RESUMEN
Intraoperative somatosensory-evoked potential (SSEP) data were collected prospectively in a consecutive series of patients with an acute lumbar herniated nucleus pulposus (HNP). Each patient underwent an open limited diskectomy, hemilaminotomy, and partial foraminotomy. The sequence of diskectomy and bony decompression was randomized, and the extent of foraminotomy was standardized. SSEP data were recorded after each operative procedure and were coded for blind interpretation. SSEP tracings were compared with each patient's baseline for changes in latency and amplitude. In the overall study, changes in amplitude and latency produced by diskectomy versus bony decompression were not statistically significant. In the six patients with lateral recess stenosis (LRS), a statistically significant reduction in latency was observed after bony decompression (averaging -2.05 ms) compared with diskectomy (-0.62 ms). In patients with underlying LRS and a HNP, minimally invasive techniques addressing the disc only may be inadequate to decompress a lumbar nerve root.
Asunto(s)
Potenciales Evocados Somatosensoriales , Región Lumbosacra/inervación , Síndromes de Compresión Nerviosa/cirugía , Raíces Nerviosas Espinales/cirugía , Adolescente , Adulto , Anciano , Discectomía , Femenino , Humanos , Disco Intervertebral/cirugía , Periodo Intraoperatorio , Vértebras Lumbares/fisiopatología , Vértebras Lumbares/cirugía , Región Lumbosacra/fisiopatología , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/fisiopatologíaRESUMEN
A prospective study was undertaken to determine the cost effectiveness of the screening ultrasound examination during the annual check-up of persons with spinal cord injury (SCI). Fifty-two patients, who were otherwise free of illness at the time of examination, were questioned for a history of genitourinary (GU) symptoms and evaluated with a plain film KUB, 24-hour creatinine clearance determination, and renal ultrasound. In those 36 patients without histories of GU symptoms, renal ultrasound alone discovered no treatable pathology. Of the 16 patients with histories of GU symptoms, renal ultrasound did show treatable disease in 13%. Effectiveness of the annual SCI follow-up may be maintained in the demonstration of treatable disease by the selective use of renal sonography only in those patients with histories of GU symptoms.
