ABSTRACT
OBJECTIVE: To determine the clinical and radiographic results and incidence of complications in lumbar arthroplasty patients. METHODS: From January, 2003 to March, 2005, 46 patients were implanted with 30 cases of the Charite Artificial Disc and 16 cases of the Prodisc. There were 28 males and 18 females with a mean age 40.6 years(range, 21~70). Diagnoses included 19 patients with discogenic back pain, and 27 patients with FBSS. All patients were examined at a minimum 2-year follow-up(mean 3.5 years). Clinical outcomes were assessed by Oswestry Disability lndex(ODI), Visual Analogue Scale(VAS),and Macnab's Criteria. Dynamic lateral flexion and extension radiographs were used to radiologic assessment. RESULTS: The ODI was reduced from 67.6% to 8.9% at the latest follow up. The mean VAS baseline was 8.29 and 2.08 at the latest follow-up. Clinical outcome was excellent or good in 40 patients(mean 87, 93% FBSS, 78% Discogenic back pain). Mean flexion/ extesion range of motion at L4-5 was 9.1degrees Charite, 9.8degrees Prodisc and at L5-S1 it were 5.5degrees, 5degrees. A total of 7 complications(15%) were noted [subsidence (2), polyethylene core wire break down (1), vertebral body posterior inferior cortex breakage (1), anhydrosis (2), nerve root damage (1)]. CONCLUSIONS: This study demonstrates the safety and efficacy of the total disc replacements especially FBSS cases.
Subject(s)
Female , Humans , Male , Arthroplasty , Back Pain , Follow-Up Studies , Incidence , Polyethylene , Range of Motion, Articular , Total Disc ReplacementABSTRACT
OBJECTIVES: The authors present three cases of brain tumors in which epidural hematomas(EDHs) were developed postoperatively in the remote areas from craniotomy sites. The preventive tactics as well as possible mechanisms of development of remote EDH are discussed. MATERIAL AND METHODS: The magnetic resonance imagings of three patients revealed a left lateral ventricular mass located just aside of foramen Monro in a 27-year-old male, a large cystic mass in the temporal lobe in a 35-year-old male, and a partially calcified pineal mass in a 27-year-old male patient. The surgical removals of these tumors were performed without any noticeable events during surgery via left frontal transcortical transventricular approach for lateral ventricular tumor, left temporal craniotomy for cystic temporal tumor, and right occipital transtentorial approach for pineal tumor. RESULTS: Postoperative EDHs remote from the sites of craniotomy were detected by the immediate postoperative computerized tomographic scans. We obtained good outcomes without any morbidity in all three patients with emergent evacuation of the hematoma. The pathologic diagnoses were lateral ventricular ependymoastrocytoma, temporal craniopharyngioma and mixed germinoma of the pineal region. CONCLUSION: It is postulated that a sudden reduction of intracranial pressure(ICP) at the time of tumor removal may strip the dura from the inner table of the skull to cause EDH from the remote site of craniotomy. Gradual reduction of ICP with slow drainage of cerebrospinal fluid before tumor removal as well as lowering the head position of patient during surgery might be helpful for preventing this unusual complication.