Clinical Neuroscience

[The changes in quality of life after instrumented surgical fusion of degenerative spondylolisthesis]


MAY 30, 2016

Clinical Neuroscience - 2016;69(05-06)


[Objective - There is no internationally accepted guideline for treatment of spondylolisthesis in the literature, otherwise this degenerative disease has great social and economical impact. There is no hungarian study examining the efficacy of instrumented fusion procedure in surgical treatment of spondylolisthesis. In current study we examined the effectiveness of fusion technique focusing on the impact of quality of life. Methods - Between 1st January, 2011 and 30th June, 2012 we examined a group of patients - who were operated on by instrumented fusion technique because of spondylolisthesis -, in the National Institute of Clinical Neurosciences, using the Oswestry Low Back Disability Questionnaire. All patients were treated after ineffective conservative treatment. The question was wheather how has changed the patients’ quality of life after the operation. Paired-sample t-test was used in this study. Results - Eighty-eight of the 97 examined patients reported different levels of impovement in the postoperative period, two patient’s condition has not changed in spite of the surgery, seven patient’s condition showed progression in average one year after the surgery. The pain improved most significantly (55.5%) (p<0.0001). Using the 16 point borderline according to the Questionnaire (over moderate disability), significant improvement was detected in 50 patients (51.5%). Succesful surgical result - according to the quality of life - was seen in 77.41% of male and in 50.98% of female patients. According to the different age groups, 72.72% of the younger (before retirement), and 53.06% of the retired patients belonged to this group. At least 15 point improvement was detected 35.05% of the patients, the overall improvement was 10.5 point. Discussion - Our results proved effectiveness of instrumented surgical fusion procedure in the treatment of degenerative spondylolisthesis. According to our results the younger male population with significant symptoms is the group, where improvement in quality of life is more pronaunced after the surgical procedure. Conclusion - The instrumented fusion surgical technique provides successful clinical and surgical outcome in patients with degenerative spondylolisthesis. It could improve the quality of life. Althought multicentre follow-up studies are needed to determine the exact indication and optimal therapy.]



Further articles in this publication

Clinical Neuroscience

[Analysis of mental arithmetic task by the “minimum spanning tree” method]

BOHA Roland, TÓTH Brigitta, KARDOS Zsófia, FILE Bálint, GAÁL Zsófia Anna, MOLNÁR Márk

[Goals - In the present study basic arithmetic induced rearrangements in functional connections of the brain were investigated by using graph theoretical analysis what becomes increasingly important both in theoretical neuroscience and also in clinical investigations. Research questions - During mental arithmetic operations (working) memory plays an important role, but there are only a few studies in which an attempt was made to separate this effect from the process of arithmetic operations themselves. The goal of our study was to separate the neural networks involved in cognitive functions. Methods - As an attempt to clarify this issue the graph-theoretical “minimal spanning tree” method was used for the analysis of EEG recorded during task performance. The effects of passive viewing, number recognition and mental arithmetic on PLI based minimal spanning trees (MST) were investigated on the EEG in young adults (adding task: 17 subjects; passive viewing and number recognition: 16 subjects) in the θ (4-8 Hz) frequency band. Results - Occipital task relevant synchronization was found by using the different methods, probably related to the effect of visual stimulation. With respect to diameter, eccentricity and fraction of leafs different task-related changes were found. Discussion - It was shown that the task related changes of various graph indices are capable to identify networks behind the various relevant dominant functions. Thus the “minimal spanning tree” method is suitable for the analysis of the reorganization of the brain with respect to cognitive functions.]

Clinical Neuroscience

[Disease burden of Duchenne muscular dystrophy patients and their caregivers]


[Background and purpose - Data on the disease burden of Duchenne Muscular Dystrophy are scarce in Hungary. The aim of this study was to assess patients’ and their caregivers’ health related quality of life and healthcare utilisations. Methods - A cross sectional survey was performed as part of the European BURQOL-RD project. The EQ-5D-5L and Barthel Index questionnaires were applied, health care utilisations and patients’ informal carers were surveyed. Results - One symptomatic female carer, 50 children (boys 94%) and six adult patients (five males) participated in the study, the latter two subgroups were included in the analysis. The average age was 9.7 (SD=4.6) and 24.3 (SD=9.8) years, respectively. Median age at time of diagnosis was three years. The average EQ-5D score among children and adults was 0.198 (SD=0.417) and 0.244 (SD=0.322), respectively, the Barthel Index was 57.6 (SD=29.9) and 53.0 (SD=36.5). Score of satisfaction with healthcare (10-point Likert-scale) was mean 5.3 (SD=2.1) and 5.3 (SD=2.9). 15 children were hospitalised in the past 12 months for mean 12.9 (SD=24.5) days. Two patients received help from professional carer. 25 children (mean age 11.1, SD=4.4 years) were helped/supervisied by principal informal carer (parent) for mean 90.1 (SD=44.4) hours/week and further family members helped in 21 cases. Correlation between EQ-5D and Barthel Index was strong and significant (0.731; p<0.01) as well as with informal care time (-0.770; p<0.01), but correlation with satisfaction with health care was not significant (EQ-5D: 0.241; Barthel Index: 0.219; informal care: -0.142). Conclusion - Duchenne muscular dystrophy leads to a significant deterioration in the quality of life of patients. Parents play outstanding role in the care of affected children. This study is the first in the Central and Eastern European region that provides quality of life data in this rare disease for further health economic studies.]

Clinical Neuroscience

[Selective dorsal rhizotomy in the treatment of spasticity - Hungarian experiences ]

FEKETE Gábor, NOVÁK László, VEKERDY-NAGY Zsuzsanna, BOGNÁR László

[Objective - We summarize our initial experiences with selective dorsal rhizotomy that we introduced in Hungary to manage the spasticity of patients with cerebral palsy. Patients and methods - Thirty spastic patients were enrolled in our study. All of the patients were operated between July 2014 and June 2015. We performed selective dorsal rhizotomy from a single-level approach at the level of conus medullaris in all cases, with electrophysiological control. Results - We could perform the surgery in all cases safely. Adverse events related either to damage of neurological structures, or to surgery did not occur. The planned rehabilitation courses before and after the operations are in progress in all cases. Conclusion - Selective dorsal rhizotomy is an irreversible surgical intervention to treat spasticity. With sufficient experience and electrophysiological control it can be performed safely, and the early results are promising. ]

Clinical Neuroscience

[Closure of nasocranial fistulas with “bath-plug” technique and multilayer reconstruction]

PISKI Zalán, BÜKI András, NEPP Nelli, BURIÁN András, RÉVÉSZ Péter, GERLINGER Imre

[Background and purpose - In case of dehiscenses developing on the anterior scull base, complete closure resulting in the cessation of the communication between the nasal cavity and the intracranial space is mandatory as soon as possible, in order to prevent serious complications. With the development of the endoscopic techniques, the endonasal management for the reconstruction has become available in recent decades. Methods - We aim to present the reconstruction techniques applied in our department in the cases of two patients recently operated at our institute. The choice of methods primarily depends on the size and the localization of the defect. Dehiscenses under 5 mm of diameter can be closed with the so called “bath-plug” technique, while bigger defects, where the required closure of the plug is not possible, can be solved with multilayer reconstruction. We use autogenous fascia, fat and muco-periosteum in both cases. Results - Our patient, who underwent the aforementioned “bath-plug” procedure, could be discharged after a few days of uneventful postoperative period. During a tenmonth follow- up period new fistula formation was not observed. In the case of a patient who underwent multilayer reconstruction, meningitis occurred postoperatively, which was resolved after antibiotic therapy. During a 17- month follow- up period recurrent liquorrhoea did not occur. Conclusion - With suitable technical background and appropriate endoscopic skills the surgeries of the anterior skull base cerebrospinal fluid fistulas can be performed efficiently and with low complication rate. These are minimally invasive procedures accompanied by less surgical trauma, morbidity and shorter hospitalization, hence these techniques are considered to be cost-effective and well- tolerated for the patients.]

Clinical Neuroscience

Paraoxonáz-1-aktivitás és fenotípusos megjelenése sclerosis multiplexben

KURTULUS Fatma, YAMAN Aylin, ELLIDAG Yasar Hamit, EREN Esin, GÖMCELI Bicer Yasemin, YILMAZ Necat

Introduction - Human serum paraoxonase (PON1) and arylesterase (ARE) are lipophilic antioxidant enzymes. PON-1 serum activity diverges in individuals and populations, which might be due to polymorphisms in the PON-1 gene. The PON1 activity phenotyping method, based on the ratio of the stimulated PON activity and the ARE activity, could determine the low-activity homozygotes (QQ), intermediate activity heterozygotes (QR), and high-activity homozygotes (RR) regardless of the genotype. The aim of the present study was to determine the PON1 phenotype distribution and enzymatic activity of PON1 and ARE in multiple sclerosis (MS) patients. Materials and methods - Thirty-four relapsing remitting MS (RRMS) patients (22 females and 12 males; median age 42 (range 20-55) years) in the remission phase and thirty-four age-sex matched healthy controls (19 females and 15 males; median age 37 (21-60) years) were included in this study. All patients had clinically definite MS according to McDonald’s criteria. Results - Serum PON1 and ARE enzyme activities, as well as salt-stimulated PON1, were not significantly different between the patient and control groups. Phenotype distributions were as follows: QQ 58.8%, QR 38.2%, and RR 3% in MS patients (n=34); QQ 44.1%, QR 50%, and RR 5.9% in the control group (n=34). QQ (low activity) phenotypic distribution was more common in MS patients than controls, but this difference was not significant (p=0.14). Conclusions - Our results did not reveal meaningful relationships between PON1 activity or PON1 phenotypes and MS. More studies in larger samples and in all phases of the disease are needed in the future.

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Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Lege Artis Medicinae

[Indications of palliative radiotherapy]


[Radiotherapy - as a part of complex, multidisciplinary therapy - indicated in 70% of patients with malignant tumors during the natural course of the disease. Unfortunately, around 40-50% of patients can not be cured due to the advanced stage, recurrence or dissemination of the disease. In such cases radiotherapy with palliative intention can be used to resolve symptoms, decrease tumor burden and increase the quality of life for the patient. Urgent radiotherapy can overcome special symptoms causing acute life-threatening conditions. The author reviews the main indications, radiotherapy techniques, dose-fractionation schedules and treatment results of palliative and urgent radiotherapy used in the daily clinical practice.]

Lege Artis Medicinae



[BACKGROUND - The WHOQOL-OLD questionnaire was developed in a multicultural way. The authors were involved in this work as members of the international task force. In order to improve services for the elderly by learning their attitudes to ageing, an Attitudes to Ageing Questionnaire (AAQ) was also developed by the working group. In the present study the authors assessed a sample of Hungarian elderly people by these two methods. Answers by elderly persons related to their quality of life, social and health conditions, as well as their attitude to ageing were analysed. PERSONS AND METHOD - A total of 333 (190 unhealthy and 143 healthy) persons over sixty years of age filled in the questionnaires either by themselves or through verbal interview. The participants’ compliance with the research was generally good. The study sample reflected the general features of the Hungarian elderly population. For statistical analysis the Microsoft SPSS for Windows version 11.0 programme was used. RESULTS - Better health condition, better mood, and a better ability for self-care improve the quality of life. Better attitudes to ageing are associated with better quality of life. CONCLUSIONS - The use of the WHOQOLOLD questionnaire is recommended in the daily practice to assess elderly Hungarians’ quality of life. The results highlight the significance of mental health in the development of the elderly persons’ attitude to ageing. The use of the new questionnaires may help change negative stereotypes related to ageing.]

Clinical Neuroscience

[Examining the psychometric properties of a new quality of life questionnaire in migraineurs]


[Background - The deleterious effect of primary headaches on the sufferers’ quality of life (QOL) has been abundantly documented using both generic and headache-specific instruments. The currently used questionnaires focus on a limited number of factors and therefore may not be sensitive enough to detect the effect of headache type and headache characteristics on QOL, despite the obvious clinical differences. We have devised a comprehensive questionnaire that may be more sensitive to the burden of headache. Objective - To assess the psychometric properties of the new questionnaire on a group of migraineurs. Patients and method - We studied 117 migraineurs who completed the validated Hungarian version of the SF-36 generic QOL measure and our new, 25-item questionnaire. Reliability was assessed by internal consistency, measured by Cronbach’s a of all items. Content validity was exam- ined by calculating the correlation of the items with subscales of the SF-36 measure. The correlation of the patients’ migraine characteristics with the questionnaire’s items was used to assess criterion validity. Results - The questionnaire was quick and easy to administer. The questionnaire demonstrated good reliability, with Cronbach’s alpha being 0.893. Content validity was adequate; most “physical” items of the new questionnaire showed significant correlations with the bodily pain and role physical SF-36 subscales and most “psychical” and “social” items were correlated with mental health and social functioning SF-36 subscales. Criterion validity was adequate, with headache severity being correlated with most of the items. Discussion - In this study the new headache-specific quality of life instrument showed adequate psychometric properties.]

Clinical Neuroscience


SZABÓ József, LAPIS István, MARIK László, KONDACS András, RUSZNYÁK Csaba

[Objectives - Between 2001 and 2005 86 patients were treated for cervical disc herniations and spondylosis at our department. Stabilization was performed with different cervical cages or spacer after discectomy and decompression. The aim of the study was to examine the changes of the patients’ pain, quality of life and work ability, fusion rate, the intervertebral disc height, changes of under and upper segments and finally curvature of cervical spine. Patients and methods - Patients were followed by the authors, clinical examination, lateral and antero-posterior radiographic examinations were performed. They were asked to fill in a questionnaire, concerning their pre- and postoperative pain, quality of life and work ability. The patients’ pain was graded using a 10-point analog scale (VAS) and with a simplified, McGill-Melzak analog scale. The quality of life was measured with a 10-graduated analog scale as well. Results - More than 77% of our patients appeared at follow up examination. The fusion rate was 89.3%, operated spaces were held in 61%. In the upper segment of operated space 7%, and in the under-segment 14% were found increasingly degenerated. The curvature of cervical spine of the patients’ were 64.51% lordotic, 27.42% straight and 8.07% kyphotic. On average the patients’ pain changed on VAS from 8.179 to 5.015; on McGill-Melzak scale from 3.89 to 2.80; quality of life changed from 8.045 to 5.463. Conclusion - By the advantage of using cages, the operative approach has become smaller than before, consequently the operative pain has become less too. In addition operation time and hospital stay were significantly shorter (p<0.005) than using traditional operation approach. The majority of the patients, pain was decreased, quality of life got better. Despite this fact only 3 patients continue their original work and 5 patients do easier work. The majority of our patients were disabled before the operation, but from that time many of them became disabled, in some cases the grade of disability increased. There can be some reasons for it: the majority of the patients have other diseases for example: lumbar spondylosis and disc herniation, hypertension, diabetes, asthma and depression. There is just a few possibility of work for the disabled people. To conclude, with some of the patients, their disability means “the way out” from unemployment. These facts do not decrease the importance and usefulness of this method. Our results with this type of operation are very similar to the international statistics. This method seems to be applicable and useful.]