Percutaneous automated nucleotomy and imaging with CT, MR and diskography in lumbar disk herniation.
Explore the source record for details and available documents.
Diskectomy, Percutaneous↗
Biomedical subjects
R Dullerud
Publications and source records attributed to R Dullerud.
Clinical results after percutaneous automated lumbar nucleotomy. A follow-up study.
This study was carried out in order to assess the clinical results after percutaneous automated nucleotomy with regard to predictive factors for the outcome. Selection criteria included patients with predominance of low-back pain, diffuse posterior disk bulges and concomitant spinal stenosis who are not normally accepted for nucleotomy. In all, 142 patients were treated. The overall success rate after an average observation time of 21 months was 56%. The results were not influenced by whether a diffuse posterior bulge or a focal hernia had been treated or not (p = 0.449). Spinal stenosis (p = 0.043) and disk space narrowing exceeding 25% of the expected width (p = 0.017) were associated with a poor outcome. By excluding these categories and patients with symptoms from more than one disk level, the success rate rose to 70%. With this selection, the results were equally good in patients with predominantly low-back pain compared to those with predominantly sciatica (p = 0.490).
Adult↗
Differentiation between contained and noncontained lumbar disk hernias by CT and MR imaging.
AIMS: The investigation was carried out in order to compare the accuracy of CT and MR imaging in depicting whether disk hernias were contained by the posterior longitudinal ligament (PLL). This is crucial in the evaluation of patients who are possible candidates for percutaneous nucleotomy, which is considered effective only in contained hernias. RESULTS: Of 124 pathologic disks examined in 114 patients, CT was more accurate than MR imaging in 7 patients due to misinterpretation of the integrity of the PLL by MR. These hernias were therefore erroneously classified as noncontained. There was consistency between the classification by CT and MR imaging in the other 117 disks, of which 109 were correct. Both methods overstaged a large hernia that was contained by the PLL, and failed to demonstrate that 7 others were noncontained. CONCLUSIONS: CT, which has higher sensitivity in depicting calcifications, representing further contraindications to percutaneous nucleotomy, is therefore recommended as the primary examination in these patients. Additional MR imaging should be considered if the results of CT are equivocal or at variance with the clinical presentation.
Adolescent↗
CT-diskography in patients with sciatica. Comparison with plain CT and MR imaging.
AIMS: The findings at CT-diskography (CT-D), including recording of the pain introduced at contrast injection, were compared with plain CT and MR imaging in 111 disks in 101 patients aged 18 to 68 years. RESULTS: Six disks which were normal at CT had normal CT-D and 5 of them had normal signal on MR imaging. The degree of annular degeneration and the depth of the annular tears were significantly associated with each other and with loss of disk height, but not with size or location of the hernias. Only the depth of the tears was significantly associated with loss of signal on MR. However, frequently complete annular tears and severe annular degeneration were seen in association with small bulges and hernias, even in disks with normal or slightly reduced signal on MR and with normal height. The type and intensity of the pain introduced were associated with each other and with the depth of the annular tears, but not with the degree of annular degeneration, size of the hernia or the MR signal intensity of the disks. CONCLUSIONS: Annular degeneration and tears on one hand, and the type and intensity of pain introduced on the other, seem to be related than separate phenomena.
Adolescent↗
CT-diskography, diskomanometry and MR imaging as predictors of the outcome of lumbar percutaneous automated nucleotomy.
PURPOSE: This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy. MATERIAL AND METHODS: Ninety-one patients, 44 females and 47 males aged 18-68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotomy R system. RESULTS: Sixty-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior bulges. CONCLUSION: The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain.
Adolescent↗
[Percutaneous automated lumbar nucleotomy. Patient selection, practical performance and clinical results].
Percutaneous nucleotomy is designed to treat small and medium-sized contained disk hernias. It is offered to patients who have not responded to conservative treatment for three months or more. The nucleotomy procedure is well tolerated by a majority of patients and the rate of complications is low. The patients can be treated as out-patients. Among a total material of 130 patients, a primary good response to the treatment was observed in 81 (62%). However, owing to recurrencies the success rate had fallen to 52% at 12-39 months (mean 22 months) after nucleotomy. In selected patients with symptoms from one disk level only, and with no evidence of spinal stenosis, or of osteophyte formation or a narrowing of the disk space by more than 25%, the results were better. Here the success rate was 61% (70% in males and 50% in females).
Adult↗
CT changes after lumbar percutaneous automated nucleotomy.
In order to assess changes occurring in disk hernias and disk spaces following percutaneous nucleotomy a follow-up CT was carried out an average of 6 months after treatment of 69 disks in 60 patients. Forty-three of the disks were also reexamined at an average of 11 months after the first follow-up. Twenty-seven percent of the hernias were reduced in size at the first follow-up. Fourteen percent were reduced and 7% had increased between the first and second follow-ups. The medium-sized and large hernias were more frequently reduced compared to the smaller ones. Reduction of the disk space was found in 29% of the cases at first follow-up. An additional 24% were reduced between the first and second follow-ups. No association was demonstrated between change in size of the herniation or disk space and clinical outcome or amount of nucleus material removed at nucleotomy.
Adult↗
CT changes after conservative treatment for lumbar disk herniation.
In order to assess changes occurring to lumbar disk herniations and bulges and to the disk spaces after conservative treatment, a follow-up CT was carried out of 106 pathologic disks in 92 patients at a mean interval of 14 months after the initial examination. There was a strong association between the evolution of the hernias and clinical results, with a decrease in size of the majority of hernias in successfully treated patients, whereas the others essentially remained unchanged (p < 0.0001). A significantly higher proportion of large hernias diminished as compared to the smaller ones (p < 0.0001). Diffuse disk bulges were associated with a poor outcome and never regressed. There was a lower incidence of diminution of the central hernias compared to other locations. Patients with normal disk space at the initial examination had a better outcome than those with disk space narrowing. Only occasionally was a reduction of the disk space observed at follow-up.
Adult↗
Acute torticollis in children due to atlanto-axial rotary fixation.
Acute, painful torticollis in a child is not uncommon. When no local changes can explain the disease, atlanto-axial rotary fixation should be considered. The position of the head is typical but the roentgenological diagnosis is difficult, and as early treatment is mandatory, it should be initiated even if the roentgenogram is "normal". We present a review of nine patients.
Acute Disease↗
Grading stenoses of the internal carotid artery by estimation of blood velocity with pulsed Doppler ultrasound.
The relationship between blood velocity and residual lumen diameter at the origin of 100 internal carotid arteries was studied. The diameter was measured by angiography and blood velocity by relatively simple Doppler ultrasound equipment. A scatter diagram between maximal velocity and diameter was used to construct a table on the sensitivity and specificity of various cutoff values for maximal velocity to diagnose stenoses of different degrees. A maximal velocity > or = 0.8 m/s had a sensitivity of 87% and a specificity of 93% to diagnose stenoses with a diameter < or = 3 mm (i.e. more than 50% diameter reduction). Thus, simple recording of maximal velocity can be used as a reliable screening method to detect patients with high- and medium-grade stenosis. Analysis of the spectral spreading of velocities across the lumen of a stenosis, or estimation of percent stenosis from the velocity in a stenosis and that in a poststenotic segment, were in our hands less useful for this purpose. None of the methods were good to detect or exclude the presence of low-grade stenosis.
Adult↗
Lumbar percutaneous automated nucleotomy. Technique, patient selection and preliminary results.
The purpose of this study was to evaluate 2 years' experience with percutaneous automated nucleotomy. Adult patients with small to medium sized disk hernias corresponding to clinical symptoms, and without evidence of free fragments or stenosis were treated on an outpatient basis. All patients had sciatica and conservative treatment had failed for at least 3 months. Using the Nucleotome R system, access to the disk was achieved in all but 6 of 172 disks in 152 patients. Degenerative disk disease or pain was the reason for technical failures. Four other procedures were discontinued because of pain and moderate hemorrhage. Except for one case of diskitis, no serious complications occurred. Of the patients in a prospective study, 63 had a follow-up period of 4 months or more. The overall clinical success rate was 62%, and was not significantly influenced by patient sex or age, duration of symptoms, level treated, disk degeneration or amount of nucleus material removed. The results are promising; however, this study indicates a need for refined patient selection in order to decrease the number of failures.
Adolescent↗
[Intraoperative ultrasonography in brain surgery].
Intraoperative ultrasound was used in 33 patients. 19 lesions were primary malignant brain tumours, including 12 gliomas, three astrocytomas and four oligodendrogliomas. There were five metastases, three meningeomas, two dysembryoplastic neuroepithelial tumours and two angiomas. One patient had an arachnoid cyst, and another an infarct. The main advantage of carrying out intraoperative ultrasound examination is that it helps to localize the tumour, particularly in small subcortical lesions where the brain surface may appear normal. Ultrasound is less useful for characterizing the tumour, although the various tumours do show some differences. As a rule, the glioblastomas are inhomogeneous and poorly marginated, while low grade gliomas are more homogeneous and well marginated. Also meningeomas and metastases tend to be homogeneous and well marginated. Periofocal oedema is hyperechogenic compared with brain tissue, with an intensity between that of normal brain tissue and tumour mass. Cyst, calcification and haemorrhage are easily demonstrated.
Adenocarcinoma↗
[Stenosis of the internal carotid artery at the bifurcation. Radiologic definition and Doppler diagnosis].
One hundred internal carotid arteries with varying degrees of stenosis were studied by angiography and doppler ultrasound. We found the minimal diameter of a stenosis, measured in mm, more suitable as reference for the doppler-based method than verbal assessment of a stenosis as slight, moderate or pronounced. The sensitivity and specificity of maximal blood velocity to diagnose high-grade stenosis is satisfactory for screening patients who might benefit from endarterectomy. Spectral velocity spread, or comparison of the velocity in the stenosis with that of a cranial reference segment of the artery did not increase the sensitivity to detect low-grade stenoses.
Adult↗
Radiological assessment of stenosis of the internal carotid artery at the junction with the common.
Stenoses at the origin of 100 internal carotid arteries from patients with ischemic cerebrovascular disease were studied by intra-arterial angiography. Three principles were employed to evaluate the degree of stenosis: 1) verbal description, grading stenoses as mild, moderate of severe, 2) estimation of the true residual diameter, and 3) calculation of percent stenosis, defined here as the diameter of the artery at the origin relative to that at the level of the angle of the mandible. The true diameter, estimated to the nearest whole mm, corresponded well with the verbal description, and correlated significantly with percent stenosis. Since the true diameter is precisely defined, easy to estimate, and directly related to its hemodynamic effect, we suggest that this simple parameter, rather than the more commonly used, but more vaguely defined term "percent lumen reduction", is used to grade stenoses of the internal carotid artery.
Adult↗
Influence of CT on tumor classification of laryngeal carcinomas.
The routine use of CT in 51 consecutive patients with squamous cell carcinoma of the larynx revealed cartilage involvement or extralaryngeal tumor growth consistent with a T4 tumor which made 14 patients candidates for laryngectomy. Only 5 of these had a T4 classification by clinical examination while 8 cases were upstaged from T3. Except for one supraglottic tumor upstaged from T2 to T4, CT did not change the classification for T1 and T2 tumors, whose localization was mainly glottic, and there were 2 false-negative examinations. It is concluded that CT is mandatory only in advanced tumors of the glottic region or when the anterior commissure is involved. However, in suspected malignancies of the sub- or supraglottic regions CT should always be carried out because these patients are at an increased risk of unexpected deep tumor growth.
Adult↗
[Resurfacing arthroplasty of the hip joint].
Explore the source record for details and available documents.
Adult↗
Coracoid process transfer for acromioclavicular dislocation.
Seventeen patients with complete separation of the acromioclavicular joint were operated on acutely with transposition of the coracoid tip to the clavicle. All the patients were examined after a mean follow-up time of 7.5 years. Twelve patients had good function, 3 had slight pain in extreme positions, and 2 had poor function with pain at rest. Eleven patients had the screw removed, 2 of them because of deep infection. In 3 patients the coracoid tip fragmented during the operation. Two patients had an unsatisfying cosmetic result. As long as nonoperative treatment gives equal or better long-term functional results, we do not recommend this operation in acute dislocations.
Acromioclavicular Joint↗
[Spread of intraabdominal effusions and computer tomography in diagnosis of abdominal abscesses].
Explore the source record for details and available documents.
Abdomen↗