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At least 415 records · Page 23Linked to original sources
PubMed1996

Prospective randomized open study between ciprofloxacin and a combination of sulfadiazine and trimethoprim in antibiotic prophylaxis in connection with transurethral prostatectomy.

A randomized open prospective study with antibodies was conducted on 398 cases of TURP to compare the efficacy of either 250 mg of ciprofloxacin twice daily (CF) or 500 mg/160mg of sulfadiazine-trimethroprim twice daily (ST) in the prevention of urinary and other infection complications. The medication was started on the evening preceding the operation and continued up to the day following the removal of an indwelling catheter. The preoperative risk factors were similar in both groups. The groups did not differ in terms of the duration of the operation, the volume of irrigation fluid or the weight of the resected chips. The incidence of immediate complications was 26% in the CF group and 20% in the ST group. All the complications were minor. There were three serious late complications, one intertervertebral discitis and one coxitis in the CF group and one endocarditis in the ST group. The patient with endocarditis died. One the removal of the indwelling catheter on the third postoperative day, bacteriuria was detected in 3% of the patients in the CF group and in 9% in the ST group. The difference was statistically significant (p < 0.05). One month after TURP, bacteriuria was detected in 7% in both study groups. It is concluded that ciprofloxacin may be more effective to preventing immediate urinary tract infections after TURP than a combination of sulfadiazine and trimethoprim. There were three serious late complications. As late as one month after TURP, bacteriuria was still diagnosed in about 7% of all patients, which is post-TURP monitoring of urinary values is important.

Aged↗
PubMed1980

Bone scanning in lumbar disc herniation.

99m technetium methylene diphosphate was used for whole body scanning and linear multiplane tomoscanning in 10 patients with typical clinical symptoms of prolapsed disc, in order to investigate whether there would be an increased focal accumulation corresponding to the bone structures adjacent to the affected disc. The diagnosis of a prolapsed disc was confined by amipaque myelography, carried out in 9 patients, and finally verified at operation. In none of the 10 cases could accumulation of radioactivity in the bony structures of the affected lumar segment be demonstrated. Consequently this method has not been adopted for the diagnosis of prolapsed lumbar discs. However it was demonstrated that 99m technetium methylene diphosphate scintillography is useful in the differential diagnosis of anchylosing spondylitis and discitis.

Adult↗
PubMed2002

Lumbar microdiscectomy: a historical perspective and current technical considerations.

A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and Wilson in the United States, this procedure has successfully reduced operative time, surgical morbidity, and incision size while allowing patients to return to work faster. Emphasis is placed on the importance of a careful preoperative clinical and radiographic evaluation by identifying factors that may help in the prediction of a successful surgical outcome. A modification of the lumbar microdiscectomy technique is described including patient positioning in the lateral position as well as minimal disc space and nerve root manipulation. In their experience performing more than 3000 microdiscectomies, the authors have produced good-to-excellent clinical results in nearly 90% of patients, with the majority returning to work within 1 month. The complication rate of dural tears, discitis, or root injury has been less than 2%, with a reoperation rate of 5%. The authors believe that lumbar microdiscectomy remains the gold standard with which all other discectomy techniques must be compared.

Diskectomy↗
PubMed2002

Use of a tubular retractor system in microscopic lumbar discectomy: 1 year prospective results in 135 patients.

OBJECT: Application of minimally invasive techniques to lumbar disc surgery has led to the development of the Microscopic Endoscopic Tubular Retractor System (METRx-MD). A prospective evaluation of results and complications was undertaken. METHODS: One hundred thirty-five patients underwent surgery in which the METRx-MD system was used; most procedures were performed on an outpatient basis, and general anesthesia was induced in all cases. All patients were followed prospectively. Outcomes were measured using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Short Form-36 (SF-36) questionnaires. Follow-up data were collected by an outside company, which also tabulated the data. Data were collected in 129 of 135 patients. Improvement was seen on the VAS (Scores 7-2), ODI (Scores 57-16), and SF-36 scales (bodily pain Scores 20-60). Patient satisfaction with results was 94% and with office services 88%. Thirty-six percent of patients returned to work at 0 to 2 weeks, 38% at 3 to 5 weeks, and 25% at 5 to 26 weeks. Hospital charges decreased by $2395 (18%). The mean operative time was 66 minutes, and the mean blood loss was 22 ml. Complications included one superficial wound infection, one discitis, three durotomies, and three cases of excessive bleeding (> 100 ml). There were five reoperations: four for recurrent disc herniations, (two ipsilateral and two contralateral to the index site) and one for spinal stenosis contralateral to the index site. CONCLUSIONS: Minimally invasive surgery in which the METRx-MD system is used is clinically effective and cost effective. Patient satisfaction was high. A mean per case cost savings of $2395 was realized. Complications rates were comparable with those associated with traditional microdiscectomy procedures.

Adult↗
PubMed2004

Surgical strategies for vertebral osteomyelitis and epidural abscess.

Pyogenic vertebral discitis and osteomyelitis (PVDO) has become an increasing problem for the spine surgeon. Despite recent advances in medical care and improved diagnostic neuroimaging, PVDO remains a major cause of illness and death in the elderly population. Infection of the spinal column often presents insidiously; however, if not treated appropriately and in a timely manner it can lead to severe neurological impairment, systemic septicemia, and progressive spinal deformity. In this paper the authors review the epidemiological and pathophysiological features and the clinical presentation of PVDO. Conventional medical therapy is described, with a particular focus on the methods of diagnosis. Surgical strategies for PVDO are then presented based on the literature and according to the practice of the senior author (S.L.O.), with an emphasis placed on structural considerations, implant selection, and techniques for augmenting vascular tissue to the site of infection.

Bacterial Infections↗
PubMed2004

Single-stage debridement and instrumentation for pyogenic spinal infections.

Surgical intervention is indicated for pyogenic vertebral discitis and osteomyelitis in patients in whom medical therapy has failed, and in those with neurological compromise, mechanical instability, epidural abscess, or intractable pain. Surgical management has evolved to include single-stage operations for debridement and stabilization as well as more aggressive reconstruction strategies with respect to instrumentation. A review of the literature demonstrates excellent outcomes with single-stage operations and placement of hardware wherever it is required. Using this method, the authors have treated 16 patients without a single incidence of recurrent infection or hardware failure after almost 2 years of follow up.

Anti-Bacterial Agents↗
PubMed1989

Nonoperative treatment of spinal epidural infections.

Spinal epidural infections were diagnosed before the onset of neurological deficits in six patients and treated nonsurgically. The diagnosis was based on the clinical presentation and on the results of myelography and computerized tomography scanning. Positive cultures were obtained from blood in all six patients, from aspiration of a paraspinous infection in two, and from a skin abscess and a pulmonary empyema in one patient each. Staphylococcus aureus was the causative organism in five cases. All patients were treated with intravenous antibiotics and remained neurologically intact throughout the course of treatment. Five patients have had no recurrence of their symptoms. One patient eventually required surgery for persistent discitis.

Adult↗
PubMed2000

Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience.

OBJECT: The authors report a retrospective analysis of 194 patients surgically treated at their institutions for symptomatic lumbar synovial cysts from January 1974 to January 1996. METHODS: Patient characteristics including age, sex, symptoms, signs, and preoperative neuroimaging studies were reviewed. Surgical procedures, complications, results, and pathological findings were correlated with preoperative assessment. One hundred ninety-four patients were surgically treated for symptomatic lumbar synovial cysts. Eighty percent were diagnosed and treated between 1987 and 1996. There were 100 men and 94 women with an average age of 66 years (range 28-94 years). The most common symptoms were painful radiculopathy (85%) and neurogenic single or multiroot claudication (44%). However, sensory loss (43%) and motor weakness (27%) were also presenting symptoms. Eleven percent of patients had undergone previous lumbar surgery prior to being referred to the Mayo Clinic. Preoperative neurological examination demonstrated motor weakness (40%), sensory loss (45%), reflex changes (57%), and variants of cauda equina syndrome (13%). In 19% of patients, normal neurological status was demonstrated. There was equal left/right-sided laterality, and eight patients presented with bilateral synovial cysts. The most commonly affected level was L4-5 (64%). All patients underwent laminectomy and resection of the cyst. Concomitant fusion was performed in 18 patients in whom clinical evidence of instability had been observed. However, subsequent fusion was required in only four patients who developed symptomatic spondylolisthesis. Surgery-related complications included cerebrospinal fluid leak (three patients), discitis (one patient), epidural hematoma (one patient), seroma (one patient), and deep vein thrombosis (one patient). One patient died 3 days after surgery of cardiac dysrhythmia. Follow-up data obtained for at least 6 months postoperatively were available in 147 patients. Of these, 134 (91%) reported good relief of their pain and 82% experienced improvement in their motor deficits. CONCLUSIONS: Lumbar synovial cysts are a more common cause of lumbar radicular pain than previously thought. Surgical removal of the cyst is a safe and effective treatment for symptomatic relief in patients with lumbar synovial cysts. A concomitant fusion procedure may be performed in select cases. In this study, only a few patients developed symptomatic spinal instability requiring a second operation.

Adult↗
PubMed2005

Conical working tube: a special device for endoscopic surgery of herniated lumbar discs.

OBJECT: The instrumentation for endoscopic discectomy continues to evolve to allow for acceptable clinical outcomes and expanding applications. The authors describe their experience in using a conical working tube equipped with a guide for angular entry of the telescope to perform endoscopic discectomy in patients with lumbar disc herniation. METHODS: Fifty-one patients (38 men and 13 women) with herniated lumbar discs underwent endoscopic lumbar surgery during the past 2.5 years at the authors' institutions. A conical working tube was inserted over sequential coaxial dilators via a muscle-splitting approach. Conventional neurosurgical instruments were used in conjunction with an angled insertion telescope. Endoscopic discectomy was performed at the L1-2 (one case), L3-4 (two cases), L4-5 (32 cases), and L5-S1 (18 cases) levels. The surgical approach was bilateral in two patients: bilateral L4-5 in one, and right L4-5 and left L5-S1 in the other. The remaining patient suffered adjacent two-level (right-sided L4-5 and L5-S1) herniations. Outcome was assessed at a mean of 11 months after surgery by using modified Macnab criteria. Outcomes were excellent in 46 (90%), fair in three (6%), and poor in two patients (4%). Complications occurred in four patients and included a dural tear in one case, postoperative neurological deterioration in two, and discitis in two; in two of these patients open surgical exploration was required. CONCLUSIONS: A separate angled entry of the telescope shortens the effective length of the working sheath and creates a better working space, thereby allowing greater instrument maneuverability and ability to use conventional neurosurgical instruments. In addition, use of this telescope in other endoscopic procedures reduces overall cost of instrumentation and treatment, and results are comparable to those reported in association with microscopic lumbar discectomy.

Adolescent↗
PubMed2004

[Invasive infection by Aspergillus terreus treated successfully with liposomal amphotericin B].

A woman of 75 years old was admitted at our hospital for evaluation of worsening and weakness in inferior limbs. Several vertebral fractures by crushing, one doubtful discitis, an infiltrate with cavitation in the right superior lobe and one infiltrate in the left superior lobe were detected. In the biopsy of the consolidation a filamentous fungus was watched and in the bronchial washing specimen culture grew Aspergillus terreus. The infiltrates disappeared with liposomal Amphotericin B remaining with oral Itraconazol during three months more. The clinical and analytical data demonstrate the existence of a Overlap syndrome associate to antiphospholipid-antibody syndrome. We comment the peculiarity of the infection by Aspergillus terreus in patients who have not been in critical care and the good response at treatment with liposomal Amphotericin B. It contrasts with the high mortality referred in a recent review. Other aspects to comment are the coexistence with a collagen vascular and an antiphospholipid-antibody syndrome with the higher titles of IgM ACA that we have found in literature.

Aged↗
PubMed1987

The use of magnetic resonance imaging in the diagnosis of postoperative lumbar conditions.

Magnetic resonance imaging is a new diagnostic procedure which may be applied to diseases of the lumbar spine and its contents. The technique is non-invasive and does not use ionizing radiation; it also has better contrast resolution than do other methods that are available. This article explores the application of the technique to postoperative conditions of the lumbar spine in relation to problems such as discitis, residual disc material, fibrosis, the size of the surrounding fatty tissue, and the shape of the neural contents.

Adult↗
PubMed1999

Thoracic disc herniation. Unilateral transpedicular approach in 35 consecutive patients.

BACKGROUND: Thoracic disc herniation is uncommon and surgery for thoracic disc herniation represents less than 1-2% of operations for disc disease. However, there is no consensus on the best approach and reports are based on small series. METHODS: A consecutive series of 35 thoracic disc herniations (25 in women and 10 in men) were treated between 1991 and 1996 using the transpedicular approach and followed in a prospective study. All patients had a preoperative MRI examination. The mean age was 51 years. The T6-7 and T7-8 level were the most frequent localization. The interval between onset of symptoms and operation ranged from 6 weeks to 4 years with a mean of 18 months. Presenting symptoms on admission was radiculopathy in 12 patients and myelopathy in 23 patients. Severe urinary symptoms were found in 2 patients, moderate symptoms in 9 patients, mild symptoms in 3 patients and 21 patient had no urinary symptoms. RESULTS: One patient was paraplegic immediately after surgery and she made no further improvement. A good result was found in 15 patients, a fair result was found in a further 11 patients but in 8 patients the outcome was unchanged with no effect of a reoperation in two cases. No clinical or radiographic features of instability were found. The postoperative course was uneventful, except in one patient with a wound abscess leading to discitis. CONCLUSIONS: The transpedicular approach can be an effective and safe method of surgical decompression in carefully selected patients.

Adult↗
PubMed2001

[Lumbar interbody fusion with threaded titanium cages. Results on 222 cases].

Retrospective analysis of 222 cases of degenerative disc disease treated by threaded cage fusion. The objective was to determine the safety and efficiency of lumbar interbody fusions using screwed titanium cages and autogenous bone. Two hundred twenty-two patients had lumbar fusion at 243 levels between L2 and S1, at one or two disc spaces. Main indication was discogenic back pain with radicular leg radiation in degenerative discopathy complicated by disc protusion, segmental canal stenosis with chronic instability or spondylolysthesis of the first degree. Previous failed surgery after discectomy, nonunion or biologically cured discitis were other indications in selected cases. Results were classified as good to excellent in 80%, 15% improved but remained disabled, 5% had minimal or no improvement. Fusion rate was 91% at one year and 96% at 2 years. Peroperative dural tears occurred in 10 patients and transient neurological deficits in 9. A superficial infection occurred in one patient. Reoperation in the first three months included a cage revision in one patient and a foraminotomy in another. Two osteoporotic women needed an additional posterior fixation for kyphotic deformity. In conclusion, lumbar interbody fusion with threaded titanium cages appears to be efficacious with an acceptable rate of complications. Experience up to 7 years confirms that impression. Long term observation is needed before recommending this new method.

Adult↗
PubMedDate not supplied

Microdiscectomy in the treatment of lumbar disc herniation.

The authors report their experience with short- and medium-term microdiskectomy for the treatment of lumbar disc herniation. It is based on 760 operations performed between 1985 and July 1999: expulsed hernias and those of large size with intense pain symptoms and/or neurologic deficit were treated. During the same period of time, the authors used enzymatic and percutaneous nucleolysis according to Onik for smaller hernias. The incidence of satisfactory results was high (90.1%), in agreement with the results published in the literature. There was a low incidence of complications (4.6%), and of these 2.8% had a benign spontaneous evolution; 1% was prevented during surgery, 0.5% was prevented with subsequent surgery, while only 0.2% was the cause of definitive failure. Unsatisfactory results were constituted by the sequelae of complications (1 discitis, 4 liquoral cysts, 1 error in level not diagnosed intraoperatively), stenosis of the lateral recess not diagnosed pre- or intraoperatively, and thus not treated; in 6.1% of cases there was no plausible justification. The microsurgical technique above all reduces the duration of hospitalization (5 days on the average, but with 91% of cases dismissed on day 3), and allows for a rapid return to work activity (after 63 days for patients who are not employees, but with a return after 20 days in 95% of cases).

Adult↗
PubMedDate not supplied

[Osteoid osteoma of the vertebral column as a cause of scoliosis].

After reminding how difficult it is to reach the diagnosis for an osteoid osteoma of rachis, the Authors report of a patient who was put under their observation after having been treated as lumbar scoliosis and discitis for one year. As they removed the osteoid osteoma, the painful symptomatology punctually disappeared and the rachis, after few months, was in its normal order.

Child↗
PubMed1992

[Lumbar disk prolapse treated with chymopapain].

We report results from 108 consecutive patients followed up for one year after chymopapain injection. The patients were selected on strict clinical and radiological criteria. In nine patients (8%) the result was poor, and they were surgically treated within one year after the injection. 99 (92%) patients improved and after one year 87 of these (81% of the total material) had returned full time to their previous occupation. The only serious complication was one case of septicemia and possible discitis. The patient made a full recovery after antibiotic treatment. On the basis of these results, we shall continue to use chymopapain injection to treat selected patients with sciatica caused by herniated lumbar discs.

Adolescent↗
PubMed2003

Medium to long-term functional outcome of patients after chemonucleolysis.

Chemonucleolysis is an established modality in the treatment of lumbar disc prolapse and has been widely used for over 39 years since its introduction by Lyman Smith in 1963. We report the medium to long-term functional outcome of patients who had chemonucleolysis for single level disc prolapse. One hundred and twelve patients were reviewed retrospectively with a mean follow-up of 9.5 years. The Oswestry Disability Index questionnaire was used to estimate the functional outcome of chemonucleolysis. An excellent or good response occurred in 79 patients (70.5%) while 12 patients (10.7%) showed moderate response with minimal disability. Treatment failed in 21 patients (18.5%) who showed poor response and 12 of these 21 patients went for surgery within a mean period of 6 months. One patient had surgery at a different level than chemonucleolysis. There was only one incident of procedure termination because of epidural contrast leak. There was no case of anaphylaxis or discitis. We concluded on the basis of our results that in carefully selected patients, chemonucleolysis is a safe and effective treatment modality for lumbar disc herniation with good medium to long-term functional outcome.

Adult↗
PubMed2003

Clinical and genetic aspects of psoriatic arthritis "sine psoriasis".

OBJECTIVE: To characterize the clinical pattern of psoriatic arthritis (PsA) sine psoriasis. METHODS: Fifty-seven patients (31 men, 26 women, mean age 46.32 +/- 14.12 yrs) with undifferentiated spondyloarthropathy (SpA) were studied. Two subsets were defined: (1) 21 patients with familial psoriasis (12 men, 9 women, mean age 49.29 +/- 14.17 yrs); (2) 36 patients without familial psoriasis (19 men, 17 women, mean age 44.58 +/- 14.00 yrs). The prevalence of the following clinical variables was evaluated: low back pain, enthesopathy, dactylitis, distal interphalangeal (DIP) arthritis, spinal involvement, and discitis. In all patients the following HLA haplotypes were tested: B7, B13, B17, B18, B27, B38, Cw6, and DR7. RESULTS: Dactylitis and DIP arthritis were markedly present in the articular subset with familial psoriasis (p < 0.0001) that also showed a high frequency rate of HLA-Cw6 (p < 0.0001 vs controls and patients without familial psoriasis). HLA-B27 was markedly frequent in patients without familial psoriasis (p < 0.0001 vs controls and p = 0.019 vs patients with familial psoriasis). In addition, in patients with familial psoriasis the log-linear model showed that the presence of HLA-Cw6 was related to the presence of DIP arthritis as well as dactylitis (likelihood ratio chi-square change of 5.891 and p = 0.015). CONCLUSION: A subset of patients with PsA "sine psoriasis" is identified by the occurrence of a SpA with dactylitis and/or DIP arthritis, presence of HLA-Cw6, and familial psoriasis in first or second-degree relatives.

Adult↗