To describe the Infinity Decompression (ID), a standardized 13-step workflow for unilateral biportal endoscopic (UBE) over-the-top (OTT) decompression of lumbar central stenosis, and to compare its perioperative and short-term clinical outcomes with conventional “N” technique with piecemeal flavectomy (N-PF). We retrospectively analyzed consecutive patients with single-level lumbar central canal stenosis treated by UBE OTT decompression by the same surgeon. Forty cases treated with N-PF were compared with 40 cases treated with the ID technique. Demographic data, operative time per level, complications and reoperations were recorded. VAS back and leg pain, ODI and modified MacNab were assessed preoperatively and at 6 months. Baseline characteristics were similar between groups. Mean operative time per level was 44.8 ± 5.8 min with ID and 73.0 ± 8.7 min with N-PF (p < 0.001). There were no intraoperative or postoperative complications in the ID group. In the N-PF group, one intraoperative dural tear (2.5
Diabetic macular oedema [DMO] is a prevalent and sight-threatening condition among diabetic patients, which can cause irreversible blindness. Since angiogenesis and inflammation are two key elements in the etiopathogenesis of DMO, intravitreal injections of vascular endothelial growth factor inhibitors [anti-VEGF] and sustained released intravitreal corticosteroid implants are currently considered as treatments of choice. The introduction, 10 years ago, of the 0.19 mg fluocinolone acetonide [FAc] implant for treating eyes with vision impairment associated with recurrent and persistent DMO represented an important advance. Since then, two randomized-control trials and many real-world studies have shown its good efficacy/safety profile and the replicability of its treatment regimen. The FAc implant is, in general terms well tolerated, although it is associated with intraocular pressure-[IOP] and cataract-related adverse events [AEs]. Most IOP-related AEs are effectively controlled with ocular-hypotensive therapies. The objective of this paper is to review the role of FAc implant in the treatment of DMO over the 10 years since its launch, as well as its impact on clinical practice outcomes.
Background: Proximal hamstring lesions are a common but challenging injury in sports medicine and orthopedics, with significant implications for patient mobility and quality of life. Surgical intervention strategies vary widely, encompassing different approaches, tools, and post-operative protocols. This review synthesizes current literature to outline best practices and innovations in the surgical treatment of these lesions. Objective: To provide a detailed narrative review of the surgical techniques used in treating proximal hamstring lesions, highlighting operative positioning, open versus endoscopic approaches, portal usage, types of fixation, and key surgical insights including pearls and pitfalls. The review also aims to discuss post-operative recommendations and activity restrictions to optimize recovery outcomes. Methods: A comprehensive literature search was conducted using major medical databases, including PubMed, focusing on studies published in the last two decades. Articles were selected based on relevance to surgical techniques for proximal hamstring injuries, encompassing case studies, retrospective analyses, and prospective trials. Results: The review details various surgical approaches, comparing open and endoscopic techniques in terms of efficacy, complication rates, and recovery times. It examines patient positioning, portal selection, and the use of different fixation devices like sutures and screws. Surgical pearls and pitfalls are discussed to enhance procedural understanding and outcomes. Post-operative protocols are analyzed, emphasizing the importance of tailored activity restrictions and rehabilitation strategies. Conclusion: This narrative review elucidates the complex surgical landscape for proximal hamstring lesions, offering a critical evaluation of techniques and outcomes. By integrating diverse surgical experiences and academic insights, it aims to guide clinicians in selecting the most appropriate, patient-specific interventions and post-operative care plans to maximize recovery and minimize complications.
Background: Longitudinal extensive transverse myelitis, which designates inflammation of the spinal cord in more than 3 vertical vertebral segments, is a rare presentation of paraneoplastic syndrome, being more common in lung or lymphoproliferative neoplasms. Before diagnosing myelitis of paraneoplastic etiology, the aim is to exclude inflammatory, metabolic, infectious and ischemic/traumatic causes. Case Presentation: We present a 62-year-old man observed in the emergency department for low back pain that had lasted 2 weeks, paresthesia of the lower limbs and severe inability to walk. He also referred sphincter anesthesia in the previous 3 days. Several examinations were carried out and the dorso-lumbar magnetic resonance imaging highlighted findings of longitudinal extensive transverse myelitis from D5-D6 to the conus medullaris. The etiological study showed papillary thyroid carcinoma as a condition for this paraneoplastic syndrome. After thyroidectomy, the patient progressively recovered from the deficits presented. Conclusions: The clinical and imaging diagnosis of myelitis is not difficult, however, finding the underlying etiology can be challenging. A whole set of laboratory and imaging tests are necessary to confirm the cause and direct treatment with the intention of potentially reversing the neurological condition.
Purpose: Retinal thickness fluctuations (RTF) have been associated with best-corrected visual acuity (BCVA). The current study aimed to assess the effectiveness of 0.19-mg fluocinolone acetonide intravitreal (FAc) implant to control RTF and its effect on BCVA. Methods: The RIVER study was a multicenter, retrospective, and non-interventional study that analyzed the data of the Retina.pt Portuguese national registry. Retinal thickness was assessed using the spectral domain optical coherence tomography (SD-OCT). The primary endpoint was the assessment of RTF. Eyes were stratified into quartiles (Q) and median-split according to their retinal thickness amplitude (RTA), retinal thickness standard deviation (RTSD), and central subfield thickness area under the curve (CST-AUC). Results: The mean RTA decreased from 187.6±150.4 µm at baseline to 151.6±126.4 µm after the Fac implant (at the last follow-up visit); p=0.1204. Mean RTSD significantly reduced from 96.3±78.1 µm at baseline to 60.8±57.3 µm at the last follow-up visit (p=0.0032). Compared to pre-FAc implant, BCVA significantly improved in eyes with RTA Q1, Q2, Q3; eyes with RTSD Q1, Q2, and Q3, and eyes with CST-AUC Q1, Q2, and Q3. According to the median split, eyes with RTA and RTSD < to median showed greater BCVA improvement. Conclusions: Regardless of the variable used to assess retinal thickness fluctuation, the FAc implant provided a significant reduction of its variability. Additionally, lower retinal thickness variability was associated with better visual outcomes.
