Revisional Percutaneous Full Endoscopic Disc Surgery for Recurrent Herniation of Previous Open Lumbar Discectomy

STUDY DESIGN: A retrospective study. PURPOSE: To determine the feasibility and effectiveness of revisional percutaneous full endoscopic discectomy for recurrent herniation after conventional open disc surgery. OVERVIEW OF THE LITERATURE: Repeated open discectomy with or without fusion has been the most common procedure for recurrent lumbar disc herniation. Percutaneous endoscopic lumbar discectomy for recurrent herniation has been thought of as an impossible procedure. Despite good results with open revisional surgery, major problems may be caused by injuries to the posterior stabilized structures. Our team did revisional full endoscopic lumbar disc surgery on the basis of our experience doing primary full endoscopic disc surgery. METHODS: Between February 2004 and August 2009 a total of 41 patients in our hospital underwent revisional percutaneous endoscopic lumbar discectomy using a YESS endoscopic system and a micro-osteotome (designed by the authors). Indications for surgery were recurrent disc herniation following conventional open discectomy; with compression of the nerve root revealed by Gadolinium-enhanced magnetic resonance imaging; corresponding radiating pain which was not alleviated after conservative management over 6 weeks. Patients with severe neurologic deficits and isolated back pain were excluded. RESULTS: The mean follow-up period was 16 months (range, 13 to 42 months). The visual analog scale for pain in the leg and back showed significant post-treatment improvement (p < 0.001). Based on a modified version of MacNab's criteria, 90.2% showed excellent or good outcomes. There was no measurable blood loss. There were two cases of recurrence of and four cases with complications. CONCLUSIONS: Percutaneous full-endoscopic revisional disc surgery without additional structural damage is feasible and effective in terms of there being less chance of fusion and bleeding. This technique can be an alternative to conventional repeated discectomy.

Comparison of results between conservative treatment and operative treatment for clavicle fractures in adults / 대한정형외과학회잡지

PURPOSE: The conservative treatment in the clavicular fractures is the gold standard. However, we found that there were some complications including angulation of clavicle and shortening of clavicular length, long-period immobilization, and nonunion in conservative treatment. This study was undertaken to evaluate union period, nonunion rate, and clinical results between conservative treatment and surgical treatment in clavicular fractures. MATERIALS AND METHODS: We evaluated 67 clavicular fractures in adults with conservative treatment (42 cases) and operative treatment (25 cases) from 1991 to 1996 and followed up for at least 1 year. RESULTS: Nonunion occurred in 4 cases (9.5%) in conservative treatment and 1 case (4.0%) in operative treatment (p>0.05) . The excellent results were 12 cases (28.6%) in conservative treatment and 12 cases (48.0%) in operative treatment (p>0.05) . CONCLUSION: We concluded that the early surgical treatment of displaced, low contact area of fracture segments of the clavicle fracture with internal fixation, even though not statistically significant, provides clinical results that are superior to those obtained with conservative care in view of early exercise of the shoulder joint, union period, rate of nonunion, correction of angular deformity and cosmetic problem. We thought that it leaves much room for consideration about the early surgical treatment for these fractures.

Avascuar Necrosis of Bone after Kidney Transplantation / 대한정형외과학회잡지

As transplantation for end-stage renal disease has become more common, avascular necrosis has become a major cause of disability after a successful transplantation. We studied the relationship between development of avascular necrosis of bone and the administration and dosage of steroid, cholesterol level and triglyceride level after transplantation in 909 patients who received kidney transplantation from March 1969 until August 1994 at Catholic University, Medical College. These patients were compared against 60 patients who received kidney transplantation and steroid therapy without developing osteonecrosis. Osteonecrosis was observed in 62 of the patients (6.8 per cent) from 3 to 37 months (mean 10) after the transplant operation. The average age was thirty-eight years (range, twenty to sixty-three years). A single bone was involved in 28 patients, while in the rest of the patients there were between two and four different sites. Altogether 109 bones were affected, 102 of them being weight-bearing. The most common sites were the femoral heads, with 32 patients having bilateral involvement. There was no association between the cumulative dosage of prednisone and the development of avascular necrosis. Although the post renal transplant cholesterol and triglyceride level were significantly elevated compared to the pre-renal transplant state, there were no significantly difference between the avascular group and control group.