Endoscopic Interlaminar Approach for Lumbar 4/5 Ipsilateral and Contralateral Decompression: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Roberto J Perez-Roman ◽  
Michael Y Wang
Keyword(s):  
Ligamentum Flavum ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Herniated Disc ◽  
Nerve Roots ◽  
Endoscopic Spine Surgery ◽  
Interlaminar Approach ◽  
Wide Range ◽  
Potential Benefits ◽  
Surgical Treatments

Abstract Lumbar radiculopathy often results from direct compression of the exiting nerve roots. This may be caused mainly by spondylotic changes with any contribution from components like a herniated disc, facet overgrowth, and ligamentum flavum hypertrophy, or any combination of them. There are a wide range of surgical treatments directed at decompressing the neural elements. Over the last decade, endoscopic spine surgery has gained popular interest because of potential benefits, including decreased bony removal, less muscle disruption, and enhanced visualization.1 A unilateral endoscopic surgical approach can accomplish an effective bilateral decompression using the ipsilateral-contralateral technique.2 This method allows for addressing both central and bilateral recess stenoses. We present a case of a 48-yr-old female with persistent bilateral lower extremity radicular pain worse on the left side with severe lumbar 4/5 stenosis and a left-sided synovial cyst causing significant foraminal narrowing. This 2-dimensional video illustrates the technique used for an endoscopic interlaminar approach for lumbar 4/5 ipsilateral and contralateral decompression. We highlight key elements regarding the positioning, workflow, and surgical technique to successfully perform this approach. Patient consented to the procedure.

Investment in the agricultural sector as a way to solve food security problems in developing countries: the example of investment activity of the US agribusiness

2021 ◽  
Author(s):  
Elena Stepanovna Ustinovich ◽  
Tatyana Petrovna Boldyreva
Keyword(s):  
Developing Countries ◽  
Large Scale ◽  
Agricultural Sector ◽  
International Investment ◽  
Investment Activity ◽  
Agricultural Investment ◽  
Wide Range ◽  
The Us ◽  
The World ◽  
Potential Benefits

It is clear to everyone that investment in the agricultural sector in developing countries is one of the most effective ways to reduce poverty and hunger in the world. Agricultural investment can generate a wide range of development opportunities. However, these benefi ts cannot be expected to arise automatically. Some forms of large-scale investment pose significant risks to investor states. It should be noted, however, that, despite discussions about the potential benefits and risks of international investment, there is still no evidence of negative actual consequences for the countries receiving investments. This article examines the issues of investment activity in relation to developing countries using the example of US agribusiness entities.

scholarly journals Model Contrast of Autonomous Vehicle Impacts on Traffic

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Derek Hungness ◽  
Raj Bridgelall
Keyword(s):  
Autonomous Vehicles ◽  
Travel Demand ◽  
Autonomous Vehicle ◽  
Sociodemographic Factors ◽  
Vehicle Miles Traveled ◽  
The Road ◽  
Traffic Conditions ◽  
Demand Models ◽  
Wide Range ◽  
Potential Benefits

The adoption of connected and autonomous vehicles (CAVs) is in its infancy. Therefore, very little is known about their potential impacts on traffic. Meanwhile, researchers and market analysts predict a wide range of possibilities about their potential benefits and the timing of their deployments. Planners traditionally use various types of travel demand models to forecast future traffic conditions. However, such models do not yet integrate any expected impacts from CAV deployments. Consequently, many long-range transportation plans do not yet account for their eventual deployment. To address some of these uncertainties, this work modified an existing model for Madison, Wisconsin. To compare outcomes, the authors used identical parameter changes and simulation scenarios for a model of Gainesville, Florida. Both models show that with increasing levels of CAV deployment, both the vehicle miles traveled and the average congestion speed will increase. However, there are some important exceptions due to differences in the road network layout, geospatial features, sociodemographic factors, land-use, and access to transit.

Inter-vertebral Height, Inter-vertebral Foramen Height and Range of Motion are Associated with Redundant Nerve Roots in Lumbar Spinal Stenosis

2020 ◽  
Author(s):  
Deng Bo ◽  
Fan Shao Hua ◽  
Feng Xin Bing ◽  
Zhenghua Hong
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Ligamentum Flavum ◽  
Leg Pain ◽  
Intervertebral Foramen ◽  
Vertebral Height ◽  
Nerve Roots ◽  
Vas Scores ◽  
Lumbar Spinal ◽  
Stenotic Segment

Abstract Background: To analyze the relational factors influencing the formation of cauda equina redundant nerve roots (RNRs) of the lumbar spinal stenosis.Methods: A retrospective study of 116 patients with lumbar spinal stenosis were treated in our department from January 2016 to June 2019. Magnetic resonance imaging (MRI) was performed to observe the shape and morphology of the redundant nerve roots of the cauda equina.We divided patient into (RNRs) group and non-RNRs( NRNRs) group based on the presence or absence of RNRs on sagittal T2-weighted MR. We analyzed the demographic characteristics, preoperative back pain visual analogue scale (VAS) scores ,preoperative leg pain VAS scores, and preoperative Oswestry disability index(ODI) scores, and also analyzed the rate of spondylolisthesis and ligamentum flavum hypertrophy. Simultaneously,the inter-vertebral height, intervertebral foramen height, inter-vertebral height +vertebral height, median sagittal diameter at the inter-vertebral space level(DIW-MSD),median sagittal diameter at the pedicel level(DV-MSD),ROM of the stenotic segment, were statistically analyzed for clinical and radiological significance.Results : Of a total 116 total patients,there were no statistically significant differences in either gender [RNRs group (n = 42, 18/24 female) and NRNR group (n = 74, 38/36 female)], age, BMI index, preoperative back pain VAS score , preoperative leg pain VAS score and preoperative ODI score(p> 0.05);however, there were statistically significant differences regard to the duration of symptoms and the rate of spondylolisthesis and ligamentum flavum hypertrophy (p<0.05);the inter-vertebral height,Intervertebral foramen height, inter-vertebral height+vertebral height, DIW-MSD ,ROM of the stenotic segment were also significantly different between the group (p<0.05).Conclusions:The inter-vertebral height, inter-vertebral foramen height, inter-vertebral height + vertebral height, DIW-MSD and ROM of the stenotic segment were the crucial factors related to RNRs in lumbar spinal stenosis.

Armchair Auditors: Crowdsourcing Analysis of Government Expenditures

2015 ◽  
Vol 12 (1) ◽  
pp. 71-91 ◽  
Author(s):  
Daniel E. O'Leary
Keyword(s):  
United Kingdom ◽  
Local Governments ◽  
Open Data ◽  
Information And Communications Technology ◽  
Government Expenditures ◽  
Data Movement ◽  
The United Kingdom ◽  
Wide Range ◽  
Potential Benefits ◽  
Open Data Movement

ABSTRACT Increasingly, there is interest in using information and communications technology (ICT) to help build a “better world.” As an example, the United Kingdom has initiated an “open data” movement to disclose financial information about federal and local governments and other organizations. This has led to the use of a wide range of technologies (Internet, Databases, Web 2.0, etc.) to facilitate disclosure. However, since there is a huge cost of generating and maintaining open data, there also is a concern: “will anyone do anything with the data?” In a speech in 2009, David Cameron, the Prime Minister of the United Kingdom, used the term “armchair auditor” to describe crowdsourcing analysis of that data. In that speech, Cameron (2009) noted: “Just imagine the effect that an army of armchair auditors is going to have on those expense claims.” Accordingly, as more and more countries and organizations generate open data, those “armchair auditors” could play an increasingly important role: to help crowdsource monitoring of government expenditures. This paper investigates a number of potential benefits and a number of emerging concerns associated with armchair auditors.

scholarly journals From Unpleasant to Unbearable—Why and How to Implement an Upper Limit to Pain And Other Forms of Suffering in Research with Animals

ILAR Journal ◽  
2020 ◽  
Author(s):  
I Anna S Olsson ◽  
Christine J Nicol ◽  
Steven M Niemi ◽  
Peter Sandøe
Keyword(s):  
Animal Experiments ◽  
The European Union ◽  
Animal Suffering ◽  
Social Functions ◽  
In Vivo Assays ◽  
Negative State ◽  
Wide Range ◽  
Potential Benefits ◽  
Degree Of Control

Abstract The focus of this paper is the requirement that the use of live animals in experiments and in vivo assays should never be allowed if those uses involve severe suffering. This requirement was first implemented in Danish legislation, was later adopted by the European Union, and has had limited uptake in North America. Animal suffering can arise from exposure to a wide range of different external and internal events that threaten biological or social functions, while the severity of suffering may be influenced by the animals’ perceptions of their own situation and the degree of control they are able to exert. Severe suffering is more than an incremental increase in negative state(s) but involves a qualitative shift whereby the normal mechanisms to contain or keep negative states at arm’s length no longer function. The result of severe suffering will be a loss of the ability of cope. The idea of putting a cap on severe suffering may be justified from multiple ethical perspectives. In most, if not all, cases it is possible to avoid imposing severe suffering on animals during experiments without giving up the potential benefits of finding new ways to cure, prevent, or alleviate serious human diseases and generate other important knowledge. From this it follows that there is a strong ethical case to favor a regulatory ban on animal experiments involving severe suffering.

Percutaneous Treatment of Herniated Lumbar Disc by Intradiscal Oxygen-Ozone Injection

1998 ◽  
Vol 4 (4) ◽  
pp. 279-286 ◽  
Author(s):  
M. Muto ◽  
F. Avella
Keyword(s):  
Physical Therapy ◽  
Neurological Deficit ◽  
Lumbar Disc ◽  
Plain Film ◽  
Percutaneous Treatment ◽  
Radicular Pain ◽  
Herniated Disc ◽  
Clinical Recovery ◽  
Herniated Lumbar Disc ◽  
Intradiscal Injection

We report our experience of treating lumbar herniated disc by intradiscal injection of an oxygen-ozone mixture. Ozone (03, MW = 48) is a triatomic molecule, having antiviral, disinfectant and antiseptic properties. Several mechanisms of action have been proposed to explain the efficacy of the treatment: analgesic action; anti-inflammatory action; oxidant action on the proteoglycan in the nucleus pulposus. We treated 93 patients (50 women, 43 men) aged from 24 to 45 yrs (average age 38 yrs) from June 1996 to April 1998. All patients presented sciatica and/or low back pain, lasting two or more months; patients had in the mean time received both medical and physical therapy with mild or no benefit. Diagnostic tests in all patients included plain film x-ray, CT and/or MR at the level of the lumbar spine disclasing a herniated or protruded disc with nerve root or thecal sac compression. We divided patients to be treated in to two groups: the first one group included 35 patients already selected for surgery who presented herniated or protruded disc with radicular pain with associated neurological deficit (hypoesthesia and partial loss of reflex). Those patients had already had medical and physical therapy for two or more months and agreed to try the percutaneous treatment before surgery. CT or MR in this group demonstrated the presence of intraforaminal, extra or sub-ligamentary and sequestrated herniated disc. The second group included 58 patients with radicular pain but without neurological deficit; patients in this group had received medical and/or physical therapy for two or more months and CT showed the presence of a small subligamentary herniated or protruded disc. We considered the results according to the modified MacNab method. In the first group we had “failure” in all patients; in seven cases the symptoms improved for one month, but recurred later on. In the second group 45 patients had “success” showing complete clinical recovery within five to six days after treatment, all remained without symptoms up to six months or more of follow-up. The remaining 13 patients presented the same symptoms again within three months after a temporary clinical recovery. The goal of this study was to present this new technique that can also be compared with a previous study of different percutaneous treatment. Clinical and neuroradiological indications and the contraindications are well known, and must be followed to achieve good results and avoid complications.

HR-ANALYST: ACHIEVEMENTS, CAPABILITIES AND CONDITIONS OF USE

2017 ◽  
Vol 6 (1) ◽  
pp. 5-11
Author(s):  
Коновалова ◽  
Valyeriya Konovalova
Keyword(s):  
Organizational Performance ◽  
Corporate Culture ◽  
Practical Application ◽  
Key Factors ◽  
Current State ◽  
Wide Range ◽  
Productivity Increase ◽  
Potential Benefits ◽  
Staffing Needs ◽  
Interaction Management

The article deals with problems of HR analytics and its practical application to improve management decisions of individual and organizational performance. The results of Russian and foreign research on the current state of and prospects for the use of HR analysts are summarizes. The levels of HR analysts (from the drafting of HR-metrics to predictive modeling) are allocated, their characteristics are disclosed. The examples of the successful use of HR analysts in modern practice are given, special attention is paid to predictive analysts, the author highlights the potential benefits of organizing, its use for a wide range of tasks: forecasting staffing needs, forecasting staff turnover, improving recruitment, better interaction management talent, identifying the most valuable employees, corporate culture and management involvement, identifying key factors for motivation and success, increase staff productivity, increase efficiency of training and formation of competencies.

Anterior Lumbar Microdiscectomy and Interbody Fusion for the Treatment of Recurrent Disc Herniation

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 334-338 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Curtis A. Dickman
Keyword(s):  
Interbody Fusion ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
X Rays ◽  
Lumbar Microdiscectomy ◽  
Disc Herniations

Abstract OBJECTIVE To demonstrate the feasibility of anterior lumbar microdiscectomy in patients with recurrent, sequestered lumbar disc herniations. METHODS Between 1997 and 1999, six patients underwent a muscle-sparing “minilaparotomy” approach and subsequent microscopic anterior lumbar microdiscectomy and fragmentectomy for recurrent lumbar disc extrusions at L5–S1 (n = 4) or L4–L5 (n = 2). A contralateral distraction plug permitted ipsilateral discectomy under microscopic magnification. Effective resection of the extruded disc fragments was accomplished by opening the posterior longitudinal ligament. Interbody fusion was performed by placing cylindrical threaded titanium cages (n = 4) or threaded allograft bone dowels (n = 2). RESULTS There were no complications, and blood loss was minimal. Follow-up magnetic resonance imaging revealed complete resection of all herniated disc material. Plain x-rays revealed excellent interbody cage position. Radicular pain and neurological deficits resolved in all six patients (mean follow-up, 14 mo). CONCLUSION Anterior lumbar microdiscectomy with interbody fusion provides a viable alternative for the treatment of recurrent lumbar disc herniations. Recurrent herniated disc fragments can be removed completely under direct microscopic visualization, and interbody fusion can be performed in the same setting.

Lumbar nerve root compression by synovial cysts of the ligamentum flavum

1984 ◽  
Vol 60 (3) ◽  
pp. 617-620 ◽  
Author(s):  
Adel F. Abdullah ◽  
Robert W. Chambers ◽  
Dennis P. Daut
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Synovial Cysts ◽  
Fine Print

✓ Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.

Reoperation for herniated thoracic discs

1999 ◽  
Vol 91 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Curtis A. Dickman ◽  
Daniel Rosenthal ◽  
John J. Regan
Keyword(s):  
Surgical Procedures ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
Disc Disease ◽  
Content Type ◽  
Initial Surgery ◽  
Cord Injury ◽  
Intradural Disc Herniation ◽  
Fine Print

Object. In this review the authors address the surgical strategies required to resect residual herniated thoracic discs. Methods. Data obtained in 15 patients who had undergone prior thoracic discectomy and who harbored residual or incompletely excised symptomatic thoracic discs were reviewed retrospectively. The surgical procedures that had failed to excise the herniated discs completely included 11 posterolateral approaches, one thoracotomy, and three thoracoscopyguided surgical procedures. Of the lesions that were incompletely resected or residual, there were 13 central calcified, two soft, 12 extradural, and three intradural discs. Indications for reoperation were often multiple in each patient and included misidentification of the level of disc disease at the initial operation (five cases), abandoning the procedure because of intraoperative spinal cord injury (three cases), inadequate visualization of the pathological entity (eight cases), migration of a soft disc fragment within the spinal canal (one case), and intradural disc extension (three cases). The symptoms at the time of reoperation included myelopathy in 13 patients and radicular pain in two patients. The mean interval before reoperation was 150 days (range 1 day–4 years). The reoperation procedures included one thoracotomy and 14 video-assisted thoracoscopic procedures performed ipsilateral (11 cases) or contralateral (four cases) to the site of the initial surgery. The herniated disc material was excised completely in all 15 cases without causing new neurological deficits. Reoperation complications included atelectasis in three patients, intercostal neuralgia in two, a loosened screw that required removal in one, residual intradural disc herniation that required a second reoperation in one patient, and a cerebrospinal fluid leak in one patient. Of the 13 patients who experienced myelopathy prior to operation, 10 recovered neurological function and three stabilized. All patients with radicular pain improved. Conclusions. Calcified, large, broad-based, centrally located, or transdural thoracic disc herniations can be difficult to resect. These lesions require a ventral operative approach to visualize the dura adequately for a safe and complete resection.

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