RESUMO
The lumbar shield is a silicone implant designed to prevent postoperative perineural adhesions, indicate a recurrent intervertebral disc rupture, facilitate further surgery at that level, and aid in the postoperative management of the patient. Over three years it has been implanted in 123 experimental patients. There are 83 control patients. Statistical analysis of the results indicates that for the first three months, those patients with the lumbar shield had less postoperative pain. The diagnosis of a recurrent lumbar disc rupture on lateral lumbar spine radiographs is illustrated. The ease of secondary surgery for a recurrent lumbar disc rupture is emphasized. The value of the lumbar shield in postoperative management is discussed, especially in the workmen's compensation/medicolegal groups. One conclusion is that the frequency of multiple secondary surgical procedures on patients with unsatisfactory initial results could be reduced by the use of the lumbar shield.
Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Equipamentos Ortopédicos , Complicações Pós-Operatórias/prevenção & controle , Elastômeros de Silicone , Adulto , Cicatriz/prevenção & controle , Humanos , Perna (Membro) , Vértebras Lombares , Dor/cirurgia , Cuidados Pós-Operatórios , Recidiva , Aderências Teciduais , Indenização aos TrabalhadoresRESUMO
A thirty-two-year-old male developed multiple neurologic symptoms. Medical evaluation disclosed hypertension, obesity, and a type IV hyperlipoprotein electrophoresis. A nuclear cerebral arteriogram showed reduced flow in the right middle cerebral artery. Arteriographic examination revealed an occlusion at the origin of this artery. The ipsilateral superficial temporal artery was too small to be used in an EC-IC bypass procedure. To correct these conditions, a two-stage procedure was performed. First, an arteriovenous fistula was created between the superficial temporal artery and its accompanying vein. Second, four and one-half months later, the temporal vein, which had by then enlarged, was resected and grafted from the proximal superficial temporal artery to the right angular artery. Angiography three months after the latter procedure showed that the anastomosis was patent.
Assuntos
Anastomose Arteriovenosa , Isquemia Encefálica/cirurgia , Revascularização Cerebral/métodos , Veias Cerebrais , Couro Cabeludo/cirurgia , Artérias Temporais/cirurgia , Adulto , Veias Cerebrais/cirurgia , Veias Cerebrais/transplante , Seguimentos , Humanos , Masculino , Couro Cabeludo/irrigação sanguíneaRESUMO
Postoperative perineural adhesions between the lumbar nerve root and the partially removed intervertebral disc are thought to be a cause of failure of the standard operative procedure for the removal of a ruptured lumbar intervertebral disc. Attempts have been made to reduce postoperative perineural adhesions by the use of epidural muscle, fat, gelatin sponge, silicone, and steroids. The present communication introduces a new implantable silicone device, a lumbar shield, designed to: (a) provide a radiopaque marker on the dorsal perimeter of the excavated lumbar disc so that the presence or absence of a recurrent disc herniation can easily be determined on plain postoperative x-ray films, (b) provide ready access to the operative site in the event of a recurrent disc herniation, (c) prevent postoperative perineural adhesions between the lumbar dura and the nerve root and the partially removed intervertebral disc, and (d) prevent postoperative adhesions between the lumbar dura and the nerve root and the paraspinal muscles. Satisfactory results of lumbar disc surgery over the past 44 years have occurred in about 90% of routine patients. The value of the lumbar shield in 82 patients (59 routine and 23 workmen's compensation/medicolegal patients) followed for 6 months is described. A satisfactory result, i.e., relief of pain or the presence of occasional postoperative pain, occurred in 85% of routine patients at 1 month, 97% at 3 months, and 95% at 6 months.
