A randomized study of the effectiveness of suprascapular nerve block in patient satisfaction and outcome after arthroscopic subacromial decompression

Purpose: The purpose of this study was to evaluate the efficiency of the suprascapular nerve (SSN) block in pain reduction after arthroscopic subacromial decompression operations and its influence on patient satisfaction. Furthermore, we wanted to evaluate whether better perioperative pain management could positively influence postoperative shoulder function. Methods: In this prospective, randomized, double-blinded clinical trial, 3 groups of patientseach with 15 participantswere treated with SSN block (10 mL of 1% ropivacaine), placebo, or a subacromial infiltration of local anesthesia (20 mL of 1% ropivacaine). Preoperative and postoperative pain was evaluated with a visual analog scale. Functional outcome was measured by the Constant-Murley score, and patient satisfaction was measured anecdotally by interview 2 days, 2 weeks, and 6 weeks after surgery. Results: The SSN group reported significantly lower levels of postoperative pain, required significantly less analgesia, had better range of motion, and had higher levels of postoperative satisfaction in comparison to the subacromial infiltration group and placebo group. Conclusions: Patients treated with SSN blocks had less pain overall, which led to a decreased need for analgesics in comparison to the subacromial infiltration and placebo groups. Furthermore, patients in the SSN-blocked group achieved better postoperative ROM and were significantly more satisfied after surgery. Level of Evidence: Level I, prospective, randomized, double-blinded clinical trial

PLIF in thoracolumbar trauma: technique and radiological results

Patients with fractures from the 11th thoracic to the 5th lumbar vertebra had a reconstruction of the anterior column with monocortical iliac crest autograft by using a single dorsal approach. The loss of correction was observed using X-rays pre- and post-operatively, at 3 months and after implant removal (IR). Successful fusion was assessed using computed tomography after the implant removal. To assess the loss of correction and intervertebral fusion rate of this technique. There are still controversial discussions about the treatment modalities of spine lesions, especially in cases of burst fractures. Dorsal, combined and ventral procedures are reported with different assets and drawbacks. We want to present a method to restore the weight-bearing capability of the anterior column using a single dorsal approach. From 2001 to 2005, a total of 100 patients was treated with this technique at our department. Follow-up examination was possible in 82 patients. The X-rays and CT scans were proofed for loss of correction and fusion rate. The anterior column has been restored using a monocortical strut graft via a partial resection of the lamina and the apophyseal joint on one side to access the disc space. The dorsal reduction has been achieved using an angular stable pedicle screw system. The mean follow-up time was 15 months (range 8–39); 67 patients had a CT scan at follow-up and 83% showed a 360° fusion. The average post-operative loss of correction was 3.3° (range 0–21). The average duration of operation was 192 min (range 120–360) and the mean blood loss was 790 ml (range 300–3,400 ml). Regarding the complications we did not have any deep wound infections. We had two epidural haematomas postoperatively with a neurological deterioration that had to be revised. We were able to decompress the neurological structures and restore the weight-bearing capability of the anterior column in a one-stage procedure. So we think that this technique can be an alternative procedure to combined operations regarding the presented radiological results of successful fusion and loss of correction

Mid-term results of PLIF/TLIF in trauma

Treatment of thoracolumbar fractures is still controversial. Several treatment options are reported to yield satisfactory results. There is no evidence indicating superiority of any treatment option. We have already presented radiological results of the use of PLIF/TLIF in trauma, which showed satisfactory results concerning intervertebral fusion and acceptable loss of correction. We examined 50 patients regarding loss of correction after implant removal and clinical outcome using a validated visual analogue score. The average time of follow-up (FU) was 35 months. We observed a total loss of correction of 4°. The pre-injury mean VAS score was 92. At FU, there was an average reduction of 17.2 points. Owing to the presented results, we suggest this method as an alternative to combined procedures