Preliminary results of a novel pure endoscopic procedure in the treatment of degenerative lumbar spinal disorders: double endoscopic technique.

BACKGROUND: With increased experience and the availability of new technical instrumentations, the surgical endoscopic indications for lumbar spinal pathologies have moved from simple prolapsed disk to canal stenosis. The available endoscopes come in two different sizes (10 mm and 6.3 mm in diameter); however, one is too bulky to use inside the spinal canal and the other is too small to achieve a fast bone decompression. In order to overcome such problems, we developed and used a different surgical technique called: double endoscopic technique. METHODS: Using this approach, we operated and prospectively collected clinical information on 17 patients (Group A) suffering from a mixed (ligament-bone hypertrophy and prolapsed disk) single segmental lumbar canal stenosis. At a median of 13 months from surgery, all the patients in this group had a very good outcome with an improvement of the VAS and ODI. RESULTS: These clinical results were compared with those from another group of patients who had undergone surgery in the same unit but using standard MIS technique (Group B). Both groups were similar in terms of number, age, symptoms and stenosis location. We compared the pre- and postoperative VAS and ODI values, the amount of postoperative pain killers used during the first week postsurgery, the length of in-hospital stays as well as the blood loss during surgery. CONCLUSIONS: Although our aim was only to present a novel surgical endoscopic technique, the results, with all the study limitations including small numbers and short follow-up, have shown that this procedure is safe and effective, yielding an outcome comparable to the standard MIS approach. Furthermore, it is less disruptive towards the involved anatomy, it gives less postoperative pain, it requires a smaller skin incision, and the blood loss is negligible. Thus, this technique may guarantee a faster clinical recovery.

Lumbar microdiscectomy under epidural anaesthesia with the patient in the sitting position: a prospective study.

In a prospective study we compared the surgical outcome, length of hospital stay, complications and patient satisfaction for patients undergoing lumbar microdiscectomy (LM) under spinal anaesthesia (SA) in the sitting position (23 patients) to those of another cohort who underwent LM under general anaesthesia (GA) in the prone or genu-pectoral position during the same time period (238 patients). We aimed to determine: (i) if epidural anaesthesia is safe for lumbar microdiscectomy; and (ii) if placing the patient in a sitting position confers an advantage in performing the operation. For all patients we calculated the time from the end of the operation to the first spontaneous urination and to the first administration of analgesic drugs. Before being discharged, patients were asked to give an opinion on the quality of analgesia obtained by epidural anaesthesia and on the sitting position used. No patient had any complications linked to epidural anaesthesia and only one patient experienced a small dural tear as a surgical complication. Twenty of 23 patients expressed satisfaction with the level of analgesia obtained and only three considered it poor. All patients found the sitting position comfortable. Advantages of the sitting position for surgery include better comfort for the patient, potential to recreate a load condition similar to the one that takes place during orthostasis and a "cleaner" operative field that uses gravity to drain blood. Of greatest concern is the possibility of the patient developing a dural tear and subsequent leaking of cerebrospinal fluid, which could also be a source of surgical complications. Currently, epidural anaesthesia allows a reduction in anaesthetic and surgical times, anaesthetic complications and, consequently, hospitalization period. Further analysis of the sitting position for the patient during surgery is required to fully assess the advantages and disadvantages of this method.

Calvarial tuberculosis as the initial presentation of AIDS.

A rare case of a young immunocompromised patient with calvarial tuberculosis as the first symptom of human immunodeficiency virus-1 positivity is presented and the pertinent literature is reviewed.