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At least 127 records · Page 7Linked to original sources
PubMed1994

[Percutaneous lumbar diskectomy].

At the Department of Neurosurgery in Trondheim, 17 patients with low backpain and sciatica have been operated upon using percutaneous lumbal discectomy. The procedure was carried out under local anaesthesia and all patients were discharged on the first day after operation. Seven patients recovered completely, four patients showed some improvement, and six patients showed no change. All the patients who reported a complete recovery experienced pre-operative stress-dependent radicular pain with mild neurological deficits. In contrast, the group of patients who showed no change suffered more constant pain, with a diffuse localization and no neurological deficits. It is important to make a thorough pre-operative evaluation of these patients, and correct selection is essential to achieve a good result.

Adult↗
PubMed1994

Anterior-approach cervical diskectomy under the operating microscope.

Since Cloward's description of it in 1958, the anterior approach to the cervical spine for excision of degenerated cervical disk causing radiculopathy and myelopathy and for excision of secondary bony spurs has become relatively standard for most spine surgeons. The procedure is easy to perform in trained hands, is a low-risk surgical operation, and has gratifying results provided patients are well selected. Many surgeons use an operating microscope while doing the procedure. The obvious advantages of the microscope are better magnification, enhanced stereoscopic visibility in a small field, better visualization of the anatomic structures, and added safety. The focused lighting is valuable in achieving satisfactory decompression of the nerve root and the spinal cord. The microscope is also a valuable teaching tool at the time of surgery. Our technique for the procedure employing the microscope is described and stereoscopic photographs taken during surgery are presented.

Cervical Vertebrae↗
PubMed1993

[Certification of ability to work in patients after percutaneous diskectomy of the intervertebral cartilage].

Following the literature and own experience, issues related to the certification of working ability among patients after percutaneous nucleotomy of the intervertebral cartilage, are discussed. Certain premises are presented, according to which an operational effect and prognosis as to recovery, should be carefully assessed. Types of jobs contraindicated and indicated are identified.

Adult↗
PubMed1993

[Percutaneous nucleotomy-diskectomy techniques. Automated and manual techniques. Indications and results].

The authors review the percutaneous techniques: automated (Nucleotome) manual, with and without motorization ("shavers") with and without discoscopy. These techniques are indicated in less than 15% of cases of disc herniations; but, if the proper indications are respected, a rate of success between 75 and 85% can be expected. The guidelines of the indications are the following: contained disc herniation (longitudinal ligament not ruptured), subacute clinical course, no lateral spinal stenosis, age under 45.... Although the percutaneous techniques are simple and safe, they must be always preceded by a medical treatment during at least 6 weeks. The pre-operative imaging is of paramount value to assess the wholeness of posterior longitudinal ligament: computerized discography (C.T.-scan+discography), M.R.I., disco-manometry.... The authors advocate for percutaneous discectomy versus chemonucleolysis, but surgical approach by micro-technique remains indicated in most cases of lumbar herniated discs, especially in cases of ruptured discs (extruded or uncontained herniations), acute clinical course, spinal canal stenosis, age more than 45, or particular anatomical situations (such as deep-seated lumbosacral space or post-operative fibrosis).

Diskectomy, Percutaneous↗
PubMed1996

[Percutaneous lumbar diskectomy].

The results after percutaneous lumbar discectomy were evaluated in 52 patients with low back pain corresponding to the L5 or S1 root. All patients were examined with a median follow-up time of 14 weeks. The patients were divided in two groups. Group 1: patients with an obvious indication for surgery (29 patients) and group 2: patients with a relative indication for surgery (23 patients). The follow-up results for patients in group 1 were comparable with the results after conventional discectomy. The results concerning follow-up low back pain in groups 1 and 2 were good or excellent in 69% and 43% of the patients respectively. The corresponding results for sciatica were 69% and 65% respectively. It is concluded that percutaneous lumbar discectomy is a possible alternative to conventional discectomy in selected patients.

Adolescent↗
PubMedDate not supplied

[Laser puncture diskectomy in discogenic lumbosacral radiculitis].

Percutaneous laser discectomy (PLD) was performed in 273 patients with herniated disc-induced lumbosacral radiculitis. Indications for PLD were based on clinical and neurological findings and results of MR tomography: no benefit from conservative treatment, pain syndrome in the lumbago stage and sciatica not presenting with severe paresis and with herniated intervertebral discs down to 6 mm in size across.

Adult↗
PubMed1988

Presentation of a new MMPI scale to predict outcome after first lumbar diskectomy.

In a pilot study MMPI was presented preoperatively to 57 patients operated for the first time for lumbar disk herniation. Six months and 24 months postoperatively, the patients were asked about their degree of pain, health status regarding back illness, and social functioning. An analysis of the individual MMPI questions in relation to outcome was performed, and on this basis we propose a new scale, the S.M. scale, which could predict poor outcome in either follow-up in 89% of the cases with poor outcome.

Back Pain↗
PubMed1993

[The diagnostic role of contrast medium-enhanced MR tomography in the diagnosis of the post-diskectomy syndrome. A prospective study of 109 patients].

In a prospective study, 132 previously operated disc levels in 109 patients with failed back surgery syndrome (FBSS) were examined by MR imaging before and after intravenous application of a contrast agent (0.1 mmol Gd-DTPA/kg). The results were compared with current CT findings in 47 cases. The images were randomized and independently assessed by two experienced radiologists. A second intervention of a total of 30 disc levels was performed in 28 patients. Contrast-enhanced-MR imaging (CE-MRI) improved the differentiation of scar from recurrent disc herniation (RDH) compared to plain MRI and CT. Agreement between the two readers was significantly higher for CE-MRI than for the other two procedures (p < or = 0.001). CE-MRI additionally had the highest diagnostic accuracy (p < or = 0.001). The preoperative diagnosis made by CE-MRI was confirmed in 27 (90%) of the reoperated disc levels. Quantitative evaluation showed that there was no contrast enhancement in RDH as opposed to pronounced enhancement of 122% in scars (p < or = 0.001). Evaluation with respect to scar age revealed a significant difference (p < or = 0.01) in contrast enhancement between scars less and more than 2.5 years old.

Adolescent↗
PubMed1992

[Automated percutaneous lumbar diskectomy (APLD): the early and late changes in the CT with a clinical correlation].

In 52 out of 162 patients treated, CT changes were measured at early and late stages and correlated with clinical findings. Reduction in height of discs was measured by digital radiography. During early stages 9.6% showed gas collections peripherally and 3.8% centrally. Early and late examination showed uniform reaction in the area of the prolapse: no changes (type I), return to normal findings (type II), diffuse reduction of a broadly based lesion (type III), reduction in focal changes based on a broad lesion (type IV). Early results: 94.3% type I, 3.8% type III, 1.9% type IV. Late results: 55.7% type I, 3.8% type II, 21.2% type III, 19.3% type IV. Maximal reduction of the height of the disc of 10% occurred in 32.6% of cases. There was no meaningful correlation between CT appearances and clinical status.

Humans↗
PubMedDate not supplied

[Automated percutaneous diskectomy. Indication, technique and results after 2 years].

Automated percutaneous lumbar discectomy (APLD) is a new method for the treatment of herniated lumbar disc. Since 1988 it is introduced in Germany. Until December 1989 the operation has been performed in 45 patients at the department of orthopaedic surgery, University of Kiel. The 2-years experiences with the new method are reported in this paper. Careful selection of patients provides excellent or good results in 70%, in 18% the method fails.

Adolescent↗
PubMedDate not supplied

[Lumbar diskectomy without or with spondylodesis? Revival of an old dilemma].

Indications for spine fusion in combination with removal of a lumbar intervertebral disc are not as well defined or as widely accepted. Extreme opinions have been expressed on both side of this issue, but it seems unreasonable that every segment should be fused after removal of a disc or that none should be. The indication for fusion or for no fusion is often based on the specialist to whom the patient is referred. Orthopedists perform often fusion, neurosurgeons rarely. The problem is not the superiority of combined operation or simple disc excision, but the right indication for one or other procedure. It is clear that for the patient with acute disc displacement with leg-pain as the predominant symptom, simple laminectomy and disc excision will yield good results in most cases. Basically the are two indications for combined operation: the first of this is a strong history of instability troubles prior to the disc prolapse; second indication is the bilateral hemilaminectomy and discectomy, which can lead the spine quite instable. Indication for secondary spinal fusion are: 1) the presence after disc excision of complain of pain in the back with relatively little sciatic radiation, sometimes as intermittent claudication; 2) the overproduction of scar tissue is seen very often in instable segment after disc excision and partial or complete facetectomy. Decompression of the nerve root and fusion may result in a great benefit. Finally we recall the possibility to perform simple fusion in flexion without excision of the disc and without laminectomy in cases with median protrusion of the disc, seen in CT in patients with chronic low back pain and inconstant radicular pain radiation. We describe our own technic of combined operation.

Humans↗