G S O'Sullivan | PubMed Health

PubMed1996

Are postoperative activity restrictions necessary after posterior lumbar discectomy? A prospective study of outcomes in 50 consecutive cases.

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVES: To determine if removing activity restrictions after surgery and encouraging early return to work would affect clinical outcomes after lumbar discectomy. SUMMARY OF BACKGROUND INFORMATION: Current practice usually recommends several weeks to months of restricted activities after lumbar discectomy. No formal studies have been done to determine the optimal period of restriction, if any, after surgery. METHODS: Fifty consecutive patients undergoing limited open discectomy for herniated lumbar intervertebral disc were prospectively treated with no restrictions at all after surgery and were urged to return to full activities as soon as possible. The patients were followed for a minimum of 2 years. At follow-up evaluation, an independent examiner evaluated each patient. RESULTS: The mean time from surgery to return to work was 1,7 weeks. Eleven of 44 (25%) patients returned to work on the next work day. Ninety-seven percent of patients who were working before surgery returned to their previous work. Forty-three of 44 (97%) patients had returned to full duty by 8 weeks after surgery. At follow-up evaluation (3.8 years), five patients had changed work; three patients increased their work level, and two decreased their work level. No patient changed employment because of back or leg pain. There were three reherniations at the operative level (6%), all occurring more than 1 year after surgery. One patient required reoperation. Back and leg pain scores at follow-up evaluation were very low. CONCLUSION: Lifting of postoperative restrictions after limited discectomy allowed shortened sick leave without increased complications. Postoperative precautions in these patients may not be necessary.

Adult↗

PubMed1992

Computerized tomographic evaluation of acetabular anatomy.

In this study, accurate identification of the location of the acetabular teardrop and ilioischial line on the cadaveric pelvis was attempted using computerized tomographic (CT) scanning and conventional roentgenographic techniques. The acetabular teardrops and ilioischial lines of four whole pelvic anatomic specimens were outlined with barium impregnated latex strings utilizing conventional roentgenograms, fluoroscopy, and stereoscopic control. Computed tomographic scanning was then performed, and axial and coronal CT reformations were created. Roentgenograms, CT scans, and magnetic resonance images of the pelves of ten patients with avascular necrosis of the femoral head were also reviewed to correlate the cadaveric study with specific clinical cases. The acetabular teardrop is a U-shaped figure on roentgenograms taken in a neutral anteroposterior projection. It is a complex geometric structure found to be in a constant position in the anteroinferior aspect of the acetabular wall. Its appearance changes with rotation of the pelvis or incident beam, as the teardrop represents a two-dimensional image of the tangents of a series of curves of varying radii. The ilioischial line is located posterior to the acetabulum and corresponds to tangents on the cortex of the posterior column. Computed tomography imaging with reconstruction identifies acetabular anatomy most clearly and allows precise measurements to be made.

Acetabulum↗