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At least 19 recordsLinked to original sources
PubMed1992

Magnetic resonance evaluation after temporomandibular joint diskectomy.

The aim of this study was to investigate the value of magnetic resonance imaging after diskectomy of the temporomandibular joint. Magnetic resonance images were obtained before and 12 months after unilateral diskectomy without disk replacement. Magnetic resonance findings at follow-up were correlated to residual pain. At the follow-up, 20 of 28 patients were free of pain in the joint that had been surgically treated, four patients had mild pain, and four patients had significant residual pain. The magnetic resonance images at follow-up showed that the joint space was filled with soft tissue after diskectomy. In patients without pain at follow-up, this soft tissue had a magnetic resonance signal that was equal or higher than that of the muscles. In the four patients with significant residual pain and in one patient with mild residual pain, the soft tissue in the joint space between the condyle and glenoid fossa had a magnetic resonance signal intensity that was lower than the muscle. On the basis of findings in a previous study, the areas of low signal intensity were interpreted as fibrous adhesions. The study suggests that areas of low signal intensity in the joint space appear to be associated with residual pain and that magnetic resonance imaging could be a valuable tool for assessment of the temporomandibular joint after diskectomy.

Cartilage, Articular↗
PubMed1992

Percutaneous diskectomy.

Automated percutaneous diskectomy and manual percutaneous diskectomy (PCD) have gained recent popularity as alternatives to traditional surgical diskectomy or microdiskectomy. Initial reports of morbidity seem low. The rates of infection, and neurologic and vascular complications appear comparable or less than the morbidity associated with surgical diskectomy or microdiskectomy. However, inconsistent reports of the efficacy of PCD may cause more concern about overuse than about the morbidity.

Automation↗
PubMed1992

Temporomandibular joint diskectomy. No positive effect of temporary silicone implant in a 5-year follow-up.

The purpose of this study was to evaluate the long-term clinical and radiologic effects of a temporary silicone implant after diskectomy of the temporomandibular joint. Forty-three temporomandibular joints in 43 patients with painful disk displacement underwent a diskectomy. A sheet of medical-grade silicone was temporarily placed in 22 patients; 21 patients did not receive an implant. The patients were clinically and radiologically examined 5 years after surgery. On the basis of symptoms and jaw function, they were classified as having good (30 patients), acceptable (8 patients), and bad (5 patients) results. All the patients with bad results and five of the eight patients with acceptable results had received implants. Erosive changes of the condyle or fossa were seen radiographically at follow-up in eight patients, each of whom had received an implant. No positive clinical or radiologic effects of the implants could be identified. The use of a temporary silicone implant after diskectomy of the temporomandibular joint in patients with internal derangement should be seriously questioned.

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↗
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↗
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↗
PubMed1992

[The use of propofol during diskectomy in neurosurgery].

The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. The necessity for the frequently recommended standardized combination of propofol with opioids should be checked with respect to the cardiovascular effects. METHODS. A series of 60 patients (ASA I and II, age range 22-79 years) selected for discectomy were prospectively randomized to three groups. Half an hour before operation all patient received 0.5 mg atropine, 50 mg promethazine and 50 mg pethidine as i.m. premedication. In all groups anaesthesia was induced with propofol in a bolus dose of 2.5 mg/kg body weight over a period of approximately 45 s. After 5 mg atracurium the patients were intubated under 100 mg succinylcholine and normoventilated with 70% nitrous oxide and 30% oxygen. For relaxation 25 mg of atracurium were given. In group I propofol was administered in a dosage of 15 mg/kg body weight per hour for 10 min after induction. After this time the propofol infusion was reduced to 6 mg/kg body weight per hour. Group II received 0.1 mg fentanyl before induction. The dosage of propofol was similar to group I. In group III 0.1 mg of fentanyl was administered before induction and propofol was given with an infusion rate of 6 mg/kg body weight from the beginning. The following parameters were controlled and documented: systolic and diastolic blood pressure (SAP and DAP), heart rate (HF), end-expiratory carbon dioxide (eeCO2), inspiratory oxygen concentration (FiO2) and peripheral oxygen saturation (sO2). Recovery time was determined as the time from the end of the propofol infusion until eye-opening on command. RESULTS. In all groups anaesthesia could be induced and maintained without complications. There was a slight increase in SAP in group I after intubation, while in the groups with fentanyl a pronounced decrease of SAP was found simultaneously with induction of anaesthesia (Fig. 1). In group I HF showed significantly higher values after intubation and for the next 15 min than in group II and group III. A rapid and pronounced increase of end-tidal carbon dioxide occurred in the fentanyl groups with the beginning of spontaneous ventilation at the end of anaesthesia. There was a significantly longer recovery time in group II with fentanyl and initial higher propofol infusion rate. A correlation between dosage of propofol and recovery time could not be found. DISCUSSION. The results of this study demonstrate that a routine combination of propofol with opioids is not necessary even for painful surgical procedures if the propofol dosage is initially increased. There are differences in cardiovascular reactions between group I without and groups II and III with fentanyl, but in our patients these changes were of no clinical importance. An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.

Adult↗
PubMed1992

Surgical treatment of temporomandibular joints in patients with chronic arthritic disease: preoperative findings and one-year follow-up.

Twenty-nine temporomandibular joints (TMJs) in 19 patients with chronic arthritic disease were surgically treated. Nine patients had rheumatoid arthritis (including two with juvenile type), six had ankylosing spondylitis and four had psoriatic arthropathy. Using a preauricular approach, diskectomies with synovectomies were performed in 23 joints (14 patients) with chronic arthritic abnormalities. Diskectomies without synovectomies were performed in six joints (five patients), which proved to have internal derangements unrelated to their chronic arthritic disease. Joints with chronic arthritis showed considerable variation in inflammatory reactions, but were characterized by increased vascularization, synovial proliferation to the articulating surfaces and mostly pannus formation and bone resorption. A response in pain relief was seen in 85% of the patients three months postoperatively and in 79% of the patients 12 months postoperatively, indicating that diskectomy with synovectomy may be favorable in patients with severe TMJ problems due to involvement of chronic arthritic disease.

Adolescent↗
PubMed1992

Postoperative diskitis: distinguishing early MR imaging findings from normal postoperative disk space changes.

To distinguish early magnetic resonance (MR) imaging findings in postoperative diskitis from normal postoperative changes, a prospective study was performed in 15 asymptomatic patients (17 disk levels) who underwent uncomplicated lumbar diskectomy and seven patients with proved postoperative diskitis. On postoperative MR images, four of the asymptomatic patients had a finding that could also be seen in patients with diskitis. Gadolinium enhancement was useful in making the distinction and occurred as follows: (a) vertebral bone marrow: all seven diskitis patients and one asymptomatic patient; (b) disk space: five diskitis patients and three asymptomatic patients; and (c) posterior anulus fibrosus: all seven diskitis patients and 13 asymptomatic patients (14 of 17 levels). This entire triad of findings, which is strongly suggestive of postoperative diskitis, was not seen in any of the asymptomatic patients. Changes in the disk space and adjacent bone marrow on pre- and post-contrast MR images after routine diskectomy are uncommon and should not be assumed to be normal postoperative changes without careful consideration and analysis for early diskitis.

Adult↗
PubMed1992

Percutaneous nucleotomy with CT and fluoroscopic guidance.

Automated percutaneous diskectomy was performed with use of computed tomographic (CT) and fluoroscopic monitoring. Degenerative disease of the intervertebral disk was treated with local administration of anesthesia and use of a nucleotome. One hundred ten patients with neurologic symptoms and morphologic changes of one segment were selected for treatment. Previous conservative therapy had been unsuccessful. Patients with completely prolapsed and sequestered fragments of herniated disks ("uncontained disk"), narrow intervertebral spaces, posterior osteophytes, diseased facet joints, and spinal stenoses were not considered candidates for percutaneous nucleotomy (PNT). After PNT, 82% of the patients had complete remission of their neurologic symptoms; Lasègue sign was negative or improved in 92%. In 18% (20 patients), the symptoms did not improve sufficiently; 11% (12 of 110) of these patients underwent surgical nucleotomy. There were no serious complications, in particular, no injuries to vital structures (nerves, thecal sac, arteries, veins), except for one case of spondylodiskitis. Guiding PNT with CT and fluoroscopy provides a safe procedure with good clinical results. The addition of CT has shortened the operation but increased over-all procedure time. In the future, a shift to outpatient treatment may offset the additional time and cost of including CT guidance.

Adult↗
PubMed1992

Vascular injury related to lumbar disk surgery.

The authors report a case of left common iliac artery injury, as a complication of diskectomy, in a 57 year-old male patient, with herniated disk at L4-L5. A review shows that L4-L5 disk space is the most common site for this rare complication of lumbar disk surgery.

Hemorrhage↗