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PubMedDate not supplied

MR imaging of Ho:YAG laser diskectomy with histologic correlation.

Twelve cadaveric vertebral specimens were imaged after holmium yttrium aluminum garnet (Ho:YAG) laser diskectomy to determine the usefulness of magnetic resonance (MR) imaging in evaluating treatment outcome. The Ho:YAG laser was operated at 1.0-2.0 J per pulse, 5 Hz, and 250-microseconds pulse width. The total energy varied between 600 and 2,700 J. Two distinct patterns emerged on MR images. Tissue ablation at higher power (1.5 and 2.0 J per pulse) produced discrete signal voids that correlated with areas of laser-induced ablation identified at gross inspection. More subtle changes, characterized by a high-signal-intensity ring, were seen in the specimens lased at 1.0 J per pulse. The latter appearance corresponded to incomplete vaporization of diskal tissue, a broader zone of minimal thermal injury, and sparing of adjacent vertebral endplates. Total mass loss did not appear to be affected by the choice of power setting (1.0 vs 1.5 J per pulse), with total laser energy held constant.

Adult↗
PubMed1987

Destructive lesions of the mandibular condyle following diskectomy with temporary silicone implant.

Dacron-reinforced silicone is widely used as disk-replacement implant material in the temporomandibular joint. A retrospective radiographic analysis was undertaken in a series of thirty-two patients on whom diskectomy had been performed. Twenty patients had received temporary silicone implants, whereas twelve patients had surgery without disk-replacement implants. Six of the patients with implants had destructive lesions of the mandibular condyles at follow-up examinations, but no such lesions were seen in any of the patients who had surgery without implants. Histologic analysis of material removed from one patient who had a second operation showed multiple particles of foreign material surrounded by focally marked inflammatory reaction with foreign body granulomas. The underlying cartilage and bone showed focal resorption and bone destruction. Electron microscopy combined with energy-dispersive x-ray microanalysis showed that the foreign material contained silicone. It was concluded that the radiographically observed destructive lesions of the mandibular condyle may be a sign of a reactive synovitis induced by silicone particles abraded from the silicone implant.

Adult↗
PubMed1992

Autogenous conchal cartilage as a replacement after a diskectomy.

A surgical procedure to place autogenous conchal cartilage as an interpositional graft after a diskectomy is described. The apparent advantages of this procedure are as follows: (1) the form of the external ear corresponds to joint morphology; (2) a graft of adequate size can be harvested; (3) the form of the external ear remains unchanged after surgery; (4) the graft can be obtained adjacent to the surgical site; (5) biologically acceptable material is used; (6) the additional expense of allogeneic grafts is avoided; and (7) excellent results have been reported.

Cartilage, Articular↗
PubMed1993

Diskectomy in treatment of internal derangement of the temporomandibular joint. Follow-up at 1, 3, and 5 years.

The efficacy of temporomandibular joint diskectomy without implants was evaluated clinically in patients with internal derangements. Seventy-two patients were examined preoperatively and 1 year postoperatively; 40 were also examined 3 years postoperatively and 15 at 5 years after surgery. Success rates were calculated according to a modification of the criteria established in 1984 by the American Association of Oral and Maxillofacial Surgery. The success rate was 83% at the 1-year follow-up. Temporomandibular joint pain was alleviated and chewing capacity was normalized in 60 patients. The outcome in 12 patients was classified as unsuccessful, mainly on the basis of residual muscle and joint pain. At the 3-year follow-up only two patients were classified as unsuccessful and none at the 5-year follow-up. Unsuccessful patients had higher frequencies of muscle soreness and osteoarthrosis than successful patients. Postoperative complications were infrequent and minor.

Adult↗
PubMed1995

Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review.

Dense peridiskal fibrosis was encountered during a lumbar diskectomy for a chronic lumbar disk herniation. Posteriorly the adhesions involved the annulus, dura mater, nerve roots, posterior longitudinal ligament, and sequestrated disk material. Anteriorly the iliac vessels were also densely adherent to the disk. When disk material was removed from a standard posterior approach, the left common iliac vein tore, leading to severe hypotension. Vascular injury by instruments has been described by many clinicians, but this indirect mechanism of injury has not been reported in the literature, nor has extensive peridiskal fibrosis been described in a spine without a history of previous surgery.

Adult↗
PubMedDate not supplied

MR artifacts after anterior cervical diskectomy and fusion: a cadaver study.

OBJECTIVE: To identify the source of metallic artifacts observed on cervical spine MR studies following anterior cervical diskectomy and fusion (ACD&F), preoperative and postoperative MR studies were done on cadavers using standard spin echo T1, T2, and GRASS imaging. MATERIALS AND METHODS: An ACD&F was performed on each cadaver at various levels using different combinations of drill burrs, curettes, and suction tips. RESULTS: Results showed that contact between the drill burr and suction tip produced the worst artifacts; however, artifacts still occurred in cases in which the suction tip was not introduced. CONCLUSION: This observation suggests that metal flakes from the curettes also produced artifacts. Image distortion was greater on GRASS imaging than on the spin echo imaging.

Artifacts↗
PubMed1997

Cartilage matrix macromolecules in lavage fluid of temporomandibular joints before and 6 months after diskectomy.

The purpose was to investigate if antigenic fragments of aggrecan and cartilage oligomeric matrix protein (COMP) are detectable by enzyme-linked immunosorbent assay in lavage fluids from the temporomandibular joint (TMJ) and to examine if the relative content of these cartilage markers changes during development of osteoarthrosis (OA) after diskectomy. Lavage fluid was obtained at surgery and 6 months postoperatively in 13 patients. Computed tomography or magnetic resonance imaging was without evidence of hard-tissue changes prior to surgery in all patients. In 9 of the patients, sufficient material for analysis was obtained at both examinations. Aggrecan and COMP were detectable in all but 2 fluids, in which the COMP levels were below detection limit. The aggrecan/COMP ratio increased in all 9 patients during the 6-month period, indicating increased release of aggrecan relative to COMP fragments. The changed aggrecan/COMP ratio possibly reflects increased cartilage turnover during development of OA. Changes compatible with OA were present on computed tomography in all cases at the 6-month follow-up. This study shows that the lavage procedure is feasible for obtaining synovial fluid from the TMJ for immunochemical analyses of tissue-derived macromolecules.

Adolescent↗
PubMed1985

Percutaneous lumbar diskectomy using a new aspiration probe: porcine and cadaver model.

A method of percutaneous aspiration of the nucleus pulposus of lumbar disks is described as performed in four pigs and three cadavers. Through a lateral oblique percutaneous approach, 80-100% of the nucleus pulposus was removed in each of the pigs; approximately 30% of the cadaver disk was removed. A unique aspiration probe and the introducing set as well as the technique are described. The implications for clinical use in patients are discussed. We believe this technique may be an alternative to both surgical diskectomies and chymopapain injection in the treatment of herniated disk disease of the lumbar spine.

Adult↗
PubMed1987

Automated percutaneous diskectomy: initial patient experience. Work in progress.

A new method has been developed for percutaneously decompressing herniated lumbar disks. The method entails gaining access to the disk space through the use of an introduction system and a cannula. A 2-mm aspiration probe called a Nucleotome is then placed through the cannula into the disk space, and the nucleus pulposus is aspirated. Thirty-six patients have undergone the procedure, with a successful result in 31. There were no significant complications encountered, and the procedure is now being done on an outpatient basis. These preliminary results indicate that automated percutaneous diskectomy has the potential to replace laminectomy in the treatment of uncomplicated herniated disks.

Humans↗
PubMed1993

Percutaneous Lumbar Diskectomy.

The development of an approach for percutaneous lumbar diskectomy (PLD) began over 20 years ago. Since then, clinical investigations of manual and automated PLD techniques have recorded an average success rate of 50% to 70%. Currently, the indications for PLD include (1) a major complaint of acute unilateral leg pain localized to a single dermatome associated witha a single-disk herniation; (2) neurologic signs or symptoms appropirate to a single-disk herniation; (3) magnetic resonance imaginng, computed tomographic, or diskographic evidence of a single herniation contained within the annulus of the lumbar disk; and (4) failure of a well-managed course of conservative treatment to relive the pain and symptoms. Conventional laminotomy/laminectomy, with or without the use of a microscope or surgical loupes, remains the usual method of surgical care for symptomatic lumbar disk disease. The role of PLD awaits further prospective randomized controlled studies.

Journal Article↗
PubMed1991

Automated percutaneous lumbar diskectomy.

Automated percutaneous lumbar diskectomy was introduced in 1985. Development of this technique was instigated by the general trend in medicine toward less invasive procedures. Technique, indications, patient selection, and a review of the current literature are presented. Cumulative data indicate that the procedure has the least potential to do harm compared to open operations for treating lumbar disk herniations.

Humans↗
PubMed1991

Diagnostic and therapeutic technology assessment. Reassessment of automated percutaneous lumbar diskectomy for herniated disks.

Although the safety of the APLD procedure is clearly established both by reports in the published literature and by a consensus of the DATTA panelists, there was no consensus among the DATTA panelists on the effectiveness of the procedure. The average 75% success rate reported in the larger studies contrasts with the 95% success rate reported for laminectomy and diskectomy. For APLD, careful patient selection is essential. Candidates must have failed an adequate trial of conservative therapy (bed rest and limitation of activity) and have disk herniation documented by appropriate imaging studies. These studies are important because they can demonstrate not only the degree of herniation, but also whether it is contained within the annulus and if any free fragments are present. For herniated lumbar disks with nuclear material outside and contiguous with the annulus, a statistically significant consensus of DATTA panelists believed that APLD is an inappropriate procedure. Another study has shown that the procedure can be taught to other surgeons without compromising patient safety, and, as reported, this holds with large numbers of cases. In appropriately selected patients, the clinical trade-off of APLD appears to be between a procedure with a 75% success rate with low risk and rapid recovery vs one with a 95% success rate and a more prolonged recovery. A research question is whether APLD could be extended to patients who have undergone previous surgery whose disks reherniate after a successful laminectomy. Conversely, does an APLD procedure that fails to relieve symptoms complicate subsequent laminectomy? It is recognized that there is a need for prospective, controlled, randomized clinical trials comparing APLD with laminectomy to resolve these and other issues.

American Medical Association↗
PubMedDate not supplied

Far-lateral disk herniation: treatment by automated percutaneous diskectomy.

Automated percutaneous diskectomy has certain advantages over other surgical approaches to the treatment of far-lateral disk herniation; primarily, the procedure can be performed under local anesthesia without soft-tissue disruption. We describe four patients with far-lateral herniations who were successfully treated with the procedure.

Adult↗
PubMed1989

[Percutaneous partial diskectomy in the dog--an alternative to surgical disk fenestration].

A new, technically simple operation method for the fenestration of disks is described which was performed successfully on six experimental dogs on the thoracolumbar disks and did not stress them very much. A percutaneous partial diskectomy (PPD) of the anulus fibrosus and the nucleus pulposus with a bone drill (diameter 5 mm) is performed. The extracted cylinder bone allows a histological judgement of the disci intervertebrales. This method was applied to 10 animal patients with discopathia, and it showed that evidently PPD is a good alternative to the conventional thoracolumbar disk surgery (dorsolateral fenestration). Besides the technical simplicity of this method its advantage is a quicker practicability and less operative stress of the patient.

Animals↗
PubMed1988

Lumbar percutaneous diskectomy.

The lumbar percutaneous diskectomy is a new procedure for the treatment of herniated lumbar intervertebral disks that have not advanced to sequestration, fibrosis, or osteophyte formation. The procedure is done under local anesthesia, and there is no entrance into the spinal canal.

Adult↗
PubMed1993

Percutaneous diskectomy for lumbar disk herniation. A preliminary report.

Percutaneous diskectomy is a new method for reducing lumbar disk herniation. This procedure is simple, safe, and only semiinvasive since it causes no direct damage to the dura or nerve roots. This technique employs a nucleotome (blunt-tipped, suction-cutting probe) with a rotating electric shaver (3 mm in diameter) that was specially developed for this procedure. It was applied to 117 patients with lumbar disk herniation whose sciatica had not been relieved by conservative treatments. The results of the technique were considered effective in 94 patients (80.3%). The improvements were even more marked in patients with protrusion or prolapse type herniation. Reviewed with postoperative examinations using magnetic resonance imaging (MRI), excision of the herniated disk, resulting in decompression of the nerve root, may be correlated with the relief of symptoms.

Adolescent↗