Cervicothoracic radiculopathy treated using posterior cervical foraminotomy/discectomy

2003 ◽  
Vol 98 (2) ◽  
pp. 131-136 ◽  
Author(s):  
James S. Harrop ◽  
Marco T. Silva ◽  
Ashwini D. Sharan ◽  
Steven J. Dante ◽  
Frederick A. Simeone
Keyword(s):  
Morbidity Rate ◽  
Symptom Duration ◽  
Specific Information ◽  
Disc Disease ◽  
Content Type ◽  
Included Patient ◽  
Posterior Cervical Foraminotomy ◽  
Disc Herniations ◽  
Fine Print

Object. The authors conducted a study to identify the effectiveness and morbidity rate associated with treating cervicothoracic disc disease (radiculopathy) via a posterior approach. Methods. Nineteen patients underwent posterior cervicothoracic laminoforaminotomy during a 5.6-year period. Medical records, imaging studies, office charts, hospital records, and phone interview data were reviewed. Specific information analyzed included patient demographics, side of lesion, and conservative treatment, symptoms, and pre- and postoperative pain levels. Pain was rated using a visual analog scale and classified into a radicular and neck component. Data in 19 patients (seven women and 12 men) who underwent 20 procedures (one patient underwent separate bilateral foraminotomies) were analyzed. The mean patient age was 54.8 years (range 38–73 years), and the follow-up period ranged from 23 to 62 months. Symptom duration ranged from 1 to 14 months (mean 3.4 months) and consisted of weakness, numbness, and painful radiculopathies in 11, 16, and 20 cases, respectively. Motor weakness was identified in 11 of 19 patients (mean grade of 4.35), and postoperatively strength normalized in eight of 11 (mean grade of 4.79). The improvement in motor scores was significant (p = 0.007). Pain was the most common presenting symptom. Preoperative radiculopathies were rated between 0 and 10 (mean 7.45), and postoperatively scores were reduced to 0 to 3 (mean 0.2) which was significant (p < 0.0001). Preoperative neck pain was rated between 0 and 8 (mean 2.55), and on follow up ranged from 0 to 2 (mean 0.5), which was also significant (p = 0.001). Conclusions. Posterior cervicothoracic foraminotomy was a safe and effective procedure in the treatment of patients with laterally located disc herniations.

Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia

1983 ◽  
Vol 59 (6) ◽  
pp. 1007-1012 ◽  
Author(s):  
Sean Mullan ◽  
Terry Lichtor
Keyword(s):  
Trigeminal Neuralgia ◽  
General Anesthesia ◽  
Recurrence Rate ◽  
Trigeminal Ganglion ◽  
Balloon Catheter ◽  
Morbidity Rate ◽  
Content Type ◽  
Biplane Fluoroscopy ◽  
Fine Print

✓ Fifty patients were treated for trigeminal neuralgia by percutaneous microcompression of the trigeminal ganglion. A No. 4 Fogarty balloon catheter was inserted under brief general anesthesia, using biplane fluoroscopy. This procedure is essentially a percutaneous simplication of the older Taarnhøj-Sheldon-Pudenz operation. The follow-up period ranged from 0.5 to 4.5 years. Pain recurred in 12% of cases during that time, and it is anticipated that within 5 years the recurrence rate will reach 20%, which is approximately the same rate as for the alternative established procedures. The advantages of this technique are freedom from discomfort on the part of the patient, a remarkable ease of performance on the part of the operator, absence of associated mortality, and a minimal morbidity rate.

Microsurgical anterior cervical foraminotomy (uncinatectomy) for cervical disc herniation

2001 ◽  
Vol 94 (1) ◽  
pp. 121-125 ◽  
Author(s):  
Al O. Taşçioǧlu ◽  
Ayhan Attar ◽  
Beliz Taşçioǧlu
Keyword(s):  
Long Term Results ◽  
Cervical Disc ◽  
Disc Space ◽  
Content Type ◽  
Long Term Follow Up ◽  
Disc Herniations ◽  
Cervical Foraminotomy ◽  
Fine Print

✓ The authors present the long-term follow-up results in three cases in which pure lateral disc herniations were surgically treated via an anterior foraminotomy (uncinatectomy) that avoided entering the disc space. The pertinent anatomical details essential for a safe approach are discussed in light of nine cadaveric neck dissections of every segment between C-1 and C-7. The surgical technique was initially studied in the cadaveric specimens and then applied in patients. The long-term results (> 2 years) in the first three patients are as good as our short-term results in another eight cases.

Late results of treatment of intervertebral disc disease with chymopapain

1983 ◽  
Vol 59 (6) ◽  
pp. 990-993 ◽  
Author(s):  
Dwight Parkinson
Keyword(s):  
Intervertebral Disc ◽  
First Generation ◽  
Clinical Pathology ◽  
Late Results ◽  
Intervertebral Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Results Of Treatment ◽  
Fine Print

✓ The authors report a 12-year follow-up review of 33 patients treated with chymopapain (Discase) injection for intervertebral disc disease. This carefully controlled series of patients was treated under local anesthesia in the prone position. Only the single offending disc that correlated with the myelographic and clinical pathology (without the use of discography) was injected with Discase. Anaphylaxis is treated instantly at the first sign of disturbance, and no patients suffered shock. The percentage of patients who were completely cured or improved continues at about 70%. Aside from sensitivity, complications attributable to proper use of the enzyme remain at zero. Follow-up review of those patients over 10 years would indicate that there is no risk of delayed organ toxicity, no risk of carcinogenesis, and no apparent risk of first-generation teratogenesis.

Selective peripheral denervation for the treatment of intractable spasmodic torticollis: experience with 168 patients at the Mayo Clinic

2003 ◽  
Vol 98 (6) ◽  
pp. 1247-1254 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
J. Eric Ahlskog ◽  
Joseph Y. Matsumoto ◽  
Mary A. Swenson ◽  
Robyn L. McClelland ◽  
...  
Keyword(s):  
Cervical Dystonia ◽  
Mayo Clinic ◽  
Respiratory Arrest ◽  
Head Position ◽  
Spasmodic Torticollis ◽  
Symptom Duration ◽  
Content Type ◽  
Excellent Improvement ◽  
Fine Print

Object. Selective peripheral denervation is currently the primary surgical treatment for intractable cervical dystonia. The authors assessed preoperative factors to determine which, if any, correlated with outcomes in patients with torticollis who had undergone this procedure. Methods. The records of 168 consecutive patients who had undergone selective peripheral denervation for cervical dystonia between 1988 and 1996 at the Mayo Clinic were reviewed. There were 89 women (53%) and 79 men (47%) with a mean age of 53.4 years. Selection of muscles for denervation was based on the patient's clinical presentation and electromyography mapping results. The most common torticollis vectors were rotational in 141 patients (84%) and laterocollis in 59 (35%). Seventy patients (42%) presented with combined vectors. The technique used to remedy both conditions involved denervation of the ipsilateral posterior cervical paraspinal and splenius capitis muscles. Denervation of the sternocleidomastoid muscle was performed on the contralateral side for rotational torticollis and on the ipsilateral side for laterocollis. A rigorous physical therapy program followed surgery. At the 3-month postoperative evaluation, 125 patients (77%) of the 162 who were available for follow up had moderate to excellent improvement in their head position, and pain was moderately to markedly improved in 131 patients (81%). The long-term follow up lasted a mean of 3.4 years and was undertaken in 130 patients. The original level of moderate to excellent improvement in head position and pain was retained in at least 71 patients (70%). Outcome was not predicted by preoperative head position, severity of abnormal posture of head, symptom duration, presence of tremor or phasic dystonic movements, or failure to respond to botulinum toxin treatment. Five patients recovered from postoperative complications including one myocardial infarction, one pulmonary embolism, and three respiratory failures. Three patients suffered from persistent C-2 distribution dysesthesias and three from slight shoulder weakness; one had a wound infection, and one died of respiratory arrest. Conclusions. Selective peripheral denervation is an effective method of achieving lasting improvement of dystonia in most patients with intractable torticollis.

Bilateral trigeminal neuralgia

1987 ◽  
Vol 67 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Ronald Brisman
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Morbidity Rate ◽  
Gasserian Ganglion ◽  
Predisposing Factor ◽  
Content Type ◽  
Bilateral Involvement ◽  
Prior Surgery ◽  
Fine Print

✓ Bilateral trigeminal neuralgia occurred in 32 (11.9%) of 269 consecutive patients who were treated with radiofrequency electrocoagulation (RFE). This is a higher incidence than has been reported before and may be explained by the prospective nature of the present study, the long follow-up period, and the inclusion of patients with mild bilateral symptoms. Multiple sclerosis is the most common predisposing factor and occurred in 18% of those with bilateral trigeminal neuralgia. Although patients with bilateral trigeminal neuralgia were more likely to have had prior surgery than those with unilateral neuralgia, they did not have a higher recurrence rate following treatment. Percutaneous RFE of the retrogasserian rootlets and gasserian ganglion, with or without glycerol, is effective in managing patients whose pain is intractable to medical therapy. The preservation of most trigeminal sensory and motor functions, the low morbidity rate, and the ability to repeat the procedure are particularly advantageous for patients with bilateral involvement.

Surgically treated lumbar disc disease in the pediatric population: an outcome study

2000 ◽  
Vol 92 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Susan R. Durham ◽  
Peter P. Sun ◽  
Leslie N. Sutton
Keyword(s):  
Back Pain ◽  
Pediatric Population ◽  
Lumbar Disc ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Content Type ◽  
Sf 36 ◽  
Study Population ◽  
Fine Print

Object. This outcome study was undertaken to investigate the long-term results obtained in surgically treated pediatric patients with lumbar disc disease by using standardized medical outcome scales and clinical follow-up examination. Methods. Twenty nine patients 17 years of age or younger underwent surgery between 1968 and 1998 for lumbar disc disease. The follow-up period ranged from 4 months to 30.5 years (mean 8.5 years). Outcome scores (health profiles) were generated using a standardized medical outcome scale, the Short Form health survey questionnaire (SF-36), and a condition-specific back pain outcome scale. Clinical follow-up data were obtained by telephone interview. The health profile of the study population closely paralleled that of the normal population and was distinctly different from the health profile of adults with low-back pain. Only physical functioning, as measured by a scale of the SF-36, was found to be impaired in a subset of the study population. The rate of reoperation was 24% over the course of the follow-up period. In contrast to similar studies in adults, there were no identifiable predictive factors for either reoperation or poor outcome. Conclusions. Lumbar disc disease in the pediatric population does not appear to lead to chronic complaints of back pain, and it does not appear to have a negative impact on overall health. This finding suggests that pediatric lumbar disc disease may be a separate entity distinct from adult lumbar disc disease, and therefore, the same conclusions regarding long-term outcome cannot be applied to the pediatric population.

Incidence and clinical features of asymptomatic meningiomas

2000 ◽  
Vol 92 (5) ◽  
pp. 766-770 ◽  
Author(s):  
Jun-ichi Kuratsu ◽  
Masato Kochi ◽  
Yukitaka Ushio
Keyword(s):  
Clinical Features ◽  
Tumor Size ◽  
Morbidity Rate ◽  
Intracranial Tumors ◽  
Period Range ◽  
Female Ratio ◽  
Content Type ◽  
Significant Difference ◽  
Fine Print

Object. The increased use of computerized tomography (CT) and magnetic resonance (MR) technology has led to an increase in the detection of asymptomatic meningiomas, although the surgical indication for these tumors remains undetermined. The authors investigated the incidence of asymptomatic meningiomas and their clinical features.Methods. An epidemiological survey was conducted of primary intracranial tumors diagnosed in Kumamoto Prefecture between 1989 and 1996. Follow-up neuroradiological imaging and clinical studies for asymptomatic meningiomas were performed.Primary intracranial tumors were diagnosed in 1563 residents. Of these lesions, 504 (32.2%) were meningiomas, and of these meningiomas 196 (38.9%) were asymptomatic. The incidence of asymptomatic meningiomas was significantly higher in individuals older than 70 years of age. Furthermore, the incidence of asymptomatic meningiomas was significantly higher in female than in male patients. Of the asymptomatic meningiomas in 196 patients, 87 (44.4%) were surgically removed, whereas 109 (55.6%) were treated conservatively. Of these conservatively treated patients, 63 received follow-up care for more than 1 year. In 20 of these 63 cases, the tumors increased in size over the 27.8-month average follow-up period (range 12–87 months), whereas in the other 43 cases, the tumor size did not increase during a 36.6-month average follow-up period (range 12–96 months). There was no significant difference with respect to age, tumor size, and male/female ratio between the patient group in which the tumor size increased and the group in which it did not increase during the follow-up period. Asymptomatic meningiomas that evidenced calcification on CT scans and/or hypointensity on T2-weighted MR images appear to have a slower growth rate.Conclusions. Among patients older than age 70 years who underwent operation for asymptomatic meningioma, the neurological morbidity rate was 23.3%; it was 3.5% among younger patients. This indicates that the advisability of surgery in elderly patients with asymptomatic meningiomas must be considered very carefully.

Surgical treatment of jugular foramen schwannomas

1995 ◽  
Vol 82 (6) ◽  
pp. 924-932 ◽  
Author(s):  
Madjid Samii ◽  
Ramesh P. Babu ◽  
Marcos Tatagiba ◽  
Abolghassem Sepehrnia
Keyword(s):  
Mr Imaging ◽  
Type A ◽  
Jugular Foramen ◽  
Intracranial Extension ◽  
Cerebrospinal Fluid Leakage ◽  
Symptom Duration ◽  
Content Type ◽  
Type D ◽  
Fine Print

✓ Sixteen patients with schwannomas of the jugular foramen were operated on in the Department of Neurosurgery of the Nordstadt Hospital in Hannover, Germany, between 1986 and 1992. Patients with neurofibromatosis were excluded. The records of the 16 patients were retrospectively reviewed. There were five women and 11 men (mean age 43 years) with a symptom duration ranging from 6 months to 20 years (mean 5 years). The predominant symptoms were hearing loss, hoarseness, and cerebellar symptoms. Computerized tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in all 16 patients. Depending on the radiological and surgical features, the tumors were classified into four types: Type A, a tumor primarily at the cerebellopontine angle with minimal enlargement of the jugular foramen (eight cases); Type B, a tumor primarily at the jugular foramen with intracranial extension (two cases); Type C, a primarily extracranial tumor with extension into the jugular foramen (one case); and Type D, a dumbbell-shaped tumor with both intra- and extracranial components (five cases). A retromastoid suboccipital craniectomy was performed for Type A tumors, and a combined cervical-mastoidectomy for Types B, C, and D. Total tumor removal was achieved in all cases. There was no operative mortality. Postoperative complications were cerebrospinal fluid leakage in one patient and mastoiditis in two patients. The follow-up period ranged from 12 to 42 months (mean 22 months). All patients were alive at the last follow-up review, and CT and/or MR imaging showed no tumor recurrence.

Failed anterior cervical foraminotomy

2003 ◽  
Vol 98 (2) ◽  
pp. 126-130 ◽  
Author(s):  
Robert J. Hacker ◽  
Christopher G. Miller
Keyword(s):  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Degenerative Cervical Disc Disease ◽  
Number Of Patients ◽  
Cervical Surgery ◽  
Cervical Foraminotomy ◽  
Fine Print

Object. Anterior cervical foraminotomy has been advocated as a procedure that preserves the motion segment while treating radiculopathy due to degenerative cervical disc disease. Because the medical literature contains no long-term follow up or randomized studies related to this procedure, the authors reviewed their results, specifically examining cases of failure to determine the efficacy of the approach. Methods. The authors identified 23 patients in whom unilateral cervical radiculopathy due to degenerative cervical disc disease was refractory to conservative therapy and in whom anterior cervical foraminotomy was performed between 1998 and 2000. The procedure involves ipsilateral exposure, microsurgical removal of the uncovertebral joint to identify the nerve root, and partial removal of the lateral anulus and or disc fragments. Data in those patients who underwent reoperation(s) were reviewed specifically for the procedure type, interval between index procedure and reoperation, and whether multiple procedures were performed. Of the 23 patients, 30% required at least one additional procedure. A good or excellent outcome at last follow-up examination was achieved in only 12 patients. Conclusions. In the current study the authors found a reoperation rate that is considerably higher than that in most series of anterior cervical surgery for radiculopathy. The presumed benefit of anterior cervical foraminotomy is preservation of the disc interspace; however, in this study, a significant number of patients failed to experience a satisfying outcome. Currently the authors do not recommend anterior cervical foraminotomy as a stand-alone procedure.

Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients

2005 ◽  
Vol 3 (5) ◽  
pp. 335-341 ◽  
Author(s):  
Lali H. S. Sekhon ◽  
William Sears ◽  
Neil Duggal
Keyword(s):  
Interbody Fusion ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Content Type ◽  
Anterior Interbody Fusion ◽  
Posterior Foraminotomy ◽  
Fine Print

Object. The potential role of cervical arthroplasty in patients who have undergone previous cervical surgery is unknown. The authors performed a prospective study involving nonrandomized clinical and radiological assessment in patients who had undergone either previous posterior cervical foraminotomy or anterior interbody fusion and who suffered new or persistent arm/neck symptoms related to neural compression. Methods. During a 30-month period, 15 patients who had previously undergone cervical spinal surgery underwent cervical arthroplasty that involved placement of the Bryan disc for neck or arm symptoms related to cervical disc disease. A total of 24 devices were implanted. Six of the 15 patients had undergone a previous posterior foraminotomy, and in nine cases an anterior interbody fusion had been perfomed at some stage prior to surgery. Clinical and radiological evaluations were performed preoperatively and after surgery to assess outcomes. A total of 24 arthroplasties were performed encompassing between one and three levels. There were no major perioperative complications or immediate device-related failures. Two patients were lost to follow up. The follow-up period ranged from 12 to 43 months (mean 24.2 ± 10.5 months). Good results were obtained in all cases as reflected by an increase in the visual analog scale score of 6.4 in terms of neck/arm pain (p < 0.05). There was no difference in Oswestry Disability Index scores for neck pain (p > 0.05) and no patient required surgery at the same level. In one patient hypermobility developed with internal subluxation of the device, which suggested a compromise adjacent to a two-level fusion at 21 months. The segment was hypermobile preoperatively. The patient has experienced recurrent neck pain but otherwise remains clinically well and has not required revision surgery to date. Conclusions. Insertion of the Bryan artificial cervical disc in patients who have previously undergone cervical fusion or posterior foraminotomy, in general, appears to be safe. It provided encouraging early clinical results, although patients with preoperative hypermobility should be treated with caution. Issues such as accelerated device-related wear and the use of arthroplasty after aggressive facetectomy resection will need further study; however, in carefully selected patients who have undergone previous surgery cervical arthroplasty may provide an additional tool in the management of cervical disc disease.

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