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      저자 : Denish Patel (검색결과 2 건)
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        The Relationship of Facet Joint Orientation and Tropism with Lumbar Disc Herniation and Degenerative Spondylolisthesis in the Lower Lumbar Spine

        Devanand Degulmadi,Bharat Dave,Ajay Krishnan,Denish Patel 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

        Study design: Retrospective study. Purpose: This study aimed to clarify the relationship of both facet tropism (FT) and the sagittally aligned facet (SAF) joint with lumbar disc herniation (LDH) and degenerative spondylolisthesis (DS). Overview of Literature: Despite several studies conducted, there is no consensus on the association of the SAF joint and FT with DH and DS. Methods: Between June 2015 and December 2017, magnetic resonance imaging scans of 250 consecutive patients who underwent surgery for LDH and DS were analyzed. The facet angles at all the lower lumbar levels were calculated, and SAF and FT were noted. The relationship between the side of disc herniation and that of the SAF joint were also determined. Statistical analysis was performed, and the relation of SAF and FT to LDH and DS was noted. Results: We observed a positive relationship between SAF and LDH at L4–5 and L5–S1 with a p -value of 0.02 (<0.05). FT demonstrated a positive association with LDH at L4–5 (p =0.047) but not at L3–4 or L5–S1. SAF demonstrated a positive relationship with DS at L3–4 (p <0.001) but not at L3–4 or L5–S1. FT demonstrated a significant relation with DS at L4–5 (p <0.001), whereas no positive association was observed at L3–4 and L5–S1. Conclusions: The L4–5 level demonstrated a significant association with SAF and FT in LDH and DS. Moreover, SAF at L5–S1 demonstrated a positive association with LDH. These findings provide useful information for future longitudinal studies to elucidate the possible causes for such phenomena.

      • KCI등재

        Does the Surgical Timing and Decompression Alone or Fusion Surgery in Lumbar Stenosis Influence Outcome in Cauda Equina Syndrome?

        Bharat Rajendraprasad Dave,Puspak Samal,Romin Sangvi,Devanand Degulmadi,Denish Patel,Ajay Krishnan 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

        Study Design: A retrospective comparative analysis of 64 patients with cauda equina syndrome (CES), who underwent either decompression alone (NF) or fusion (F) surgery. Purpose: We compared the outcomes and timing effects. Overview of Literature: CES can cause loss of autonomic control of vesicular function and lower limb neurological deficits. Prompt diagnosis and emergency surgery markedly improve outcome. Although decompression only is a mainstream technique, there is guarded recovery of vesicular dysfunction. Decompression ventrally in a narrow window requires manipulation of neural tissue in an already jeopardised critical canal and may accentuate irreversible damages. In F surgery, the adequate exposure leads to a lower neural manipulation. Methods: Until January 2008, we treated CES with decompression (laminectomy and/or discectomy). However, from that month forward, all our single-level CES patients have received a fusion operation. In this study, characteristic categorical variables and outcomes were analysed. Results: In a retrospective analysis of 64 patients, NF (n=37) and F (n=27) who received treatment, we found that both groups improved significantly on follow-up in all objective parameters. Although, the comparison of clinical and functional outcome data between the two groups was statistically insignificant, the average value of objective outcome such as vesicular function, low back pain (LBP), and complications was better for patients in F group compared with NF group. However, the patient satisfaction for the F group was also lower, in view of their residual symptoms and disabilities. Contrary to common perceptions, we found that the timing of surgery does not influence the recovery rate for either approach. Conclusions: Although both the techniques appear to be equally effective, the fusion approach overall showed a definite edge over non-fusion, with respect to reduced incidence of iatrogenic dural tears, LBP, and overall outcome, even despite the lower patient satisfaction.

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