The effect of endovenous laser ablation on restless legs syndrome.

OBJECTIVES: Venous disease was proposed as a cause of restless legs syndrome (RLS) by Dr Karl A Ekbom in 1944, but has since remained largely unexplored. This study examines the effect of endovenous laser ablation (ELA) in patients with concurrent RLS and duplex-proven superficial venous insufficiency (SVI). METHODS: Thirty-five patients with moderate to very severe RLS (as defined by the 2003 National Institute of Health (NIH) RLS criteria) and duplex-proven SVI completed an international RLS rating scale questionnaire (IRLS) and underwent standard duplex examination to objectively measure the baseline severity of their conditions. They were separated into non-operative and operative cohorts. The operative cohort underwent ELA of refluxing superficial axial veins using the CoolTouch CTEV 1320 nm laser and ultrasound-guided sclerotherapy of the associated varicose veins with foamed sodium tetradecyl sulphate (STS). All patients then completed a follow-up IRLS questionnaire. Baseline and follow-up IRLS scores were compared. RESULTS: Operative correction of the SVI decreased the mean IRLS score by 21.4 points from 26.9 to 5.5, corresponding to an average of 80% improvement in symptoms. A total of 89% of patients enjoyed a decrease in their score of > or =15 points. Fifty-three percent of patients had a follow-up score of < or =5, indicating their symptoms had been largely alleviated and 31% had a follow-up score of zero, indicating a complete relief of RLS symptoms. CONCLUSIONS: ELA of refluxing axial veins with the CTEV 1320 nm laser and foamed STS sclerotherapy of associated varicosities alleviates RLS symptoms in patients with SVI and moderate to very severe RLS. RECOMMENDATIONS: SVI should be ruled-out in all patients with RLS before initiation or continuation of drug therapy.

Survivorship analysis of pedicle spinal instrumentation.

Between 1985 and 1989, the senior author performed 120 consecutive pedicle instrumentation cases--78 Steffee (VSP) procedures and 42 procedures using Cotrel-Dubousset instrumentation. Posterolateral or posterior fusions using autogenous iliac bone graft were performed across the instrumented vertebrae in all cases. Survivorship analysis was used to calculate a predicted cumulative rate of success for this series of patients over 10 years postoperative follow-up. The criteria of failure of pedicular instrumentation or "death" of an implant were defined as 1) screw bending, 2) screw breakage, 3) infection, 4) loosening of implants, 5) any rod or plate hardware problems, or 6) removal of hardware due to a neurologic complication. Out of 526 pedicle screws (175 Cotrel-Dubousset screws, 351 VSP screws) there were 22 problem screws (22/526 = 4.18%). Six screws had bent, none were infected, 16 screws had broken, and none were loose. The 22 problem screw events occurred in 12 patients. In seven patients, the instrumentation failure was an incidental radiographic finding, in that patients had a solid posterolateral fusion. The remaining five patients had screw breakage in association with a pseudarthrosis. Life table calculations predicted the survivorship of instrumentation without complications would be 80% at 10 years postoperative follow-up. Actuarial analysis predicted the survivorship of solid posterolateral fusion at 90% at 10 years follow-up. This survivorship rate is similar to those predicted at 10 years follow-up for other more widely used orthopedic surgical implants such as total hip arthroplasty components.