Lumbar disc herniation: evaluation of information on the internet.

STUDY DESIGN: An original study was performed evaluating the information presented on existing web sites for the topic of lumbar disc herniation. OBJECTIVES: The purpose of this study was to evaluate the type and quality of internet information available to patients on the topic of lumbar disc herniation. Our secondary objectives were to rank the identified World Wide Web sites with respect to the caliber of relevant information and to determine the propensity for secondary commercial gain by the web site sponsors. SUMMARY OF BACKGROUND DATA: Two-thirds of the United States population "surfs" the internet. A substantial percentage of internet users search for medical information on the World Wide Web. Because no standards exist regarding the publication of medical literature on the internet, the relevant web sites vary dramatically in terms of content and quality. Misleading or inaccurate information poses a theoretical risk to patients seeking treatment for medical conditions. METHODS.: Five search terms (lumbar disc herniation, herniated nucleus pulposus, herniated disc, slipped disc, and sciatica) were entered into 5 commonly used search engines. The first 25 links displayed by each engine were evaluated for a theoretical total of 625 web sites. Each site was evaluated in terms of content, authorship, and secondary commercial gain. An information quality score of 0 to 25 points was generated for each site; a score of 20 or greater was indicative of "high-quality" content. RESULTS: Our search identified 169 unique web sites of which only 16 (9.5%) scored >or=20 on the information quality score; 103 (60.9%) scored

Posterolateral intertransverse lumbar arthrodesis in the New Zealand White rabbit model: II. Operative technique.

BACKGROUND CONTEXT: Although the New Zealand White (NZW) rabbit model has been increasingly used for spinal fusion research, reported complication rates have been as high as 23%. The substantial animal morbidity and mortality associated with the model makes experimentation inefficient and can lead to faulty data analysis. Operative complications are in part the result of suboptimal execution of the experimental protocol. PURPOSE: To describe an experimental protocol for posterolateral intertransverse lumbar arthrodesis in the NZW rabbit and to analyze the effect of the protocol on the complication rate of this model. STUDY DESIGN/SETTING: This is a descriptive analysis of the surgical technique (and related complications) used for posterolateral spinal arthrodesis in the NZW rabbit model. This study was performed at a university research facility. METHODS: The complications of posterolateral intertransverse lumbar arthrodesis in the NZW rabbit were analyzed before and after instituting a refined experimental protocol. RESULTS: A total of 77 NZW rabbits underwent a posterolateral lumbar arthrodesis. In the first 48 animals (Group A) complications occurred at a rate of 26% and included anesthetic demise, nerve palsies, wound infections or seromas and fusion of the wrong level. After the institution of a refined experimental protocol, there were no complications in a second group of 29 rabbits (Group B). CONCLUSIONS: Adherence to a precise experimental protocol for posterolateral lumbar arthrodesis can minimize complications, thereby enhancing the NZW rabbit as a cost-effective and accurate animal model for spinal fusion research.

Endoscopic gastrocnemius recession: evaluation in a cadaver model.

The purpose of this study was to describe a new method of gastrocnemius recession using an endoscopic approach and to determine the accuracy of incision placement during gastrocnemius recession. Fifteen fresh-frozen cadaveric limbs underwent an endoscopic gastrocnemius recession utilizing a two-portal technique. All limbs were anatomically dissected after the procedure and each was examined for injury to the sural nerve. The ability to visualize the sural nerve intraoperatively, improvement in ankle dorsiflexion, time requirement for the procedure, incision size, and appropriateness of placement to facilitate recession were recorded for each specimen. An average of 83% of the gastrocnemius aponeurosis was transected in all 15 cadavers. After modifications of the technique, the final eight cadavers were noted to have had the entire (100%) gastrocnemius aponeurosis transected. Sural nerve injury occurred in one specimen (7%) in which the aponeurosis and the sural nerve were not well visualized. The sural nerve was definitively visualized during the procedure in 5 of 15 specimens (33%). No Achilles tendon injury was noted in any specimen. There was a mean improvement in ankle dorsiflexion of 20 degrees (range, 10 degrees-30 degrees) during full knee extension. The average length of time to perform the procedure was 20 minutes (range, 10-35 minutes). The average medial and lateral incision lengths used in the two-portal technique were 18 mm (range, 14-22 mm) and 17 mm (range, 12-19 mm), respectively, and the average distance from the midpoint of the medial incision to the level of the gastrocnemius-soleus junction was 26 mm (range, 5-60 mm). These results indicate that a complete gastrocnemius aponeurosis transection may be obtained utilizing a modified endoscopic gastrocnemius recession, but visualization of the sural nerve is poor with possible risk of iatrogenic nerve injury.

Anatomic study of the gastrocnemius-soleus junction and its relationship to the sural nerve.

BACKGROUND: Gastrocnemius recession is performed for equinus contracture of the ankle and as an adjunct treatment for various foot pathologies. Successful release relies on many factors, including a thorough knowledge of the anatomy of the gastrocnemius-soleus junction and its relationship to the sural nerve which may be vulnerable to iatrogenic injury. Neither the average width of the tendon at the gastrocnemius-soleus junction, the anatomy of the sural nerve with respect to the gastrocnemius-soleus junction, nor appropriate landmarks for accurate incision placement at this level to avoid undesirable vertical extension, however, have yet to be acceptably defined. METHODS: Fourteen fresh-frozen cadavers were dissected and the width of the tendon at the gastrocnemius-soleus junction, the distance of the sural nerve from the lateral border of the tendon at this level, the length of the fibula, and the distance from the distal tip of the fibula to the gastrocnemius-soleus junction were measured. RESULTS: The average width of the gastrocnemius-soleus complex at the junction was 58 mm (range, 44-69 mm), the average distance of the sural nerve from the lateral border of the gastrocnemius-soleus complex at the level of the gastrocnemius-soleus junction was 12 mm (range, 7-17 mm), the average percentage of this distance as compared to the entire width of gastrocnemius-soleus junction was 20% (range, 13%-27%), and the ratio of the distance of the gastrocnemius-soleus junction from the distal tip of the fibula divided by the length of the fibula was 0.5 (range, 0.5-0.6). CONCLUSION: These results provide some guidelines as to the approximate size of the gastrocnemius-soleus complex at the site of gastrocnemius recession along with the location of the sural nerve at the musculotendinous junction. Also, the results indicate that the fibula can serve as a reproducible anatomic landmark to enable localization of the gastrocnemius-soleus junction at the time of gastrocnemius recession.