Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors have developed and algorithm for management of spondylolysis and spondylolisthesis. Since March 1983, 15 patients with an average age of 20 years and with greater than 50% anterior displacement have been treated. The mean follow-up period is 24 months. Before surgery the average anterior displacement was 72%, the average delta angle at L5-S1 representing kyphosis was 73 degrees, and the average lumbar lordosis from L1 to L5 was 64 degrees. An anterior release and fusion was combined with a posterior reduction and instrumentation using the internal fixator. Correction of the anterior displacement averaged 46%, while the kyphosis was corrected a mean of 20 degrees and the lordosis a mean of 12 degrees. The L4 segment was preserved in 13 cases and the L4-L5 angle was improved by a mean of 7 degrees. Postoperative pain and function were improved in all cases. Neurologic complications occurred in four patients, three permanent and one temporary. Hardware failure occurred in two patients, and reoperation has been required in one. Further follow-up evaluation of this technique is required.
 ...
PMID:Severe spondylolisthesis. Reduction and internal fixation. 338 4

A clinical and radiological long-term follow-up study is presented of 175 patients under the age of 20 years operated on for symptomatic isthmic spondylolisthesis of L5. The mean observation time was 15 years (range 5-30 years). There were 89 female and 86 male patients; mean age at operation was 14.8 years. Posterior fusion was carried out in 112 cases, posterolateral fusion in 60 and anterior fusion in 3; a concomitant laminectomy was performed in 34 cases. One segment (L5-S1) was fused in 54 patients, two segments (L4-S1) in 104, and three segments (L3-S1) in 17. Autogenous cortico-spongeous bone was used in 119 cases and free periosteal grafts in 56. At follow-up, solid bony fusion was found in 145 patients; 30 patients (17.1%) had non-union. The data for these two groups were compared statistically. The frequency of nonunion was significantly higher after posterior than after posterolateral fusion (P< 0.05), in two-level fusions than in one-level fusions (P = 0.003), and in cases where periosteal rather than cortico-spongeous bone grafts had been used (P<0.01). The posterior fusion technique using periosteal grafts gave the highest rate of non-unions, whereas the posterolateral technique with cortico-spongeous grafts gave the highest rate of successful fusions (P < 0.001). Non-union occurred significantly more often in cases of grade I slip (36%) than in cases of grade II (7%), III (8%) or IV slip (0%). The higher frequency of nonunions in grade I slips was associated with more frequent use of the posterior fusion technique in cases of minor or moderate grades of slip. The duration of postoperative bed rest or duration of immobilization in a corset had no statistically significant influence on fusion rate. The rate of non-union had no statistically significant association with the long-term clinical result. Postoperative pain symptoms, however, lasted longer in non-union patients (mean 14.2 months) than in successfully fused patients (mean 4.5 months; P<0.01). The results show the benign nature of the condition, which seems to be a self-limiting process leading to stabilization of the affected segment. The posterolateral fusion technique using autogenous cortico-spongeous bone grafts is recommended as the method of choice for most cases.
 ...
PMID:Solid fusion vs. non-union in long-term follow-up of in situ fusion without internal fixation in symptomatic spondylolisthesis in young patients. 2005 32

OBJECT Decompression without fusion for degenerative lumbar stenosis is an effective treatment for both the pain and disability of neurogenic claudication. Iatrogenic instability following decompression may require further intervention to stabilize the spine. The authors review the incidence of postsurgical instability following lumbar decompression, and assess the impact of surgical technique as well as study design on the incidence of instability. METHODS A comprehensive literature search was performed to identify surgical cohorts of patients with degenerative lumbar stenosis, with and without preexisting spondylolisthesis, who were treated with laminectomy or minimally invasive decompression without fusion. Data on patient characteristics, surgical indications and techniques, clinical and radiographic outcomes, and reoperation rates were collected and analyzed. RESULTS A systematic review of 24 studies involving 2496 patients was performed, assessing both open laminectomy and minimally invasive bilateral canal enlargement. Postoperative pain and functional outcomes were similar across the various studies, and postoperative radiographie instability was seen in 5.5% of patients. Instability was seen more frequently in patients with preexisting spondylolisthesis (12.6%) and in those treated with open laminectomy (12%). Reoperation for instability was required in 1.8% of all patients, and was higher for patients with preoperative spondylolisthesis (9.3%) and for those treated with open laminectomy (4.1%). CONCLUSIONS Instability following lumbar decompression is a common occurrence. This is particularly true if decompression alone is selected as a surgical approach in patients with established spondylolisthesis. This complication may occur less commonly with the use of minimally invasive techniques; however, larger prospective cohort studies are necessary to more thoroughly explore these findings.
...
PMID:Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts. 2642 49