Search PubMed⌕ Search

Biomedical subjects

M Laus

Publications and source records attributed to M Laus.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Anterior surgery for the treatment of soft cervical disc herniation.

The authors present the results obtained in a series of 57 cases of soft cervical disc herniation submitted to anterior surgery. The cases included 52 radiculopathies and 5 myeloradiculopathies. Among the radiculopathies, 20 cases were treated by discectomy without magnification, and interbody fusion, and 32 by radical microdiscectomy, completed with interbody fusion in 19 cases and without fusion in 13. The 5 cases of myeloradiculopathy were all treated by microdiscectomy, with fusion in 2 cases and without fusion in 3. The results of treatment of the radiculopathies were evaluated as excellent or good in 80% of the cases treated by "macro" technique, and in 84% of those treated with "micro" technique; in the latter cases, more rapid and complete regression of pain, were always observed probably due to the more radical neurological compression obtained. The 5 cases of myeloradiculopathy obtained excellent results, with evident sensory and motor recovery. Long-term results for cases treated with or without fusion did not differ; the complications observed in the entire series may all be related to use of interbody grafting. The authors conclude that the method of choice in the surgical treatment of soft cervical herniation, with radicular or myeloradicular compression, is radical anterior microdiscectomy without interbody fusion.

Bone Transplantation↗
PubMedDate not supplied

Degenerative spondylolisthesis: lumbar stenosis and instability.

Degenerative spondylolisthesis may manifest itself with different clinical pictures depending on the phase of the spondylotic disease. Based on pathophysiological criteria 24 patients affected with degenerative spondylolisthesis were divided into three groups: group I: those with spondylotic instability; group II: those with lumbar stenosis and current or potential segmental instability; group III: those with lumbar stenosis and naturally stabilized spondylolisthesis. Group I was treated by posterolateral fusion; group II by laminectomy, removal of the medial portion of the facets and posterolateral fusion; group III by laminectomy and removal of the medial portion of the facets. Long-term results were positive in 100% of the cases in group I, 90% in group II and 83% in group III, with no statistically significant differences between groups, because of the limited series of cases. The authors conclude that surgery for the treatment of degenerative spondylolisthesis must be based on age, symptoms, and the phase of the disease, and that when these indications suited to the clinical-radiographic picture are taken into account, good results may be obtained with different operations.

Adult↗
PubMedDate not supplied

Complications in the surgical treatment of lumbar stenosis.

The authors analyze the complications which may occur in the surgical treatment of lumbar stenosis. They report 4 cases of cauda equina syndrome and 8 dural tears in 96 patients aged from 21 to 81 years submitted to multiple bilateral laminectomy. Based on a review of the patients some considerations on surgery for the treatment of lumbar stenosis are discussed. The advanced age of the patients, hypertension, diabetes, vasculopathies in general, severe neurological deficit dating back some time contraindicate surgery. When surgery is indicated a correct preoperative evaluation by MRI from T12 to the sacrum is required to determine the extent of the laminectomy and a safe and accurate intra- and postoperative bleeding control is mandatory. Dural laceration may be repaired by a thoracolumbar fascia patch.

Age Factors↗
PubMedDate not supplied

Lumbosciatic pain and coagulopathies.

Three cases of nerve compression causing lumbosciatic pain and/or cruralgia due to hematoma secondary to coagulopathies of varying etiology are described. The cases involved a multiple nerve root syndrome of the cauda equina due to extradural hematoma in coagulopathy resulting from the administration of dicumarol drugs, a neuropathy of the crural nerve caused by hematoma of the iliopsoas muscle in hemophilia B, and a neuropathy of the sciatic nerve caused by hematoma in the gluteus and thigh in coagulopathy resulting from the administration of dicumarol drugs. In all three of the cases the clinical picture resembled that of lumbar disc herniation, but a careful evaluation of each patient's history, objective picture, and laboratory and radiological testing allowed us to make a correct diagnosis. Medical therapy is based on the correction of the coagulopathy by means of suitable drugs or hemoderivates. Surgical treatment is reserved for the most severe cases.

Acute Disease↗
PubMedDate not supplied

Extruded cervical disc herniation: treatment with anterior microdiscectomy.

Nine cases of extruded cervical disc herniation (7 with radiculopathy, 2 with acute myeloradiculopathy) were treated by radical anterior microdiscectomy, with opening of the posterior longitudinal ligament, removal of the extruded peridural disc material, bilateral resection of the posterior part of the uncovertebral joints; in 6 cases surgery was completed with Smith-Robinson intersomatic fusion. In all of the cases symptoms rapidly regressed, with considerable neurological recovery. There were no major complications in any of the cases, and 2-5 years after surgery results were evaluated as excellent in 7 cases and good in 2. The use of the operating microscope allows for removal of extruded disc herniations under magnification, in a bloodless surgical field and with no manipulation of the nervous structures. Because of these features, this method is preferred to traditional posterior surgery and anterior surgery without magnification.

Adult↗
PubMedDate not supplied

Chemonucleolysis: advantages and disadvantages.

The authors report their experience with 60 patients treated for lumbar disc herniation by chemonucleolysis with chymopapain and followed-up 1 to 3 years after treatment. Long-term results were as follows: excellent: 50%; good: 40%; fair: 8.2%; poor: 1.8%. The high percentage of positive results is attributed to the rigid criteria for patient selection used, which resulted in treatment by chemonucleolysis in only 18.6% of the surgical cases of lumbar disc pathology observed. 27.2% of the patients treated complained of disorders which resulted in postoperative complications and/or prolonged convalescence: prolonged low back pain and vertebral stiffness in 20%, persistent contralateral sciatic pain in 5.4%; intense but transitory worsening of the sciatica in 1.8%. The most feared complication of chemonucleolysis is paraplegia occurring after the inadverted injection of the enzyme into the spinal fluid. This risk overshadows the positive attributes of the method. The most important advantage of chemonucleolysis, as compared with surgery, is that it avoids epidural scarring and permanent postoperative anatomical changes. Patients may benefit from these advantages, but they must be willing to accept the negative aspects of the method, as well.

Adolescent↗
PubMedDate not supplied

Lateral retrovascular approach to the upper cervical spine.

The authors describe the surgical anatomy of lateral approach to the upper cervical spine. The approach is retrovascular retropharyngeal extraoral allowing for anterolateral exposure of the upper cervical column, and it may be enlarged posteriorly on the homolateral posterior hemiarch of C1 and C2, and/or inferiorly on the lower cervical column. Absolute indications to this approach are anterolateral fusion with transarticular screws C1-C2 and excision of skeletal neoplasms adjacent to the vertebral artery. For other indications such as the treatment of anterior neoplasms and spinal cord decompression it is preferable to use pre-vascular extraoral approach or transoral approach.

Adolescent↗
PubMedDate not supplied

Failed back syndrome: a study on 95 patients submitted to reintervention after lumbar nerve root decompression for the treatment of spondylotic lesions.

The persistence of lumbar and nerve root pain after nerve root decompression surgery may be attributed to one of five causes; 1) progression of the spondylotic disease in the presence of peridural fibrosis; 2) recurrence of disc herniation or new hernia; 3) stenosis of the spinal or nerve root canal; 4) arachnoiditis; 5) vertebral instability. In most patients with peridural fibrosis and worsening of spondylotic lesions regression of nerve root symptoms was obtained after several months of conservative treatment, which continues to constitute essential treatment for most patients with recurrence of lumbar symptoms. The authors report the results obtained with the surgical treatment of 95 patients performed between 1981 and 1991 and divided into the categories listed above. Of these patients, 70 were submitted to further decompression surgery while 25 were submitted to posterolateral vertebral fusion. Reintervention obtained useful results in 83% of the cases where there had been recurrence of disc herniation; nerve root release obtained positive results in 100% of the cases where there was stenosis. Results obtained after wide decompression were poor in all of the cases with arachnoiditis; in these patients conservative treatment with T.E.N.S. can obtain a fair amount of control over pain. Positive results were obtained in 84% of the 25 patients submitted to posterolateral fusion for the treatment of vertebral instability, with fusion obtained in 96% of the cases. Surgical treatment is indicated for psychotic, neurotic patients or those with insurance-related motivations only when the organic cause of the symptoms is clearly evident.

Adolescent↗
PubMedDate not supplied

Differential diagnosis of low back pain.

Low back pain is a symptom common to many vertebral and extravertebral affections. The origin of low back pain mostly derives from a pathology localized in the spine, as in the case of degenerative lesions, neoplastic lesions, infections, fractures, metabolic diseases such as osteoporosis, or more rarely, rheumatological diseases. The causes of extravertebral low back pain may be renal, pancreatic, gastrointestinal, or of the female genital apparatus. The authors present a series of clinical aspects which must always be taken into consideration in order to avoid errors in the diagnosis and evaluation of a patient with low back pain.

Diagnosis, Differential↗
PubMedDate not supplied

Posterolateral spinal fusion: a study of 123 cases with a long-term follow-up.

A total of 123 patients submitted to posterolateral fusion according to the Wiltse method were followed-up after 2-10 years (mean 6 years and 2 months). The series included: isthmic spondylolisthesis: 80; degenerative spondylolisthesis: 18; failed back syndrome: 25. Good morphological fusion of the arthrodesis evaluated by conventional radiology and CT, was obtained in 87% of the entire series, while in 89% of the cases excellent or good clinical results were obtained according to the Friberg evaluation scale. Extent of the fusion to 1 or 2 intervertebral segments, or association of laminectomy did not influence the results. Clinical and radiographic results were maintained stable in time: in only 3 cases did we observe clinical deterioration due to degeneration of the segment located above the fusion 3-7 years after surgery. The only important complications observed were one cauda equina syndrome due to peridural hematoma after laminectomy-fusion, and one iliocaval venous thrombosis. The results of the series studied and the data reported in the literature show that posterolateral fusion is a method capable of providing a high percentage of good clinical and radiographic results, and it may be favorably compared with methods of interbody fusion and of pedicular fixation, compared to which it has the advantage of involving a minor number of complications. Anterior interbody fusion is however indicated for stabilization of the reduction of severe spondylolisthesis in the adolescent. Fusion with pedicular osteosynthesis is indicated for the treatment of macroscopic instability and in fusions which are extended to more than two intervertebral segments.

Adolescent↗
PubMedDate not supplied

Recurrent lumbar disc herniation: what recurs? (A morphological study of recurrent disc herniation).

A morphological study was conducted on disc material obtained during surgical discectomy in 20 patients. The series was divided into 4 groups. Group I: 3 patients who had never been operated on before; group II: 3 patients who had already been submitted to discectomy but at a level which differed from that of the disc examined; group III: 4 patients treated surgically for contralateral herniation; group IV: 10 patients with true recurrent disc herniation, that is, already submitted to surgery for the treatment of homolateral herniation of the same disc. All of the cases submitted to surgery had been operated on more than a year previously. Moreover, the disc material obtained during autopsy in a patient operated 15 years before for disc herniation was studied. A morphological study of the cases and the data reported in the literature reveals that the fibrocartilaginous tissue of recurrences differs from that of primary herniation because of the presence of large collagen bundles associated with fibrillar framework. This aspect suggests the hypothesis that is also supported by the autoptic material examined that recurrent disc herniation is formed by repair tissue that substitutes the part of the disc that is operated on, and that recurrent herniation is caused by mechanical collapse of the repair tissue. From a surgical point of view, a distinction may be made in terms of early recurrences, which appear within one year of surgery and are formed by disc tissue which is identical to that of primary herniation, and late recurrences, the subject of this morphological study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Anterior surgery of the upper part of the cervical spine by prevascular extraoral approach.

Anterior surgery of the upper part of the cervical spine, that is, proximal to C3, may be performed by transoral approach, possibly enlarged by glossomandibulotomy, by a retrovascular extraoral approach, or by a prevascular extraoral approach. The authors describe the surgical method of prevascular extraoral approach that allowed them to effectively treat osteoma localized at C2 and C3, post-laminectomy instability at C3 and C4, solitary metastasis at C3. As compared to transoral surgery the prevascular extraoral approach has the advantage of avoiding the risk of infection from germs in the oral cavity and of allowing for easier postoperative management, avoiding tracheotomy and/or prolonged dysphagia. As compared to a retrovascular approach the prevascular approach obtains a truly anterior exposure instead of an anterolateral one. Prevascular extraoral approach should thus be used whenever possible. Transoral surgery is indicated for decompression, of the brainstem and a bilateral retrovascular approach may be used to perform anterolateral fusion at C1-C2.

Aged↗