Percutaneous Posterolateral Transforaminal Endoscopic Discectomy: Clinical Outcome, Complications, and Learning Curve Evaluation.

Ongoing technological development combined with better understanding of endoscopic anatomy has made posterolateral endoscopic discectomy an appealing surgical option for the management of herniated lumbar disc. We evaluated clinical outcomes, complication rates, and surgical learning curve with the percutaneous posterolateral transforaminal endoscopic discectomy technique (PPTED). PPTED was performed on 150 patients from 2004 to 2008. And 124 patients were available for follow-up. Data regarding pain, postoperative complications, neurological status, operation time, and subjective patient satisfaction were recorded. A satisfactory clinical outcome as reflected in the VAS (mean 3.6) and ODI improvement (mean 21%) scores was reported; 20.9% of the patients required additional surgery. Learning curve assessment showed a significant difference (p = 0.043) for fewer revision surgeries as surgeons became more experienced. Patients who had endoscopic discectomy as a primary surgery achieved significantly lower VAS (p = 0.04) and ODI improvement (p = 0.004) scores compared with patients having transforaminal endoscopic discectomy as revision surgery. The complication rate was 1.6%, including one case of post-surgery hypoesthesia and one deep wound infection. The percutaneous posterolateral transforaminal endoscopic discectomy technique has a satisfactory clinical outcome with a low complication rate. Results for endoscopic surgery for revision or recurrent disc herniation are comparable to those of open revision surgery; the steep learning curve can be overcome with training and suitable patient selection.

External fixation of the spine: surgical salvage option for complex spinal infections.

The use of external fixation has been described for various conditions but has never become a popular technique in spine surgery. The objective of this study is to describe the successful application of external fixation of the spine in three cases of complex spine infection. The first case is a 51-year-old male with T2-T3 spinal osteomyelitis secondary to Actinomyces lung infection causing epidural abscess and signs of cord compression. Laminectomy and debridement of the epidural abscess was performed, and external fixation was applied percutaneously spanning C7-T5. The second case is an 18-year-old soldier with a gunshot wound to the abdominal cavity with small bowel perforation and fracture of L1 and L2. Retroperitoneal infection developed at this level and was drained percutaneously. External fixation of T10-L4 was performed. The third case is a 60-year-old male who underwent resection of a locally invasive lung tumor at T3. Postoperative CSF leak and widespread infection was noted, mandating debridement and removal of the infected hardware. External fixation of T1-T8 was applied for temporary stabilization. All patients tolerated the procedure well, and rapid ambulation and physical therapy was initiated. Under broad-spectrum antibiotic therapy, resolution of infection was noted in all three cases as well as good sagittal and coronal axis alignment on follow-up imaging. We conclude that external fixation of the spine is a safe and effective surgical technique that can be considered as salvage treatment for spinal infections accompanied by segmental spinal instability.

Results of lumbar disk prosthesis after a follow-up period of 48 months.

BACKGROUND: Damage to the intervertebral disk is usually corrected by means of a prosthesis. OBJECTIVES: To report the outcome of the artificial lumbar disk replacement with the Charité SB III disk prosthesis in 20 patients after a 48 month follow-up. METHODS: The 20 patients were evaluated clinically and radiographically during this period. Preoperative diagnosis included degenerative diskopathy in 17 patients and failed posterior conventional diskectomy in 3. The prosthesis was implanted at one level in 17 patients and bi-level implantation was performed in the other 3 patients. RESULTS: Eighty percent of patients reported satisfactory to very good results. Poor results were reported by four patients, one of whom underwent posterolateral fusion and another is waiting for the same operation. There were two dislocations of the prosthesis followed by immediate revision surgery. CONCLUSIONS: Contraindications for surgery appear to be the principal cause of failure rather than the prosthesis itself.