Posterior dynamic stabilization

The purpose of this study is to report our experience with posterior dynamic stabilization, using an interspinous distracter that avoids excessive lumbar spine instrumentation, tolerating the segmental movement without foraminal conflict and preserving the adjacent segment. Twenty-nine patients with ages ranging from 48 to 70 [mean 56 years] underwent surgery using this device. All patients had low back pain that radiated to the lower limb in 21 cases. The follow-up period ranged from 6 to 12 months [mean 9 months]. Majority of patients showed outstanding results with relief of their symptoms. Interspinous distracter insertion is a safe and reliable tissue sparing technique that restores function by stabilizing the spine and maintaining the foraminal height, the natural functional anatomy and dynamism. It offers an alternative to rigid stabilization of lumbar stenosis with mild to moderate instability. Basic knowledge of spinal motion and careful selection of the patients is indispensable prior to its use

Success of heparin use in intraventricular haematoma treatment

Prevent closure of an external intraventricular drainage with the use of heparin. A patient with intraventricular haemorrhage presented with repetitive closure of intraventricular drainage tube. A trial heparin infusion directly into the ventricle was attempted to prevent further closure of the catheter. The heparin used at a dose related of 340 units per 10 ml of intraventricular haematoma was effective in dissolving the clot and maintaining the external drainage patency. Thrombolytic therapy with intraventricular infusion of heparin may be life saving in intraventricular haemorrhage

Unstable thoracolumbar fractures: surgical treatment and results

From 2002 to 2004, 12 patients with unstable thoracolumbar fractures were treated surgically. A posterior short segment pedicle screw implant protected with hooks was used in 12 patients; anterior decompression with grafting and application of the Kaneda device was used in 3 patients in association with the posterior fixation. The average follow-up was 32 months [range: 15-48 months]. The clinical outcome was satisfactory in 9 out of 12 patients. Radiographic imaging findings showed a slight loss of reduction, but the clinical outcome of the patients was not affected. No pseudarthrosis and no implant failures were recorded. The outcome of patients with complete spinal cord injury was still poor despite the phenomenal advances in fixation devices and surgical procedures. Much progress is still to be made to ameliorate the functional outcome of patients who are victims of thoracolumbar fractures

Precutaneous radiofrequency neurolysis for trigeminal neuralgia

In this retrospective study efficiency of selective percutaneous radiofrequency neurolysis in the gasserian ganglion was evaluated in 200 patients with a mean follow-up of seven years by the senior author and co-workers at the Department of Neurosurgery at St. George's Hospital Beirut. Mean age of patients was 60 years with a predominant number of patients having essential neuralgia [184 patients]. Excellent relief was obtained in 92 patients with another 36 patients achieving pain relief after a second intervention. Sixty-nine patients had recurrence not amenable to repeat intervention. And another 3 patients had bad penetration of foramen ovale. Thirty-two patients required reintervention with glycerol and fibrin glue. Complications included sensory loss of cornea in 6 cases, anaesthesia dolorosa in 8 cases, coagulation of motor root of the fifth nerve in 2 cases, intense pain of the ear [paralysis of tensor tympani] in 4 cases and damage to oculomotor nerve in one case. The authors propose that radiofrequency rhizotomy may be a safe and effective procedure in the neurosurgical armamentarium for the treatment of patients having trigeminal neuralgia

Current surgical treatment of Parkinson's disease

There has been a renaissance in the surgical management of Parkinson's disease. This has been due to long-term effects of levodopa and a better understanding of the basal ganglia and its circuitry. Ablative surgery and neurostimulation are the only realistic surgical options at present. Although surgical treatments, such as ablation and stimulation are effective, they are not useful for stopping the progression or restoring the system. Neural transplantation helps restore the system by using a number of techniques. Targets mostly used are in the thalamus, globus pallidus and subthalamic nucleus. A number of factors must be considered including patient's age, disability and his wishes. Globus pallidus stimulation might be preferable for patients who suffer from dyskinesia as a major source of disability. Pallidotomy might be appropriate in cases where frequent stimulator adjustments are impractical. Subthalamic nucleus stimulation is more suitable for patients with significant off periods and in younger patients in whom it may be desirable to maintain intact circuitry. Fetal neural transplantation, stem cell transplantation, xenotransplantation, adrenal medullary transplantation and transplantation of genetically engineered cells are at various stages of development and research. Ethical issues surrounding these process are likely to arouse strong emotions and have to be carefully considered

Current surgical treatment of Parkinson's disease

There has been a renaissance in the surgical management of Parkinson's disease. This has been due to long-term effects of levodopa and a better understanding of the basal ganglia and its circuitry. Ablative surgery and neurostimulation are the only realistic surgical options at present. Although surgical treatments, such as ablation and stimulation are effective, they are not useful for stopping the progression or restoring the system. Neural transplantation helps restore the system by using a number of techniques. Targets mostly used are in the thalamus, globus pallidus and subthalamic nucleus. A number of factors must be considered including patient's age, disability and his wishes. Globus pallidus stimulation might be preferable for patients who suffer from dyskinesia as a major source of disability. Pallidotomy might be appropriate in cases where frequent stimulator adjustments are impractical. Subthalamic nucleus stimulation is more suitable for patients with significant off periods and in younger patients in whom it may be desirable to maintain intact circuitry. Fetal neural transplantation, stem cell transplantation, xenotransplantation, adrenal medullary transplantation and transplantation of genetically engineered cells are at various stages of development and research. Ethical issues surrounding these process are likely to arouse strong emotions and have to be carefully considered