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Biomedical subjects

W C Watters

Publications and source records attributed to W C Watters.

11 recordsLinked to original sources
PubMed1997

Discography of lumbar discs after surgical treatment for disc herniation.

STUDY DESIGN: Eighty-three patients were identified who had discography performed at a disc level that had been subject to previous laminectomy and partial discectomy, and who had also undergone discography at one or more additional levels. The results of these studies were retrospectively reviewed. OBJECTIVE: To define the results of discography performed on previously operated discs. SUMMARY OF BACKGROUND DATA: It is not uncommon for the physician to encounter patients with complaints of persistent chronic back pain after surgical treatment of a lumbar disc herniation. Although such patients are frequently studied by discography, there is very little scientific literature to document the expected results. METHODS: A retrospective study of the results of discography on previously operated disc was performed. RESULTS: A positive pain response was significantly more likely in the previously operated discs than in the unoperated discs (P < 0.0001). Posterior extravasation of dye was noted in 34% (35 of 102) of the postoperative discs and 21% (29 of 136) of the unoperated discs. Positive concordant pain provocation was noted in 48 (75%) of the 64 discs showing posterior dye extravasation; 28 were postoperative discs and 20 were unoperated discs. CONCLUSIONS: Patients presenting with disabling back pain who had previously undergone surgical treatment for a herniated nucleus pulposus show a high (72%) incidence of concordant pain with discography of the previously operated level. Only 34% of the previously operated discs demonstrated posterior extravasation of discography dye. Persistence of a posterior anular defect was associated with a higher incidence of positive concordant pain response.

Adult↗
PubMed1994

Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up.

STUDY DESIGN: This study retrospectively reviewed the outcomes of 126 patients treated for cervical radiculopathy with either simple anterior cervical discectomy (ACD) or anterior cervical discectomy and fusion (ACF). OBJECTIVES: Complications, short-term, and long-term outcomes were compared to determine which was the superior procedure in the treatment of cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Both procedures were performed for identical reasons on similar patient groups in an identical manner. The ACF group had a tricortical autograft implanted after the discectomy. METHODS: Complications and short-term follow-up were determined by review of hospital and office charts and radiographs. Long-term follow-up was by phone interview. RESULTS: Anterior cervical discectomy had a significantly reduced mean operative time, blood loss, and hospital stay. There were 16 complications for ACF, 15 of which were graft-related and 4 complications for ACD. There was, however, no difference in mean time to return to work between the two groups. Long-term follow-up demonstrated an average low level of neck and arm pain in both groups. Continued donor site pain was not a long-term problem. Slightly more ACF than ACD patients were satisfied with the long-term results of their surgery. CONCLUSIONS: Neither procedure is ideal for the treatment of cervical radiculopathy. Anterior cervical discectomy results in decreased hospital cost and surgical morbidity. Anterior cervical discectomy and fusion results in more rapid resolution of patient pain. The ideal procedure would appear to be ACF performed with a theoretical biomaterial that would be minimally expensive and consistently promote successful arthrodesis.

Adult↗
PubMed1994

Percutaneous diskectomy for disk space infections.

To diagnose and treat intervertebral disk space infection, we used percutaneous diskectomy in four patients to harvest a large amount of disk material and to decompress and lavage the infected disk space with a broad spectrum antibiotic solution. This treatment regimen rapidly diminished pain and shortened the acute clinical course of the process. The long-term course in this small number of patients, however, appears not to have been altered.

Acute Disease↗
PubMed1993

Childhood intervertebral disc calcification.

Two cases of intervertebral disc calcification in children are reported. A 13-year-old boy presented with right subscapular pain radiating into the axilla with radiographic demonstration of multiple calcified intervertebral discs and a herniated fragment of calcified nucleus pulposus at T2-3. His condition improved with conservative therapy, and follow-up radiographic evaluation revealed resolution of the herniated calcified disc material. A second case of multiple intervertebral disc calcifications was observed incidentally in an asymptomatic 6-year-old boy. The clinical presentation of this condition, its incidence, natural history, proposed etiologies, treatment options, and outcome are reviewed.

Adolescent↗
PubMed1989

The use of dexamethasone in primary lumbar disc surgery. A prospective, randomized, double-blind study.

Corticosteroids have been used by many spine surgeons in the postoperative management of lumbar disc surgery patients. The potential side effects of these medications are significant, and yet there is little information available either supporting or contraindicating their use in the postoperative setting. This prospective, randomized double-blind study was designed to assess the effectiveness of the corticosteroid dexamethasone in decreasing postoperative pain and hospital stay after primary lumbar disc surgery. The patients' pain status was assessed both preoperatively and postoperatively by a standard pain questionnaire and pain drawing. Each patient's response to the questionnaire and pain drawing, as well as his usage of narcotics and days of postoperative hospitalization, were recorded and analyzed. Dexamethasone was shown to have a significant and selective effect on reducing leg pain postoperatively, while also significantly reducing the usage of injectable narcotics and shortening the postoperative hospital stay.

Dexamethasone↗
PubMed1988

Treatment of the isolated lumbar intervertebral disc herniation: microdiscectomy versus chemonucleolysis.

A long-term goal of spine surgeons has been to reduce the morbidity, cost, and recuperative period of primary lumbar disc surgery. In this paper, microdiscectomy and chemonucleolysis are evaluated and compared with respect to achieving these goals. Two groups of successive, noncompensation patients numbering 50 each were studied. All patients met standard clinical and imaging criteria for an isolated lumbar vertebral disk herniation. One group was treated with chemonucleolysis and the second with micodiscectomy. Average follow-up exceeded 3 years. While both treatment groups achieved the stated goal when compared with traditional laminectomy, the microdiscectomy groups demonstrated statistically superior treatment results, with reduced time to return to work, and fewer required subsequent surgical procedures.

Follow-Up Studies↗
PubMed1981

Congenital dislocation of the hip. A review.

Congenital dislocation of the hip usually results from capsular stretching caused by fetal malposition and crouching late in the third trimester. Early recognition of hip dislocation or instability soon after birth permits prompt treatment. Ortolani's and Barlow's maneuvers, respectively, reduce into and displace from the acetabulum a femoral head that is insecurely contained therein. The diagnosis of CDH in the first month of life usually depends on these clinical components of the physical examination of the newborn, because similar device, in this age group can usually maintain the displaced hip in sufficient flexion and abduction to permit reduction and normal development. By 3 months of age, the nuclei of the pelvis and upper femur have ossified enough to permit radiologic diagnosis of CDH. Problems related to treatment increase as the child grows older. In infants up to 6 months of age, closed methods with a harness usually succeed. Beyond 6 months, the soft tissues shorten and prevent easy reduction. These patients almost always require pre-reduction traction. An adductor tenotomy also facilitates reduction and apparently lessens compressive forces on the femoral head, an important consideration in preventing avascular necrosis of the head. Children over 1 year old develop bony changes, such as excessive femoral valgus and anteversion and deformity of the acetabulum. Treatment in these patients requires realignment of bony deformities with femoral or pelvic osteotomies in addition to the measures noted previously. The gentleness and high success rate of early treatment make early diagnosis of CDH an important consideration in infants and newborns.

Acetabulum↗
PubMedDate not supplied

Multiple dislocations of the cervical spine in a patient with juvenile rheumatoid arthritis and Down's syndrome.

Both Down's syndrome and juvenile rheumatoid arthritis can cause instability of the cervical spine. Patients with Down's syndrome usually have instability of the atlantoaxial joint. With juvenile rheumatoid arthritis, cervical instability is a manifestation of a more generalized process involving ligamentous laxity, posterior facet ankylosis, and growth disturbances of the vertebral bodies. When the two syndromes occur in the same patient, the potential exists for serious cervical instability. In the 14-year-old girl reported here, the two conditions coexisted, and more severe cervical spine involvement occurred than was originally anticipated. Prior awareness of the combined effects of Down's syndrome and juvenile rheumatoid arthritis on the stability of the cervical spine should be useful in the management of future cases.

Adolescent↗