Influential factors related to functional status after full-endoscopic lumbar discectomy / 北京大学学报(医学版)

OBJECTIVE@#To explore the influential factors associated with functional status of those patients who undertook a full-endoscopic lumbar discectomy operation.@*METHODS@#A prospective study was conducted. A total of 96 patients who undertook a full-endoscopic lumbar discectomy operation and met inclusive criteria were enrolled in the study. The postoperative follow-up was held 1 month, 3 months and 6 months after operation. The self-developed record file was used to collect the patient's information and medical history. Visual analogue scale (VAS) score, Oswestry disability index (ODI) score, Gene-ralised anxiety disorder-7 (GAD-7) scale score and patient health questionnaire-9 (PHQ-9) scale score were applied to measure pain intensity, functional status, anxiety status and depression status. Repeated measurement analysis of variance was used to explore the ODI score 1 month, 3 months and 6 months after operation. Multiple linear regression was recruited to illuminate the influential factors associated with functional status after the operation. Logistic regression was employed to explore the independent risk factors related to return to work 6 months after operation.@*RESULTS@#The postoperative functional status of the patients improved gradually. The functional status of the patients 1 month, 3 months and 6 months after operation were highly positively correlated with the current average pain intensity. The factors influencing the postoperative functional status of the patients were different according to the recovery stage. One month and 3 months after operation, the factors influencing the postoperative functional status were the current average pain intensity; 6 months after operation, the factors influencing the postoperative functional status included the current average pain intensity, preoperative average pain intensity, gender and educational level. The risk factors influencing return to work 6 months after operation included women, young age, preoperative depression status and high average pain intensity 3 months after operation.@*CONCLUSION@#It is feasible to treat chronic low back pain with full-endoscopic lumbar discectomy operation. In the process of postoperative functional status recovery, medical staffs should not only take analgesic mea-sures to reduce the pain intensity experienced by the patients, but also pay attention to the impact of psychosocial factors on the recovery. Women, young age, preoperative depression status, and high average pain intensity 3 months after operation may delay return to work after the operation.

Research on the clinical application of drainage tube after the operation of percutaneous endoscopic lumbar discectomy / 中国骨伤

OBJECTIVE@#To investigate the clinical significance and related factors of drainage tube after percutaneous endoscopic lumbar discectomy(PELD).@*METHODS@#The clinical data of 151 patients with lumbar disc herniation who underwent PELD from January 2019 to September 2019 was retrospectively analyzed. According to whether the drainage tube was used after operation, the patients were divided into drainage tube group and non drainage tube group. The placement time and total drainage volume were recorded. The characteristics of patients, such as age, gender, body mass index, lumbar disc herniation segment, smoking history, basic diseases and whether taking anticoagulants, were analyzed by single factor and multiple factor.@*RESULTS@#Drainage tubes were used in 32 patients after PELD. There were statistical differences in visual analogue scale(VAS) and Japanese Orthopaedic Assiciation(JOA) scores between postoperative and preoperative of that in two groups(P<0.05). There were statistical differences in VAS and JOA scores at discharge between two groups(P<0.05), while there were no statistical differences at other time points(P>0.05). Univariate analysis showed that age, basic diseases and whether taking anticoagulants were related to the use of drainage tube, but gender, body mass index, lumbar disc herniation segment and smoking history were not significantly related to the use of drainage tube. Multivariate analysis showed that elderly patients, complicated with hypertension and diabetes, taking anticoagulants were related to the use of drainage tube.@*CONCLUSION@#The use of drainage tube after percutaneous endoscopic lumbar discectomy can improve the symptoms of lumbar and leg pain in early stage. For elderly patients with hypertension, diabetes and taking anticoagulants drugs, drainage tube can be considered after transforaminal endoscopy.

Unilateral mydriasis: a complication of spine surgery in prone position / Midríase unilateral: uma complicação da cirurgia de coluna em decúbito ventral

Abstract Prone position though is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible cause of anisocoria. Anisocoria partially improved but persisted till follow up.

Resumo O posicionamento em decúbito ventral, embora comumente usado para melhorar o acesso ao local cirúrgico, pode estar associado a uma variedade de complicações. Distúrbios ou perda visual no Perioperatório é uma complicação rara, mas devastadora, que está principalmente associada à cirurgia de coluna vertebral em decúbito ventral. Relatamos aqui o caso de um paciente de 42 anos de idade, ASA - II, que desenvolveu anisocoria com dilatação pupilar esquerda após microdiscetomia lombar em decúbito ventral. Após uma avaliação adicional do paciente, observamos que a paralisia segmentar dos músculos pupilares esquerdos seria a possível causa de anisocoria. A anisocoria melhorou parcialmente, mas persistiu até o acompanhamento.

Dysphagia Incidence after Outpatient Anterior Cervical Surgery Using Instrumentation versus No Instrumentation / Incidencia de la disfagia tras la cirugía cervical anterior ambulatoria con instrumentación y sin instrumentación

ABSTRACT Objective: Dysphagia is a relatively common occurrence in the postoperative period following anterior cervical surgery, with some indicating rates as high as 79%. In most cases, it remains only a transient phenomenon. The cause has been debated, with most speculating injury to nerves in the swallowing mechanism. The objective of this study was to determine if the presence of instrumentation during anterior cervical surgery in the outpatient setting would affect the incidence, duration and severity of dysphagia. Methods: We did a retrospective review of the medical records of 50 consecutive patients who had undergone single-level instrumented anterior cervical discectomy and fusion. Then we compared that group with our control group of 50 patients who had had simple single-level anterior cervical discectomy without instrumentation or fusion. The patients were evaluated for the presence of dysphagia as well as neck disability index outcome scores. Results: There was no significant difference between the groups in postoperative neck disability index outcomes at the two-year follow-up (p = 0.182). Dysphagia occurred only in the instrumented group, with an incidence of 12% (six patients): their symptoms lasted on average three weeks, and all six patients experienced only mild severity on the Bazaz-Yoo scale. There was statistically significant difference between the two groups (p = 0.012). Conclusion: There was a greater trend towards postoperative dysphagia in cases with instrumentation (12% of the patients). Dysphagia was transient with mild severity in patients who received instrumentation compared with those who underwent discectomy alone.

RESUMEN Objetivo: La disfagia es una ocurrencia relativamente común en el período postoperatorio después de la cirugía cervical anterior, con algunas tasas indicadoras tan altas como 79%. En la mayoría de los casos, sigue siendo sólo un fenómeno transitorio. Su causa ha sido discutida, atribuyéndose principalmente a una lesión en los nervios del mecanismo de deglución. El objetivo de este estudio fue determinar si la presencia de la instrumentación durante la cirugía cervical anterior en el contexto ambulatorio afectaría la incidencia, duración y severidad de la disfagia. Métodos: Realizamos una revisión retrospectiva de las historias clínicas de 50 pacientes consecutivos que habían tenido discectomía y fusión cervical anterior con instrumentación a un solo nivel. Entonces comparamos ese grupo con nuestro grupo de control de 50 pacientes a quienes se les había practicado una discectomía cervical anterior a un solo nivel simple sin instrumentación o fusión. Los pacientes fueron evaluados con respecto a la presencia de disfagia, así como en relación con las puntuaciones del resultado del índice de la discapacidad cervical. Resultados: No hubo diferencias significativas entre los grupos en cuanto a los resultados del índice de discapacidad cervical postoperatorio en el seguimiento de dos años (p = 0.182). La disfagia se produjo sólo en los grupos con instrumentación, con una incidencia de 12% (seis pacientes): sus síntomas duraron un promedio de tres semanas, y los seis pacientes experimentaron toda una severidad leve en la escala de Bazaz-Yoo. Hubo una diferencia estadísticamente significativa entre los dos grupos (p = 0.012). Conclusión: Hubo una mayor tendencia a la disfagia postoperatoria en los casos con instrumentación (12% de los pacientes). La disfagia fue transitoria con severidad leve en los pacientes que recibieron instrumentación, comparada con la de los que experimentaron discectomía solamente.

Complications of non-endoscopic discectomy: a retrospective study of twenty-one years / Complicações da discotomia não endoscópica: estudo retrospectivo de vinte e um anos / Complicaciones de la discectomía no endoscópica: estudio retrospectivo de veintiún años

ABSTRACT Objective: To report and compare the number and grade of major complications presented with non-endoscopic thermal discectomy and nucleoplasty for the treatment of discogenic axial lumbar pain using laser and radiofrequency. Methods: A 21 years retrospective study was conducted of the clinical charts of patients whose reason for consultation was axial lumbar pain from degenerative disc disease, and who underwent surgery using non-endoscopic discectomy and nucleoplasty (NEDN). Two groups were established; the first, NEDN with laser, and second, NEDN with radiofrequency. The number and types of complications reported in the case-series were counted, and their statistical differences determined. Results: The inclusion criteria were fulfilled by 643 of the medical charts. 26 complications were reported, the most common being radiculitis (n=12). Statistically significant differences were found between the complications occurring in the two groups (p=0.01). Conclusion: The number of complications showed statistically significant difference. The severity of the complications and adverse outcomes provide an argument for choosing one technology over the other. Training and the learning curve stage are important factors to be taken into account, to avoid complications.

RESUMO Objetivo: Relatar e comparar o número e grau das complicações importantes apresentadas com discotomia e nucleoplastia térmica não endoscópica no tratamento da dor lombar axial discogênica usando laser e radiofrequência. Métodos: Estudo retrospectivo de 21 anos, realizado com os prontuários clínicos de pacientes cujo motivo da consulta foi dor lombar axial por doença degenerativa do disco, que foram submetidos a cirurgia empregando discotomia e nucleoplastia não endoscópica (NEDN). Dois grupos foram estabelecidos, o primeiro, NEDN com laser e o segundo, NEDN com radiofrequência. O número e os tipos de complicações relatadas na série de casos foram contabilizados, e suas diferenças estatísticas foram determinadas. Resultados: Os critérios de inclusão foram satisfeitos por 643 prontuários clínicos. Foram relatadas 26 complicações, sendo a mais comum a radiculite (n = 12). Foram encontradas diferenças estatisticamente significativas (p = 0,01) entre as complicações que ocorreram nos dois grupos. Conclusão: O número de complicações mostrou diferença estatisticamente significativa. A gravidade das complicações e os resultados adversos fornecem um argumento para a escolha de uma tecnologia sobre a outra. O treinamento e a curva de aprendizagem são fatores importantes a considerar para evitar complicações.

RESUMEN Objetivo: Relatar y comparar el número y grado de las complicaciones importantes que se presentaron con la discectomía y nucleoplastia térmica no endoscópica para el tratamiento del dolor lumbar axial discogénico utilizando láser y radiofrecuencia. Métodos: Estudio retrospectivo de 21 años de las historias clínicas de pacientes cuyo motivo de consulta fue el dolor lumbar axial debido a enfermedad degenerativa del disco, que fueron sometidos a cirugía mediante discectomía y nucleoplastia no endoscópica (NEDN). Se establecieron dos grupos, el primero, NEDN con láser y el segundo, NEDN con radiofrecuencia. Se contaron el número y los tipos de complicaciones relatadas en la serie de casos, y se determinaron sus diferencias estadísticas. Resultados: Los criterios de inclusión fueron satisfechos por 643 historias clínicas. Se encontraron 26 complicaciones, siendo la más común la radiculitis (n = 12). Se encontraron diferencias estadísticamente significativas entre las complicaciones ocurridas (p = 0,01). Conclusión: El número de complicaciones mostró una diferencia estadísticamente significativa. La gravedad de las complicaciones y los resultados adversos proporcionan un argumento para elegir una tecnología sobre la otra. La capacitación y la curva de aprendizaje son factores importantes a tener en cuenta para evitar complicaciones.

Complications of the anterior approach to the cervical spine / Complicações do acesso anterior à coluna cervical / Complicaciones de acceso a la columna cervical anterior

OBJECTIVE: To evaluate the complications of anterior approach to the cervical spine in patients who underwent cervical arthrodesis with instrumentation. METHODS: Prospective and descriptive study was conducted from January 2009 to April 2010. All patients who underwent arthrodesis of the cervical spine by anterior approach were included, regardless the diagnosis. Access was made by the anterior approach on the right side. We evaluated the number of operated levels (1, 2 or 3 levels) and, the type of procedure performed: discectomy and placement of cage and plate (D+C+P), discectomy with placement of a cage (D+C) or corpectomy with placement of cage and plate (C+C+P). All complications related to surgical approach were reported. RESULTS: We studied 34 patients, 70% male. The average age was 50 years and mean follow-up was 8 months. Eighteen percent of patients had complications, distributed as follows: dysphasia (33%) and dysphonic (67%). Among patients who developed complications, most underwent to D+C+P (83%) and no complications were found in patients where no cervical plate was used. Regarding levels, both complications were identified in patients operated to one or two levels. However, in patients operated on three levels, only dysphonia was identified. CONCLUSION: The most frequent complication was dysphonia. Patients who presented more complications were those undergoing discectomy and fusion with cage and anterior cervical plate. All cases of dysphonia were in this group. The number of accessible levels does not seem to have affected the incidence of complications. .

OBJETIVO: Avaliar as complicações do acesso anterior à coluna cervical em pacientes submetidos à artrodese cervical com instrumentação. MÉTODOS: Estudo prospectivo e descritivo realizado no período de janeiro/2009 a abril/2010. Todos os pacientes submetidos à artrodese de coluna cervical por via anterior foram incluídos no estudo, independentemente do diagnóstico. O acesso foi realizado pela via anterior no lado direito. Foi avaliado o número de níveis operados (1, 2 ou 3 níveis) e o tipo de procedimento realizado: discectomia com colocação de cage e placa (D+C+P), discectomia com colocação de cage (D+C) ou corpectomia com colocação de cage e placa (C+C+P). Todas as complicações relacionadas ao acesso cirúrgico foram relatadas. RESULTADOS: Foram estudados 34 pacientes, sendo 70% do sexo masculino. A média de idade foi de 50 anos e o tempo de seguimento médio foi de oito meses. Dezoito por cento dos pacientes apresentaram complicações assim distribuídas: disfagia (33%) e disfonia (67%). Dentre os pacientes que evoluíram com complicações, a maioria foi submetida à realização de D+C+P (83%) e nenhuma complicação foi encontrada nos pacientes nos quais não foram colocadas placas cervicais. Com relação aos níveis, ambas as complicações foram identificadas nos pacientes operados em um ou dois níveis. Já nos operados em três níveis, somente a disfonia foi identificada. CONCLUSÃO: A complicação mais encontrada foi a disfonia. Os pacientes que mais apresentaram complicações foram os submetidos à discectomia e artrodese com cage e placa cervical anterior. Todos os casos de disfonia estavam neste grupo. O número de níveis acessados não parece ter interferido na ...

OBJETIVO: Evaluar las complicaciones del acceso anterior a la columna cervical en pacientes sometidos a artrodesis cervical con instrumentación. MÉTODOS: Estudio prospectivo y descriptivo realizado en el período de Enero/2009 hasta Abril/2010. Todos los pacientes sometidos a artrodesis de la columna cervical por vía anterior fueron incluidos en el estudio, independientemente del diagnóstico. El acceso fue realizado por vía anterior, por el lado derecho. Fueron evaluados el número de niveles operados (1, 2 o 3 niveles) y el tipo de procedimiento realizado: discectomía con colocación de cage y placa (D+C+P), discectomía con colocación de cage (D+C), o corpectomía con colocación de cage y placa (C+C+P). Se informaron todas las complicaciones relacionadas con el acceso quirúrgico. RESULTADOS: Fueron estudiados 34 pacientes, siendo 70% del sexo masculino. El promedio de edad fue de 50 años y el tiempo promedio de seguimiento fue de ocho meses. Dieciocho por ciento de los pacientes tuvieron complicaciones distribuidas de la siguiente manera: disfagia (33%) y disfonía (67%). De los paciente que desarrollaron complicaciones, la mayoría fue sometida a la realización de D+C+P (83%) y ninguna complicación fue relacionada con las técnicas que no utilizaron placas cervicales. Con relación a los niveles, las dos complicaciones fueron identificadas en los pacientes operados en uno o dos niveles. Sin embargo, en los operados en três niveles, sólo fue identificada la disfonía. CONCLUSIÓN: La complicación más frecuente fue la disfonía. Los pacientes que más presentaron complicaciones fueron aquellos sometidos a discectomía y artrodesis con cage y placa cervical anterior. Todos los casos de disfonía estaban en este grupo. El número de niveles operados no parece haber afectado a la incidencia ...

Subacute Course of Common Iliac Arterial Laceration in Lumbar Disc Surgery

Vascular injuries in lumbar disc surgery are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important to be aware of the perioperative implications of this rare occurrence to lower mortality risk. A 20-yr-old man with a right L4-5 lumbar disc protrusion was operated on routinely under a surgical microscope. A bloody surgical field was noted temporarily during a discectomy along with a decreased blood pressure. After fluid resuscitation with an ephedrine injection, the bleeding soon stopped spontaneously and his vital signs were stabilized. Fifty hours after the operation, the patient showed signs of hypovolemic hypotension with abdominal distension. The right femoral artery pulsation was absent on palpation. An enhanced CT angiography revealed a retroperitoneal hematoma and obstruction of the left common iliac artery. An urgent laparotomy was done to repair the injured vessel by excision and interposition of a graft. The patient had an uneventful recovery.The subacute course of deterioration might have been due to intermittent blood leakage from the lacerated common iliac artery, which was sealed spontaneously. It is very important to pay close attention to post-surgical clinical manifestations to avoid a potentially fatal outcome in lumbar disc surgery.

Efficacy of Postoperative Radiograph for Evaluating the Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion

BACKGROUND: After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders. METHODS: One hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated. RESULTS: PSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group. CONCLUSIONS: Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.

Efficacy of Postoperative Radiograph for Evaluating the Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion

BACKGROUND: After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders. METHODS: One hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated. RESULTS: PSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group. CONCLUSIONS: Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.

Discopatías lumbares: patología, diagnósticos y tratamiento quirúrgico / Lumbar disc: pathology, diagnostic and surgical treatment

La patología raquídea lumbar degenerativa de la que es una parte la Hernia Discal, es una causa más frecuente de Síndrome Lumbociático. De los pacientes con esta entidad clínica alrededor del 90 por ciento mejora con tratamiento médico consistente en reposo, analgésico antiinflamatorios, fisioterapias, etc, indicado por diferentes especialistas. Sólo alrededor de un 10 por ciento de los pacientes tiene indicación quirúrgica, decisión que debe ser la resultante de una correcta evaluación clínica y de una adecuada correlación clínico radiológica. Por tratarse de una patología frecuente especialmente en nuestra época de gran experiencia física de tipo laboral y deportiva, con mayor incidencia en edades productivas de los pacientes, con un costo social alto y necesidad de una reincorporación precoz a sus actividades, es importante definir el rol del tratamiento quirúrgico, la oportunidad de su indicación, la técnica adecuada, su costo y resultados.

The Disc Hernia witch forms part of the Lumbar Spinal Degenerative Disease is the most frequent cause of the Lumbociatic Syndrome. Ninety percent of the patients with this syndrome get better with medical treatment consisting of rest, analgesics, anti inflammatory drugs, Physiotherapy , Kinesiotherapy, etc, indicated by different specialists. Only around 10 percent of the patients require surgery, decision that should be the result of a correct clinical evaluation and an adequate clinical radiological correlation. As it is a frequent syndrome specially in these days of great physical demand in work and sports, with a high rate of incidence in the productive age of the patients, a high social cost and the need of a pront returne to the work field, it is important to define the role of the surgical treatment, the adequate timing and technique and its cost and results.

Early Clinical Experience with the Mobi-C Disc Prosthesis

PURPOSE: We have experienced 23 patients who had underwent cervical disc replacement with Mobi-C disc prosthesis and analyzed their radiological results to evaluate its efficacy. PATIENTS AND METHODS: This study was performed on 23 patients with degenerative cervical disc disease who underwent CDR with Mobi-C disc prosthesis from March 2006 to June 2006. RESULTS: The age of the study population ranged from 31 to 62 years with mean of 43 years, and 16 male and 7 female cases. Regarding axial pain, the average preoperative VAS score was 6.47 +/- 1.4, while at final follow-up it was 1.4 +/- 0.7 (p < 0.001). The preoperatively VAS score for radiculopathy was 6.7 +/- 0.7 compared with an average score of 0 +/- 0 at the final follow-up (p < 0.001). At postoperative 6th month, Odom's criteria were excellent, good, or fair for all 23 patients (100%). 7 patients (30.4%) were classified as excellent, 15 patients (65.2%) as good, and 1 patients (4.4%) as fair. Prolo economic and functional rating scale was average 8.9 +/- 0.7 at postoperative 6th month. ROM in C2-7, ROM of FSU, and ROM in upper adjacent level were well preserved after CDR. CONSLUSION: This report would be the first document about the CDR with Mobi-C disc prosthesis in the treatment of degenerative cervical disc disease. CDR with Mobi-C disc prosthesis provided a favorable clinical and radiological outcome in this study. However, Long-term follow-up studies are required to prove its efficacy and ability to prevent adjacent segment disease.

Efficacy of Adcon-L gel or Healon-GV in epidural fibrosis after lumbar microdiscectomy

To evaluate the efficacy of anti-adhesion barrier agents following lumbar microdiscectomy. Healon GV or Adcon-L was applied to a laminectomy defect overlying the duramater in 60 patients assigned to 3 randomized groups: Group I - Adcon-L [n=21], Group II - Healon GV [n=21], and Group III - control group, no adhesion barrier used [n=18]. We conducted this study between 2004 and 2006 at Selcuk University, Konya, Turkey. No significant difference was found between the 3 groups either in the outcome measurements according to visual analogue score and the Oswestry Disability Index or in the radiological evaluation of epidural fibrosis by application of those anti-adhesion barrier agents. When comparing group III with groups I and II, we could not find a statistically significant difference in the clinical results and in the outcome measures [p>0.01]. The epidural application of popular anti-adhesion barriers, after lumbar microdiscectomy was not found to be effective regarding outcome measures in human spinal surgery

Neurosurgical gossypiboma radiologically mimicking a lumbar abscess

Lumbar discectomy is the most common operative technique at neurosurgery clinics around the world. The complications of lumbar disc operation include infections, dural tear, bleeding, vascular, and intestinal injuries. Infectious complications of lumbar disc surgery are superficial and profound tissue infections, meningitides, and epidural abscess. Although retained surgical sponges [gossypiboma] are well known intraoperative complications in other surgical branches, they have not been widely reported in neurosurgery. In this report, we present a case of retained surgical sponge at the operation site and discuss with the literature

Bilateral vocal cord injury following anterior cervical discectomy: could a better preoperative exam have prevented it?

We present a rare case of bilateral vocal cord injury [BVCI] following anterior cervical discectomy with fusion [ACD/F] in a 47 year old man. The patient experienced post-extubation stridor and whispering voice in the recovery room. Clinical assessment led to the diagnosis of BVCI. The patient was treated by tracheostomy and made a full recovery. What is unique about this case is that the patient had no reason for a preexisting unilateral vocal cord injury [UVCI] prior to this surgery. There have been only two similar cases in the English literature in which the patients had a preexisting unilateral vocal cord paralysis [UVCI]. We recommend a more detailed preoperative airway exam to include a voice exam with specific voice fatigue questioning on all patients coming for ACD/F. Such detailed assessment may uncover hidden UVCI and allow a safer perioperative period

Study of the effectiveness of gentamycin injection in disc space during lumbar discectomy in prevention of postoperative discitis

This prospective study was performed on 150 patients operated upon by lumber discectomy. Seventy-five cases were treated by an injection of 2 ml ampoule of gentamycin in the disc space that was removed; while in the other 75, 2 ml ampoule of sterile water was injected in the disc space. The study showed six cases of postoperative discitis, all in the placebo group, and three cases were diabetics. All cases were in L4-5 disc space. The frequency of discitis was 6/150. In gentamycin group, the frequency was 0%; while in the placebo group, it was 8%. It was concluded that the intraoperative prophylaxis with gentamycin is effective in the prevention of postoperative discitis

Leeds procedure--a treatment modality for scoliosis.

The present study comprises of forty patients of scoliosis in growing age group (10-25 years) with Cobbs angles ranging from 52"-98". They were treated with Leeds procedure which is by anterior loosening followed by Posterior Harrington fixation + Luque derotation + Fusion and Costoplasty. Majority of the curves were thoracic (60%), and right sided (72%). Average correction of the deformity after surgery was 45%. Satisfaction level of patients and parents was good in 60% of the cases. The modality of treatment was decided on the basis of personality of each case, its demand and requirement, time of presentation and the potential for increasing severity. Anterior spinal surgery for scoliosis is an effective procedure in hands of experienced surgeons and it reduces stiffness of the curve, shorten the anterior column, decreases thoracic lordosis which leads to some improvement of pulmonary function. But there is greater risk of damage to vital structures with higher risks of cardiorespiratory failure. The potential risks have to be balanced with the expected rewards. The optimum method of correction has to be decided by careful preoperative evaluation. Combined procedure of anterior and posterior surgery causes lesser decrease in pulmonary functions than costoplasty alone, and achieving better cosmetic correction. This study reaffirms the role of anterior spinal surgery in India as the patients due to lower levels of health awareness present late and with severe deformities.

RM en columna lumbar operada: utilidad de la técnica Flair para diferenciar hernia discal de fibrosis epidural / MRI in differentiation between recurrent disk herniation and postoperative scar: value of Flair sequences

El diagnóstico diferencial entre fibrosis epidural y hernias de disco recurrentes o residuales en pacientes sintomáticos operados de hernias discales es muchas veces dificultoso. La RM con secuencias de Spin Echo T1 antes y después de administrar gadolinio cumple un importante rol para diferenciar éstas dos entidades. Las características de la señal en secuencias T1 y T2 no son fiables para distinguir entre hernia y cicatriz. A fin de evaluar la utilidad de la técnica flair en la diferenciación entre hernia discal y fibrosis epidural estudiamos con RM 37 pacientes sintomáticos operados de hernias discales en secuencias TSE-T2 en cortes sagitales, flair en cortes axiales y SE-T1 en cortes sagitales y axiales antes y después de administrar gadolinio. Los hallazgos fueron posteriormente cotejados con los cortes axiales en SE-T1 luego de administrar contraste. esta secuencia se utilizó como gold standard para el diagnóstico definitivo. Concluimos que la técnica flair es una alternativa válida para el diagnóstico diferencial entre fibrosis epidural y hernia discal

Prevention of post surgical peridural fibrosis using new anti-adhesion barrier gel

A prospective study was done on 40 patients [20 as controls and 20 for which Adcon-L was used]. All patients undergone first time unilateral, single level lumbar discectomy in a trial to evaluate the safety and effectiveness of Adcon-L as an adjunct to surgery to inhibit peridural scar and related symptoms following lumbar discectomy. Patients were followed up and evaluated six months postoperatively both clinically and by MRI. Radicular pain was recorded using a [0-10] standardized visual analog scale in which 0 = no pain and 10 = excuriating pain. Scar was scored on 0-4 scale on MRI, in which 0 = no scar and 4 = more than 75% of the MRI field containing scar. The results were promising as there was an increase in the number of patients with minimal or no scar by 250% increase. The number of patients having extensive scar was reduced in Adcon group by 83.3%. No major complications were encountered

Cirugía fallida del disco intervertebral lumbar: etiología / Ethiology of the lumbar intervertebral disc failed surgery

Se revisaron todos los pacientes operados de disquectomía en nuestro departamento de enero de 1991 a diciembre de 1992 para investigar los casos de recurrencia del síndrome doloroso lumbar irradiado. En el periodo señalado se operaron 182 pacientes por hernia de disco intervertebral lumbar, de los cuales 21 requirieron cirugía de revisión (11.6 por ciento) y se consideraron como casos de cirugía lumbar fallida. De estos 21 casos, las causas de fracaso fueron: fibrosis post-quirúrgica en 10 casos (47.6 por ciento), inestabilidad post-quirúrgica en siete (38 por ciento), fístula de líquido cefalorraquídeo en dos (9.5 por ciento), hernia de disco a otro nivel en un caso (4.7 por ciento) y finalmente infección de la herida en otro (4.7 por ciento). Se concluye que debe agotarse el tratamiento conservador antes de indicar cirugía del disco intervertebral, evitar en lo posible el tratamiento quirúrgico y en su caso disminuir la cantidad de resección de disco y liberar ampliamente la raíz afectada. Se considera igualmente indispensable el buen entrenamiento quirúrgico