Percutaneous lumbar discectomy: indications and surgical results in 35 consecutive cases.

Thirty-five patients (27 men and eight women) who met our criteria of case selection for percutaneous lumbar discectomy (PLD) were treated by this method during the period May 1992 to June 1993. Thirty-six spaces, including one man with double disc disease, were decompressed. Patients ranged in age from 14 to 64 years. All patients but one were followed up for a minimum of six months. The operative results, evaluated by a more objective functional grading system, revealed a short-term (two months) success rate of 83% and a mid-term (six months) success rate of 76%. This discrepancy resulted from two recurrences of sciatic symptoms. It indicates that the medical conditions of those who have received PLD are by no means static, but instead may fluctuate. The operative result was similar to that of open discectomy, averaging 81.1% in reported series. Our "functional grading system" reflects these fluctuations quantitatively. With respect to the operative success rate, there was a statistical difference between the very good, good and fair-poor indication groups of patients, as were categorized by our major criteria of indications that included three clinical manifestation criteria and the other three radiographic findings. This result emphasizes the critical role of case selection in the operative success rate. Complications consisted of one disc infection which cleared without sequelae. This study provides an objective means of selecting cases and evaluating surgical results which, in turn, makes the use of this procedure convincing and predictable.

Video thoracoscopic laser sympathectomy for palmar hyperhidrosis.

Palmar hyperhidrosis (PH) is common in Orientals from subtropical areas. Many therapeutic modalities are used in practice, but none has proved to be entirely satisfactory. We have developed a new therapeutic technique by combining a video thoracoscopic system with a surgical laser unit (both waveguide CO2 laser and fibre-optic Nd:YAG laser). The operation was performed under general anaesthesia with alternative one-lung ventilation. With this technique, we are able to identify the sympathetic trunk on the TV screen and confirm its proper level with accurate ablation by intraoperative vasomotor monitoring. Consequently, an adequate sympathectomy can be definitely achieved through laser extirpation. We have successfully treated 300 PH patients with this technique from 1990 to 1992. The ages ranged from six to 63 years with a mean of 26.6. There were 125 males and 175 females. Most patients underwent en bloc ablation of the T2 segment which includes a major part of the T2 ganglion with its adjacent trunk which overlays the T2 rib head. All of them obtained a satisfactory relief of PH except 13 patients. The procedure did not result in a change of vital signs. There was neither obvious injury to lung nor bleeding. No Horner's syndrome was produced. The commonest complication was compensatory hyperhidrosis in various degrees encountered in about half of the cases. Two-thirds of the patients were followed up for more than 12 months and only three had recurrence. Based on our experience, the technique is considered to be a minor and safe procedure and able to achieve a definite and long-lasting therapeutic effect. It causes minimal discomfort and scarring. Particularly, the operation time and hospital stay were markedly shortened in comparison with other conventional open sympathectomy procedures.

Prognostic factors of intraspinal neurilemmoma and meningioma with severe preoperative motor deficits.

A total of 20 cases of intraspinal benign tumors (13 neurilemmomas and seven meningiomas) with severe motor deficits operated on from 1978 to 1991 were reviewed. Motor deficits were graded according to the classification of Cooper and Ebstein. Grade IV represented slight movement of the lower extremities, but no ability to walk or stand; grade V was complete paralysis. There were 16 patients classified as grade IV and four classified as grade V. All patients underwent total excision of the tumor and postoperative physical therapy. After various periods of follow-up, 13 patients could walk independently, five could walk with assistance, one could stand, and one was still restricted to a wheelchair. For the 13 patients who could walk independently, 11 were able to stand within one month after surgery. In contrast, of the seven patients who could not walk independently, only two managed to stand within one month of surgery. Statistically, age, duration of paraplegia and tumor location all had a significant influence on the recovery of motor function. Being able to stand within one month of surgery was predictive of a good recovery.