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The Neck Disability Index (NDI), a common Patient-Reported Outcome Measure (PROM) for neck pain, lacks sufficient study on its psychometric properties in preoperative patients with cervical spondylotic myelopathy (CSM). This study aims to address these gaps by conducting an exploratory factor analysis of the Japanese NDI. The objectives are 2-fold: (1) to scrutinize the psychometric properties and internal consistency of the Japanese NDI, and (2) to explore the specific regions of pain and numbness influencing the NDI. A single-center observational study. A total of 100 preoperative patients with CSM. The NDI and Numerical Rating Scale (NRS) were employed to assess preoperative neck disability and pain and numbness in various body regions. Demographic and clinical characteristics were collected, encompassing age, sex, body mass index, American Society of Anesthesiologists classification, smoking status, comorbidities, pain and numbness at various sites using the NRS, and NDI. For evaluating the psychometric properties and internal consistency of the NDI, exploratory factor analysis (EFA) and Cronbach's α coefficient were utilized. Furthermore, the impact of pain and numbness on NDI factors was examined through multivariable regression analysis. EFA identified 2 factors—Physical and Mental—highlighting the dual nature of neck-related disability. Physical factors (std.β=0.724, p<.001) exerted a stronger impact on NDI scores compared to Mental factors (std.β=0.409, p<.001). Cronbach's α coefficient was 0.831 for physical factors and 0.723 for mental factors, indicating a high level of internal consistency. Numbness in the hand (std.β=0.338, p<.001) and pain in the neck (std.β=0.202, p=.035) were significant variables influencing Physical factor, while numbness in the hand (std.β=0.485, p<.001) and pain in the head (std.β=0.374, p<.001) impacted mental factor. This study contributes valuable insights into the psychometric properties of the NDI in preoperative patients with CSM. The identified factors emphasize the importance of addressing both physical and sensory symptoms in preoperative care. [ABSTRACT FROM AUTHOR]

The high recurrence rate of odontogenic keratocysts (OKC) entails a large number of follow-up interventions after primary surgery. This study aimed to compare recurrent with primary OKC in regard to recurrence rate, treatment modality, radiographic and clinical findings. A single center retrospective cohort study with surgically treated OKC between 2012 and 2021 was conducted. The primary predictor was recurrence type of the lesion: primary (P-OKC), first recurrence (R1-OKC) and second recurrence (R2-OKC). The primary outcome variables were recurrence and time to recurrence. 68 surgeries were identified. Recurrence was not significantly associated with recurrence type (p = 0.906) but with the method of surgery (p < 0.001). Marsupialized R1-OKC recurred earlier than marsupialized P-OKC. Diameter was significantly associated with recurrence type (p = 0.002). R1-OKC had a smaller median diameter than P-OKC and R2-OKC were smaller than R1-and P-OKC. P-OKC were associated with teeth in 79% of surgeries, R1-OKC in 61% and R2-OKC in 27% (p = 0.007). Postoperative numbness was present after 40% of surgeries and decreased to 15% at follow-up, independently of recurrence type. Time to recurrence may be shorter for recurrent marsupialized OKC. Recurrent OKC are smaller and less often associated with teeth. Postoperative numbness after OKC surgery has a good prognosis. [ABSTRACT FROM AUTHOR]

This study evaluated the spread of a local anesthetic, using MRI and sensory blockade, after an intertransverse process block (ITPB) at the medial aspect of the retro-superior costotransverse ligament (retro-SCTL) space – the medial retro-SCTL space block. Ten healthy volunteers received a single-injection ultrasound-guided medial retro-SCTL space block at the T4-T5 level using a mixture of 10 ml 0.5 % bupivacaine with 0.5 ml gadolinium. At 15 min, they underwent a high resolution, fat suppressed, T1 weighted MRI scan of the cervicothoracic spine. Loss of sensation to cold was assessed at 15 and 60 min, and then hourly for 5-h, after the block. MRI showed consistent (100 %) spread of local anesthetic to the intercostal and paravertebral spaces, anterolateral aspect of the vertebral body (sympathetic chain), costotransverse space, neural foramina, and epidural space in all participants. However, sensory blockade was variable across the ipsilateral hemithorax. Hypoesthesia was more common than anesthesia in both the anterior (median [IQR], 3.5 [2–5] vs 0 [0–1.25], p < 0.001) and posterior (median [IQR], 6[3–7] vs 2[1–3], p < 0.001) hemithorax. Additionally, more dermatomes exhibited anesthesia in the posterior compared to the anterior hemithorax (median [IQR], 2[1–3] vs 0[0–1.25], p = 0.01). A variable number of contralateral dermatomes were also affected in 3 (30 %) volunteers. There was no statistically significant correlation between the local anesthetic spread and the number of hypoesthetic (r = 0.53, p = 0.11) or anesthetic (r = 0.09, p = 0.78) dermatomes on the ipsilateral hemithorax. A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax. • Intertransverse process blocks (ITPB) are often proposed as alternatives for a paravertebral block but its pattern of local anesthetic (LA) spread and mechanism of action remains unknown. • MRI evaluation following a single-injection ITPB at the retro-SCTL space (retro-SCTL space block), utilizing 10.5 ml of LA, demonstrates consistent spread to the ipsilateral intercostal, paravertebral spaces, neural foramina and epidural space in all volunteers studied. • It also demonstrates consistent LA spread to the ipsilateral sympathetic chain and costotransverse space. • Despite the spread it only produced ipsilateral sensory blockade that was variable and wider over the posterior than anterior hemithorax. • Although a single level retro-SCTL space block demonstrates consistent spread of LA to the anteromedial neural targets, future research is warranted to ascertain the dose of LA necessary to consistently produce sensory blockade over the anterior hemithorax. [ABSTRACT FROM AUTHOR]

Liangpingyou, a well-known Chinese pomelo (Citrus grandis L.) variety, elicits a unique and uncharacterized numbing aftertaste. To understand the molecular bases and characteristics of the pomelo-induced numbing sensation, we first determined that hydroxyl sanshools, the major Sichuan pepper chemosensates, were not responsible via silylation-GC–MS analysis. Pomelo peel juice was then subjected to solid-phase extraction to form 4 fractions, and key sensory-active substances were screened via taste dilution analysis. Three simple coumarins, meranzin hydrate, isomeranzin, and marmin, were identified to induce numbing, which has not been previously reported. Sensory studies via extensively modified half-tongue tests and verification steps revealed recognition thresholds within 0.49–1.78, 0.32–1.56, and 0.43–1.46 μmol/L for numbness, pungency, and astringency, respectively. The temporal dominance trends showed the following taste notes: Meranzin hydrate–numbing dominated, isomeranzin–numbing and pungent, and marmin–astringent and numbing. Molecular docking analysis suggested that coumarins target the receptors TRPV1, TPRA1, and KCNK3 [Display omitted] • Pomelo numbing attributes, numbness, pungency, and astringency, are characterized • Coumarins e.g. meranzin hydrate instead of OH-sanshools are pomelo numb elicitors • Modified sensory analysis reduces cross-interaction & adaptation of orosensations • Recognition threshold and temporal dominance of coumarin attributes are obtained • Three numbing coumarins bind to chemoreceptors, TRPV1, TRPA1, and KCNK3 in silico. [ABSTRACT FROM AUTHOR]

Dysesthesia is symptomatology that includes but is not limited to sensations of pain, burning, crawling, biting, numbness, piercing, pulling, cold, shock-like, pulling, wetness, and heat. These sensations can cause significant emotional distress and functional impairment in affected individuals. Although some cases of dysesthesia are secondary to organic etiologies, most cases exist without an identifiable infectious, inflammatory, autoimmune, metabolic, or neoplastic process. Ongoing vigilance is required for concurrent or evolving processes, including paraneoplastic presentations. Elusive etiologies, unclear treatment regimens, and stigma leave patients and clinicians with a difficult path forward marked by "doctor shopping," lack of treatment, and significant psychosocial distress. We address this symptomatology and the psychosocial burden that often comes with it. Although notoriously labeled as "difficult to treat," dysesthesia patients can be effectively managed, making life-changing relief possible for patients. [ABSTRACT FROM AUTHOR]

Lower lip hypoesthesia is the most common complication following osseous genioplasty. Concentrated growth factor (CGF) has recently been shown to improve neural regeneration. The aim of this study was to evaluate the effect of concentrated growth factor on neurosensory recovery after osseous genioplasty. Patients who underwent osseous genioplasty between June 2017 and February 2020 were enrolled. CGF was applied to the mental nerve on one side. The treatment side was randomized, and the other side was considered as the control. Lower lip hypoesthesia was assessed preoperatively and postoperatively (1 week, 1, 3, 6, and 9 months) using the two-point discrimination test and a 10-point visual analogue scale (self-reported paresthesia). The assessor was blinded. Twenty-six female patients completed the study. At 1 and 3 months, both the mean two-point discrimination value and mean visual analogue scale score were significantly lower in the CGF group than in the control group (P < 0.001). At 3 months, the percentage of patients with lower lip hypoesthesia in the CGF group was significantly lower than that in the control group (P < 0.001). Both groups showed resolution of lower lip hypoesthesia at 6 months. Concentrated growth factor may accelerate the recovery of long-standing sensory nerve impairment following mental osteotomy. [ABSTRACT FROM AUTHOR]

This prospective study aimed to evaluate neurosensory disturbance and quality of life in patients who underwent mandibular resection for benign tumors and whose inferior alveolar nerve (IAN) was either preserved or sacrificed. Mandibular resection was indicated owing to the presence of osteoradionecrosis in 25 patients and ameloblastoma in 15 patients. Resection was unilateral in 24 patients and bilateral in 16 patients. The authors assessed the inferior alveolar nerve's sensory dysfunction by measuring the electroexcitability of skin receptors using an electro-odontometer. Study participants' quality of life was estimated with the oral health impact profile (OHIP)-14 and short-form (SF)-36 questionnaire. All the patients in whom the inferior alveolar nerve was sacrificed experienced persistent numbness in the area of innervation with mental nerve on the affected side. The average pain threshold reached preoperative levels (point 1–22.7 ± 2.5, p-value =.025; point 2–25.8 ± 2.7, p-value =.023) 6 months after the operation in patients in whom the IAN was preserved (point 1–23.7 ± 2.3, p-value =.022; point 2–25.4 ± 2.8, p-value =.025). The results of the OHIP-14 and SF-36 showed that patients with preserved IANs had a significantly better quality of life than the patients in whom the IAN was sacrificed. The results of OHIP-14 twelve months after the operation in unilateral resection: control group - 16.0 ± 1.6, p-value =.029; study group - 8.0 ± 0.8, p-value =.029, and in bilateral resection: control group - 26.0 ± 3.2, p-value =.044; study group - 9.0 ± 0.7, p-value =.027. The possibility of sparing the inferior alveolar nerve should not be ignored when planning mandibular resection and reconstruction. [ABSTRACT FROM AUTHOR]

Trigeminal neuralgia (TN) remains a challenging disease with debilitating symptoms and variable efficacy in terms of treatment options. Microvascular decompression (MVD) with internal neurolysis (IN) is an alternative treatment that might benefit patients but has limited understanding. We performed a systematic review of IN for the treatment of TN. Studies from 2000 to 2021 that had assessed IN for TN were aggregated and independently reviewed. A total of 520 patients in 12 studies were identified, with 384 who had undergone IN (mean age, 53.8 years; range, 46–61.4 years; mean follow-up, 36.5 months). Preoperative symptoms had been present for ∼55.0 months before treatment, and pain was predominantly in V2 and V3 (26.8%), followed by other distributions. Of the patients, 83.7% (range, 72%–93.8%) had had an excellent to good outcome (Barrow Neurological Institute pain scale score [BNI-PS], I–II). The pain outcomes at 1 year were excellent for 58%–78.4%, good or better for 77%–93.75%, and fair or better for 80%–93.75% of the patients. On average, facial numbness after IN was experienced by 96% of the patients. However, at follow-up, facial numbness remained in only 1.75%–10%. Most of the remaining numbness was not significantly distressing to the patients. Subgroup comparisons of IN versus recurrent MVD, IN versus radiofrequency ablation, the effects of IN in the absence of vascular compression, and IN with and without MVD were also evaluated. IN represents a promising surgical intervention for TN in the absence of vascular compression and for potential cases of recurrence. Complications were limited in general but require further study. [ABSTRACT FROM AUTHOR]

Patients with instability because of congenital craniovertebral anomalies often have complex C1-C2 osseovascular anomalies. C2 nerve root sacrifice has been described to address such difficult anatomy during posterior C1-C2 fixation and has its own downsides. Its preservation as a recent alternative poses greater surgical challenge, and the considerations differ from other causes of craniovertebral junctional instability; the pertaining outcomes have been scarcely studied. The objective of this study was to prospectively determine the feasibility and outcomes related to C2 nerve root preservation in patients with congenital atlantoaxial dislocation (CAAD) after posterior C1-C2 fixation. In this observational study, 63 patients (126 nerve roots) with CAAD after posterior fixation were prospectively assessed. Underlying osseovascular anomalies affecting the feasibility of C2 nerve root preservation, and C2 nerve–related dysfunction at 12 months follow-up were analyzed. The overall C2 nerve root preservation rate was 89.7%. Even in the presence of extreme joint obliquity/spondyloptosis and anomalous vertebral artery, it was feasible in about three fourths. After preservation, 28.3% patients developed new-onset C2 nerve root dysfunction: neuralgia in 2, dysesthesia in 6, and hypoesthesia/paresthesia in 9. The symptoms were not disabling in most patients. In most patients with CAAD, C2 nerve root preservation is feasible despite an aberrant bony and vascular anatomy. A few patients after nerve root preservation develop related symptoms that are conservatively manageable, with no significant adverse consequences. Given the controversy in the literature on C2 nerve sacrifice–related outcomes, we favor an attempt at C2 nerve root preservation. [ABSTRACT FROM AUTHOR]

• Impact of postoperative residual numbness on patient satisfaction has not been well studied. • Residual numbness had a greater impact than leg/back pain on patient satisfaction. • We suggest not only back and leg pain but also numbness should be evaluated pre- and postoperatively. Decompression surgery is the most common surgical treatment for lumbar spinal stenosis (LSS). Relatively low satisfaction rate was reported. Patients often complaint of residual numbness despite significant pain relief. We hypothesized that numbness had a significant impact on patient satisfaction, but had not been evaluated, which is associated with low satisfaction rate. This study aimed to examine how much numbness is associated with patient satisfaction. We retrospectively reviewed prospectively collected data from consecutive patients who underwent decompression without fusion for LSS. We evaluated the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness preoperatively and at the final follow-up visit. Improvement was evaluated using minimum clinically important differences (MCIDs). Patient satisfaction was evaluated using the question, "How satisfied are you with the overall result of your back operation?". There are four possible answers consisting of "very satisfied (4-point)", "somewhat satisfied (3-point)", "somewhat dissatisfied (2-point)", or "very dissatisfied (1-point)". Spearman correlation was used to evaluate the association between patient satisfaction and reaching MCIDs. A total of 116 patients were included. All three components had correlation with patient satisfaction with the correlation efficient of 0.30 in LBP, 0.22 in leg pain, and 0.33 in numbness. Numbness had greatest correlation efficient value. We showed that numbness has a greater impact than leg/back pain on patient satisfaction in patients undergoing decompression for LSS. We suggest not only LBP and leg pain but also numbness should be evaluated pre- and postoperatively. [ABSTRACT FROM AUTHOR]

This study examined the interaction between myofibrillar proteins (MPs) and the numbing substance hydroxy- α -sanshool (α -SOH) in a thermal environment, and provided an explanation of the numbness perception mechanism through muti-spectroscopic and molecular dynamics simulation methodology. Results showed that addition of α -SOH could reduce the particle size and molecular weight of MPs, accompanied by changes in the tertiary and secondary structure, causing the α -helix of MPs transitioned to β -sheet and β -turn due to the reorganization of hydrogen bonds. After a moderate heating (60 or 70 °C), MPs could form the stable complexes with α -SOH that were associated with attachment sites and protein wrapping. The thermal process might convert a portion of α -SOH' into hydroxy- β -sanshool' (β -SOH'). When docking with the sensory receptor TRPV1, the RMSD, RMSF and binding free energy all showed that β -SOH' demonstrated a low affinity, thereby reducing the numbing perception. These findings can provide a theoretical foundation for the advanced processing of numbing meat products. [Display omitted] • α -SOH promoted MPs' thermal degradation. • α -SOH facilitated the actin–myosin binding. • Moderate heating (60 or 70 °C) induced a stable MPs/ α -SOH complex. • α -SOH' exhibited better affinity to the TRPV1 receptor than the β -SOH'. [ABSTRACT FROM AUTHOR]

Peripheral neuropathy is a common neurodegenerative condition characterized by numbness, tingling, pain, and weakness that frequently starts in the distal limbs. Arising from multiple etiologies, many peripheral neuropathies exhibit a slowly progressive course due to axon degeneration for which no effective treatments exist. During the past decade, numerous crucial insights into mechanisms of axon degeneration in peripheral neuropathies emerged from experiments involving nerve-cutting procedures, revealing the central role of the SARM1 axon degeneration pathway in both. Here I review commonalities and differences in the role of SARM1 after nerve cut and in several acquired and inherited peripheral neuropathies. This new knowledge now paves the way for the development of therapeutics that directly address root causes of various kinds of neuropathies. • Axon degeneration in several acquired and hereditary neuropathies is mediated by SARM1. • Different upstream mechanisms lead to SARM1 activation. • Targeting SARM1 pathway may lead to effective therapies for peripheral neuropathies. [ABSTRACT FROM AUTHOR]

Background Context: Unintended dural tears (DTs) are common in spinal surgeries. Some authors have reported that the outcomes in lumbar surgery patients with DTs are equivalent to those in patients without DTs, but this remains uncertain.Purpose: To assess the effect of unintended DTs on postoperative patient-reported outcomes.Study Design/setting: A multicenter retrospective observational study.Patient Sample: We enrolled patients undergoing lumbar spine surgery at eight hospitals between April 2017 and November 2018.Outcome Measures: We collected data regarding patients' backgrounds, operative factors, occurrence of unplanned DTs during surgery, postoperative complications, patient-reported outcomes, such as pain or dysesthesia of the lower back, buttock, leg, or plantar area, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction.Methods: We divided the patients into a DT- group (without DTs) and a DT+ group (with DTs). First, multivariate logistic regression analyses were conducted to reveal risk factors for occurrence of DTs. Then, we used propensity score matching to obtain a matched DT- group (mDT- group) and a matched DT+ (mDT+ group). Student's t test was used for comparing continuous variables and Pearson's chi-square test for comparing categorical variables between the two groups.Results: We enrolled 2,146 patients in this study. The number of patients with unintended DTs was 166 (7.7%). Older age, body mass index, ossification of posterior longitudinal ligament / yellow ligament, spinal deformity, and revision surgery were significant risk factors for DTs. We used propensity score matching to compare 163 of the patients with DTs with 163 patients without DTs. No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the mDT- and mDT+ groups. When comparing preoperative with postoperative pain and dysesthesia, a statistically significant improvement was found in each group (p<.01 for all variables) except for sensory disorder of the plantar area, where a significant improvement was only observed in dysesthesia of the mDT- group (p<.01). Although some improvements were observed, they were not statistically significant in terms of pain in the mDT- (p=.06) and mDT+ (p=.13) groups and dysesthesia in the mDT+ (p=.13) group. No significant differences were found in postoperative outcomes, such as EQ-5D (p=.44) and ODI (p=.89) scores, and postoperative satisfaction (p=.73) between the two groups.Conclusions: Although insufficient improvement of sensory disorder of the plantar area was observed, patients with DTs showed almost equivalent postoperative outcomes compared with patients without DTs. [ABSTRACT FROM AUTHOR]

We report the case of a child who, shortly after undergoing suboccipital craniotomy for resection of a medullary cavernoma, developed corneal and conjunctival epithelial breakdown of the right eye with ipsilateral facial hypoesthesia as well as erosions and crusting of the eyelids, nostril, and lips on the right side. This combination of findings likely results from acute injury to the ipsilateral trigeminal ganglion, leading to acute neurotrophic keratitis and trigeminal trophic syndrome. [ABSTRACT FROM AUTHOR]

Upper extremity sensory disturbances are primary symptoms that affect the quality of life (QOL) of patients with cervical spondylotic myelopathy. Although laminoplasty is 1 of the surgical options, its effects on sensory disturbances have remained unclear. We aimed to determine whether surgical intervention would improve the sensory disturbances of patients with cervical spondylotic myelopathy. We conducted a prospective clinical trial of 101 patients who had undergone open door laminoplasty. For an objective sensory assessment, we measured the current perception thresholds (CPTs) in the patients' forearms and palms using PainVision PS-2100. For a subjective sensory assessment, numbness in the upper extremities was rated using a visual analog scale (VAS). Using the VAS scores, the patients were divided into those with improvement and without improvement. Their self-reported 36-item short-form health survey and Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire scores were compared. The postoperative CPTs in relationship to the preoperative CPTs at 3, 6, and 12 months was 99.3%, 98.1%, and 93.8% in the forearm and 93.6%, 90.6%, and 87.8% in the palm, respectively. The corresponding postoperative numbness VAS scores were 63.8%, 50.5%, and 48.0%. At 12 months postoperatively, the 36-item short-form health survey physical and role component summary scores, cervical spine function effectiveness rates, upper and lower extremity function, and QOL items in the Japanese Orthopaedic Association cervical myelopathy evaluation questionnaire were significantly higher in the improvement group. Our findings have indicated that improvement in postoperative subjective sensory disturbances will occur relatively earlier and will be significantly greater than the improvement in objective sensory disturbances. Furthermore, improvement in the subjective sensory disturbances contributes to functional spinal cord recovery and patients' health-related QOL. [ABSTRACT FROM AUTHOR]

Pudendal nerve decompression surgery has not been studied or reported for the treatment of penile numbness in the absence of pain. Herein, we report a case of a male patient with chronic numbness of the penis and erectile dysfunction in the absence of pelvic pain who was found to have pudendal nerve entrapment. This patient was treated with surgical decompression of the pudendal nerves that resulted in the return of genital sensation and erections. Thus, we propose that pudendal nerve entrapment may be considered as a cause of penile numbness and that pudendal nerve decompression surgery in these patients may be effective. [ABSTRACT FROM AUTHOR]

• Treatment of mice with vincristine impaired whisker tactile behavioral responses and whisker afferent impulses. • The behavioral and electrophysiological impairments were associated with decreased Piezo2 currents in Merkel cells. Piezo2 channel dysfunction in Merkel cells may contribute to the loss of the sense of touch following vincristine treatment. Loss of the sense of touch or numbness in fingertips and toes is one of the earliest sensory dysfunctions in patients receiving chemotherapy with anti-cancer drugs such as vincristine. However, mechanisms underlying this chemotherapy-induced sensory dysfunction is poorly understood. Whisker hair follicles are tactile organs in non-primate mammals which are functionally equivalent to human fingertips. Here we used mouse whisker hair follicles as a model system to explore how vincristine treatment induces the loss of the sense of touch. We show that chronic treatment of mice with vincristine impaired in vivo whisker tactile behavioral responses. In vitro electrophysiological recordings made from whisker hair follicle afferent nerves showed that mechanically evoked whisker afferent impulses were significantly reduced following vincristine treatment. Furthermore, patch-clamp recordings from Merkel cells of whisker hair follicles revealed a significant reduction of mechanically activated currents via Piezo2 channels in Merkel cells. Collectively, our results suggest that Piezo2 channel dysfunction in Merkel cells contribute to the loss of the sense of touch following the chemotherapy treatment regimen with vincristine. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy, especially eversion carotid endarterectomy (ECEA), is a standard treatment of carotid artery stenosis but continues to have deficiencies. We have described a modified ECEA technique that focuses on the quality of life (QoL), called Q-modified eversion carotid endarterectomy (QCEA). The modifications mainly include the skin incision, surgical approach, and arterial anastomosis. The purpose of the present study was to evaluate the clinical efficacy of QCEA and the QoL of patients after QCEA. We performed a retrospective study of 109 patients were had undergone ECEA or QCEA from October 2016 to December 2017. The data from all interventions were prospectively collected in a dedicated database. The primary efficacy outcome was the composite of any stroke, myocardial infarction, or death through the 1-year follow-up period. The secondary endpoint was the QoL of patients after ECEA or QCEA on the seventh postoperative day, including incision hematoma, incision numbness, facial swelling, and scar length. QCEA was performed in 41 patients and ECEA in 45 patients. No statistically significant differences were found in operating or clamping time between the 2 groups. The incidence of facial swelling (4.9% vs. 28.9%; P = 0.040) and incision numbness (4.9% vs. 24.4%; P = 0.011) in the QCEA group was significantly lower than that in the ECEA group. The average scar length of the QCEA group was significantly shorter than that of the ECEA group (5.1 ± 1.4 cm vs. 7.6 ± 2.1 cm; P < 0.001). No transient ischemic attack, stroke, myocardial infarction, or mortality occurred in either group during the 1-year follow-up. Our results suggest that QCEA can reduce incision numbness, facial edema, and scar length, thereby improving the QoL of patients. [ABSTRACT FROM AUTHOR]

Percutaneous endoscopic lumbar discectomy (PELD) is a popular surgical procedure for the treatment of lumbar disc herniation (LDH). However, a small proportion of patients will have poor surgical outcomes. We sought to identify the predictors for poor outcomes after PELD. A total of 241 patients who had undergone PELD were followed up. Their numerical rating scale (NRS) for pain and Oswestry Disability Index scores were analyzed. They were divided by outcome (excellent, good, fair, poor) using the MacNab criteria. Their clinical history, physical examination, imaging, and surgical findings were compared among the groups. Ordinal logistic regression analysis was used to identify independent predictors for poor outcomes. The preoperative mean total NRS for back pain, NRS for leg pain, and Oswestry Disability Index scores were 4.3 ± 2.6, 5.6 ± 2.5, and 52.1% ± 23.0%. At 2 years after PELD, the corresponding scores had decreased to 1.2 ± 1.7, 0.9 ± 1.5, and 8.4% ± 11.2% (P < 0.001). The excellent, good, fair, and poor outcome rates were 44.4%, 31.5%, 17.4%, and 6.6%, respectively. Ordinal logistic regression analysis revealed that 2-level PELD (P = 0.001), a history of lumbar fusion (P = 0.007), and Modic changes (P = 0.011) were independent predictors for poor outcomes. Numbness was an independent predictor for excellent outcomes (P = 0.014). PELD appears to be an effective surgery for LDH. Two-level PELD, a history of lumbar fusion, and Modic changes at the same level were independent predictors for poor outcomes after PELD. Patients with LDH with numbness were more likely to have excellent outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to explore the symptom profiles and predominant symptoms in newly diagnosed breast cancer women before and after receiving docetaxel chemotherapy. A pre-post study recruited adult women with stage I-III breast cancer undergoing docetaxel chemotherapy using convenience sampling. The 13-item symptom severity subscale of the M. D. Anderson Symptom Inventory-Taiwan Form was used to measure symptoms. The study employed latent profile analysis to identify subgroups based on symptom severity before and after docetaxel chemotherapy. Descriptive statistics, including mean and frequency, were used to compare and contrast the most prevalent and severe symptoms within each subgroup to confirm the predominant symptoms. The study identified four and two symptom profiles before and after docetaxel treatment, respectively. Disturbed sleep was identified as a prevalent symptom for all participants, regardless of their chemotherapy status. The predominant symptoms before treatment were disturbed sleep, dry mouth, difficulty remembering, and fatigue, while disturbed sleep and numbness were the predominant symptoms after treatment. The findings of this study are significant, as they contribute to the current understanding of the symptom experience of breast cancer individuals undergoing docetaxel chemotherapy. Healthcare professionals should prioritize assessing and managing these symptoms, including identifying contributing factors to poor sleep. Addressing symptom profiles related to sleep can improve the quality of life of breast cancer individuals undergoing docetaxel chemotherapy. • Provide a unique and comprehensive method to identify symptom profiles. • Identify disturbed sleep as a predominant symptom throughout docetaxel chemotherapy. • Docetaxel chemotherapy often leads to numbness, a key symptom of chemotherapy-induced neuropathy. [ABSTRACT FROM AUTHOR]

Measures of patient-reported quality of life (QoL) are increasingly being used to tailor services that are funded by Clinical Commissioning Groups (CCG) in England. Mandibular osteotomies may result in altered sensation of the lower lip, but we know of limited evidence about the resulting effect on QoL. The modified Bristol orthognathic patient outcomes questionnaire was given to patients who had mandibular osteotomies at the Queen Elizabeth Hospital, Birmingham, between March 2006 and April 2016. Questionnaires were collected at the final orthognathic postoperative appointment. The significance of the difference in QoL between those who had altered sensation of the lower lip and those who did not was compared using a two-tailed t test. During this period 170 patients had mandibular orthognathic operations. Completed questionnaires were received from 117 of those patients (69%) during this period, after a follow up of about six months. We found no significant difference between the perceived benefits of treatment between the 41 who had altered sensation and the 74 who did not (p = 0.30). Only 5/41 who reported residual numbness six months postoperatively stated that they would not choose to have the same treatment again. In conclusion, orthognathic surgery results in an appreciable improvement in QoL and should continue to be funded by CCG in England. Contrary to the perception of some clinicians, those patients with residual numbness of the lip did not have significantly poorer QoL. Future interpretation of the data will be improved if they are collected both before and after the operation. [ABSTRACT FROM AUTHOR]

Background: Syphilis is a sexually transmitted infection that was nearly eradicated in 2001 but is now making a resurgence. It has a wide range of clinical manifestations depending on disease stage. Neurosyphilis is an infrequently seen infectious disease with central nervous system involvement that can occur in either early- or late-stage syphilis. The diagnosis of neurosyphilis is challenging, primarily because Treponema pallidum, the infecting organism, cannot be cultured in vitro. This article describes a patient with neurosyphilis and reviews the epidemiology and clinical manifestations, diagnostics, and treatment of neurosyphilis.Case Report: In compliance with the request of the Privacy Board of our institution, the numerical age of this patient has been omitted. A sexually active teenage girl who was treated for primary syphilis 2 years earlier presented to a tertiary children's hospital with paresthesia and weakness of her right leg, left arm, and neck. Magnetic resonance imaging revealed cervical intramedullary cord edema consistent with transverse myelitis. Serum studies showed positive syphilis enzyme immunoassay, T. pallidum particle agglutination assay, and fluorescent treponemal antibody absorption. A serum rapid plasma reagin test was negative. A lumbar puncture was performed with normal cell count and protein. A cerebrospinal fluid Venereal Disease Research Laboratory test was negative. She was diagnosed with neurosyphilis and treated with intravenous steroids and penicillin G, with near complete resolution of symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The Centers for Disease Control and prevention has noted a steady rise of the incidence of syphilis since 2002. Emergency physicians should be familiar with the spectrum of the clinical manifestations of syphilis, challenges in diagnostics, and appropriate treatment course. [ABSTRACT FROM AUTHOR]

Background: Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA.Methods: In total, 258 knees were included in this prospective patient-reported outcome measure case-control study. Demographic details, type and length of incision, pre-operative and 1-year post-operative Knee Society Scores were recorded and compared.Results: The prevalence of numbness at 1 year was 53%, with a female preponderance. Patients older than 70 years were less affected. Discomfort due to numbness was recorded in 8.7% of the patients, 75% of which were female. The length of the incision correlated positively with the presence of numbness. The Knee Society Scores did not correlate with the presence or area of numbness.Conclusion: Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome. [ABSTRACT FROM AUTHOR]

Carotid artery dissection (CAD) is a significant cause of ischemic stroke. Early recognition and treatment of CAD is important to prevent accompanying cerebral ischemia. This case report presents an atypical clinical presentation of CAD and emphasizes the diagnostic challenge for emergency physicians. A 54-year-old woman presented to the emergency department with a bilateral headache of 4 days' duration, hypesthesia of the left fifth cranial nerve, dysgeusia, and partial Horner syndrome on the left side. Magnetic resonance angiography showed a left-sided CAD without any signs of cerebral ischemic events. Antiplatelet therapy with clopidogrel was started, and the patient did not show any deterioration in the weeks thereafter. CAD can present with different combinations of cranial nerve palsies and should be in the differential diagnosis of dysgeusia and hypesthesia of the trigeminal nerve. Early recognition of CAD can be challenging in patients with rare cranial nerve involvement, but early treatment is crucial to prevent cerebral ischemic events. [ABSTRACT FROM AUTHOR]

A rare case of familial genetic disorder Klippel-Feil syndrome and Arnold-Chiari malformation caused by cervical spondylotic myelopathy was reported here. The reconstruction of stability and spinal cord decompression was achieved by anterior cervical discectomy, fusion, and internal fixation. Although the disease genetic characteristics have been studied, operation is necessary when it leads to abnormal neurologic symptoms and the surgery of surgery can have a beneficial outcome. [ABSTRACT FROM AUTHOR]

Background Physical signs often are present in many psychiatric conditions, making up a fundamental part of them and accompanying the psychiatric manifestations themselves. Identifying minor neurological signs is especially of interest due to they are easily accessible through simple neurological examination and could be a useful if underused tool for the diagnostic process and patient therapy. Method A group of depressed patients ( n =85) and group of healthy individuals ( n =101) that served as control were examined using the Wartenberg wheel, a medical device for neurological use, in order to determine the presence of hypoesthesia on both sides of their ankles. Results The data revealed: i) patients with depression are generally more likely to present malleolar hypoesthesia than healthy participants; and ii) participants who presented malleolar hypoesthesia presented greater depressive symptomatology as well as greater anxiety symptomatology at the time of assessment. Limitations Although all patients in this study were taking psychotropic medication, anxiolytics and antidepressants are not associated with skin sensitivity. As is usual, the categorization of hypoesthesia is based on participant subjectivity. However, this subjectivity cannot explain the differences between depressed patients and healthy individuals. Conclusions The present findings corroborate that localized tactile sensitivity is altered in depression and correlates with anxiety-depressive symptomatology, even on a subclinical level. The observation of neurological soft signs such as the detection of malleolar hypoesthesia in patients with depressive symptomatology is easily accessible using a simple neurological examination, and it could became a powerful tool that could provide objective information on affective disorders. [ABSTRACT FROM AUTHOR]

Abstract: Context: Overall, end-of-life (EOL) discussions are unrelated to psychological distress and associated with lower rates of aggressive care near death. Nevertheless, patients who report that they feel emotionally numb about their illness might encounter difficulties cognitively processing an EOL discussion. Objectives: We hypothesized that emotional numbness would modify the effect of EOL discussions on the receipt of less aggressive EOL care. Methods: Data were derived from structured interviews with 290 participants in the federally-funded Coping with Cancer Study, a multisite, prospective cohort study of patients with advanced cancer followed-up till their death. Patients'' reports of EOL discussions with their physician and emotional numbness were assessed at a median of 4.6 months before their death. Information about aggressive EOL care (i.e., ventilation, resuscitation in the last week of life, death in the intensive care unit) was obtained from postmortem caregiver interviews and medical charts. Main and interactive effects of EOL discussions and emotional numbness on aggressive EOL care, adjusting for potential confounds, were evaluated using multiple logistic regression. Results: The likelihood of aggressive EOL care associated with having EOL discussions increased by a factor of nine (adjusted odds ratio=9.02, 95% CI 1.37, 59.6, P =0.022) for every unit increase in a patient''s emotional numbness score. Conclusion: Emotional numbness diminishes a patient''s capacity to benefit from EOL discussions. The EOL decision making may be more effective if clinical communications with emotionally numb patients are avoided. [Copyright &y& Elsevier]

Abstract: The sensation of numbness, prosthesis noise production, and kneeling difficulties are generally considered, by most surgeons, minor issues after total knee arthroplasty, but their frequency and relationship to patient expectations and satisfaction have been seldom described. We analyzed 49 patient responses to both an Oxford Knee Score and a separate questionnaire with specific questions about numbness, kneeling, and noise. Of these patients, 69% reported noise production, 71% reported numbness, and 82% reported kneeling difficulties. The mean scores for the magnitude of numbness and kneeling difficulties improved between the time frames of less than 6 months and more than 6 months postoperation, whereas noise scores worsened. None of these changes were statistically significant at the 5% level. Combinations of these issues do affect patient satisfaction and are greater for patients more than 6 months postoperation. A preoperative patient education program, informing patients about these issues, may improve patient satisfaction. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to compare the intermediate-term outcomes of anterior cruciate ligament (ACL) reconstruction by use of bone–patellar tendon–bone (BPTB), quadriceps tendon with a bone plug (BQT), and quadriceps tendon without a bone plug (QT). Methods: We evaluated 198 primary ACL reconstructions in 191 patients at a mean of 55.6 months postoperatively. Assessment included side-to-side comparison of range of motion, arthrometer values, presence of effusion, anterior knee pain, and numbness. Comparisons were made between QT and BQT patients and between men and women. The results were compared with data from 30 patients in a previous study who had undergone ACL reconstruction by the same surgeon (W.R.S.) with BPTB. Results: Range of motion averaged −3.2° ± 2.2° of extension to 134.3° ± 10.2° of flexion for the operative extremity compared with −3.6° ± 2.07° to 134.2° ± 10.6° for the contralateral extremity at final follow-up. KT-1000 manual maximum measurements (MEDmetric, San Diego, CA) of the operative extremity averaged 0.94 mm more than those of the normal contralateral knee. When compared with BPTB autograft, the quadriceps tendon autograft showed significantly better results, with less anterior knee pain (4.56% v 26.7%), less anterior numbness (1.5% v 53.3%), a higher percentage of arthrometer measurements showing a side-to-side difference of 0 to 3 mm (88% v 68%), and better extension (mean loss, 0.55° v 2.77°). There was no significant difference between the 2 groups with regard to loss of flexion, Lachman test, pivot-shift test, presence of effusion, or number of failures. Conclusions: Central quadriceps tendon autograft, QT or BQT, produces equivalent results when compared directly with BPTB autograft in arthroscopically assisted ACL reconstruction. There was no difference in results between men and women with a quadriceps tendon autograft, either with or without the use of a bone plug. ACL reconstruction using quadriceps tendon autograft is an effective surgical option that reduces donor-site morbidity. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

Abstract: A “Salting-out Taste-masking System” generates a long lag time for numbness and bitterness masking, with subsequent immediate drug release to exert pharmacological effects. In this study, the effects of physicochemical properties of salting-out agents and water-soluble polymers in the salting-out layer on the dissolution behaviors of acetaminophen were investigated and predominant factors for lag time generation (Lag time index, hereafter LI) and subsequent drug release (Rapid release index, hereafter RI) were discussed. Each prepared formulation showed a different dissolution profile of acetaminophen with a lag time and subsequent immediate release. Significant correlations between both LI and RI and ΔCST (the salting-out power of salting-out agents) (r 2 =0.90, 0.67, respectively) and between both LI and RI and CST1 (the sensitivity of water-soluble polymers to a salting-out effect) (r 2 =0.98, 0.71, respectively) were shown. These results suggest that the components showing a strong salting-out effect inside the beads lead to extended lag times and slow drug releases after the lag times. Results further suggest the use of CST1 to evaluate suitable combinations of salting-out agents and water-soluble polymers in this system. [Copyright &y& Elsevier]

Abstract: Salting-out effects were utilized for developing a multiparticulate system balancing numbness masking and high bioavailability. A “salting-out taste-masking system” consisting of a drug core containing acetaminophen as a model drug, a salting-out layer containing sodium carbonate (Na2CO3) and hydroxypropylmethylcellulose (HPMC), and a water-penetration-control layer consisting of cetanol was designed and prepared. The system successfully generated a long lag time while achieving immediate drug release. In the system, the Na2CO3 release rate was slower and the lag time was longer than when the water-penetration-control layer was not present. During the release of Na2CO3 from the system, the release of HPMC and drug was suppressed. These results indicated that the water-penetration-control layer maintained a high concentration of Na2CO3, prevented HPMC''s dissolution, and generated a long lag time of drug release. The system generated longer lag time and released drug more immediately than formulation containing the water-penetration-control layer of same thickness without the salting-out layers. These results indicated the salting-out layers were necessary for obtain a long lag time and subsequent immediate drug release. This novel taste-masking system has the potential to be a useful multiparticulate dosage form for effective, safe, and user-friendly drug therapy. [Copyright &y& Elsevier]

Abstract: All who viewed the horror caused by Hurricane Katrina could see the reactions of terror, paralysis, loss, and grief. For those who lived through the event itself, these same symptoms are often continued as the survivor relives the horror over and over again. Posttraumatic stress disorder (PTSD) is a psychological and physical reaction to a stressful event that any of us might face, whether we live through it or just witness it repeatedly on television. But emotional distress differs from posttraumatic stress disorder. Why do some persons suffer more extensively? How do you tell when someone has PTSD? How can you help? The lessons learned in the aftermath of this terrible natural disaster may be applied to many other situations for patients or providers alike. [Copyright &y& Elsevier]

1. Skin and rectal temperatures were recorded continuously in 70 measurements during typical tasks of infantry and artillery training at 0 to -29°C. The duration of the measurements varied from 55min to 9.5h.2. The distribution of finger skin temperatures was quite similar at ambient temperature ranges 0 to -10°C and -10 to -20°C, while at -20 to -30°C the finger temperatures were clearly lower.3. At different ambient temperature ranges, 20–69% of finger temperatures were low enough to cause cold thermal sensations.4. Sensation of cold was experienced at a finger temperature of 11.6±3.7°C (mean±SD). [Copyright &y& Elsevier]

Abstract: Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant. [Copyright &y& Elsevier]

Keywords: Trigeminal schwannoma; Meckel cave; Trigeminal nerve; Facial numbness The clinical presentation includes facial pain, facial numbness, ataxia, and cluster-like headaches, although they may be an incidental finding in some instances.[2] Tumors that affect the gasserian ganglion located within Meckel cave tend to cause significant pain, whereas tumors that primarily arise from the trigeminal nerve root cause sensory loss with minimal pain.[1] Treatment options include microsurgical resection, gamma knife radiosurgery, or watchful waiting.[3] Schwannomas affecting multiple cranial nerves in a child may also be a manifestation of neurofibromatosis type 2.[4] Trigeminal schwannoma, Meckel cave, Trigeminal nerve, Facial numbness. [Extracted from the article]

Although patients with isolated oral syndrome or facial sensory loss following stroke of thalamic ventroposteromedial (VPM) nucleus have been reported, there have been no reports of numbness in the tip of the tongue and lower lip. Furthermore, symptoms in the tip of the tongue caused by stroke are typically characterized as gustatory sensory disturbances. A 62-year-old hypertensive man experienced an acute onset of severe numbness in the left tip of the tongue and ipsilateral lower lip. Neurological examination revealed no other abnormalities except for the aforementioned numbness. Head computed tomography showed a small hematoma in the medial part of the right thalamus, most likely within the VPM nucleus. The somatosensory impulse of the tongue is conveyed via the lingual nerve, and it reaches the contralateral medial VPM proper via the trigeminal spinal nucleus. Therefore, thalamic stroke mainly involving the medial VPM proper has the potential to elicit numbness in the tip of the tongue. A major portion of the VPM nucleus is vascularized by the inferolateral arteries. The inferolateral arteries vary greatly in the number and position of the arteries and their tributaries, and small-vessel disease in this territory can present with diverse symptoms because of this complexity. These findings indicate that central neurological involvement should not be overlooked in the case of sensory disturbance restricted to the tip of the tongue and lip. [Copyright &y& Elsevier]

Child sexual abuse (CSA) studies have greatly contributed to theory, policy, and practice worldwide. Surprisingly, although trauma studies in particular have highlighted the importance of peritraumatic responses to trauma, this aspect is underdeveloped in the context of child abuse studies. The current study profiles the peritraumatic responses of children to abuse, based on adults' retrospective accounts of their childhood experiences. 180 adults who retrospectively reported having been sexually abused in childhood completed a questionnaire that included four categories of common peritraumatic responses to CSA: automatic, behavioral, cognitive and affective. Latent class analysis revealed a number of classes in each of the questionnaire's four categories. Within each, classes were identified and the relationships within and between them, as well as with abuse characteristics were explored. Existing theory with respect to peritraumatic responses to trauma, and to CSA in particular, should be reconsidered based on the multifaceted model proposed in the current study. The findings point to a previously unrecognized peritraumatic response to trauma: numbness and seeking ways to survive ongoing abuse. Finally, recommendations are provided for incorporating the current model in both prevention and intervention efforts in the CSA field. [ABSTRACT FROM AUTHOR]

Abstract: Brannegan R, Bartt R. Second lumbrical muscle recordings improve localization in severe carpal tunnel syndrome. Objective: To determine how often the second lumbrical motor potential is present when the abductor pollicis brevis (APB) motor potential is absent in severe carpal tunnel syndrome (CTS). Design: Prospective study of consecutive patients with severe CTS and an absent motor potential from the APB. Setting: Single-center public hospital−based electromyography lab. Participants: Patients with a clinical diagnosis of CTS who had an absent median sensory response and an absent median motor response to APB on routine nerve conduction testing. Twenty-two hands of 19 patients were examined. Interventions: Not applicable. Main Outcome Measure: Presence and distal latency of motor potential to the second lumbrical. Results: The second lumbrical potential was present in 17 hands (77%). The distal motor latency to the second lumbrical was prolonged in all (mean, 9.1ms; normative value, <4.1ms). Conclusions: Second lumbrical recordings improve localization in many patients with severe CTS when routine median sensory and motor conduction studies produce no potentials. [Copyright &y& Elsevier]

• Vincristine treatment impaired tactile behavioral responses in vivo. • It selectively impaired functions of SA1, but not RA and SA2 mechanoreceptors. • The effect may underlie tactile dysfunctions in patients treated with vincristine. Loss of the sense of touch in fingertips and toes is one of the earliest sensory dysfunctions in patients receiving chemotherapy with anti-cancer drugs such as vincristine. However, mechanisms underlying this chemotherapy-induced sensory dysfunction is incompletely understood. Whisker hair follicles are tactile organs in non-primate mammals which are functionally equivalent to human fingertips. Here we used mouse whisker hair follicles as a model system and applied the pressure-clamped single-fiber recording technique to explore how vincristine treatment affect mechanoreceptors in whisker hair follicles. We showed that in vivo treatment of mice with vincristine impaired whisker tactile behavioral responses. The pressure-clamped single-fiber recordings made from whisker hair follicle afferent nerves showed that mechanical stimulations evoked three types of mechanical responses, rapidly adapting response (RA), slowly adapting type 1 response (SA1) and slowly adapting type 2 response (SA2). Vincristine treatment significantly reduced SA1 responses but did not significantly affect RA and SA2 responses. Our findings suggest that SA1 mechanoreceptors were selectively impaired by vincristine leading to the impairment of in vivo whisker tactile behavioral responses. [ABSTRACT FROM AUTHOR]

One hundred and thirteen knees were assessed for lateral skin flap numbness, 5–227 weeks following IB2 total knee arthroplasty. The final 53 had the numb area measured. To define the anatomy of the cutaneous nerves we dissected four cadaveric knees. Eighty-six percent of patients had a numb area on objective assessment but only 60% had subjective numbness, 62% of which had improved. Patients had a larger numb area if they were aware of a numb patch, had a scar over 22 cm long or were less than 25 weeks following surgery. We conclude that not all patients will get lateral skin flap numbness and improvement occurs with time. The area of numbness can be reduced by using a shorter proximal incision, which preserves branches of the medial and intermediate cutaneous nerves of thigh. [Copyright &y& Elsevier]

We report a rare case of familial inherited abnormal bone hyperplasia and ossification of the yellow ligament complicated by spinal stenosis. Complete reconstruction of stability and spinal cord decompression were achieved by posterior total laminectomy, fusion, and internal fixation. We cannot clearly describe the inheritance characteristics of the disease. Although the risk of surgical treatment is high, it is still necessary to perform surgery, and the effect of the operation is substantial. [ABSTRACT FROM AUTHOR]

Laminoplasty has been widely accepted as a standard treatment option for the patients with cervical spondylotic myelopathy (CSM) with good clinical outcomes. However, some patients suffered from the residual arm numbness postoperatively. But the preoperative factor relating to residual arm numbness and its impact on the outcomes of laminoplasty are not well established. To identify the preoperative factor relating the residual arm numbness after laminoplasty, and to demonstrate the effect of the residual numbness on the change of clinical scores and radiographic parameters. Retrospective cohort study One hundred three patients who underwent laminoplasty for CSM and were followed up over 2 years after surgery. Japanese Orthopedic Association (JOA) score including detailed component score (finger motion, upper extremity motion, lower extremity motion, upper extremity sensory, trunk sensory, lower extremity sensory, bladder function), visual analogue scale (VAS; arm pain, arm numbness and neck pain), 36-Item Short-Form Health Survey (SF-36; physical component summary and mental component summary), preoperative radiographic x-ray film parameters (C7 slope, C2-C7 lordotic angle, C2-C7 sagittal vertical axis and range of cervical motion) and preoperative Magnetic Resonance Imaging (MRI) findings (the severity of stenosis and the existence of snake-eye appearance). Patients were divided into two groups; residual arm numbness group (postoperative VAS >40mm) and control group (≤40mm). Following to univariate analysis comparing the preoperative factors between groups, the variables of p<0.01 were included in the multivariate linear regression analysis (Dependent variable: VAS of arm numbness 2-year postoperatively). In addition, the changes of clinical score and radiographical parameters after 2 years of laminoplasty were compared using mixed-effect model. The residual arm numbness group included 42 patients (23 female, 67.5±11.3 years old) and the no numbness group included 61 patients (42 female, 65.1±12.7 years old). In the multivariate analysis after univariate comparison, gender and preoperative arm pain were demonstrated as the independent variables (p=0.017 and 0.046) correlating with the postoperative residual numbness. Contrary to our hypothesis, the preoperative arm numbness and intensity change of MRI were not significant factors relating to the residual arm numbness. In the comparison of the change after surgery, the improvement of physical component summary of SF-36 was significantly low in residual arm numbness group (0.040). In our data set, up to 40% of the CSM patients had residual arm numbness 2 years after laminoplasty. Female and preoperative severe arm pain was the independent predictor for the residual arm numbness. The patients with residual arm numbness showed the lower improvement of quality of life compared to the patient without numbness. These results can help physicians to provide adequate information to treat the CSM patients and help surgeons to predict the patients with poor surgical outcomes preoperatively. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]