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At least 1,333 records · Page 74Linked to original sources
PubMed2001

Cauda equina syndrome as a postoperative complication in five patients operated for lumbar disc herniation.

STUDY DESIGN: A retrospective analysis of records and radiographs in five patients who developed acute cauda equina syndrome after surgery for lumbar disc herniation. OBJECTIVES: To postulate as a possible pathophysiologic mechanism the venous congestion caused by preexisting spinal stenosis and to present a management plan: extended decompression within 48 hours. SUMMARY OF BACKGROUND DATA: Cauda equina syndrome is reported as a sequela in 0.2%-1% of the surgeries for lumbar disc herniation. There is, however, no consensus on the possible pathophysiologic mechanism to the complication or to its management. METHODS: Preoperative investigations consisted of magnetic resonance imaging, or myelography and computed tomography. There was a good correlation between clinical appearance and radiographic findings in all patients. When the complication became apparent in four of the patients, they were investigated with magnetic resonance imaging and reoperated on within 48 hours with wide decompressions. RESULTS: The index operation was reported uneventful in all patients. Postoperative magnetic resonance imaging did not show the cause of the cauda equina syndrome, nor could this be established at the reoperation. Before surgery, all five patients had preexisting narrowing of the spinal canal. In no case was the lumbosacral disc the index level. Two patients recovered fully, whereas the other three experienced varying degrees of residual symptoms. There was no correlation between the end result and the delay until secondary decompression. CONCLUSION: Relative spinal stenosis may contribute to the development of cauda equina syndrome after surgery for lumbar disc herniation. A venous congestion can be triggered by postoperative edema, leading to nerve root ischemia. The treatment of choice seems to be extended decompression within 48 hours.

Adult↗
PubMed1998

[Golden standard: patellar tendon-plasty--technique and management of postoperative complications].

ACL reconstruction with a patellar tendon autograft has reached a high grade of perfection. Surgery can be performed mini-open or arthroscopically, both techniques are presently equal in morbidity and results. The optimal insertion areas for the graft have been defined and can be controlled intra- and postoperatively by radiographs. The bone blocks of the graft allow for stable fixation and an aggressive functional rehabilitation program stressing active full extension of the joint. Disadvantages are a certain donor site morbidity and a rate of restrictions in range-of-motion. The management of arthrofibrosis should address the pathogenesis. Localized arthrofibrosis is caused by a mechanical conflict in the knee and removal of the mechanical block will usually solve the problem. Generalized arthrofibrosis is a complex process involving the entire joint and resulting in a wide-spread proliferative reaction of the connective tissue. The surgical management must be more complex involving open debridement and capsulotomies.

Anterior Cruciate Ligament↗
PubMed1989

[Effect of time of operation and clinic organization on postoperative complications].

During a 1-year period 1082 general surgical interventions were prospectively documented and their complication rates evaluated by a score system. Factors responsible for the complication rates and possibly depending on hospital organization should be analysed. The complication rates were influenced by the selection of the weekday, the length of operation time and the extent of discrepancy between planned and required operation time. Furthermore, the complication rates paralleled the extent of utilization of the operation theatre during a workday. The complication rates were not affected by the beginning of operation and the operation month as well as the monthly utilization of the operation theatres. Whether the weather did influence the complication rates could not be decided: higher complication rates were found in the summer as compared to the winter period, but the complication score was independent of the level of the outside temperature and humidity.

Germany, West↗