scholarly journals Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road

2019 ◽  
Vol 81 (01) ◽  
pp. 017-027
Author(s):  
Michael Bender ◽  
Carolin Gramsch ◽  
Lukas Herrmann ◽  
Seong Woong Kim ◽  
Eberhard Uhl ◽  
...  
Keyword(s):  
Blood Loss ◽  
Pain Score ◽  
Hospital Setting ◽  
University Hospital ◽  
Disk Herniation ◽  
Training Requirements ◽  
Lumbar Disk ◽  
Duration Of Surgery ◽  
Lumbar Disk Herniations

Abstract Objective Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting. Methods One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique. Results Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4–L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02). Conclusions The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

Biportal Endoscopic Lumbar Decompression for Lumbar Disk Herniation and Spinal Canal Stenosis: A Technical Note

2016 ◽  
Vol 78 (04) ◽  
pp. 390-396 ◽  
Author(s):  
Jin Eum ◽  
Sang Lee ◽  
Luigi Sabal ◽  
Sang Eun
Keyword(s):  
Spinal Canal ◽  
Technical Note ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Lumbar Decompression ◽  
Canal Stenosis ◽  
Lumbar Disk Herniations ◽  
Lumbar Spinal

Background and Study Aims Endoscopic lumbar diskectomy through the interlaminar window is gaining recognition. Most of the literature describes these endoscopic procedures using specialized uniportal multichannel endoscopes. However, a single portal limits the motion of the instruments and obscures visualization of the operating field. To overcome this limitation, we propose a new technique that utilizes two portals to access the spinal canal. The biportal endoscopic lumbar decompression (BELD) technique uses two portals to treat difficult lumbar disk herniations and also lumbar spinal stenoses. Patients and Methods Seventeen patients were treated with BELD for 11 lumbar disk herniations and 6 lumbar spinal stenoses. Preoperative back and leg visual analog scale (VAS-B and VAS-L, respectively) scores and the Oswestry Disability Index (ODI) were recorded and compared with corresponding values on final follow-up. Results There was an average follow-up of 14 months. For the disk herniation group, preoperative VAS-L (7.8750 ± 1.24) and ODI (51.73 ± 18.57) was significantly different from follow-up postoperative VAS-L (0.87 ± 0.64, p = 0.000) and ODI (9.37 ± 4.83, p = 0.001). For the stenosis group, preoperative VAS-B (6.17 ± 1.94), VAS-L(7.83 ± 1.47), and ODI (63.27 ± 7.67) were significantly different from follow-up postoperative values (2.5 ± 1.04, p = 0.022; 2.00 ± 1.67, p = 0.001; 24.00 ± 6.45, p = 0.000, respectively). One patient underwent revision microdiskectomy for incomplete decompression. Conclusions BELD can achieve a similar decompression effect as microdiskectomy and unilateral laminotomy for bilateral decompression with a smaller incision than tubular diskectomy.

Application of a Targeted and Quantificational Foraminoplasty Device in Percutaneous  Transforaminal Endoscopic Discectomy for L5-S1 Disc Herniation: Preliminary Clinical Outcomes

2021 ◽  
Author(s):  
Jinlong Liu ◽  
Junlong wu ◽  
Honglei Zhang ◽  
Rui Zuo ◽  
Jiabin Liu ◽  
...  
Keyword(s):  
Leg Pain ◽  
Fluoroscopy Time ◽  
Low Back ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Vas Score ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disk herniation(LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5-S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSY at the L5-S1 level.MethodsBetween January to August of 2018, Fifty-six patients with lumbar disk herniation at the single level of L5–S1 and underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the the TESSYS group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time and fluoroscopy time evaluated for the operation efficiency. Clinical outcomes were assessed by visual analog scale(VAS) score and Oswestry Disability Index(ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.ResultsThe average puncture time (5.29±2.05 minutes), foraminoplasty time (12.82±2.52 minutes) and fluoroscopy time (26.29±5.96 seconds) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07±3.13 minutes, p<0.01; foraminoplasty time, 17.18±2.92 minutes, p<0.01; fluoroscopy time, 34.73±6.86 seconds; p<0.01). No significant differences were observed between the 2 groups in the decompression time (p=0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoprative , in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).ConclusionThe targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disk herniation at the L5-S1 level.

scholarly journals Polyethylene glycol-coated collagen patch (hemopatch®) in open partial nephrectomy

2021 ◽  
Author(s):  
Michael Staehler ◽  
S. Rodler ◽  
M. Schott ◽  
J. Casuscelli ◽  
C. Stief ◽  
...  
Keyword(s):  
Renal Function ◽  
Polyethylene Glycol ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Low Complexity ◽  
High Complexity ◽  
Open Partial Nephrectomy ◽  
Duration Of Surgery ◽  
Coated Collagen

Abstract Purpose To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). Results Median age was 65.2 years (range 12.7–95.2) with median follow-up of 9.43 months (0.03–49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38–143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75–167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1–38 cm) in CPN with 4.8 cm (range 3.8–18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). Conclusions Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.

scholarly journals Effect of Patients' Education on Their Performance and Outcomes Regarding Lumbar Disk Herniation

2019 ◽  
Vol 1 (2) ◽  
pp. 9
Author(s):  
Heba A. Ali ◽  
Safaa M. Hamed
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Program Implementation ◽  
Lumbar Disc ◽  
Structured Interview ◽  
Statistical Correlation ◽  
University Hospital ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk

Context: Lumbar disc herniation is a common condition in adults and can impose a heavy burden on both the individual and society.Aim: The present study aimed to evaluate the effect of patients' education on their performance and outcomes regarding lumbar disk herniation.Methods: Quasi-experimental design used to achieve aim in this study. The study conducted at the orthopedic outpatient clinic at Benha University Hospital. Purposive sample of 60 patients of both genders who aged from (18-60 years old) included in the study. Patients who were attending surgical operation regarding lumbar disk herniation excluded. Three tools used to collect the study data. These are structured interview questionnaire regarding the patients' demographic characteristics, medical data, and patient's knowledge regarding lumbar disk herniation, observational checklist for patient's practice regarding lumbar disk herniation exercises, and modified Oswestry low back pain & disability scaleResult: There was a statistically significant improvement in the total level of patient's knowledge, practices & outcomes immediately post and three months post-program implementation. Also, there was a significant statistical correlation between patients' knowledge and pain disability scale three months post-program implementation.Conclusion: The results of the study conclude that the educational program was effective and resulted in a significant improvement in patient's knowledge, practice, and outcomes regarding lumbar disk herniation. The study suggested equips the orthopedic department with simple illustrated guidelines protocol covering lumbar disc herniation practices, knowledge; reapply this research on a more substantial probability sample acquired from different geographical areas in Egypt for generalization.

Incidence of Vitamin Deficiency after Laparoscopic Roux-en-Y Gastric Bypass in a University Hospital Setting

2006 ◽  
Vol 72 (12) ◽  
pp. 1196-1204 ◽  
Author(s):  
Ronald H. Clements ◽  
Venkata G. Katasani ◽  
Rajendra Palepu ◽  
Ruth R. Leeth ◽  
Teresa D. Leath ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Vitamin C ◽  
Hospital Setting ◽  
Vitamin Deficiency ◽  
Water Soluble ◽  
University Hospital ◽  
Vitamin B ◽  
Vitamin Deficiencies ◽  
Black Patients

Vitamin deficiency after gastric bypass surgery is a known complication. The purpose of this study was to measure the incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. All patients who underwent laparoscopic Roux-en-Y gastric bypass from January 2002 to December 2004 and completed a 1- and 2-year follow-up after surgery were selected. Of the total 493 patients, 318 (65%) had vitamin results at 1-year follow-up. Of the 366 eligible for the 2-year follow-up, 141 (39%) had vitamin results. Patients were further grouped based on gender, race, and Roux limb length, and incidence of vitamin deficiencies were studied. The incidence of vitamin A (retinol) deficiency was 11 per cent, vitamin C was 34.6 per cent, vitamin D25OH was 7 per cent, vitamin B1 was 18.3 per cent, vitamin B2 was 13.6 per cent, vitamin B6 was 17.6 per cent, and vitamin B12 was 3.6 per cent 12 months after surgery. There was no statistical difference in the incidence of vitamin deficiencies between 1 and 2 years. In univariate and multivariate logistic regression of 1- and 2-year follow up, black patients (vitamins A, D, and B1 for 1 year and B1 and B6 for 2 years) and women (vitamin C at 1 year) were more likely to have vitamin deficiencies. Vitamin deficiencies after laparoscopic Roux-en-Y gastric bypass are more common and involve more vitamins, even those that are water soluble, than previously appreciated. Black patients tend to have more deficiencies than other groups. The bariatric surgeon should be committed to the long-term follow-up and care of these patients. Further prospective and randomized studies are necessary to provide appropriate guidelines for supplementation.

scholarly journals POST-HERETIC NEURALGIA

2016 ◽  
Vol 23 (01) ◽  
pp. 056-059
Author(s):  
Sadaf Ahmed Asim ◽  
Humaira Maryum Agha ◽  
Qamar-un -Nisa ◽  
Muhammad Masroor
Keyword(s):  
Pain Score ◽  
University Hospital ◽  
Test Results ◽  
Post Herpetic Neuralgia ◽  
Duration Of Symptoms ◽  
Local Infiltration ◽  
Long Term Follow Up ◽  
The Mean

Objectives: To assess the efficacy of intra-lesional triamcinolone in for thetreatment of Post Herpetic Neuralgia. Study Design: Prospective interventional study. Setting:Dermatology Department of Dow University Hospital. Period: July 2014 to June 2015. Patientsand Methods: Twenty nine patients with diagnosis of Post Herpetic Neuralgia were includedafter taking written and informed consent. An insulin syringe was used for the injections andthe medicines were injected intralesionally. The mixture contained 30/70% of triamcinolone toxylocaine ratio for local infiltration in post herpetic scars. Pain relief assessment was done withthe help of visual analogue scale (VAS) after two months. Mean pain score before therapy andafter therapy was compared with one sample student t test. Results: Out of total 29 patients 14were male and 15 were females. The mean age ±SD was found to be 45.9± 15.4 years. Themost common region involved was Chest. The mean ±SD duration of Symptoms was 5.58 ±1.80 weeks. The mean pain score before therapy was 6.86 ± 1.66 which after one month oftherapy reduced to 3.72 ± 1.86. The reduction in pain was statistically significant (p<0.001).Conclusion: Post Herpetic Neuralgia can be effectively treated by the local infiltration of amixture of triamcinolone and lignocaine. It is recommended that long-term follow-up studiesshould be done with corticosteroids only or in combination with local anesthetics to additionallyevaluate the effectiveness of such treatment in postherpetic neuralgia.

Outcome Predictors of the Transforaminal Endoscopic Spine System Technique for Single-level Lumbar Disk Herniation

2018 ◽  
Vol 79 (04) ◽  
pp. 285-290 ◽  
Author(s):  
Jinchun Wu ◽  
Bin Yu ◽  
Bin He ◽  
Gang Liu ◽  
Jidong Ju ◽  
...  
Keyword(s):  
Multivariate Analyses ◽  
Symptomatic Improvement ◽  
Older Age ◽  
Outcome Predictors ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Endoscopic Spine Surgery ◽  
High Intensity Zone

Background Endoscopic spine surgery has become increasingly popular. However, no study has researched the predictive factors for different outcomes. This study is the first to evaluate the outcome predictors of the transforaminal endoscopic spine system (TESSYS) technique for lumbar disk herniation (LDH). Methods We performed a prospective study of 80 patients meeting the inclusion criteria who underwent TESSYS for LDH. Clinical outcomes were assessed by the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the modified MacNab criteria. Univariate and multivariate analyses were performed to evaluate the outcome predictors. Results There were 36 men and 44 women with a mean age of 48.76 ± 15.60 years (range: 24–78 years). The mean follow-up time was 25.15 ± 9.76 months (range: 12–48 months). The VAS and ODI scores at the last follow-up were significantly improved (p < 0.001). Based on the modified MacNab criteria, the global outcomes were excellent in 34 patients (42.5%), good in 26 patients (32.5%), fair in 11 patients (13.75%), and poor in 9 patients (11.25%). The percentage of symptomatic improvement was 88.75%, and the success rate (excellent or good) was 75%. In the univariate and multivariate analyses, LDH with older age (odds ratio [OR]: 6.621; 95% confidence interval [CI], 0.632–20.846; p = 0.019), high-intensity zone (HIZ) (OR: 8.152; 95% CI, 0.827–4.380; p = 0.003), and larger disk herniation (OR: 6.819; 95% CI, 0.113–4.825; p = 0.017) were the most significant negative outcome predictors. Conclusions TESSYS is an effective method to treat LDH. Older age, the existence of an HIZ, and a large disk herniation were the most important predictors for a worse outcome.

CT Changes after Conservative Treatment for Lumbar Disk Herniation

1994 ◽  
Vol 35 (5) ◽  
pp. 415-419 ◽  
Author(s):  
R. Dullerud ◽  
P. H. Nakstad
Keyword(s):  
Conservative Treatment ◽  
Strong Association ◽  
Clinical Results ◽  
Initial Examination ◽  
Lumbar Disk Herniation ◽  
Disk Space ◽  
Lumbar Disk ◽  
Lumbar Disk Herniations ◽  
Disk Space Narrowing

In order to assess changes occurring to lumbar disk herniations and bulges and to the disk spaces after conservative treatment, a follow-up CT was carried out of 106 pathologic disks in 92 patients at a mean interval of 14 months after the initial examination. There was a strong association between the evolution of the hernias and clinical results, with a decrease in size of the majority of hernias in successfully treated patients, whereas the others essentially remained unchanged (p < 0.0001). A significantly higher proportion of large hernias diminished as compared to the smaller ones (p < 0.0001). Diffuse disk bulges were associated with a poor outcome and never regressed. There was a lower incidence of diminution of the central hernias compared to other locations. Patients with normal disk space at the initial examination had a better outcome than those with disk space narrowing. Only occasionally was a reduction of the disk space observed at follow-up.

scholarly journals The impact of post PCNL tube type on blood loss and postoperative pain

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Salman Jamil ◽  
M Hammad Ather
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Pain Score ◽  
Randomized Study ◽  
University Hospital ◽  
P Value ◽  
Nephrostomy Tube ◽  
Tube Type ◽  
The Impact ◽  
Hemoglobin Drop

Objective: To evaluate the impact of nephrostomy tube type on postoperative pain and blood loss following percutaneous nephrolithotomy (PCNL). Methods: This is a prospective non-randomized study performed at Aga Khan University Hospital from July 2017 to June 2018. In this study we prospectively studied adult patients (16 to 65 years) who underwent unilateral PCNL. Patients who had nephrostomy with balloon (12Fr Foley’s catheter) were compared with patients who had nephrostomy without balloon (12Fr Nelaton™ catheter). STONE Nephrolithometry score was used to assess the stone complexity. Mean pain score at six and 24 hours and mean hemoglobin drop at 24 hours was compared between two groups using independent sample t-test, p-value of <0.05 was considered significant. Results: Over one year, 198 PCNL were performed out of which 119 were included for analysis. Sixty-six had nephrostomy tube with balloon and 53 had nephrostomy tube without balloon. Mean STONE score (9.66±1.4 vs. 9.64±1.24) and operative time (72.84±28.34 vs. 86.05±32.1 minutes) was comparable. Mean postoperative pain score at 6 hours and 24 hours postoperative was significantly lower in balloon group as compared to without balloon group. Mean Hemoglobin drop was similar in both groups (p=0.60). Conclusion: The use of nephrostomy tube with balloon after PCNL as this is associated with less pain and comparable hemoglobin drop as compare to nephrostomy tube without balloon. doi: https://doi.org/10.12669/pjms.36.3.1558 How to cite this:Jamil S, Ather MH. The impact of post PCNL tube type on blood loss and postoperative pain. Pak J Med Sci. 2020;36(3):---------.  doi: https://doi.org/10.12669/pjms.36.3.1558 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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