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At least 19 recordsLinked to original sources
PubMed1994

A comparison of the effects of automated percutaneous diskectomy and conventional diskectomy on intradiscal pressure, disk geometry, and stiffness.

Diskectomy, chemonucleolysis, percutaneous diskectomy, and laser ablation are used to treat patients with sciatica. The effects of percutaneous diskectomy on the intradiscal pressure of the human disk are not known. Our aims were to determine (a) whether removal of nucleus through automated percutaneous diskectomy significantly reduces intradiscal pressure without altering the disk geometry and stiffness, and if so, how much nucleus removal is required to achieve these goals; and (b) whether the effects of conventional diskectomy on these same parameters are equivalent to removal of nucleus through automated percutaneous diskectomy. Cyclic compressive loads of 20-900 N were applied to lumbar disks. Conventional diskectomy or automated percutaneous diskectomy (performed for 40 min with biomechanical measurements made four times at 10-min intervals) was then performed under zero load and the specimens retested under the same cyclic compressive loading. There were significant (p < 0.01) decreases in intradiscal pressure (by 7% under 900 N) after 10 min of automated percutaneous lumbar diskectomy. There were no further significant decreases in pressure during the next 30 min of percutaneous diskectomy. There were also significant decreases in pressure due to a puncture hole made with the Nucleotome trephine alone, without removal of disk material, and there was no difference in pressure after trephining alone and after percutaneous diskectomy. Decreases in disk height were significant, ranging from 5% at 10 min to 7% at 40 min of treatment. There were equivalent decreases in intradiscal pressure and disk height due to removal of similar amounts of nucleus during conventional diskectomy and during 40 min of percutaneous diskectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Synovectomy and diskectomy of the temporomandibular joint in patients with chronic arthritic disease compared with diskectomies in patients with internal derangement. A 3-year follow-up study.

Twenty-five temporomandibular joints (TMJs) in 15 patients with chronic arthritic disease were treated with synovectomy and diskectomy. Twenty patients with internal derangement of 27 TMJs treated with diskectomy served as a control group. A response in pain relief was seen in 73% of the patients with chronic arthritic disease and in 80% of the patients with internal derangement 3 yr postoperatively. In both groups of patients a significant increase in mouth opening capacity and lateral movement of the mandible was seen postoperatively, with no significant difference in the improvement between the two groups. Four patients with chronic arthritic disease were reoperated within the 3-yr observation period. This study indicates that synovectomy and diskectomy of the TMJ may reduce pain and improve mandibular function in patients with severe chronic arthritic TMJ disease.

Adolescent↗
PubMed1998

Laminectomy compared with laparoscopic diskectomy and outpatient laparoscopic diskectomy for herniated L5-S1 intervertebral disks.

The objective of this study was to evaluate the clinical efficacy and cost effectiveness of inpatient and outpatient laparoscopic lumbar diskectomy (LLD) compared with laminectomy (LAM) in the surgical treatment of disabling L5-S1 disk herniation. Sixty-two adults underwent surgery for herniated L5-S1 intervertebral disks (31 LLD and 31 LAM). Operative blood loss (EBL) (milliliters), operative time (ORT) (minutes), hospital stay (LOS), and rehabilitation time to normal activity (REHAB) (days), recurrent symptoms, postoperative morbidity, percent pain free, and hospital patient charges were calculated. Thirty LLD patients (97%) had immediate relief of disk pain. Morbidity after LLD included transient urinary retention (one) and rectus hematoma (one). One LAM patient had a pseudomeningocele. Among patients observed for > or =6 months, with a median follow up time of 34 months, 22 of 25 LLD patients (88%) returned to normal activity, while 12 of the LAM group (52%) were disabled (p = 0.004). Functional outcome was improved by LLD for workers compensation patients followed > or =6 months, with 86% LAM disabled, vs. 10% LLD (p = 0.001). Sixteen LLD patients (52%) and 18 (58%) of the LAM group needed postoperative physical therapy. Four LLD patients recurred; three required reoperation. Four LAM patients had surgery for recurrent disk herniation. ORT was longer for LLD than LAM (210 vs. 158 minutes, median, p < 0.05). EBL and REHAB time were significantly reduced with LLD, vs. LAM. With a median follow-up of 34 months, 58% of LLD and 39% of LAM patients followed > or =6 months were pain free. Outpatient LLD (n = 9) reduced LOS (1 day vs. 2 days and 4 days, p < 0.01) and lowered patient charges ($4,405 vs. $5,723 and $7,192, p < 0.01) compared with inpatient LLD (n = 23) and LAM, respectively. LLD is a safe, cost-effective, minimally invasive alternative to LAM for treating herniated L5-S1 disks. Compared with LAM, LLD reduces EBL, LOS, REHAB time, and patient charges, improves function, and increases long-term pain relief. Cost effectiveness is optimized when LLD is performed as outpatient surgery.

Adult↗
PubMed2000

Subchondral marrow changes after laser diskectomy in the lumbar spine: MR imaging findings and clinical correlation.

OBJECTIVE: We examined MR imaging findings and determined the clinical significance of subchondral bone marrow changes in the lumbar spine of holdium:yttrium aluminum garnet laser diskectomy patients. MATERIALS AND METHODS: We retrospectively reviewed the pre- and postoperative MR images of 109 patients with recurrent radiculopathy, lower back pain, or both 1 year after laser diskectomy of 178 disks. From this group of patients, MR images were also obtained in 11 patients with subchondral marrow changes 5-7 years after surgery. These patients were interviewed regarding residual lower back pain. Thirteen asymptomatic laser diskectomy patients also underwent follow-up MR imaging within 1 year of surgery. RESULTS: After surgery, subchondral marrow abnormalities were identified in 41 of 109 laser diskectomy patients. The remaining 68 patients had no postoperative subchondral bone marrow changes. Postoperative subchondral marrow changes were not associated with inflammation of the adjacent disk space and did not affect surgical outcome. Bone marrow changes decreased in size in the 11 patients examined 5-7 years after laser diskectomy, and eight of these patients described their lower back pain as improved. In 13 asymptomatic laser diskectomy patients, one new subchondral marrow abnormality was identified. CONCLUSION: Subchondral marrow abnormalities may occur in the vertebral end plates after holmium:yttrium aluminum garnet laser diskectomy. However, these changes probably do not affect surgical outcomes and appear to resolve over time.

Adult↗
PubMed1994

Lumbar diskectomy for recurrent disk herniation.

Eighty-two patients who underwent reoperation using a lumbar microdiskectomy approach for recurrent back and leg pain were evaluated retrospectively. Patients were entered consecutively except for exclusion of those who had a spinal fusion in addition to the diskectomy or those where a diskectomy was performed as an adjunct to decompression for spinal stenosis. As a percentage of all diskectomies performed by us over the 13 years of the study, the overall rate of reoperation (including all patients who underwent more than one diskectomy procedure regardless of vertebral level and side) was 7.4%, with those having a reoperation on the same level and either the same or contralateral side as the initial procedure representing 4.5%. Long-term outcomes obtained from 68 questionnaire responses (83% compliance) included 56% who had successful leg pain relief, 54% who had successful back pain relief, 44% who successfully returned to work, 51% who successfully returned to normal activity, and 73% who were satisfied with the results of surgery. Poor outcomes correlated most significantly with reoperation on the same vertebral level, same side, and short (< or = 1 year) time interval between consecutive diskectomies. A major conclusion was that workers' compensation patients presenting within 1 year with recurrent complaints after diskectomy and whose radiologic findings indicate a same-level, same-side recurrence represent extremely poor outcome risks for repeat diskectomy.

Adult↗
PubMed1995

Laparoscopic lumbar diskectomy: preliminary report of a minimally invasive anterior approach to the herniated L5-S1 disk.

Approximately 300,000 patients each year in the United States undergo laminectomy for disabling lumbar disk herniation. Postlaminectomy hospitalization is 3-7 days and convalescence may be prolonged. As an alternative to laminectomy, we have developed a technique for performing L5-S1 lumbar diskectomy laparoscopically. Using an anterior approach, the intervertebral disk space is opened and the diskectomy is performed under direct videolaparoscopic imaging. After pneumoperitoneum is established, the patient is placed in a steep Trendelenburg position. The small bowel is retracted cephalad and the colon moved to the left. The iliac vessels are identified visually and by Doppler probe. Then the presacral space is dissected in the midline to expose the L5-S1 disk. The disk annulus is opened with the Nd:YAG contact laser (four cases) or the harmonic scalpel (three cases). Diskectomy is performed under direct videolaparoscopic vision using standard neurosurgical instruments modified for laparoscopy. The posterior longitudinal ligament can be visualized directly to define the posterior limits of the completed diskectomy. Laparoscopy lumbar diskectomy has been performed on seven patients (five male, two female). No perioperative complications occurred. All seven patients had immediate relief of back pain after laparoscopic lumbar diskectomy. Five patients were discharged the next day and two on the second postoperative day. L5-S1 laparoscopic lumbar diskectomy is feasible and safe. It may be an effective minimally invasive alternative to laminectomy.

Adult↗
PubMed1994

Nerve root complications of percutaneous laser-assisted diskectomy performed at outside institutions: a technical note.

Two patients, treated with percutaneous laser-assisted diskectomy, developed postoperative nerve root complications. The first patient, whose diskectomy had been performed by a gastroenterologist, suffered an acute foot drop that resolved following delayed surgical diskectomy, whereas the second patient's L4 and L5 root deficits remained permanent. Percutaneous laser-assisted diskectomy, by reducing intradiscal volume, is considered an alternative to open surgery in the management of contained lumbar disc herniations. After an L4-L5 diskectomy and a fenestration procedure performed 2 months later for a sequestrated disc herniation and segmental stenosis, the first patient's foot drop resolved. Unfortunately, the second patient's L4 and L5 root injuries, without MRI and myelo-CT surgical pathology, were complete. The laser-assisted diskectomy may produce reversible and irreversible nerve root injuries.

Adult↗
PubMed2002

Upper cervical anterior diskectomy and fusion improves discogenic cervical headaches.

STUDY DESIGN: Retrospective patient identification and prospective data collection were performed. OBJECTIVE: To evaluate the outcome of anterior cervical diskectomy and fusion for discogenic cervical headaches. SUMMARY OF BACKGROUND DATA: Cervicogenic headaches affect up to 2.5% of the population. One cause is discogenic pain. Because anterior cervical diskectomy and fusion may improve neck pain, the effect of this procedure on discogenic cervical headaches was evaluated. METHODS: Nine patients with severe refractory cervicogenic headaches who underwent anterior cervical diskectomy and fusion of the upper cervical discs were retrospectively identified on the basis of clinical, radiographic, and diskography findings. Pain was measured by a numerical rating scale, and function by the Oswestry Disability Index. RESULTS: The study involved six women and three men with a mean age of 52 (range, 35-72 years) and a mean follow-up period of 37 months (range, 24-49 months). Anterior cervical diskectomy and fusion was performed at both C2-C3 and C3-C4 in seven patients, at C2-C3 in one patient, and at C2-C3, C3-C4, and C4-C5 in one patient. Associated symptoms included nausea, arm pain, dizziness, and visual disturbances. All the patients improved. All stated that they would have the same surgery again for the same outcome. The mean numerical rating score improved from 8 (range, 5-10) to 2.7 (range, 0-7) ( < 0.001), and five patients (56%) had total headache relief. The mean Oswestry Disability Index improved from 62 (range, 42-87) to 35 (range, 2-82) ( < 0.009). The associated symptoms resolved in all the patients. There was early moderate to severe dysphagia in three patients, and mild dysphagia in four patients. At the final follow-up assessment, five patients evidenced mild dysphagia. CONCLUSIONS: Anterior cervical diskectomy and fusion appears to be quite effective for discogenic cervical headache, but should be reserved for patients who are extremely impaired and refractory to all other treatments.

Adult↗
PubMed2000

Transcutaneous lumbar diskectomy for internal disk derangement: a new indication.

BACKGROUND: Percutaneous diskectomy has been used effectively to treat lumbar disk herniation. The purpose of this review was to determine whether transcutaneous diskectomy is an effective surgical option for treating lumbar internal disk derangement. METHODS: Comprehensive retrospective review via personal interview included 103 consecutive patients available for long-term follow-up. For determining results as excellent, good, fair, or poor, the criteria included subjective relief of back and/or leg pain, ability to perform preinjury job functions, residual physical restrictions, use of medications, and need for subsequent surgery. Factors affecting results were statistically analyzed. RESULTS: The overall success rate was 83%, with no statistically significant differences in results based on sex, workers' compensation status, or levels of diskectomy. CONCLUSIONS: The favorable results from this series illustrate the high success rate of transcutaneous lumbar diskectomy in a heterogeneous patient population. Coupling the rate of success with a low rate of complications, transcutaneous lumbar diskectomy appears to be an effective, minimally invasive treatment for internal disk derangement.

Activities of Daily Living↗
PubMed1995

Laparoscopic laser lumbar diskectomy. Operative technique and case report.

Approximately 300,000 patients each year in the United States undergo laminectomy for disabling lumbar disc herniation. Post-laminectomy hospitalization is 3-7 days and convalescence may be prolonged. As an alternative to laminectomy, we have developed a technique for performing L5-S1 lumbar diskectomy laparoscopically. Using an anterior approach, the intervertebral disc space is opened and the diskectomy is performed under direct videolaparoscopic imaging. After pneumoperitoneum is established, the patient is placed in a steep Trendelenburg position. The small bowel is retracted cephalad and the colon is moved to the left. The iliac vessels are identified visually and by Doppler probe, and the presacral space is dissected in the midline to expose the L5-S1 disc. In the case presented, the disc annulus was opened with the Nd:YAG contact laser, and diskectomy was performed under direct videolaparoscopic vision using standard neurosurgical instruments modified for laparoscopy. The posterior longitudinal ligament can be visualized directly to define the posterior limits of the completed diskectomy. In the case described, pain relief was confirmed immediately after the procedure. The patient was discharged after 2 hospital days, and returned to normal activity in 8 days.

Adult↗
PubMed1999

Laser-assisted diskectomy performed by an internist resulting in cauda equina syndrome.

An internist performed percutaneous laser-assisted diskectomies (PLADs) on a patient with a sequestrated disc and stenosis. Subspecialists who perform PLADs should be trained in patient selection and lumbar diskectomy techniques. Chymopapain, percutaneous nucleotome-assisted diskectomy, and PLADs are alternatives to microdiskectomy for the management of lumbar disc herniations. PLADs were performed at the L4-5/L5-S1 levels in a 38-year-old woman with magnetic resonance (MR)-documented L4-5 stenosis and disc disease. After PLADs, she developed a subacute cauda equina syndrome. Two months later, a neurosurgeon performed an L4-5 coronal hemilaminectomy with diskectomy. Within 6 postoperative weeks, she was neurologically intact. Only specialists trained in the selection, neurodiagnostic, and surgical management of lumbar disc disease should perform PLADs.

Adult↗
PubMed1992

Magnetic resonance evaluation after temporomandibular joint diskectomy.

The aim of this study was to investigate the value of magnetic resonance imaging after diskectomy of the temporomandibular joint. Magnetic resonance images were obtained before and 12 months after unilateral diskectomy without disk replacement. Magnetic resonance findings at follow-up were correlated to residual pain. At the follow-up, 20 of 28 patients were free of pain in the joint that had been surgically treated, four patients had mild pain, and four patients had significant residual pain. The magnetic resonance images at follow-up showed that the joint space was filled with soft tissue after diskectomy. In patients without pain at follow-up, this soft tissue had a magnetic resonance signal that was equal or higher than that of the muscles. In the four patients with significant residual pain and in one patient with mild residual pain, the soft tissue in the joint space between the condyle and glenoid fossa had a magnetic resonance signal intensity that was lower than the muscle. On the basis of findings in a previous study, the areas of low signal intensity were interpreted as fibrous adhesions. The study suggests that areas of low signal intensity in the joint space appear to be associated with residual pain and that magnetic resonance imaging could be a valuable tool for assessment of the temporomandibular joint after diskectomy.

Cartilage, Articular↗
PubMed1992

Percutaneous diskectomy.

Automated percutaneous diskectomy and manual percutaneous diskectomy (PCD) have gained recent popularity as alternatives to traditional surgical diskectomy or microdiskectomy. Initial reports of morbidity seem low. The rates of infection, and neurologic and vascular complications appear comparable or less than the morbidity associated with surgical diskectomy or microdiskectomy. However, inconsistent reports of the efficacy of PCD may cause more concern about overuse than about the morbidity.

Automation↗
PubMed1990

Diskectomy in treatment of disk derangement. A one and three year follow-up.

Diskectomy for treatment of temporomandibular joint disk derangements was evaluated clinically. The study comprised 40 consecutive patients (50 joints) with pain in the joint area and functional impairment not alleviated with nonsurgical therapy for at least 6 months. Diskectomy was performed in 32 joints. In 18 joints both diskectomy and minor arthroplasty were performed. No disk substituting implants were used. At 1 year follow-up 85% of the patients were free of symptoms from the temporomandibular joint area and showed normalized mandibular movements. Twenty patients were followed for 3 years. Two patients with arthrosis showed recurrence of symptoms. It was concluded that diskectomy is an effective surgical procedure for treatment of temporomandibular joint disk derangements.

Adult↗
PubMed1997

Video-assisted thoracoscopic diskectomy and fusion.

Thoracoscopic diskectomy has been described in adults as an alternative to thoracotomy for access to the anterior spine for correction of scoliosis, but its use in children for correction of spinal deformities has not been reported. Eight patients have undergone video-assisted thoracoscopic diskectomy with fusion before posterior instrumentation. In five patients, the posterior fusion and instrumentation followed the thoracoscopic procedure under the same anesthesia; in three patients it was staged and performed 1 week later. The mean time required for the thoracoscopic procedure was 174 minutes. Intraoperative bleeding requiring transfusion developed in one patient. No other complications occurred. The authors conclude that the minimally invasive approach for access to the thoracic cavity for anterior diskectomy and fusion will be the preferred approach because of the potential for significant reduction in postoperative discomfort and complications such as atelectasis and pneumonia. Postoperative hospitalization may not be decreased, however, because the patient must still recover from the open posterior instrumentation and fusion operation.

Adolescent↗
PubMed2001

Small bowel perforation as a complication of microsurgical lumbar diskectomy. A case report and brief review of the literature.

Ventral perforation is a rare complication of lumbar diskectomy. Injury to retroperitoneal vessels is the most common serious complication to such perforation. Ventral perforation with damage to the bowel is rarely reported. The authors present the first case report of injury to the small bowel during a microsurgical lumbar diskectomy. The case illustrates the importance of awareness of bowel injury as a possible complication of diskectomy. Possible pre- and postoperative considerations are also discussed. A brief review of the literature on bowel injuries after this common surgical procedure is also given.

Autopsy↗
PubMed2003

Prostaglandin E1 but not corticosteroid increases nerve root blood flow velocity after lumbar diskectomy in surgical patients.

The purpose of this study was to clarify whether prostaglandin E1 (PGE(1)) or corticosteroid could increase blood flow in the nerve root because neurologic symptoms in spinal stenosis may be based on the vascular insufficiency in the nerve root. Fifty-seven patients undergoing lumbar diskectomy were randomly assigned to one of three groups. Each group received one of three protocols for intravenous injection: 10 mL of saline solution, group A (n = 19); 10 mL of PGE(1) (20 microg) solution, group B (n = 19); and 10 mL of dexamethasone (8 mg) solution, group C (n = 19). After lumbar diskectomy, a probe for laser Doppler flowmetry was placed directly on the lumbar nerve root. Nerve root blood flow (RBF) velocity and mean arterial pressure (MAP) were measured before injection (T0), 5 minutes after the start of injection (T1), 10 minutes after the start of injection (T2), and 10 minutes after the end of injection (T3). In groups A and C, these did not change throughout the time course. In group B, MAP decreased significantly at T1 (92%; P <.001), T2 (89%; P <.0001), and T3 (91%; P <.0001), while RBF velocity increased significantly at T1 (125%; P <.05), T2 (128%; P <.05), and T3 (121%; P <.05) compared with T0. The values in group B were different from those in group A (P <.05) and group C (P <.05) at T1 and T2. The results show that intravenous injection of low-dose PGE(1), but not corticosteroid, increases RBF velocity after lumbar diskectomy.

Adrenal Cortex Hormones↗
PubMed1998

Duropleural fistula manifested as a large pleural transudate: an unusual complication of transthoracic diskectomy.

A 52-year-old patient presented with large symptomatic transudative pleural effusion 4 months following T8 to T9 transthoracic diskectomy. Anterior approach diskectomy has replaced the traditional laminectomy for treating symptomatic centrally herniated and calcified thoracic disks. We describe in this report the first case of a large cerebrospinal fluid collection in the pleural cavity caused by persistent postoperative duropleural fistula. The possibility of a duropleural fistula should be entertained in patients who present with a pleural effusion following transthoracic diskectomy.

Diskectomy↗