Interlaminar spacer: a review of its mechanism, application, and efficacy.

BACKGROUND: The management of neurogenic intermittent claudication encompasses myriad modalities, with the use of Interlaminar spacer being among the newer ones. METHODS AND RESULTS: A review of work-to-date on Interlaminar spacer is presented, which was first introduced in November 2005. A multitude of both clinical and radiographic studies among both orthopedists and neurosurgeons embracing its ease of insertion, decreased operative duration and morbidity, and often same-day hospital discharge while obtaining therapeutic benefits seemingly comparable to more traditional decompressive techniques is discussed. It acts via modification of the normal relationships between both soft and hard tissues, and some initial studies have reported patient satisfaction exceeding 70%. CONCLUSIONS: This review will allow the clinician to better understand Interlaminar spacer's indications in the context of current literature and, moreover, help one determine when its insertion is most likely to produce symptom relief. Although never directly compared against traditional decompression, there is evidence based on standard outcome reporting instruments that it can offer therapeutic efficacy at least comparable to its proven operative predecessors. More recent work examining its long-term patient outcomes has begun to reveal its shortcomings as well as the urgency of further studying its efficacy. Clinicians should consider its insertion with cautious enthusiasm, especially considering some of its recently published poor patient outcomes and the newer interspinous devices on the horizon.

Role of nitric oxide in skin flap delay.

Surgical delay of skin flaps before transfer is known to improve flap viability. This study attempts to elucidate the mechanism of vasodilation by exploring the effects of nitric oxide on the microcirculation of delayed skin flaps. Using a skin flap model in 22 CD-1 white mice, the diameter of two nonterminal choke arteries was measured using in vivo videomicroscopy. Vessel flow was also measured using an optical Doppler velocimeter. Similar measurements were recorded in several animals on the same vessels in which subcutaneous dissection without elevation was performed. Average vessel diameter ranged from 21.77 to 25.55 microm before skin flap delay. Average flow ranged from 1.72 to 2.44 nl/sec before delay. Next, each animal received an intraperitoneal dose of nitro-aminomethyl-1-arginine (L-NAME), a nitric oxide synthase inhibitor delivered by means of osmotic pump at a level of 0 (n = 13 arteries), 20 (n = 10), 50 (n = 8), or 100 mg/kg/day (n = 7). Flaps were re-elevated 72 hours later and the aforementioned measurements were repeated. Vessel diameter increased to 44.92 microm in the control (0 mg/kg L-NAME) animals. Flow increased to 7.66 nl/sec in the control animals. Vessel dilation and flow did not change significantly in the nonoperative vessels. As the dose of L-NAME increased in the treated animals, there was a significant decrease in vasodilation and flow (p = 0.015 and p = 0.03, respectively). The authors' results demonstrate that nitric oxide is an important element of vasodilation and contributor to the phenomenon of skin flap delay.

Velopharyngoplasty and tonsillectomy: whether to perform them simultaneously.

Velopharyngoplasty (VPP) and tonsillectomy (TE) have been used for the surgical correction of velopharyngeal incompetence (VI) and its associated speech impairments, which include rhinolalia, rhinophonia, and nasal snorting. Performing the procedures together during the same operative session has been shown, on a limited basis, to offer some benefits to the primarily juvenile patient population. The authors report the findings noted from the performance of this operation during the past 14 years.