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At least 55 records · Page 3Linked to original sources

PubMedDate not supplied

Plasma radio-frequency-based diskectomy for treatment of cervical herniated nucleus pulposus: feasibility, safety, and preliminary clinical results.

BACKGROUND AND PURPOSE: Several techniques, including chymopapain, mechanical aspiration, laser-based disk decompression, and endoscopic keyhole surgery, have been proposed as minimally invasive alternatives to fusion for treating cervical disk herniation, though none has gained wide acceptance. The purpose of this study was to assess feasibility, safety, and preliminary clinical results of percutaneous plasma-mediated radio-frequency-based diskectomy for cervical disk herniation. METHODS: Patients (N = 55) with cervical soft disk protrusion were treated over a 29-month period. They had radicular pain; 3 patients also had moderate myelopathy. The procedure was performed with the Perc-DC SpineWand by using an anterior approach. Most cases were conducted with local anesthetic on an outpatient basis. Clinical outcomes were graded by using the Macnab criteria. RESULTS: At 2 months, outcomes were good or excellent in 44/55 (80%) patients; the success rate was similar at 6 months, when 44 (85%) patients (n = 52/55) had good or excellent results. One clinically relevant complication (infectious diskitis) occurred within the first month postprocedure and was successfully treated. One technical complication (in situ rupture of the device tip) was observed; however, the patient remained asymptomatic during the 2-year follow-up. The 3 patients with clinical myelopathy experienced regression of cord compression symptoms; MR imaging in 2 patients showed morphologic evidence of reduction of cord compression. CONCLUSIONS: Plasma radio-frequency-based diskectomy in the cervical spine appears to be a minimally invasive low-risk approach, which is easy to perform, associated with only minimal discomfort to the patient, and effective in the short term.

Adult↗

PubMed1994

[Microsurgical and endoscopic laser diskectomy in osteochondrosis of the lumbar spine].

Experimental studies have revealed that a pulse surgical laser based on alumo-yttrium garnet with neodymium ensures bloodless diskectomy and evaporation of a pulposus nucleus in the volume sufficient for decompression of the intervertebral disk. Biomechanical studies of spinal resistance following puncture endoscopic laser decompression of the intervertebral disk (PELDID) and microsurgical laser diskectomy (MLD) have demonstrated that these surgical interventions fail to disturb the stability of the spinal portion operated on. A total of 75 patients with radicular syndrome were operated on with the proposed procedures: 32 with PELDID and 43 with MLD. The subsequent studies have shown that 69 (92%) patients returned to previous work at week 7 and 5 (6.7%) at week 9 of postoperation. The major manifestation of radicular syndrome--leg pain--was eliminated in 100% after MLD and in 96.9% after PELDID.

Diskectomy↗

PubMed1985

Diskectomy of the temporomandibular joint: a double-contrast arthrotomographic follow-up study.

The manner in which temporomandibular joint soft-tissue structures remodel following diskectomy has been assessed by double-contrast arthrotomography. Pre- and postoperative arthrograms were compared in ten joints. The intra-articular soft-tissue cover of the bony components was frequently thicker 1 to 3 years after the operation. The most pronounced thickening was observed in the mandibular fossa, whereas a thinner cover was found on the condyle and the tubercle. Development of a thick soft-tissue cover on the articulating surfaces indicates that the temporomandibular joint has a capacity articulating surfaces indicates that the temporomandibular joint has a capacity for functional adaptation following diskectomy. This may be an essential factor for a favorable postoperative result.

Adult↗

PubMed1992

Geographic variation in lumbar diskectomy: a protocol for evaluation.

In 1989 the Maryland Hospital Association (MHA) began developing a protocol related to lumbar diskectomy, a procedure with widely reported geographic variation in its use. The MHA's Laminectomy Advisory Committee drafted three criteria for performance of lumbar diskectomy and also developed a data-collection instrument with which the eight hospitals participating in a pilot study could abstract the necessary data from medical records. Both individual hospital and aggregate results showed wide variation in compliance with the criteria. These findings suggest research and development activities such as refinement of the data-collection instrument, use of the protocol for bench-marking, further investigation of clinical and other determinants of rate variation, and study of the effect of new diagnostic technology on utilization rates for this procedure.

Catchment Area, Health↗

PubMed1991

Automated percutaneous lumbar diskectomy.

The use of automated percutaneous lumbar diskectomy for the treatment of herniated lumbar disks is increasing. More than 3000 physicians have been trained to perform the procedure, and over 40,000 cases have been completed worldwide. This review describes the development of automated percutaneous lumbar diskectomy, the selection of appropriate patients, how the technique is performed, and its efficacy relative to other methods of treatment.

Humans↗

PubMed1991

Automated percutaneous lumbar diskectomy according to the Onik method: conclusive considerations.

The Onik method of automated percutaneous diskectomy in the treatment of the herniated lumbar disk offers undeniable advantages which we have already elaborated in our preliminary studies. Nevertheless, further experience with this technique has allowed us to pinpoint several aspects worthy of more attention: patient selection and long-term results. The patient selection procedure must follow Maroon and Onik's original protocol to the letter in order to single out those patients in whom contained disk herniation has caused actual sciatic pain and not merely low back pain. Imaging tests such as CT scan, MRI, and myelography have proved useful mainly in identifying contraindications for the technique, while only intraoperative diskography has been capable of diagnosing the contained status of the disk herniation, the basic criterion for selection. We reviewed 98 automated percutaneous lumbar diskectomies after a follow-up period ranging from 6 months to 2 1/2 years and found the results to be satisfactory, in spite of a slight deterioration of the good results at 6-9 months, following which there was no further change.

Adult↗

PubMed1991

The Onik method of automated percutaneous lumbar diskectomy (A.P.L.D.). Criteria of selection, technique, and evaluation of results.

The Onik method of automated percutaneous lumbar diskectomy is a new type of percutaneous surgery for the treatment of herniated lumbar disk. Candidates for this procedure should be carefully evaluated on the basis of precise clinical criteria and instrumental diagnosis. The goal is to select patients in whom excellent results can be achieved, recognizing the limitations as well as the merits of the technique. The surgical approach is described and the potential difficulties are discussed, since this technique must be performed with precision and without trauma in order to obtain good results. The clinical results of 500 patients treated by the Onik method of automated percutaneous lumbar diskectomy are reported. The follow-up period ranged from 6 months to 2 1/2 years. The patients were divided into three groups according to the strength of the indication for A.P.L.D.; the quality of the result is reported for each group.

Adult↗

PubMedDate not supplied

[Automated endoscopic percutaneous diskectomy in the treatment of lumbar disk hernia].

Results of the conventional lumbar disc herniation surgery are not always satisfactory, in spite of the progress made in microsurgical technique. For that reason neurosurgeons started looking for an alternative method of treatment. A combination of the percutaneous posterolateral approach, which was used in chemonucleolysis, accompanied by the development of diagnostics, surgical techniques and technology of medical instruments, are important stages in the development of automatic endoscopic percutaneous diskectomy. The aim of percutaneous diskectomy is derived from pathophysiological principles, i.e. it is based on the reduction of nucleus pulposus volume, namely on the lowering of intradiscal pressure, under the condition that the anulus fibrosus continuity has been preserved. In the past three years 132 patients have been treated with this method with the success rate of 81%. We consider this method to be the best way to the final goal which can be called the protective lumbar disc surgery.

Adolescent↗

PubMed1989

Diagnostic and therapeutic technology assessment. Percutaneous lumbar diskectomy for herniated disks.

Percutaneous diskectomy, particularly using Onik's nucleotome, has promise. It is too early, however, to decide if the percutaneous approach to reducing lumbar disk herniation will achieve a permanent place in the surgical armamentarium. Nevertheless, it is clear that patient selection is important. At the minimum, an adequate trial of conservative therapy must be followed by diagnostic imaging that documents a herniation that can be treated in this fashion and correlates with the patient's neurological signs and symptoms. If free fragments are found, a laminectomy of some sort will be required to remove the offending material. Patients who are at risk for general anesthesia or may be allergic to chymopapain were mentioned by the panel as special subpopulations for whom the procedure may be indicated despite the lack of wide experience with it. The rapidly rising popularity of automated percutaneous lumbar diskectomy via the nucleotome will hopefully be followed in the near future with larger studies with long-term follow-up.

American Medical Association↗

PubMed1987

Results of temporomandibular joint diskectomies in Sweden 1965-85.

There have been divergent opinions about the prognosis of temporomandibular joint diskectomy. Therefore we have retrospectively evaluated all diskectomies performed in Sweden during the period from 1965 to 1985. Eighty-seven patients had been operated upon with this technique and 69, with a follow-up time of 6 months or longer (median 20 months), were analyzed. The median of maximal opening increased and 74% of the patients had less frequent and less intensive pain at the follow-up examination than before surgery. The overall results of the operations were good in 51% of the patients (none or mild pain and opening greater than or equal to 35 mm and horizontal movements greater than or equal to 5 mm), acceptable in 22% of the patients (none or mild pain and opening greater than or equal to 30 mm) and bad in 28% of the patients (severe pain or opening less than 30 mm). The preoperative pain was found to be more diffuse in the patients with bad postoperative results than in the patients with good and acceptable results. This emphasizes the importance of avoiding operating on patients with sources of pain and functional limitation other than the temporomandibular joint proper. The operation should be used restrictively and only on accurately diagnosed patients with severe pain and functional limitation that originate in the joint and have not been alleviated by adequate nonsurgical treatment. The risk of residual pain or limitation of opening should be included in the preoperative evaluation.

Adolescent↗

PubMed1994

Should fusion accompany lumbar diskectomy? A medium-term answer.

The results of lumbar diskectomy for a sciatic syndrome in 90 patients were reviewed at an average of 8.5 years after operation. The best results were achieved in those patients who had their diskectomy within 12 months of the onset of their symptoms and through minimal approaches. Eighty-six percent of patients returned to gainful employment. Sixteen patients (18%) returned with low back pain attributable to the loss of intervertebral disk, of whom eight (9%) required secondary spinal fusion for control of pain. Seven of these latter patients obtained gratifying clinical and functional results. The findings suggest there is insufficient indication for routine spinal arthrodesis combined with lumbar disk excision. Those eight patients (9%) who developed a disabling postdiskectomy/postlaminectomy instability syndrome did so usually as a consequence of excessive bone and ligament excision and benefitted significantly from subsequent spinal arthrodesis.

Adolescent↗

PubMed1994

Percutaneous cervical diskectomy: preliminary experience.

We assessed the feasibility of percutaneous treatment of a cervical herniated disc. In the lumbar region, the surgical instrument for percutaneous diskectomy passes only through the paravertebral muscles, while in the cervical region there is considerable risk of nervous, parenchymal and vascular lesions. Moreover, open surgery for cervical herniated nucleus pulposus is a well-established, low-risk procedure, with little risk of epidural fibrosis, the main complication of lumbar open surgery; a percutaneous procedure should therefore have a low morbidity rate. A safe percutaneous approach to cervical discs could be useful for biopsy and for treatment of high-risk patients for general anaesthesia. We treated 15 patients with cervical herniated nucleus pulposus; all gave informed consent and refused or were not eligible for open surgery. We used the Nucleotome described for treatment of lumbar herniated discs; except for the first three cases, we used colour Doppler sonography to detect hazardous structures in the path of the probe. We had one complication, a cervical haematoma due to damage to the inferior thyroid artery, prior to the use of ultrasound.

Cervical Vertebrae↗

PubMed2006

Lumbar diskectomy in a human-habituated mountain gorilla (Gorilla beringei beringei).

The authors report a case of a human-habituated mountain gorilla, Alvila, resident at the San Diego Zoo, who was found to have a herniated intervertebral lumbar disc after being attacked by the gorilla troop's silverback male gorilla. Ultimately, the gorilla required surgical intervention for her disease and made a full recovery. To our knowledge, this is the only known case of spine surgery. A 36-year-old female human-habituated mountain gorilla (Gorilla beringei beringei), resident at the San Diego Zoo, was noticed by caregivers to walk with a substantial limp after being attacked by the gorilla troop's silverback male gorilla. Magnetic resonance (MR) imaging of her lumbar spine revealed a large herniated disk at the L1-2 level on the right. This finding appeared to correlate well with the gorilla's symptoms. The gorilla underwent a lumbar diskectomy under loupe. Post-operatively the gorilla did very well. The right leg weakness was immediately improved post-operatively. The gorilla continued to "crutch walk" initially, swinging on the upper extremities and not bearing weight on the lowers. However, by 2 weeks the limp was no longer noticeable to the zoo caregivers. The wound healed well and there was no evidence of wound infection or CSF leak. The gorilla was reunited with her troop and has reintegrated well socially. With 10 months of follow-up, the gorilla continues to do well. This is the only known case of spine surgery in a gorilla. For best surgical results, one needs to consider the similarities and differences between the gorilla and human vertebral anatomy. We believe that careful pre-operative planning contributed to the good early post-operative result. Ultimate assessment of the long-term outcome will require additional follow-up.

Animals↗

PubMed2003

Decreased strength and mobility in patients after anterior cervical diskectomy compared with healthy subjects.

OBJECTIVE: To evaluate whether patients acquired normal physical function after cervical disk prolapse and surgery compared with healthy matched controls. DESIGN: Cross-sectional study. SETTING: Hospital in central Finland. PARTICIPANTS: Fifty-three patients with cervical diskectomy and 53 healthy matched controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Postoperative physical function was studied by measuring muscle strength and range of motion (ROM) values of the neck and grip strength. Disability was assessed by the neck and shoulder pain index and by the Oswestry index, mood by the Short Depression Inventory; and pain on a visual analog scale (VAS). RESULTS: Most patients recovered well after the operation. Forty-three percent of the patients still experienced moderate or high pain (VAS score, >30mm). Subjective pain and disability were associated with decreased neck movement and strength. Both ROM and cervical muscle strength values were significantly lower (P<.001) in all the measured directions in cervical disk surgery patients compared with healthy controls. ROM was mostly confined in extension (25%). Muscle strength of the neck was mostly confined in both rotation directions (38%). No statistically significant difference in grip strength was found between the groups. CONCLUSION: The loss of muscle strength and ROM is clearly visible postoperatively and thus the effectiveness of the early identification and rehabilitation of these deficits merits further studies.

Activities of Daily Living↗

PubMed1997

MRI artifacts following anterior cervical diskectomy.

BACKGROUND: Magnetic resonance imaging (MRI), despite being an excellent imaging technique in neurosurgical practice, is unfortunately susceptible to numerous artifacts. Some of these artifacts are easily identifiable and do not interfere; however, others are more subtle and can be easily mistaken for false pathology. Postoperative MRI can further complicate the imaging interpretation, by producing another group of artifacts. It is imperative for practicing neurosurgeons, as well as neuroradiologists, to have a clear understanding of these postoperative artifacts. METHODS: We discuss four cases who had been operated for anterior cervical decompression with bony fusion. All the patients had a postoperative MRI of the cervical region that showed a "false compression" of the cervical cord. The normal computed tomography (CT) scan in some cases and the discrepancy with the clinical condition of the patients excluded the diagnosis of compression of the cervical cord. RESULTS: The overall appearance of the postoperative MRI can be very difficult to interpret. The artifact seen following anterior cervical diskectomy is an example of such a situation. We have confirmed that the postoperative MRIs showing artifacts do not indicate cord or root compression; a routine postoperative plain X ray or CT scan of the operated area can also confirm the absence of compression. CONCLUSION: These are examples of cases in which the postoperative MRI had an unexpected metallic artifact that not only caused difficulty in the interpretation of the images but at times suggested a clinical problem when actually there was none. Very thin cut CT scans may not show these artifacts that are picked up by the sensitive MRI study. A proper clinical evaluation and selection of the appropriate MRI techniques and the MRIs can eliminate or at least decrease the incidence of the artifacts. Above all, further education of practicing physicians is needed to avoid false alarms caused by these metallic artifacts.

Adult↗

PubMed2001

[Spinal epidural fibrosis following lumbar diskectomy and antiadhesion barrier].

Although diskectomy after hemilaminectomy always produces some fibrosis, only few patients develop clinical symptoms. Fibrosis is one of the causes for failed lumbar disc surgery. Identification of fibrosis as the cause of recurring lumbar or sciatic pain requires the existence of a good clinical history and selective physical examination of the patient. MR is the imaging technique of choice although CT and myelography can be useful in some cases. Surgery can correct recurrent hernias, segmentary instability or spinal stenosis, but good results are less likely in patients with epidural fibrosis. When this exists, surgery should be directed to performing an arthrodesis of the vertebral space since the operation itself can destabilize the segment resulting in instability of the affected segment. Application of ADCON-L did not worse and in some cases improved the clinical condition of patients in double blind studies. Our multicentric double blind study showed no clinical differences among 253 patients at six months after surgery. Additionally, since this gel seems to avoid the development of fibrosis, it may prevent one of the main causes of failed disc surgery and, if reoperation is necessary due to disc remains or a lateral stenosis, the absence of fibrosis would facilitate surgery.

Diskectomy↗

PubMed2000

Bilateral subdural hematomas following routine lumbar diskectomy.

Intracranial hypotension is a rare, and possibly underrecognized, cause of headache in middle age. Occurring spontaneously in the vast majority of cases, it has been occasionally reported after certain neurosurgical procedures involving craniectomy. We report a unique situation in which a patient developed severe postural headache typical of intracranial hypotension, which was complicated by bilateral subdural hematomas, immediately following a routine lumbar diskectomy; the headache resolved spontaneously. We suggest that an intraoperative microscopic dural breach was the site of sustained, but self-limited, cerebrospinal fluid leakage that eventually led to intracranial hypotension.

Aged↗

PubMed2004

Emergency thoracic diskectomy for the acute onset of paraplegia: report of two cases.

BACKGROUND: Thoracic disk herniation is a rare event, and acute presentation of this lesion is even less common. METHODS: Case reports. FINDINGS: Both patients presented with rapidly progressing lower extremity weakness and sphincter dysfunction. Radiographic work-up revealed large herniated thoracic disks with spinal cord compression. Emergency thoracic diskectomy was performed. RESULTS: Both patients had partial reversal of neurologic and sphincter abnormalities after emergency surgery. CONCLUSIONS: Thoracic disk herniation, although rare, should be considered when patients present with acute thoracic myelopathy. Early surgical intervention may reverse some neurologic injuries.

Acute Disease↗