improvement in patients with NTM not receiving anti-mycobacterial pharmacotherapy. A retrospective review of 77 subjects that were followed from June 2006 to September 2014 was performed. Baseline time point was defined as the first positive sputum culture for NTM; symptoms, pulmonary function, and radiology reports were studied. Subjects were followed for up to 24 months and results analyzed at specified time points. Half of the subjects received chest PT at baseline. Cough improved at 12 (p = 0.001) and 24 months (p = 0.003) in the overall cohort when compared with baseline, despite lack of NTM antibiotic treatment. Cough decreased at 6 (p = 0.01), 9 (p = 0.02), 12 (p = 0.02) and 24 months (p = 0.002) in subjects that received chest PT. Sputum production also improved at 24 months in the overall cohort (p = 0.01). There was an increase in the percent change of total lung capacity in subjects that received chest PT (p = 0.005). Select patients with NTM may have clinical improvement with chest PT, without being subjected to prolonged antibiotic therapy. Future studies are warranted to prospectively evaluate outcomes in the setting of non-pharmacologic treatment and aid with the decision of antibiotic initiation.
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