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Biomedical subjects

J A Ameriks

Publications and source records attributed to J A Ameriks.

6 recordsLinked to original sources
PubMed2000

Minimally invasive 360 degrees instrumented lumbar fusion.

A retrospective preliminary study was undertaken of combined minimally invasive instrumented lumbar fusion utilizing the BERG (balloon-assisted endoscopic retroperitoneal gasless) approach anteriorly, and a posterior small-incision approach with translaminar screw fixation and posterolateral fusion. The study aimed to quantify the clinical and radiological results using this combined technique. The traditional minimally invasive approach to the anterior lumbar spine involves gas insufflation and provides reliable access only to L5-S1 and in some cases L4-5. A gas-mediated approach yields many technical drawbacks to performing spinal surgery. A minimally invasive posterior approach involving suprafascial pedicle screw instrumentation has been developed, but without wide-spread use. Translaminar facet fixation may be a viable alternative to transpedicular fixation in a 360 degrees instrumented fusion model. Past studies have shown open 360 degrees instrumented lumbar fusion yields high arthrodesis rates. The study examined the cases of 46 patients who underwent successful 360 degrees instrumented lumbar fusion using a combined minimally invasive approach. Anterior lumbar interbody fusion (ALIF) at one or two levels was performed through the BERG approach; a gasless retroperitoneal approach to the lumbar spine allowing the use of standard anterior instrumentation. Posteriorly, all patients underwent successful decompression, translaminar fixation, and posterolateral fusion at one or two levels through one small (2.5-5.0 cm) incision. Results showed mean hospital stay of 2.02 days; mean combined blood loss was 255 cc; and mean pain relief was 56%, with 75.5% of patients reporting good, excellent, or total pain relief. Forty-two of 46 patients (93.2%) achieved a solid fusion 24 months after surgery. A total of 47% of all patients working prior to surgery returned to work following surgery. The study showed that minimally invasive 360 degrees instrumented lumbar fusion, when performed utilizing these approaches, yields a high rate of solid arthrodesis (93.3%), good pain relief, short hospital stays, low blood losses, accelerated rehabilitation, and a quick return to the workforce. The BERG approach offers technical advantages over the traditional gas-mediated laparoscopic approach to the anterior lumbar spine.

Adult↗
PubMed2000

Gasless endoscopic anterior lumbar interbody fusion utilizing the B. E.R.G. approach.

BACKGROUND: Several authors have reported success using a gas-mediated transperitoneal approach for lumbar interbody fusion. However, this approach has not been shown to reliably and predictably address segments above L4-5. METHODS: The B.E.R.G. approach was attempted in 202 patients who required anterior lumbar interbody fusion (ALIF). Of those, 168 were completed successfully without conversion to an open procedure. The anterior retroperitoneal approach required no gas insufflation. The gasless environment allowed for the use of standard anterior instrumentation and a variety of fusion grafts and devices. RESULTS: Mean hospital stay was 1.95 days, with 73% of patients discharged in <47 h following surgery. Clinical results from the first 50 patients, with a minimum 2-year follow-up, include a 92% fusion rate and 78% of patients reporting significant pain relief of greater than 50%. CONCLUSIONS: The B.E.R.G. approach offers significant technical advantages over the standard gas-mediated transperitoneal approach for ALIF. The clinical results are similar to those reported for open approaches and the gas-mediated transperitoneal approach.

Adult↗
PubMed1980

Embolization for hepatoportal arteriovenous fistula.

The simultaneous occurrence of an intrahepatic hepatoportal fistula and portal hypertension generates questions about the priority and methods of treatment. Catheter embolization of the small-to-moderate fistula is not required, and surgical decompression of portal hypertension is recommended.

Aged↗
PubMed1975

Hepatic cell adenomas, spontaneous liver rupture, and oral contraceptives.

During the past decade, an increasing number of hepatic cell adenomas have been reported. Sppntaneous rupture, a life-threatening complication of this rare tumor, has been noted more frequently. Eight patients with hepatic cell adenomas have been treated at our center. Three patients first developed symptoms from hemoperitoneum. Palpable tumors were discovered in three asymptomatic patients during routine examinations. Two patients had upper abdominal pain from intrahepatic hemorrhage. All patients were young women using oral contraceptive agents. Emergent hepatic lobectomy was performed in the three patients with rupture. The other five patients underwent selective angiographic studies, prior to elective liver resections. All survived operation and have done well since. The increased incidence of hepatic cell adenomas may be related to the use of oral contraceptive agents.

Adenoma↗