MyMedR

Fulltext Surgical reduction technique (transpedicle) for unstable thoracolumbar burst fractures with retropulsion resulting in severe spinal canal stenosis: a preliminary case report

Choo CH, Kwan MK, Chris Chan YW

AME Case Rep, 2018;2:38.

PMID: 30264034 DOI: 10.21037/acr.2018.07.02

Thoracolumbar burst fractures are common entity in polytraumatized patients. The retropulsed burst vertebral fracture may result in spinal canal invasion with or without neurological deficit. In this situation, early surgical stabilization with decompression is vital to restore neurological function. We employed a posterior approach with a unique transpedicular reduction technique at the level of fracture for decompression and stabilisation.

Matched MeSH terms: Decompression, Surgical

Fulltext Is arthoscopy of the shoulder safe - a study/perspective on arthroscopic subracromial decompression

Loh YC, Trail IA

Med J Malaysia, 2002 Jun;57(2):205-8.

PMID: 24326652

Fourteen fit and healthy patients underwent arthroscopic subacromial decompression (ASD) of shoulder for rotator cuff impingement. Their blood chemistry was analysed pre-operatively, 24 hours post-operatively and 2-3 weeks post-operatively. Levels of haematocrit, sodium, potassium, creatinine and urea were measured. The blood chemistry returned almost to the pre-operative level at 2-3 weeks post-operatively. There was no statistically significant differences found. This study concludes that arthroscopic subacromial decompression is a safe technique when considering the blood parameters despite the haemodilution seen in all patients.

Matched MeSH terms: Decompression, Surgical

Fulltext Complete Recovery of Thoracic Myelopathy after Eleven Months of Paraplegia: A Case Report

Manmohan S, Nor Azlin ZA, Fazir M, Dzulkarnain A, Goh JH

Malays Orthop J, 2015 Mar;9(1):32-34.

PMID: 28435594 MyJurnal DOI: 10.5704/MOJ.1503.004

Instances of neurological recovery after early decompression of the spine in non-traumatic spinal cord compression are well documented. We present a patient with paraplegia of 11 months' duration due to atypical spinal tuberculosis who showed complete neurological recovery in three months.

Matched MeSH terms: Decompression, Surgical

Fulltext Acute neurological deficit caused by thoracic pseudomeningocele after spinal surgery

Foo CH, Hii BYS, Wong CC, Ohn KM

BMJ Case Rep, 2021 Jul 12;14(7).

PMID: 34253529 DOI: 10.1136/bcr-2021-243788

Postoperative pseudomeningocele usually has a benign course. We report a rare presentation of postoperative acute neurological deficit caused by compressive thoracic pseudomeningocele. This patient had posterior spinal fusion and decompression surgery for thoracic ossification of posterior longitudinal ligament and ligamentum flavum. Intraoperative incidental durotomy was covered with hydrogel dural sealant. She developed acute neurological deterioration 1 week after index surgery. Emergency decompression surgery was performed. One year after the surgery, she showed good neurological recovery.

Matched MeSH terms: Decompression, Surgical

Fulltext Endoscopic-assisted Enucleation of Radicular Cysts - A Case Report

Kahairi A, Ahmed Khan S, Amirozi A

Malays J Med Sci, 2010 Jan;17(1):56-9.

PMID: 22135528

The standard management for the majority of benign jaw cysts is enucleation, marsupialisation, curettage and decompression. Enucleation has the advantage that the whole specimen is sent for microscopic evaluation so that more sinister pathological processes (i.e. squamous cell carcinoma) may not be missed. In a large cystic lesion, enucleation is still possible, but technical difficulties might be encountered. In such instances, inevitable damage can occur to the surrounding structures. We report a case of a large radicular cyst of the maxilla that was enucleated via endoscopic assistance through the Caldwell Luc approach.

Matched MeSH terms: Decompression, Surgical

Mini open carpal tunnel release using Knifelight: evaluation of the safety and effectiveness of using a single wrist incision (cadaveric study)

Teh KK, Ng ES, Choon DS

J Hand Surg Eur Vol, 2009 Aug;34(4):506-10.

PMID: 19675032 DOI: 10.1177/1753193409100962

This cadaveric study evaluates the margin of safety and technical efficacy of mini open carpal tunnel release performed using Knifelight (Stryker Instruments) through a transverse 1 cm wrist incision. A single investigator released 32 wrists in 17 cadavers. The wrists were then explored to assess the completeness of release and damage to vital structures including the superficial palmar arch, palmar cutaneous branch and recurrent branch of the median nerve. All the releases were complete and no injury to the median nerve and other structures were observed. The mean distance of the recurrent motor branch to the ligamentous divisions was 5.7 +/- 2.4 mm, superficial palmar arch was 8.7 +/- 3.1 mm and palmar cutaneous branch to the ligamentous division was 7.2 +/- 2.4 mm. The mean length of the transverse carpal ligament was 29.3 +/- 3.7 mm. Guyon's canal was preserved in all cases.

Matched MeSH terms: Decompression, Surgical/instrumentation*; Decompression, Surgical/methods

Fulltext Arthroscopic resection of the distal clavicle with concomitant subacromial decompression: a case series

Chan H, Ooi C, Lim M, Ong E, Zulkiflee O

Malays Orthop J, 2014 Jul;8(2):59-62.

PMID: 25279097 MyJurnal DOI: 10.5704/MOJ.1407.007

Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders(1). Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).

Matched MeSH terms: Decompression, Surgical

Predicted cervical canal enlargement and effective cord decompression following expansive laminoplasty using cervical magnetic resonance imaging

Yusof MI, Hassan E, Abdullah S

Surg Radiol Anat, 2011 Mar;33(2):109-15.

PMID: 20658232 DOI: 10.1007/s00276-010-0704-7

Posterior translation of the spinal cord occurs passively following laminoplasty with the presence lordotic spine and availability of a space for the spinal cord to shift. This study is to predict the distance of posterior spinal cord migration after expansive laminoplasty at different cervical levels based on measurement of posterior translation of the spinal cord in normal cervical morphometry.

Matched MeSH terms: Decompression, Surgical/methods*

Fulltext Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy

Tang IP, Prepageran N, Subrayan V, Tajunisah I

Med J Malaysia, 2008 Oct;63(4):337-8.

PMID: 19385499 MyJurnal

Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.

Matched MeSH terms: Decompression, Surgical/methods*

Fulltext Endoscopic orbital decompression for Graves' ophthalmopathy

Tang IP, Prepageran N, Shashinder S

Med J Malaysia, 2008 Mar;63(1):67-8.

PMID: 18935740

We report a male patient of Graves' Disease with bilateral exophthalmos who had undergone bilateral transnasal endoscopic orbital decompression with subsequent improvement of 3 mm in orbital proptosis bilaterally without any complications. Transnasal endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques especially for purely cosmetic reasons.

Matched MeSH terms: Decompression, Surgical/methods*

Fulltext Neurological recovery following posterior decompression of spinal secondaries

Razak M, Sappani K

Med J Malaysia, 1998 Sep;53 Suppl A:6-11.

PMID: 10968177

This is a retrospective study comprising 45 patients who underwent decompressive laminectomy due to secondary malignancy in the spine. There were 31 males and 14 females. Two of them had no weakness, one was treated for radicular pain and the other for severe intractable back pain. Forty-three patients presented with weakness of the limb of which six patients were able to walk unaided, four with an aid, twenty four were unable to walk of which eleven of them were completely paralysed. Nineteen of the patients had urinary incontinence. Out of 10 patients in Frankel's D, 3 of them regained almost normal power post operatively and were able to walk without any aids at the time of discharge. There were 6 patients in Frankel's C and 2 improved. Of 17 patients in Frankel's B, 6 of them improved and were able to walk with walking aids. Only one out of ten patient from Frankel's A had showed an improvement. A total of three patients deteriorated post operatively and all of them presented with multiple level involvement. There was no change in the post operative status of the two patients who did not have weakness. Overall only 27% of the patient showed improvement following decompressive laminectomy.

Matched MeSH terms: Decompression, Surgical*

Fulltext Delayed decompression of chronic C1C2 subluxation in a pediatric patient with tetraplegia--is recovery possible?

Razif M, Lim HH

Med J Malaysia, 2001 Jun;56 Suppl C:76-9.

PMID: 11814256

A 2 year-old Malay girl was admitted to our institution with a chesty cough and breathlessness but later found to have a chronic C1/C2 subluxation for one and half year with tetraplegia. Her cervical cord was decompressed and occipito-cervical fusion performed. Her neurological status improved significantly post-operatively and is able to care for her personal hygiene. The authors believe that the ability of the cervical cord to recover in the paediatric age group is remarkable that surgical option should be considered even when all seen lost. We believe that this is the first report in the literature to support this potential.

Matched MeSH terms: Decompression, Surgical*

Surgical outcomes of transmastoid facial nerve decompression: Preliminary data from a Malaysian tertiary hospital from 2013-2018

Siang PG, Ying XT, Dayang Suhana AM, Ing PT

Med J Malaysia, 2020 05;75(3):281-285.

PMID: 32467545

INTRODUCTIONS: Facial nerve palsy (FNP) occurs in 7-10% of temporal bone fractures. The aim of this study was to review the surgical outcome of nine patients with severe to complete traumatic facial nerve (FN) injury.

METHODS: The patients were evaluated clinically and FNP was graded using the House Brackmann (HB) scale. High resolution computerized tomography (HRCT) of the temporal bone was used to evaluate temporal bone fractures. Transmastoid facial nerve decompression was performed and the facial nerve function was re-evaluated in subsequent follow ups.

RESULTS: There were five cases with immediate onset and four with delayed onset of FNP. Only three cases had pure temporal bone fractures, the others were associated with other life threatening injuries. The sensitivity and specificity of HRCT temporal bone to detect the obvious facial canal fracture line were 50% and 40% respectively. 75% of patients with immediate onset of HB grade VI FN palsy who were operated within a month recovered completely. Surgeries for the delayed onset FNP were performed at a mean of 70 days (range 51-94). All recovered to HB grade II-III from severe FNP.

CONCLUSIONS: Our study demonstrated that transmastoid FN decompression surgery was beneficial to traumatic nerve injury. Early intervention resulted in better outcomes. However, FN function could still be salvaged even in delayed FN decompression.

Matched MeSH terms: Decompression, Surgical*

Fulltext Acute cauda equina syndrome secondary to free fat graft following spinal decompression

Imran Y, Halim Y

Singapore Med J, 2005 Jan;46(1):25-7.

PMID: 15633005

A 63-year-old man developed acute cauda equina syndrome due to fat graft compression. Following decompressive laminectomy and posterior instrumented fusion with pedicle screw fixation for spinal stenosis of L5 and S1 vertebral levels, free fat grafting was performed to cover the exposed dura. The patient developed gradual neurological deficit three days postoperatively. This started with sensory loss and weakness of the affected dermatomes and myotomes, followed by bowel incontinence on the 12th postoperative day. Intraoperatively, significant dural compression by the fat graft was confirmed. Immediate removal of the fat graft resulted in recovery from cauda equina syndrome.

Matched MeSH terms: Decompression, Surgical/adverse effects*

Fulltext Unusual Posterior Epidural Migration of Intervertebral Herniated Disc: A Report of Two Cases

Tamburrelli FC, Perna A, Oliva MS, Giannelli I, Genitiempo M

Malays Orthop J, 2018 Nov;12(3):47-49.

PMID: 30555647 DOI: 10.5704/MOJ.1811.012

Disc herniation is one of most common causes of spine surgery. Because of the presence of posterior longitudinal ligaments, disc fragments often migrate into the ventral epidural space. A posterior epidural herniation of a disc fragment is a rare occurrence. We report two cases of posterior migrated disc fragments, with, radiological and clinical findings. Because of the rarity of a posterior migration of the intervertebral disc fragments, a differential diagnosis can be challenging. This painful syndrome associated with neurological lower limb deficits can be confused initially, with other posterior epidural space-occupying lesions such as tumours, abscess or hematomas. A gadolinium-enhanced MRI scan is the gold standard for a correct diagnosis. Early surgical decompression of the spine with a posterior approach remains the optimal technique in ensuring the best possible outcome for the patient.

Matched MeSH terms: Decompression, Surgical

Fulltext Good recovery of prostate carcinoma with spine metastases to t9 following laminectomy

Muhammad Wafiuddin

Borneo Journal of Medical Sciences, 2020;14(1):61-66.

MyJurnal

Prostate carcinoma is a common health issue that can metastasise in the spine. A 65-year-old male was diagnosed with prostate carcinoma and two years later he developed a progressive neurological deficit over the bilateral lower limb. He experienced severe back pain, became paraplegic and the quality of life was severely impaired. Radiographic investigations were done and revealed osteoblastic bone metastasis at thoracic vertebrae with spinal cord compression. The patient underwent surgical decompression surgery at the T9 level mainly for pain control. Six months post-surgery not only the pain was well controlled but patient able to ambulate with walking aid. It is a rare post-operative result as the neurological recovery in a patient with complete paralysis is less than 3%. This type of recovery is possible when the cause of the neurological deficit is mainly mechanical compression from tumour rather than cord ischaemia from traumatic injury.

Matched MeSH terms: Decompression, Surgical

Fulltext White cord syndrome: A devastating complication of spinal decompression surgery

Vinodh VP, Rajapathy SK, Sellamuthu P, Kandasamy R

Surg Neurol Int, 2018;9:136.

PMID: 30090668 DOI: 10.4103/sni.sni_96_18

Background: Reperfusion injury of the spinal cord or "white cord syndrome" refers to the sudden onset of neurological deterioration after spinal decompressive surgery. Associated magnetic resonance (MR) findings only include focal hyperintensity on T2-weighted images without any other pathological changes.

Case Description: A patient with cervical stenosis secondary to metastatic tumor in the intradural and extradural compartments presented with lower limb paraparesis. She underwent an uneventful tumor excision accompanied by posterior cervical decompression and fusion. Postoperatively, she was quadriplegic and required ventilator support. The emergent postoperative MR scan revealed focal hyperintensity on the T2-weighted image consistent with spinal cord edema extending into the lower brain stem.

Conclusion: Very few cases of reperfusion injury of the cervical spinal cord or "white cord syndrome" are described in the literature. Here we present a patient who, following cervical laminectomy and fusion for excision of metastatic tumor, developed quadriplegia. Notably, postoperative MR showed only findings of upper cervical cord and lower brain stem edema consistent with a "white cord syndrome" without other compressive pathology.

Matched MeSH terms: Decompression, Surgical

Fulltext Thyroid associated ophthalmopathy - a review

Mallika PS, Tan AK, Aziz S, Syed Alwi SAR, Chong MS, Vanitha R, et al.

Malays Fam Physician, 2009;4(1):8-14.

PMID: 25606151 MyJurnal

Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Smoking has been identified as the strongest risk factor for the development of the disorder. The pathogenesis involves activation of both humoral and cell mediated immunity with subsequent production of gycoaminoglycans, hyaluronic acid resulting in oedema formation, increase extraocular mass and adipogenesis in the orbit. The natural history of the disease progresses from active to inactive fibrotic stage over a period of years. Diagnosis is mainly clinical and almost all patients with ophthalmopathy exhibit some form of thyroid abnormality on further testing. Treatment is based on the clinical severity of the disease. Non-severe cases are managed by supportive measures to reduce the symptomatology and severe cases are treated by either medical or surgical decompression. Rehabilitative surgery is done for quiescent disease to reduce diplopia and improve cosmesis.

Matched MeSH terms: Decompression, Surgical

Fulltext Tandem Spinal Stenosis

Zulkefli, A., Ramanathan, R.

Malays Orthop J, 2010;4(1):46-49.

MyJurnal

A 42 years old gentleman presented with predominant low back pain associated with bilateral lower limb neurological deficit leading to an initial diagnosis of lumbar stenosis. Further history taking and examination revealed upper limb neurological deficit, and the lower limbs actually presented with upper motor neuron instead of lower motor neuron signs. Imaging studies confirmed the clinical findings with presence of both cervical and lumbar spinal stenosis. Twostage decompression procedures were performed at 6 monthintervals starting with cervical decompression. Postoperative improvement was noted on follow-up. This case highlights the importance of accurate diagnosis of cervical pathology for patients presenting with or referred for predominantly lumbar symptomology

Matched MeSH terms: Decompression, Surgical

Spontaneous retrobulbar haemorrhage secondary to orbital varices of inferior ophthalmic vein-a case report

Haizul, I.M., Umi Kalthum, M.N., Mae-Lynn, C.B., Faridah, H.A.

Journal of Surgical Academia, 2012;2(2):49-51.

MyJurnal

A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.

Matched MeSH terms: Decompression, Surgical

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