Percutaneous laser discectomy: experience and long term follow-up.

The classical microsurgical approach in the treatment of herniated nucleus pulposus (HNP) has been substituted over the years by endoscopical approach, in which it is possible to practice via endoscopy a laser thermo-discoplasty, and by percutaneous laser disc decompression and nucleotomy. Percutaneous laser disc decompression and nucleotomy have been performed worldwide in more than 40,000 cases of HNP. Because water is the major component of the intervertebral disc and in HNP pain is caused by disc protrusion pressing against the nerve root, a 980 nm Diode (Biolitec AG-Germany) laser introduced via a 21-G needle under X-ray or CT-scan guidance and local anesthesia, vaporizes a small amount of the nucleous pulposus shrinking the disc and relieving the pressure on the nerve root. A multicentric retrospective study with a mean follow-up of 6 years was performed on 900 patients suffering from relevant symptoms that had been therapy-resistant for 6 months on average before consulting our department. Evaluation included 585 (65%) males and 315 (35%) females. The average age of patients operated was 46 years (18-54). The success rate at a mean follow-up of 5 years (2-6 years) was about 70% with a very low complication rate.

Percutaneous surgical treatment in lumbar spinal stenosis with Aperius-PercLID: indications, surgical technique and results.

Interspinous spacers have recently been used in the treatment of lumbar spinal stenosis. In vitro studies have demonstrated a reduction in facet joint forces by 68% and annulus pressures by 63%. MRI studies have demonstrated increased canal and neural foraminal area after implantation of these devices. Previous studies by Zucherman et al. (Spine 30:1351-1358, 2005) demonstrated patient satisfaction rates of 71-73%.We carried out a multicentric retrospective study to assess the clinical outcomes following percutaneous posterior decompression using an interspinous spacer device (Aperius™-PercLID™ System; Kyphon-Medtronic). A total of 70 patients were included in the study. All of them had evidence of radiologically and clinically proven lumbar stenosis. The average age was 63.5 years. Patients completed the Zurich Claudication Questionnaire (ZCQ) and recorded pain levels on a Visual Analogue Scale (VAS). Average stay in hospital was 2 days. The average improvement in ZCQ included both symptomatic pain disappearance and functional ambulatory recovery. The average VAS pain score improved from 8.2 to 3.6 (scale of 1 to 10). The overall patient satisfaction rate was 76%. No complications were detected at 6 months' follow-up.

Embryonic development of the posterolateral structures of the knee.

The development of the structures in the posterolateral corner of the knee was studied in fifteen human embryos and seventeen fetuses by means of serial sections in the coronal and sagittal planes. The attachments of the lateral meniscus and fibular head to the popliteal tendon and muscle are formed during the process of cavitation that forms the bursa. The connection between the tendon and the posterior border of the lateral meniscus forms obliquely to follow the direction of the muscle and tendon. The edge of the bursa is limited by attachments that connect the tendon to the lateral meniscus and fibular head. In this study, no direct ligamentous continuity was found to exist between the posterolateral femur and tibia during development. The only ligament that indirectly connects the lateral femur posteriorly to the proximal segment of the tibia, which has never been reported in human development, is the one that links the popliteal tendon to the fibular head. We have designated this the popliteo fibular ligament which was also found in adult specimens. This ligament should not be confused with the arcuate popliteal ligament.