Percutaneous laser disc nucleotomy.

In September 1988, the first laser decompression of a symptomatic contained bulging disc was performed in the United States. This author participated in a case study of 333 patients treated with the neodymium (Nd)-impregnated yttrium aluminum garnet (YAG) laser of 1064-nm wavelength. He also treated 117 patients with the potassium titanyl phosphate (KTP) laser of 532-nm wavelength. Detailed surgical techniques and followup statistics of the 117 patients treated with the KTP laser are presented and compared with those of a subset of 36 of the 333 patients treated with the Nd:YAG laser. Of the 117 patients treated with the KTP laser, 23 patients were at the 2-year followup, and 46 patients at the 1-year followup, at the time of this writing. A statistically significant reduction in overall average patient pain was documented by disc level as a function of followup duration. Variation in average specific neurologic findings (knee jerk, reflex, toe strength, ankle jerk, pinprick, and Lasague's sign) by disc level as a function of followup duration was not significant. These procedures were accomplished with no major complications. The success rate based on a 2-year followup was 72%. The success rate with the Nd:YAG laser was very similar, at 70%. These data provide encouraging information substantiating the validity of laser surgery for percutaneous disc nucleotomy.

Tibial tubercle transfer: a long-range follow-up study.

The prime indications for tibial tubercle transfer are 2 or more complete patellar dislocations with trivial trauma or recurrent subluxation with or without pain causing "giving way." A high "Q" angle, flat lateral condyle, aplastic patella or positive apprehension test may be associated but are not always prime indications in surgery. Methods of fixation are of individual preference in this series and a single screw sufficed. An arthrotomy is not always necessary but is suggested if indicated. If the proximal tibial epiphysis is open, corrective measures are suggested that do not involve the extension of the proximal tibial epiphysis into the tibial tubercle. The tubercle should be advanced to compensate for patella alta and lined up with the femoral shaft. Transplantation of the tubercle medially 3/4'' and distally 1/2'' was generally satisfactory in a series of 377 operations with an average follow up of 3 1/2 years.

Congenital pseudarthrosis of the tibia: successful one stage transposition of the fibula into the distal tibia. A case report.

An infant male presented at age 17 months with an established pseudarthrosis in a kyphoscoliotic right tibia. During the ensuing 6 years, three unsuccessful McFarland bypass bone grafts were performed. Then the distal end of the proximal fibula was placed into the medullary cavity of the proximal end of the distal tibia without disturbing the proximal portion of the fibula. This was augmented by autogenous bone graft. Union occurred in one year. The child has been followed for 7 years and the pseudarthrosis remains healed.