Two Portal Percutaneous Endoscopic Decompression for Lumbar Spinal Stenosis: Preliminary Study.

STUDY DESIGN: Retrospective. PURPOSE: To report the outcomes of patients with lumbar spinal stenosis treated with percutaneous endoscopic decompression, focusing on the results of clinical evaluations. OVERVIEW OF LITERATURE: There are no studies about two portal percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis. METHODS: Medical and surgical complications were examined and clinical results were analyzed for 30 patients who consecutively underwent two portal percutaneous endoscopic decompression for lumbar spinal stenosis were reviewed. The operations were performed by unilateral laminotomy for bilateral decompression. RESULTS: All patients displayed clinical improvement when were evaluated with visual analog scale (VAS) score of pain, Oswestry disability index (ODI) and Macnab criteria. The improvement of VAS and ODI was 8.3±0.7 to 2.3±2.6 and 65.2±13.7 to 24.0±15.5, respectively (both p<0.05). Complications were the same as for open decompression. The most common complication was transient nerve root paresthesia. CONCLUSIONS: Surgical decompression with two portal percutaneous endoscopic decompression has initial benefits, but long-term studies should pay more attention to the risks of postoperative instability and restenosis as well as the need for re-operation. Further investigations with long-term results are thus required.

Open tennis elbow release surgery (in chronic case).

OBJECTIVE: To assess the results of open tennis elbow surgery in patients whom the elbow had failure after conservative treatment. MATERIAL AND METHOD: Retrospective analysis of 22 patients underwent tennis elbow surgery at the HRH Princess Maha Chakri Sirindhorn Medical center during the period from January 2003 to December 2010. Age, sex, duration of symptom, pain score and complications were included in analysis. Patients were asked to rate their pain on a 0-10 visual analogue pain scale (VAS). Grip strength of both hands was measured with a digital hand dynamometer Measurements were made with the elbow fully extended and the average of two measurements was recorded as the strength. RESULTS: The mean visual analogue pain score at one month fell from 6.7 (5.0-8.6) to 2.1 (1.0-3.4) (p < 0.05). When the grip strengths were measured, the increases that occurred at one month, two months and six months postoperative were significant (p < 0.05). One superficial wound infection was found which responded to oral antibiotics. CONCLUSION: The release of tennis elbow (failure after conservative treatment) is an effective procedure with low rate of complications.

Percutaneous trigger thumb release with 18 guage needle.

OBJECTIVE: The aim of the present study was to determine the clinical results and safety of percutaneous release in trigger thumbs. MATERIAL AND METHOD: Forty-five thumbs of 43 patients were percutaneous released under local anesthesia. Pain score were calculated in the preoperative and postoperative periods. RESULTS: Forty-three thumbs was successful release. Two thumbs had signs of discomfort and triggering because of incomplete release. These patients underwent open release. Superficial tendon lacerations were seen during these open procedures. There were no wound complications or signs of digital nerve or artery injury in any of the patients. The preoperative mean VAS was 30.6 (20-36). This decreased to 3.5 (0-5) at the first postoperative month (p < 0.05) and to 2.1 (0-3; p < 0.05) at the second month. When the VAS scores at the first and second months were compared, the difference was statistically significant. CONCLUSION: Percutaneous release of trigger thumbs is a cheap, safe and effective procedure with a low rate of complications.

The results of ankle arthrodesis with screws for end stage ankle arthrosis.

Aim of this study was to evaluate the results of ankle arthrodesis with screws in patients with ankle arthrosis. The author studied 19 patients (20 feet) who had been treated by ankle arthrodesis with screws from 2003 to 2008. Ten patients were men (11 feet) and nine (9 feet) were women. Their mean age was 56 years (30 to 65), and the average duration of follow-up was four years (2 to 6). Two compression screws were used in all feet. Union was achieved in 19 of the 20 feet (95%). Average scores for pain and clinical condition are increase after operation. One re-operation was performed for nonunion. Author conclude that ankle arthrodesis with screws was effective treatment for ankle arthrosis.

Plantar fascia release and calcaneal spur excision for sub-calcaneal heel pain.

Aim of this study was to evaluate the results of open plantar fascia release and calcaneal spur excision in patients with plantar fasciitis. The author studied retrospectively the results in 16 patients who had been treated with open plantar fascia release and calcaneal spur excision from 2002 to 2008. Two patients were men and fourteen were women. Their mean age was 43.3 years (39 to 52). Based on visual analog scale the results were pain free in 12 feet and some pain in four. There are two patients with superficial skin infection which can be manage with local wound care and oral antibiotic. We conclude that open plantar fascia release and calcaneal spur excision can relieve pain in patients who resist conservative treatment.

Infantile hip arthroscopy: the relationship between neurovascular anatomy and the portal pathway.

OBJECTIVE: In the past, studies of hip arthroscopy portal path relate with extra-articular structures were done in adults. This study was investigated in the infantile group. MATERIAL AND METHOD: 10 hips of fresh infantile cadavers. K-wire diameter 2.4 mm. are representing scope pathway. Three portals (anterior, anterolateral and posterolateral) in supine position without traction were chose to used in this study. RESULTS: One cadaver was female and four were male. The mean age and weight when death occurred was 74 days and the mean weight was 3584.4 gm. At the anterior portal, the most lateral branch of LFCN was frequently injured. The average distant of femoral nerve to the K-wire was 11.2 (7-14) mm. Transverse branch of lateral femoral circumflex artery had an average distant 8.5(6-14) mm and the terminal branch could be identified in four hip and average distance was 1 mm. At the anterolateral portal two, greater trochanter were injured by K-wire. In the posterolateral portal the average distant from K-wire to sciatic nerve was 13.2 mm. CONCLUSION: From this pilot study, the distance of major neurovascular structure as related to hip scope path is nearly a centimeter on average.