Frontiers in Surgery最新文献

Objective: To investigate the risk factors of low back pain after oblique lumbar interbody fusion (OLIF) in patients with low grade degenerative lumbar spondylolisthesis (DLS).

Methods: This retrospective study included 116 patients with single-level low-grade lumbar spondylolisthesis with low back pain who underwent OLIF surgery in our hospital from December 2017 to October 2020. Demographic, clinical, surgical, and radiological characteristics of this population were analyzed to determine the relationship between these characteristics and the degree of low back pain relief after OLIF.

Results: A total of 116 patients (average age 58.61 ± 7.01 years) were included in this study. Among them, 33 patients had poor improvement of low back pain after surgery, and 83 patients had satisfactory effect after surgery with obvious relief of low back pain. Postoperative disc height increase ≤2.5 mm (P = 0.000) was most correlated with poor improvement of low back pain symptoms after OLIF. The factors positively correlated with poor improvement of low back pain symptoms after OLIF in patients with low-grade degenerative lumbar spondylolisthesis included the increase of spondylolisthesis grade (OR = 17.665; 95%CI: 3.262-95.678 P = 0.001), disc height increase ≤2.5 mm (OR = 34.377; 95%CI: 5.632-209.818 P = 0.000). The factors negatively correlated with poor improvement of low back pain symptoms after OLIF in patients with low-grade degenerative lumbar spondylolisthesis included no osteoporosis (OR = 0.067; 95%CI: 0.013-0.350 P = 0.001), no cage subsidence (OR = 0.208; 95%CI: 0.048-0.903 P = 0.036), duration of preoperative low back pain symptoms ≤36 months (OR = 0.045; 95%CI: 0.007-0.277 P = 0.001).

Conclusions: OLIF can significantly improve the low back pain symptoms in patients with low-grade degenerative lumbar spondylolisthesis. High grade of spondylolisthesis before operation, duration of low back pain symptoms more than 36 months, osteoporosis, postoperative cage subsidence, and postoperative segmental disc height improvement less than 2.5 mm are risk factors for low back pain after operation.

Objectives: To explore the experience of tumor control technique in robot-assisted laparoscopic bladder diverticulectomy (RALBD) in the treatment of bladder diverticulum tumor, intraoperative tumor control and postoperative comprehensive treatment.

Patients and methods: We treated three male patients with bladder diverticulum tumors. Case 1 involved a 63-year-old with a 3.0 cm tumor in the diverticulum on the right bladder wall. Case 2 involved a 70-year-old with a 1.0 cm cauliflower-like tumor in the diverticulum on the left bladder wall. Case 3 involved a 64-year-old with a 3.0 cm tumor in the diverticulum on the right bladder wall. Each patient underwent robot-assisted laparoscopic partial cystectomy (PC) with ureteral Double J (D-J) stent placement. To minimize the risk of intraoperative tumor spread, we implemented enhanced surgical techniques. Systemic chemotherapy and adjuvant intravesical chemotherapy were recommended to reduce the risk of tumor recurrence and metastasis.

Results: Postoperative pathology confirmed papillary urothelial carcinoma in all three cases. Each patient was followed up for over 20 months, with no evidence of recurrence or distant metastasis observed through cystoscopy and chest and abdominal CT scans.

Conclusion: For patients with urothelial carcinoma in a bladder diverticulum, robot-assisted laparoscopic bladder-sparing surgery is a viable option when appropriate cases are selected. Effective intraoperative tumor control and comprehensive postoperative treatment are crucial to minimizing recurrence and metastasis risks. The robotic approach offers enhanced precision and visualization compared to traditional open or laparoscopic techniques, potentially leading to improved outcomes regarding intraoperative tumor control and reduced postoperative complications. However, this study is limited by its small sample size of only three patients and short-term follow-up. A larger sample of patients is needed to confirm the advantages of the robotic approach.

Retained drain fragments, though rare, can lead to significant complications in orthopedic surgery(1). This case report presents a 57-year-old woman who developed gluteal tendinopathy and Trendelenburg gait two years after a total hip arthroplasty (THA) due to a retained drain fragment. A less experienced surgeon encountered resistance during drain removal on the first postoperative day and applied excessive force, unknowingly leaving a fragment inside. The patient initially had no symptoms, but later presented with pain and gait disturbances. Radiographic evaluation revealed the retained drain, necessitating surgical removal and gluteus medius augmentation. The patient subsequently underwent a structured rehabilitation program. This case emphasizes the importance of careful drain management, proper postoperative evaluation, and collaborative patient-doctor decision-making to prevent such complications.

Background: We analyzed trends in age at surgery and surgical approach over time and geography.

Methods: We performed a systematic review according to PRISMA-IPD guidelines to include individual patient data. Collected data included age at surgery, location of surgery, and surgical approach. The surgical approach was independently categorized as the exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). EBP was defined as exploring the brachial plexus in the supraclavicular fossa and applying a choice of coaptation procedures. NTwoRE included those sourcing donor nerves from, or entirely occurring outside of the plexus without exploring the root of the brachial plexus.

Results: Regression analysis of age at surgery 1985-2020 showed that age at BPBI surgery is rising (p < 0.05). Surgery was performed at a younger age in patients from Europe (7.06 ± 7.77 months) and Asia (7.58 ± 5.33 months) than those from North America (10.44 ± 5.01 months) and South America (14.71 ± 4.53 months) (p < 0.05). NTwoRE was more common in North America (37%) and least common in Europe (12%). Age at EBP was 7.2 ± 5.77 months, and age at NTwoRE was 15.85 ± 13.18 months (p < 0.05). The incidence of NTwoRE is increasing time.

Conclusions: Age at NBPP surgery is increasing over time. Regional differences exist in age at NBPP surgery. Approaches to NBPP surgery that avoid exploration of BP roots are becoming more popular. Age at EBP is lower than age at NTwoRE.

Background: Spinal cord vascular malformations (SCVMs) in children are relatively rare and present unique challenges due to their distinct physiological characteristics. These malformations often manifest with nonspecific clinical symptoms, increasing the likelihood of misdiagnosis. The treatment of pediatric SCVMs requires a tailored approach, with the choice between microsurgical intervention and endovascular embolization depending on the specific type of malformation and individual patient factors.

Case report: We report a case of a 6-year-old male who presented with a sudden onset of headache. Initial cranial imaging did not reveal any significant intracranial vascular malformations. However, thoracic spine magnetic resonance imaging (MRI) identified an abnormal signal, and digital subtraction angiography (DSA) confirmed the diagnosis of SCVMs. The patient underwent microsurgical treatment and was discharged in good health. Follow-up DSA confirmed the complete resolution of the vascular malformations.

Conclusion: This case, along with a review of the literature, underscores the importance of thorough spinal evaluations in pediatric patients with spontaneous intracranial hemorrhage, especially when intracranial vascular malformations are not identified. A high index of suspicion for SCVMs is crucial. Early and accurate diagnosis, followed by appropriate treatment through microsurgical resection or endovascular embolization, can significantly improve therapeutic outcomes in children with SCVMs.

Background: The primary objective of this study was to estimate the effective cerebral perfusion pressure (CPPe), critical closing pressure (CrCP), and resistance-area product (RAP) of the intravascular common carotid artery using three different methods. These estimates were then compared to the reference method of linear regression (LR).

Methods: In our previous study, we employed linear regression to evaluate the values of CrCP and RAP. To assess the consistency of results obtained from alternative assessment methods (CPPe, CrCP, and RAP) with the linear regression LR, we conducted a secondary analysis of the previously collected data. We estimated the CPPe, CrCP, and RAP of the intravascular common carotid artery using three different methods: Belford's method (mean/diastolic pressure), Czosnyka's method (systolic/diastolic pressure, CZO), and Schmidt's method (systolic/diastolic pressure, SCH), and compared these estimates with LR. CPPe is calculated as the difference between mean arterial pressure and CrCP. The primary outcome was the mean differences and biases between CPPe, CrCP, and RAP of intravascular common carotid artery, the secondary outcome was correlations and agreement among these various estimates of CPPe measurements.

Results: Nineteen patients were included in this analysis. The median age was 53.5 ± 11.6 years, with 73.7% being men. There were no significant differences in CPPe, RAP and CrCP between the right common carotid artery (RCCA) and the left common carotid artery (LCCA) by using three different methods. Compared to the LR, the mean differences in CPPe and CrCP values were no significant for LCCA according to SCH, CZO and BEL method. But for RAP, the three methods are different in terms of mean differences compared with the LR. CPPe and CrCP revealed a small mean bias compared CPP_CZO with CPP_LR. Comparing CPPLR measurements with CPPBEL, the mean bias was higher with wider LoA. BEL and CZO showed a strong correlation with LR in Pearson correlation coefficients.

Conclusion: The CPPe, CrCP, and RAP values obtained using the CZO calculation methods are comparable to those measured using the reference method. These findings may provide valuable insights for patients undergoing digital subtraction brain angiography, aiding in the determination of the most suitable approach for individualized blood pressure management.

Objective: The aim of this study is to comprehensively evaluate the efficacy of laser ablation and crystallized phenol application in the treatment of pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and the patients' return to normal life.

Material and method: Data from patients treated for pilonidal sinus disease with laser ablation and crystallized phenol application at our clinic between January 2020 and September 2023 were retrospectively reviewed. Preoperative data including pit counts, disease stage, preoperative pilonidal abscess history, disease duration (week), treatment success, recurrence/persistent disease, postoperative complications, healing time (days), and visual analogue scale (VAS) scores on postoperative days 1 and 7, as well as return to normal life (days), were analyzed.

Results: A total of 121 patients were included in the study, with 51 receiving laser ablation and 70 receiving crystallized phenol application. The postoperative outcomes revealed that the wound healing period and postoperative VAS values were statistically significantly better in the laser ablation group.

Conclusion: Wound healing was faster and postoperative pain was less in the laser group compared to the phenol group. According to this study, both methods can successfully treat the disease in selected cases.

Introduction: To develop an intelligent system based on artificial intelligence (AI) deep learning algorithms using deep learning tools, aiming to assist in the diagnosis of lumbar degenerative diseases by identifying lumbar spine magnetic resonance images (MRI) and improve the clinical efficiency of physicians.

Methods: The PP-YOLOv2 algorithm, a deep learning technique, was used to design a deep learning program capable of automatically identifying the spinal diseases (lumbar disc herniation or lumbar spondylolisthesis) based on the lumbar spine MR images. A retrospective analysis was conducted on lumbar spine MR images of patients who visited our hospital from January 2017 to January 2022. The collected images were divided into a training set and a testing set. The training set images were used to establish and validate the deep learning program's algorithm. The testing set images were annotated, and the experimental results were recorded by three spinal specialists. The training set images were also validated using the deep learning program, and the experimental results were recorded. Finally, a comparison of the accuracy of the deep learning algorithm and that of spinal surgeons was performed to determine the clinical usability of deep learning technology based on the PP-YOLOv2 algorithm. A total of 654 patients were included in the final study, with 604 cases in the training set and 50 cases in the testing set.

Results: The mean average precision (mAP) value of the deep learning algorithm reached 90.08% based on the PP-YOLOv2 algorithm. Through classification of the testing set, the deep learning algorithm showed higher sensitivity, specificity, and accuracy in diagnosing lumbar spine MR images compared to manual identification. Additionally, the testing time of the deep learning program was significantly shorter than that of manual identification, and the differences were statistically significant (P < 0.05).

Conclusions: Deep learning technology based on the PP-YOLOv2 algorithm can be used to identify normal intervertebral discs, lumbar disc herniation, and lumbar spondylolisthesis from lumbar MRI images. Its diagnostic performance is significantly higher than that of most spinal surgeons and can be practically applied in clinical settings.

Objective: Evaluating the clinical value of the modified single-incision posterior median approach with expandable tubular assistance for lumbar interbody fusion in managing degenerative lumbar spine diseases.

Method: A retrospective analysis was conducted on 121 patients with single-level degenerative lumbar spine disease treated in our spine surgery department from January 2017 to December 2021. Of these, 72 patients underwent a modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion (single-incision MIS-TLIF group), while 49 patients received the classic open posterior median incision P-TLIF (open surgery group). We collected basic demographic data including age, gender, BMI, and surgical level. Surgical-related indicators such as operation time, intraoperative blood loss, postoperative drainage, length of hospital stay, hospital costs, and complication rates were compared between the two groups. Laboratory results [whole blood C-reactive protein (CRP), serum creatine kinase (CK)] and clinical outcomes [VAS scores for low back and leg pain, Oswestry Disability Index (ODI), excellent and good rate according to the modified MacNab criteria, and interbody fusion rate according to the Brantigan criteria] were also evaluated.

Result: There were no significant differences in the basic demographics between the two groups. The operation time, postoperative hospital stay, and hospital costs were also similar between the groups. However, significant differences were observed in intraoperative blood loss, postoperative drainage, and complication rates. On postoperative days 1 and 3, whole blood CRP and CK levels showed marked differences between the groups. At 3, 6, and 12 months postoperatively, the single-incision MIS-TLIF group had lower ODI scores and VAS scores for back pain compared to the open surgery group. The excellent and good rate according to the MacNab criteria was higher in the single-incision MIS-TLIF group. There were no significant differences in leg pain VAS scores and interbody fusion rates at 12 months postoperatively between the groups.

Conclusion: The modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion is highly effective in treating degenerative lumbar spine diseases. It results in less postoperative pain, faster recovery, and significant improvement in postoperative functional outcomes, making it a valuable treatment option.