Cervical spondylotic myelopathy (CSM) is a degenerative condition that results in a non-traumatic, progressive and chronic compression of the cervical spinal cord. Surgery is indicated for patients with moderate to severe myelopathy or progressive myelopathy. Literature shows that decompressive surgery halts progression of the condition. We undertook this study to see if there is a worthwhile improvement in function in patients who had spine decompression for cervical spondylotic myelopathy. From a retrospective review of our medical records, a total of 61 patients had decompressive surgery for cervical myelopathy during the period between January 2008 and January 2014. 11 Patients were excluded because their cervical myelopathy was due to compression from tuberculosis or a tumour. 33 patients had incomplete records. We are reporting on the 17 patients who had complete records. From the patients' notes we recorded the detailed preoperative neurologic examination usually done for these patients in our clinic. This was compared to the neurological examination done at 6 months, 12 months and at more than 2 years follow-up. Where this examination was not adequate, patients were called in for the neurologic examination.Introduction:
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Arthroscopic surgery performed on the medial or lateral compartments of the knee most commonly involves resection or repairs of tears of the posterior horns of the menisci. In osteoarthritic, anterior cruciate ligament-deficient, ligamentously tight, or very large adult knees, arthroscopic surgery through the conventional anterolateral and antero-medial ports can be difficult. It often gives rise to the risk of iatrogenic damage to the articular surfaces and structures of the knee. Establishing an accessory medial and/or lateral port for instrumentation has proved an easy and safe technique in conducting arthroscopic surgery to the posterior (medial and/or lateral) compartments of the knee. This technique was used on 103 patients where access to the posterior compartments of the knee proved problematic. The technique is simple but highly effective and safe and is recommended for the inexperienced arthroscopist.
Two surgeons performed arthroscopic subacromial decompression (ASD) on 302 shoulders between January 1995 and January 1999. The mean age of patients was 49.6 years (28 to 81). The mean follow-up period was 36 months (4 to 62). Evaluated using the modified UCLA scoring system, 91% of patients had a good to excellent result at short-term follow-up. However, patients reviewed for two years or longer showed a 98% successful outcome. The commonest delay in improvement was stiffness, with six patients requiring surgical intervention. Early mobilisation with posterior capsular stretching is recommended. Careful clinical assessment of patients with chronic rotator cuff impingement and accurate identification of arthroscopic impingement signs ensures a successful outcome. Our study confirms other reports that ASD leads to good results in carefully selected patients.
Tears of the posterior horn of the menisci often call for arthroscopic surgery to the medial or lateral compartments of the knee. In osteoarthritis knees, or when there is anterior cruciate ligament deficiency or joint tightness, using conventional anterolateral and anteromedial portals can be difficult. This is so also in very large adult knees. There is a risk of iatrogenic damage to the articular surfaces and structures of the knee. The establishment of an accessory medial and/or lateral portal for instrumentation makes it easy and safe to perform arthroscopic surgery to the posterior medial and/or lateral compartments. The author used this technique in 103 patients in whom access to the posterior compartments was problematic. The simple but effective technique is particularly useful for the inexperienced surgeon or arthroscopist in training.
From January 1995 to January 1999, the author performed arthroscopic subacromial decompression (ASD) on 220 patients. The mean age of patients was 47.4 years (28 to 72). The follow-up period ranged from 4 to 60 months. The modified UCLA scoring system was used to evaluate patients at four months and again at 24 to 60 months. At short-term follow-up, 91% of patients achieved good to excellent results. However, patients reviewed for two years or longer showed a 98% successful outcome. Stiffness was commonly the last thing to improve, and three patients required surgical intervention. Early mobilisation with posterior capsular stretching is recommended. Careful clinical assessment of patients with chronic rotator cuff impingement and accurate identification of arthroscopic impingement signs ensures a successful outcome. This study confirms other reports that ASD produces good results in carefully-selected patients.
Using a biodegradable implant (Suretac), the author performed arthroscopic shoulder surgery for superior labral detachments, anterior to posterior (SLAP) on 40 patients from January 1994 to January 1999. This study evaluated the short and long-term outcome. The mean age of the patients, 29 of whom participated in competitive overhead sporting activities, was 32 years. There were 34 patients with SLAP 2 lesions, three with SLAP 3 lesions and three with SLAP 4 lesions. The follow-up period ranged from 4 to 60 months. All patients were evaluated at four months and then again at 24 to 60 months, using the modified UCLA scoring system. Results were good to excellent four months postoperatively in 85%. Reviewed at two years and longer, 95% of patients had good to excellent results, with 83% of sportsmen resuming their previous overhead sporting activities.
