Study Design Prospective clinical study. Purpose The present study aimed to examine the neurological recovery pattern in cervical spondylotic myelopathy (CSM) after anterior cervical decompression and compare it with the existing reports in the literature. Overview of Literature Neurological recovery and regression of myelopathy symptoms is an important factor that determines the outcomes of surgical decompression. The present findings contribute to the literature on the pattern of neurological recovery and patient prognosis with respect to the resolution of myelopathy symptoms after surgery. Methods This prospective study was conducted in Government Medical College in Jammu, North India between November 2012 and October 2014, a total of 30 consecutive patients with CSM were included and treated with anterior decompression and stabilization. They were prospectively followed up for 1 year and were evaluated for their neurological recovery pattern. The postoperative outcome was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. The recovery rate was calculated using Hirabayashi’s method. The JOA score was assessed before the operation and postoperatively at 1 week, 2 weeks, 1 month, 3 months, 4 months, 6 months, and 1 year. Results The postoperative mJOA score was 0 in the 1st month, 12.90±3.57 in the 3rd month, 13.50±3.55 in the 4th month, 14.63±3.62 in the 6th month, and 14.9±3.24 at the final follow-up of 1 year. The average recovery rate during the 1st month follow-up was 0%, and that during the 3rd month follow-up was 12.91% with a range of 0%–50%. The average recovery rate during the 4th month was 32.5%, with a range of 0%–60%, while that during the 6th month was 72.83%, with a range of 0%–100%. The average recovery rate during the final follow-up of 1 year was 54.3%. Conclusions Neurological recovery after surgical decompression starts from the 3rd postoperative month and progresses until the 6th postoperative month; thereafter, it gradually plateaus over the subsequent 6 months until it steadies. Symptom duration is an important factor that requires consideration while determining postoperative neurological recovery.
Background: Postoperative urinary retention (POUR) is a common problem with overall rates looking at the entire surgical population quoted between 4% and 6%. POUR has been defined as the inability to void in the presence of a full bladder.Methods: This was a prospective, single-centre, observational study conducted between June 2015 to December 2016 at a tertiary care centre of Northern India. The study group enrolled 186 patients undergoing various lower limb surgeries under spinal anesthesia.Results: In the present study, out of 186 patients, 101 patients were male and 85 patients were female. Most of the patients were in the 41-60 years age group (78) followed by 72 patients were in the >61 years age group. 21 patients (11.29%) suffered with post operative urine retention (POUR) in whom catheterization was required, the incidence of POUR in joint replacement surgeries was 20.96% (13/62). In the present study incidence of POUR was more in males (12 patients) as compared to females (9 patients). POUR was more common in the elderly age group.Conclusions: By carefully identifying patients at risk, adopting appropriate anesthetic techniques and perioperative care principles and accurately monitoring bladder volume by ultrasound, POUR may be prevented and the associated morbidity minimized. Hence it becomes imperative to evaluate the true incidence and consequences of POUR in large prospective clinical studies. Spontaneous micturition should remain a criterion for discharge after spinal anaesthesia.
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