Study DesignRetrospective.PurposeTo report the outcomes of patients with lumbar spinal stenosis treated with percutaneous endoscopic decompression, focusing on the results of clinical evaluations.Overview of LiteratureThere are no studies about two portal percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis.MethodsMedical and surgical complications were examined and clinical results were analyzed for 30 patients who consecutively underwent two portal percutaneous endoscopic decompression for lumbar spinal stenosis were reviewed. The operations were performed by unilateral laminotomy for bilateral decompression.ResultsAll patients displayed clinical improvement when were evaluated with visual analog scale (VAS) score of pain, Oswestry disability index (ODI) and Macnab criteria. The improvement of VAS and ODI was 8.3±0.7 to 2.3±2.6 and 65.2±13.7 to 24.0±15.5, respectively (both p<0.05). Complications were the same as for open decompression. The most common complication was transient nerve root paresthesia.ConclusionsSurgical decompression with two portal percutaneous endoscopic decompression has initial benefits, but long-term studies should pay more attention to the risks of postoperative instability and restenosis as well as the need for re-operation. Further investigations with long-term results are thus required.

BackgroundChronic elbow pain has several causes. Instability pain is one of the differential diagnosis. Posterolateral rotatory instability (PLRI) of the elbow results from lateral collateral ligament (LCL) insufficiency. This instability has been recognized in association with trauma of the elbow. The standard treatment of LCL insufficiency is ligament reconstruction with a tendon graft. Treatment outcome of LCL reconstruction in atraumatic PLRI cases has been rarely reported. This study reports the results of LCL reconstruction in patients with chronic lateral elbow pain from atraumatic PLRI.Materials and methodsData were collected from 36 patients referred to our institution for surgery because of chronic lateral elbow pain between November 2011 and June 2015. Six patients with atraumatic PLRI underwent LCL reconstruction with tendon graft. Demographic data, number of steroid injections, postoperative clinical examination, Mayo Elbow Performance Index, 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and complications were recorded with a mean follow-up of 24 months.ResultsReconstruction resulted in significant improvement of pain. The mean postoperative Mayo Elbow Performance Index score was 97.5 (range, 95-100), and the score of the 11-item version of the Disabilities of the Arm, Shoulder, and Hand was 9 (range, 3.3-33). Postoperative instability test results were negative in all patients. Mean postoperative range of motion was 136° in flexion and 1° in extension. No complications were detected at the follow-up assessment.ConclusionsWe consider LCL reconstruction is one of the reference treatments for atraumatic PLRI because it provides effective and reliable results.

In the present study, the thenar muscles were evaluated using magnetic resonance imaging (MRI), in addition, the correlations between thenar muscle changes, clinical findings and electrodiagnostic results from patients with carpal tunnel syndrome were investigated. The subjects were 13 patients (17 wrists) who were clinically diagnosed with carpal tunnel syndrome. In all patients, a medical history was obtained and physical examination was performed, in addition to assessment using the Kapandji scoring system, visual analogue scale (VAS), quick-disabilities of the arm, shoulder and hand (Q-DASH) score, electrodiagnostic results of the median nerve, and MRI of the thenar muscles. Thenar muscle volume was not significantly correlated with clinical data or the electrodiagnostic results. The thenar muscle major axis was significantly correlated with grasp power (P<0.05) and the Kapandji score (P<0.05), while the thenar muscle minor axis was significantly correlated with abductor pollicis brevis distal motor latency (APB DML) (P<0.01). In addition, the thenar muscle minor axis/thenar muscle major axis ratio was significantly correlated with APB DML and Kanatani's stage. Notably, thenar muscle thinness was significantly correlated with the severity of electrodiagnostic changes, while the grasp power and Kapandji score were correlated with thenar muscle thickness. Furthermore, it was demonstrated that thenar muscle thinness was significantly correlated with the severity of electrodiagnostic changes; in addition, there was a significant correlation between the thenar muscle major axis and the grasp power or Kapandji score. Taken together, these results revealed that thenar muscle atrophy did not affect patient-based assessments, including VAS and Q-DASH, but reflected electrodiagnostic results, particularly DML and severity. The results of the present study suggest that thenar muscle atrophy can be used to estimate the severity of carpal tunnel syndrome.

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