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At least 343 records · Page 19Linked to original sources
PubMedDate not supplied

The surgery of cervical disk disease: new perspectives.

Current trends in the surgical treatment of cervical disk disease, when compared with those of the 1960s, have been unimpressive. There is an ongoing refinement of anterior procedures, which seem to be effective for both myelopathy and radiculopathy, ranging from simple diskectomy and/or fusion to variously radical anterior decompressions. This refinement has demonstrated that however simple or radical the anterior procedure is, the results seem to be the same and that bone grafting is not necessarily critical to success. Posterior procedures, both for root exploration and spinal cord decompression, have fewer advocates but remain important procedures. Their magnitude relative to that of anterior surgery and the lack of refinement of laminectomy over the past 50 years probably accounts most for the preference for anterior surgery. Anterior and posterior disk surgery both have their place based on a surgion's preference. One can expect 80 to 100% acceptable results with radiculopathy and 50 to 70% with myelopathy.

Cervical Vertebrae↗
PubMed1995

Image-guided access techniques.

For increasing safety in access and guidance of endoscopes and instruments, fast real-time radiologic imaging should be integrated. Open designed Magnetic Resonance Imaging (MRI), Computer Tomography (CT), and Electron Beam Tomography (EBT) scanners permit adequate transparency of the operative field. CT and EBT as hybrid scanners can be combined with fluoroscopy. MRI avoids X-ray exposure and entails the possibility of 3D localisation, while open access and keyhole imaging allows nearly real-time guidance of instruments. EBT has the largest gantry (90 cm) for using long instruments, and the image acquisition requires only 50 msec (34 images/sec at 8 levels). However, computed reconstruction of the data takes about 3 times longer than conventional CT. Until EBT can be accelerated, CT will be the golden standard of guidance-techniques in high risk areas, because the tips of the instruments can be precisely visualised within +/- 0.5 mm (MRI: 3.5 mm). MRI-guidance can be used for low risk access techniques. This safe interactive transparent guidance technique has the potential to reduce complications, and it adds significant advantages to micro-invasive operative procedures such as percutaneous diskectomies, pain and cancer therapy with ethanol, or gene-technology implants in the new field of "surgical tomography".

Diagnostic Imaging↗
PubMed1995

Holmium:YAG surgical lasers.

"Holmium:YAG (Ho:YAG)" is the shorthand name for a family of solid-state lasers that use the doping element holmium in a laser crystal (e.g., YAG [yttrium-aluminum-garnet]) and that emit energy at approximately 2.1 microns. This wavelength is relatively new to medicine and has been used in laser surgery for only about the last six years. Like the carbon dioxide (CO2) laser when it was first used clinically, the Ho:YAG laser is poised for rapid and wide-spread use. Ho:YAG lasers, like CO2 lasers, offer precise cutting with minimal damage to adjacent tissue; however, unlike CO2 lasers, they also offer fiberoptic delivery (which is ideal for endoscopic use) and the ability to treat tissue in a liquid-filled environment (e.g., saline, blood). The initial specialty for which the Ho:YAG laser was used was arthroscopic surgery, especially diskectomy. Today, it is effectively used in many surgical specialties, including general surgery, urology, laparoscopy, neurosurgery, lithotripsy, angioplasty, orthopedic surgery (which includes procedures such as meniscectomy, bone sculpting [may also be performed in plastic surgery], and some experimental surgery, such as cartilage shrinking to tighten loose joints), and dentistry. Because of its broad range of potential applications, it has been called the "Swiss Army Knife" of lasers. High-powered Ho:YAG lasers, which enable surgeons to work more quickly and cut more smoothly, have been made available only within the last three years (units offering > 20 W) to 18 months (units offering > 60 W). Because of this rapid increase, high-powered units are still relatively expensive, and it is not yet clear whether maximum power outputs will continue to increase or whether the cost of higher-power units will begin to come down. Although low-power and high-power Ho:YAG lasers can be used for the same procedures, their different ranges of possible clinical techniques make them better suited to different applications: low-power units are preferable for small-joint and some head-and-neck surgeries or for office use, and high-power units are more suitable for use in major surgery, such as gastrointestinal surgery or surgery in large joints. This evaluation includes two units at both ends of the Ho:YAG power spectrum--one 10 W and one 60 W--and thus provides a guide to evaluating other Ho:YAG lasers that are currently available or that will be entering the market.(ABSTRACT TRUNCATED AT 400 WORDS)

Carbon Dioxide↗
PubMedDate not supplied

Technique for CT guided microendoscopic dissection of the spine.

The indications for percutaneous nucleotomy techniques are limited to disk herniation without dislocated free fragments. In cases with free fragments we have developed a new technique for percutaneous sequestrectomy. Under CT and fluoroscopic guidance spinal endoscopy was performed. In the past, percutaneous diskectomies were X-ray-guided with or without endoscopy. In this paper we describe the combination of CT-scanning, fluoroscopy and microendoscopy for guidance of nucleotomes, lasers, microendoscopes and micro-instruments. The technique was performed on 20 patients (17 outpatients) with chronic back pain. To date no major complications occurred. The method offers an effective outpatient treatment of small free fragments and scar tissue in the spinal canal and the foramen.

Adult↗
PubMed1994

Interbody fusion and instrumentation.

Fusion indications in adult degenerative disk disease of the lumbosacral spine include isolated disk resorption, primary and secondary instability, recurrent disk herniation, and pseudarthrosis. Common to these indications are variable proportions of biomechanical insufficiency of the motion segment, instability, deformity, and spinal stenosis. Apart from favorable psychosocial and work related variables, satisfactory outcome is dependent on treatment by a combination of diskectomy, decompression, and deformity correction, in addition to fusion. Isolated intertransverse or interbody fusions show variable fusion rates that are increased by concurrent instrumentation. Persistent pseudarthrosis rates and instrumentation failures have prompted circumferential fusion techniques. Posterior lumbar interbody fusion (PLIF) and segmental pedicle-based plate fixation overcome earlier problems with PLIF by allowing for wide decompression and increased exposure for disk space preparation, minimizing neural injury. Pedicle fixation restores segmental stability and minimizes graft retropulsion. Restoration of anterior column support prolongs instrumentation life, and increases fusion rates irrespective of the number of levels fused. Disk space distraction, with the use of instrumentation as a working tool, permits safer decompression of the intraforaminal zone, a common area of stenosis, and single or multilevel deformity correction to restore coronal, axial, and sagittal alignment and spinal balance. Even though the surgical technique is demanding, fusion rates up to 96% and clinical success up to 86% are achieved.

Adult↗
PubMed1993

Safety of chemonucleolysis. Adverse effects reported in the United States, 1982-1991.

This survey covers 121 "serious" and "unexpected" adverse events after treatment with chymodiactin (chymopapain for injection) among approximately 135,000 patients in the United States. They were reported to the Food and Drug Administration (FDA) within 15 days of notification of the manufacturer between 1982 and the end of 1991. They included fatal anaphylaxis (seven cases), infections (24 cases), hemorrhage (32 cases), and neurologic (32 cases) and miscellaneous (15 cases) events, with a mortality rate of 0.019%. Anaphylactic reactions reported in a postmarketing survey can be attributed to chymopapain itself and infections to lack of asepsis during its administration. The causes of other adverse reactions cannot be as clearly defined, but many are unlikely to have been due to chymopapain or its administration. More careful selection of patients and closer attention to technique during chemonucleolysis have dramatically reduced the incidence of these adverse events, which occur far less frequently than after diskectomy.

Adult↗
PubMedDate not supplied

Spinal stenosis. The narrow lumbar spinal canal syndrome.

This is a report of 7 cases of narrow lumbar spinal canal syndrome encountered in 7 patients in a community hospital in one year. Nerve compression occurred from pressure from enlarged posterior elements. Although the clinical manifestations were unspecific, the lumbar spine radiographs and myelographic features are quite characteristic. Supported by myelography and/or operative findings, surgical management consisted of decompression laminectomy at multiple levels, together with diskectomy at the appropriate levels. The interim results observed at one year follow-up examination were excellent.

Adult↗
PubMedDate not supplied

Metallic postoperative artifacts on cervical MR.

Spectroscopy of cervical diskectomy specimens obtained from sheep demonstrated that metallic susceptibility artifacts are produced by microscopic amounts of nickel, copper, and zinc. Sufficient quantities of metals to produce artifacts are deposited only by contact of metal drill bits and suction tips. If these instruments do not come in contact during surgery, susceptibility artifacts are not observed.

Animals↗
PubMed1995

Different surgical approaches to far lateral lumbar disc herniations.

In far lateral disk surgery, although total facetectomy provides the best exposure and allows for removal of medial and far lateral extruded disk fragments, the risk of instability is increased as a result of excision of the pars interarticularis, Medial facetectomy uncovers the lateral and subarticular recess and preserves stability but does not allow for proper visualization of the far lateral compartment. The isolated extraforaminal approach provides access only to far lateral sequestrated fragments and does not allow access for more medial diskectomy or decompression of associated stenosis. Combining the extraforaminal exposure with a laminotomy, hemilaminectomy, or laminectomy complements the intertransverse (ITT) approach and affords access both to lateral and to medial disk lesions and stenotic abnormalities. The advantages and disadvantages of the less popular extraforaminal, transpars, percutaneous, and anterior decompressive techniques are also assessed. No one technique of far lateral disk excision is applicable for the management of all lesions. It is more appropriate to choose the right operation for the right patient.

Humans↗
PubMed1995

A short history of non-vascular interventional radiology.

Interventional Radiology can be defined as minimally invasive closed percutaneous procedures for diagnosis or treatment and guided by imaging techniques. Parallel to the development of Interventional vascularRadiology, non vascular techniques have evolved. Margulis coined the term "Interventional Radiology" describing percutaneous extraction of residual gallstones. Fluoroscopy guided biopsy of the lung and mediastinum were described in the thorax by Nordenstrom. Percutaneous approach to the bile ducts was clinically applied by Wiechel, Lunderquist and Wallace. T-Tube extraction of residual gallstones was popularized by Burhenne. Cross sectional imaging, Ultrasonography and Computed Tomography offered the indispensable anatomical precision allowing a percutaneous approach to the deeply located structures in an axial plane. Haaga and Alfidi described percutaneous tissue sampling and drainage procedures guided by CT. Holm developed Ultrasound guided drainage and Otto initiated the perforated transducer. Percutaneous drainage of fluid collections rapidly became a standard. Plastic stents were inserted percutaneously in the bile ducts by Pereiras. Percutaneous neurolysis of the coeliac plexus was described by Hegedus Direct injection of ethanol and laser ablation of liver tumors, diskectomy and tubal recanalization are other more recently developed procedures.

Bile↗
PubMed1996

[The reduction of ferromagnetic artifacts by using a fast-spin-echo sequence in the postoperative assessment of degenerative diseases of the cervical spine].

This study was aimed at investigating if fast spin echo (FSE) pulse sequences can increase the diagnostic capabilities of MRI in the patients with degenerative disease of the postoperative cervical spine, considering their lower magnetic susceptibility than that of conventional spin echo (SE) sequences. The patient population consisted of 15 patients submitted to diskectomy after Cloward and Caspar. MR images were acquired with a 1.5-T unit (Signa, General Electric) with T2-weighted FSE versus conventional T1- and T2-weighted SE images. Thanks to fewer metallic artifacts, FSE images of the postoperative cervical spine yielded more pieces of information than conventional SE sequences in demonstrating the spine and its content. The best results were obtained in the patients with canal stenosis (8 patients) and myelomalacia (2 patients). In addition, the myelographic effect, another major semiologic feature of the FSE technique, provided further diagnostic information in these patients. Moreover, shorter examination times resulted in better patients tolerance, especially in those with recent surgery. Finally, reducing motion, blood flow or CSF flow artifacts definitely improved FSE image quality.

Aged↗
PubMed1993

Diagnostic arthroscopy of temporomandibular joint on outpatient. Review of 47 examinations, 40 cases.

The diagnostic arthroscopy was performed on 47 temporomandibular joints from 40 patients having anterior disc displacement without reduction with restricted mouth opening or painful anterior disc displacement with reduction. All patients were outpatients and subjected to arthroscopic examination under local anesthesia. Previous to arthroscopy, routine clinical and radiographic examination, and magnetic resonance imaging were carried out for all joints. Adhesion was better observed by arthroscopic examination, perforation was suggested by magnetic resonance imaging as well as arthroscopic examination, and bone change was better observed by magnetic resonance imaging. However diagnostic arthroscopy should be considered as an invasive examination, it is practical to the clinician and patient as complementary to decide the indication of arthroscopic surgery, open surgery (diskectomy) or maintenance of conservative treatment.

Adult↗
PubMed1997

Structural alterations in the TMJ disk in patients surgically treated for internal derangements (ADD).

Twenty-eight patients with temporomandibular dysfunction problem have been subjected to diskectomy unilaterally. The diagnosis was in 23 patients ADD (anterior disk displacement) without reduction and in another five ADD with reduction. The disk was removed in total according to a routine procedure. Surgical observation of a firm connection between the inferior surface of the disk and the condylar head was noted in eighteen patients. The disk tissue was orientated on a cork sheet according to its position in the fossa and subjected to histological examination. Histopathological analysis showed that the posterior attachment was a considerable part of the specimen in 12 out of 28 disks. Splitting of the disk was confined to the inferior surface. Chondrocytes were found close to the inferior surface. Surface irregularities, tags, were noticed on the inferior surface in thirteen cases. However, cellular signs of inflammation were found in the retrodiskal tissue in eight cases.

Adult↗
PubMed1998

Translaminar lumbar epidural endoscopy: technique and clinical results.

To provide baseline outcome data for a new lumbar microinvasive diskectomy done with standard arthroscopic instrumentation, we retrospectively reviewed the cases of 190 patients. All patients were assessed by a modified MacNab outcome classification with a minimum of a 2-year follow-up. All complications of this procedure were reported as well. No previous outcome data are available for this procedure, since it has been done primarily at one center, by the same surgeon, using his previously reported techniques. Results were good or excellent in 175 patients and fair or poor in 15. Complications were not severe and were easily remedied. This success rate is comparable to rates reported for other minimally invasive operations on the lumbar spine. This new technique of minimally invasive lumbar spine surgery provides minimal morbidity and a long-term outcome comparable to that of other standard procedures. The added benefits of using standard arthroscopic instrumentation are discussed.

Adult↗
PubMed1998

Surgical treatment for temporomandibular joint osteoarthrosis. Case report.

TMJ osteoarthrosis and internal derangements are in close connection, representing a substantial portion of temporomandibular disorders. The authors wish to underline the role of surgery in the treatment of this degenerative disease to improve function and to alleviate pain. A 63 year-old woman suffering from closed-lock with reduced opening movements was accepted in our Department in March, 1995. Clinical and radiological evaluations showed bilateral closed lock and severe TMJ osteoarthrosis. Occlusal, pharmacological and physical therapy were performed for one year, without results. Bilateral condylectomy and diskectomy with arthroplasty were carried out. Immediate muscular rehabilitation after surgery was performed by the patient. Follow-up 3, 6, 12 months after surgery were carried out. Full opening movements and reduction of pain were obtained 20 days after surgery. The patient, followed-up one year after surgery, presented effective mandibular movements and adequate amelioration of clinical picture. TMJ surgery in association with physical therapy represents in selected cases an adequate procedure for the treatment of TMJ degenerative disease.

Arthroplasty↗
PubMed2000

Surgery for lumbar disc prolapse.

OBJECTIVES: The primary rationale for surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. Claims of the merits of alternative surgical procedures are made without clear evidence about clinical outcomes. The objective of this review was to assess the effects of surgical interventions for the treatment of lumbar disc prolapse. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Medline, Embase, Biosis, Dissertation Abstracts, Index to UK Thesis, and reference lists of the retrieved articles up to March 1997 and we corresponded with experts. SELECTION CRITERIA: Randomised and quasi-randomised trials of the surgical management of lumbar disc prolapse. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary. MAIN RESULTS: Twenty-seven trials were found. There were methodological weaknesses in many of the trials. Sixteen of the 27 trials were of some form of chemonucleolysis. Ten trials compared different surgical techniques, although only one of these compared surgical discectomy with conservative management. Surgical discectomy produced better clinical outcomes than chemonucleolysis with chymopapain, and chemonucleolysis produced better clinical outcomes than placebo. Three trials showed no difference in clinical outcomes between microdiscectomy and standard discectomy. Three trials failed to show a significant reduction in scar formation or improved clinical outcomes by inserting an inter-position membra ne to cover the spinal dura after discectomy. Three trials of percutaneous discectomy provided moderate evidence that it produces poorer clinical outcomes than standard discectomy or chymopapain. We found no published randomised trials of laser discectomy. REVIEWER'S CONCLUSIONS: Chemonucleolysis is more effective than placebo and it is less invasive but less effective than surgical disectomy. Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are unclear.

Diskectomy↗
PubMed1997

Efficacy of lumbar discectomy and percutaneous treatments for lumbar disc herniation.

The changing health care environment necessitates careful re-evaluation of all costly elective procedures. Low back surgery is a typical example. This article reviews the current literature addressing the efficacy of surgery and invasive percutaneous treatments for discogenic sciatica. It also discusses the prospects for the continuation of reimbursement for these procedures under a system of managed health care. Relevant articles were identified using the MEDLINE and Current Contents databases, from bibliographies of articles identified from these databases, from recommendations of experts in the field, and from the Canadian Cochrane++ Collaboration. The review includes randomized clinical trials, meta-analyses, published practice guidelines and large case series. The literature is classified and discussed in these quality strata. The review includes 9 randomized trials, 6 meta-analyses or review articles, one evidence-based practice guideline, 38 surgical case series and 35 additional references. Though incomplete, the existing evidence indicates that open discectomy shortens the duration of discogenic sciatica in selected patients. Neurologic outcomes are similar in operated and unoperated patients. Predominant leg pain, evidence of nerve root tension and concordant symptoms and imaging findings, are associated with favorable surgical results. Chemonucleolysis is also associated with more rapid pain relief than conservative treatment, but provides less certain benefit than standard discectomy. Available data on other percutaneous disc treatments do not currently support a statement on efficacy. Various percutaneous techniques are available but there is no solid scientific evidence of efficacy. The benefits of open discectomy, principally reduced duration of pain, appear to justify its use in carefully selected patients when discogenic sciatica fails to improve with conservative measures. Though elective, the procedure will probably continue to be available under managed care, but with increasing scrutiny of operative indications.

Cost-Benefit Analysis↗
PubMed1999

[Surgical treatment of lumbar intervertebral disk displacement. Indications and methods].

The decision about operative or non-operative treatment of herniated lumbar discs has to be based on the results of clinical and neurological examination. Results of imaging techniques as CT or MRI are secondary. Various percutaneous endoscopic or open techniques have been described. The most appropriate technique is determined by the anatomical situation of the dislocated lumbar disc tissue. Intradiscal percutaneous therapies such as percutaneous nucleotomy and laser decompression are possible, but they revealed poor results in prospective randomized and controlled studies. Chemonucleolysis remains as an effective intradiscal technique at the time, but is afflicted with side effects and complications. Endoscopic transforaminal or interlaminary techniques are still experimental. Whenever open surgery is necessary, microsurgical techniques are preferred. If a certain technique is to be applied, there has to be the correct indication, technical support for and experience in using the choosen method.

Diskectomy↗