mild Interlaminar decompression for the treatment of lumbar spinal stenosis: procedure description and case series with 1-year follow-up.

OBJECTIVES: mild interlaminar decompression is a minimally invasive procedure for the treatment of patients with symptomatic lumbar spinal stenosis. This report describes the mild procedure and presents 1-year clinical outcomes of patients treated with mild. METHODS: mild treats lumbar spinal stenosis by removing portions of the lamina and ligamentum flavum to restore space in the lumbar spine. The procedure is conducted under fluoroscopic guidance, and is performed with moderate sedation. One-year follow-up was obtained for 17 patients treated with the mild procedure. Clinical evaluations were conducted at baseline and at 1-year follow-up with the 10-point Visual Analog Score and Oswestry Disability Index. RESULTS: mild treatments were completed with no major device-related or procedure-related complications. The baseline mean Visual Analog Score of 7.6 improved at 1 year after the procedure to 2.3, a decrease of 5.4 cm points, or an average percentage decrease of 70.0%. Average baseline Oswestry Disability Index of 48.4 improved to 21.7 at 1 year, an improvement of 26.6 points. DISCUSSION: The mild technique provides an attractive early option for the treatment of symptomatic lumbar spinal stenosis after failed injection therapy, but before more invasive surgical treatment. For 17 patients with 1-year follow-up, the mild procedure provided significant pain relief and increased mobility. This procedure leaves no implants behind, and therefore does not limit subsequent, more invasive procedures that require implants.

Comparative evaluation of noninvasive compression adjuncts for hemostasis in percutaneous arterial, venous, and arteriovenous dialysis access procedures.

PURPOSE: To assess the relative efficacy of three compression adjuncts -- D-Stat Dry (D-Stat), QR Powder (QR), and XS Powder (XS) -- for reducing time to hemostasis in patients who underwent diagnostic and interventional percutaneous procedures. MATERIALS AND METHODS: D-Stat, QR, or XS was applied in 176 percutaneous diagnostic arterial, therapeutic arterial, venous, and arteriovenous dialysis access (AVDA) procedures in 138 patients. The mean time to hemostasis and application-related complications were retrospectively assessed. RESULTS: Mean time to hemostasis was significantly reduced in all applications of QR (3.1 minutes +/- 1.1) and XS (3.7 minutes +/- 1.1) relative to D-Stat (6.2 minutes +/- 1.1, P < .001 vs both). For therapeutic arterial procedures, mean time to hemostasis for QR and XS was 3.6 minutes +/- 1.1 and 4.8 minutes +/- 1.1, respectively, and this was significantly less than that of D-Stat (10.0 minutes +/- 1.2; P < .001 vs QR, P < .01 vs XS). Mean times to hemostasis for QR and XS were also shorter than that with D-Stat in diagnostic arterial and AVDA procedures (P < .05). For venous procedures, mean time to hemostasis for QR (1.9 minutes +/- 1.2) was significantly shorter than that with both D-Stat (4.0 minutes +/- 1.2, P < .05) and XS (3.7 minutes +/- 1.2, P < .05). Minor immediate complications (hematoma <5 cm) occurred in 2.8% of applications. No access site infections were observed. CONCLUSIONS: All three agents effectively reduced time to hemostasis with minimal associated complications. QR was found to be more effective than D-Stat in all four procedure types.

Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures.

Vertebral body compression fractures can cause chronic pain and may result in progressive kyphosis. Although vertebroplasty has been used to treat pain, it does not attempt to restore vertebral body height and eliminate spinal deformity. Percutaneous balloon kyphoplasty is a novel technique, which involves the introduction of inflatable bone tamps into the fractured vertebral body for elevation of the endplates, prior to fixation of the fracture with bone cement. Our initial experience with this minimally invasive procedure indicates that percutaneous balloon kyphoplasty can be efficacious in the treatment of painful, osteoporotic vertebral compression fractures.