Conical working tube: a special device for endoscopic surgery of herniated lumbar discs

2005 ◽  
Vol 2 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Mazhar Husain ◽  
Deepak K. Jha ◽  
Sunil Agrawal ◽  
Nuzhat Husain ◽  
Rakesh K. Gupta
Keyword(s):  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Effective Length ◽  
Special Device ◽  
Lumbar Surgery ◽  
Content Type ◽  
The Past ◽  
Working Space ◽  
Endoscopic Discectomy ◽  
Fine Print

Object. The instrumentation for endoscopic discectomy continues to evolve to allow for acceptable clinical outcomes and expanding applications. The authors describe their experience in using a conical working tube equipped with a guide for angular entry of the telescope to perform endoscopic discectomy in patients with lumbar disc herniation. Methods. Fifty-one patients (38 men and 13 women) with herniated lumbar discs underwent endoscopic lumbar surgery during the past 2.5 years at the authors' institutions. A conical working tube was inserted over sequential coaxial dilators via a muscle-splitting approach. Conventional neurosurgical instruments were used in conjunction with an angled insertion telescope. Endoscopic discectomy was performed at the L1–2 (one case), L3–4 (two cases), L4–5 (32 cases), and L5—S1 (18 cases) levels. The surgical approach was bilateral in two patients: bilateral L4–5 in one, and right L4–5 and left L5—S1 in the other. The remaining patient suffered adjacent two-level (right-sided L4–5 and L5—S1) herniations. Outcome was assessed at a mean of 11 months after surgery by using modified Macnab criteria. Outcomes were excellent in 46 (90%), fair in three (6%), and poor in two patients (4%). Complications occurred in four patients and included a dural tear in one case, postoperative neurological deterioration in two, and discitis in two; in two of these patients open surgical exploration was required. Conclusions. A separate angled entry of the telescope shortens the effective length of the working sheath and creates a better working space, thereby allowing greater instrument maneuverability and ability to use conventional neurosurgical instruments. In addition, use of this telescope in other endoscopic procedures reduces overall cost of instrumentation and treatment, and results are comparable to those reported in association with microscopic lumbar discectomy.

Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy

1993 ◽  
Vol 78 (2) ◽  
pp. 216-225 ◽  
Author(s):  
H. Michael Mayer ◽  
Mario Brock
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Motor Deficits ◽  
Low Back ◽  
Content Type ◽  
Sensory Deficits ◽  
Endoscopic Discectomy ◽  
Disc Herniations ◽  
Fine Print

✓ Percutaneous endoscopic discectomy is a new technique for removing “contained” lumbar disc herniations (those in which the outer border of the anulus fibrosus is intact) and small “noncontained” lumbar disc herniations (those at the level of the disc space and occupying less than one-third of the sagittal diameter of the spinal canal) through a posterolateral approach with the aid of specially developed instruments. The technique combines rigid straight, angled, and flexible forceps with automated high-power suction shaver and cutter systems. Access can thus be gained to the dorsal parts of the intervertebral space where the disc herniation is located. Percutaneous endoscopic discectomy is monitored using an endoscope angled to 70° coupled with a television and video unit and is performed with the patient under local anesthesia and an anesthesiologist available if needed. Its indication is restricted to discogenic root compression with a minor neurological deficit. Two groups of patients with contained or small noncontained disc herniations were treated by either percutaneous endoscopic discectomy (20 cases) or microdiscectomy (20 cases). Both groups were investigated in a prospective randomized study in order to compare the efficacy of the two methods. The disc herniations were located at L2–3 (one patient), L3–4 (two patients), or L4–5 (37 patients). There were no significant differences between the two groups concerning age and sex distribution, preoperative evolution of complaints, prior conservative therapy, patient's occupation, preoperative disability, and clinical symptomatology. Two years after percutaneous endoscopic discectomy, sciatica had disappeared in 80% (16 of 20 patients), low-back pain in 47% (nine of 19 patients), sensory deficits in 92.3% (12 of 13 patients), and motor deficits in the one patient affected. Two years after microdiscectomy, sciatica had disappeared in 65% (13 of 20 patients), low-back pain in 25% (five of 20 patients), sensory deficits in 68.8% (11 of 16 patients), and motor deficits in all patients so affected. Only 72.2% of the patients in the microdiscectomy group had returned to their previous occupation versus 95% in the percutaneous endoscopic discectomy group. Percutaneous endoscopic discectomy appears to offer an alternative to microdiscectomy for patients with “contained” and small subligamentous lumbar disc herniations.

Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations

2001 ◽  
Vol 94 (2) ◽  
pp. 216-220 ◽  
Author(s):  
Sean M. Lew ◽  
Thomas F. Mehalic ◽  
Kristin L. Fagone
Keyword(s):  
Return To Work ◽  
Lumbar Disc ◽  
Intervertebral Discs ◽  
Work Status ◽  
Outpatient Basis ◽  
Content Type ◽  
Endoscopic Discectomy ◽  
Disc Herniations ◽  
Far Lateral ◽  
Fine Print

Object. Far-lateral (extraforaminal) and foraminal disc herniations comprise up to 11% of all herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. Accessing these lateral disc herniations endoscopically via a percutaneous transforaminal approach offers several theoretical advantages over the more traditional procedures. The object of this study was to assess the safety and efficacy of treating patients with far-lateral and foraminal disc herniations via a percutaneous transforaminal endoscopic approach. Methods. A retrospective analysis was performed of 47 consecutive patients who underwent surgery via this approach. All procedures were performed after induction of a local anesthetic on an outpatient basis. Outcome was measured with Macnab criteria and by determining a patient's return-to-work status. The median follow-up period was 18 months (range 4–51 months). Excellent or good outcome was obtained in 40 (85%) of 47 patients. Of the 38 patients working before the onset of symptoms, 34 (90%) returned to work. Five patients (11%) experienced poor outcomes and subsequently underwent open procedures at the same level. Of the 10 recipients of Workers' Compensation, Macnab criteria indicated a significantly worse outcome (70% excellent or good), but an excellent return-to-work status was maintained (90%). There were no complications. Conclusions. Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of far-lateral and foraminal disc herniations.

Posterior epidural migration of sequestered lumbar disc fragments

1999 ◽  
Vol 90 (2) ◽  
pp. 264-266 ◽  
Author(s):  
Pierre Robe ◽  
Didier Martin ◽  
Jacques Lenelle ◽  
Achille Stevenaert
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Contrast Material ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Content Type ◽  
Diagnostic Pitfalls ◽  
Fine Print

✓ The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.

Efficacy of chymopapain chemonucleolysis

1985 ◽  
Vol 62 (5) ◽  
pp. 662-666 ◽  
Author(s):  
Manucher J. Javid
Keyword(s):  
Marked Improvement ◽  
Lumbar Disc ◽  
Slight Improvement ◽  
Content Type ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ A 9- to 12-year follow-up review was conducted in 105 of 124 patients who were treated with chymopapain chemonucleolysis for herniated lumbar disc. The data were obtained from responses to a questionnaire. Seventy-nine patients (75.2%) reported marked improvement, six (5.7%) had slight improvement, and 20 (19.0%) had no improvement. Of the 87 patients not receiving workman's compensation, 70 patients (80.5%) had marked improvement; four (4.6%) had slight improvement; and 13 (14.9%) had no improvement. Of the 18 compensation cases, nine patients (50.0%) had marked improvement; two patients (11.1%) had slight improvement; and seven patients (38.9%) had no improvement. These results are comparable to those reported for surgical discectomy, and confirm that chymopapain chemonucleolysis is an alternative to surgery.

Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine

1990 ◽  
Vol 72 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Joseph C. Maroon ◽  
Thomas A. Kopitnik ◽  
Larry A. Schulhof ◽  
Adnan Abla ◽  
James E. Wilberger
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Spinal Nerve ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Enhanced Ct ◽  
Disc Herniations ◽  
Microsurgical Approach ◽  
Far Lateral ◽  
Fine Print

✓ Lumbar-disc herniations that occur beneath or far lateral to the intervertebral facet joint are increasingly recognized as a cause of spinal nerve root compression syndromes at the upper lumbar levels. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the incorrect interspace. If these herniations are diagnosed, they often cannot be adequately exposed through the typical midline hemilaminectomy approach. Many authors have advocated a partial or complete unilateral facetectomy to expose these herniations, which can lead to vertebral instability or contribute to continued postoperative back pain. The authors present a series of 25 patients who were diagnosed as having far lateral lumbar disc herniations and underwent paramedian microsurgical lumbar-disc excision. Twelve of these were at the L4–5 level, six at the L5–S1 level, and seven at the L3–4 level. In these cases, myelography is uniformly normal and high-quality magnetic resonance images may not be helpful. High-resolution computerized tomography (CT) appears to be the best study, but even this may be negative unless enhanced by performing CT-discography. Discography with enhanced CT is ideally suited to precisely diagnose and localize these far-lateral herniations. The paramedian muscle splitting microsurgical approach was found to be the most direct and favorable anatomical route to herniations lateral to the neural foramen. With this approach, there is no facet destruction and postoperative pain is minimal. Patients were typically discharged on the 3rd or 4th postoperative day. The clinical and radiographic characteristics of far-lateral lumbar-disc herniations are reviewed and the paramedian microsurgical approach is discussed.

Minds and brains: angels, humans, and brutes

1982 ◽  
Vol 57 (3) ◽  
pp. 309-315
Author(s):  
Mortimer J. Adler
Keyword(s):  
Nervous System ◽  
Animal Behavior ◽  
Personal Experience ◽  
Human Beings ◽  
Content Type ◽  
The Past ◽  
Wide Range ◽  
Conceptual Thought ◽  
The Brain ◽  
Fine Print

✓ In his 1982 Cushing oration, a distinguished philosopher, author, and discerning critic presents a distillate of his phenomenally wide range of personal experience and his familiarity with the great books and teachers of the present and the past. He explores the differences and relationships between human beings, brute animals, and machines. Knowledge of the brain and nervous system contribute to the explanation of all aspects of animal behavior, intelligence, and mentality, but cannot completely explain human conceptual thought.

New treatment of lumbar disc herniation involving 5-hydroxytryptamine2A receptor inhibitor: a randomized controlled trial

2005 ◽  
Vol 2 (4) ◽  
pp. 441-446 ◽  
Author(s):  
Masahiro Kanayama ◽  
Tomoyuki Hashimoto ◽  
Keiichi Shigenobu ◽  
Fumihiro Oha ◽  
Shigeru Yamane
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Low Back ◽  
Content Type ◽  
Medical Interventions ◽  
Randomized Controlled ◽  
Nsaid Group ◽  
Fine Print

Object. Serotonin or 5-hydroxytryptamine (5-HT) is a chemical mediator associated with nucleus pulposus—induced radiculopathy. Inhibition of 5-HT receptors may potentially alleviate symptoms in patients with lumbar disc herniation. This prospective randomized controlled study was performed to evaluate the efficacy of the 5-HT2A receptor inhibitor in the treatment of symptomatic lumbar disc herniation. Methods. Forty patients with sciatica due to L4–5 or L5—S1 disc herniation were randomly allocated to treatment with the 5-HT2A inhibitor (sarpogrelate 300 mg/day) or nonsteroidal antiinflammatory drugs (NSAIDs; diclofenac 75 mg/day). Low-back pain, leg pain, and numbness were evaluated using a visual analog scale (VAS) before and after a 2-week course of treatment. The patients received only allocated medicine during the 2-week regimen and were thereafter allowed to choose any treatment options depending on their residual symptoms. One-year clinical outcomes were assessed based on the rates of additional medical interventions. The mean VAS score improvements in the 5-HT2A and NSAID groups were 33 and 46% for low-back pain, 32 and 32% for leg pain, and 35 and 22% for leg numbness, respectively. After the 2-week regimen, no additional medical interventions were required in 50% of 5-HT2A—treated patients and 15% of those receiving NSAIDs. Epidural or nerve root block procedures were performed in 35% of the 5-HT2A group and 45% of the NSAID group. Surgery was required in 20% of the 5-HT2A group and 30% of the NSAID group patients. Conclusions. The current study provided evidence that the efficacy of the 5-HT2A inhibitor was comparable with that of NSAID therapy for lumbar disc herniation. The 5-HT2A inhibitor has the potential to alleviate symptoms in patients with lumbar disc herniation.

Stereotaxic clipping of arterial aneurysms and arteriovenous malformations

1977 ◽  
Vol 46 (1) ◽  
pp. 12-23 ◽  
Author(s):  
Edward I. Kandel ◽  
Vyacheslav V. Peresedov
Keyword(s):  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Special Device ◽  
Content Type ◽  
Arterial Aneurysms ◽  
Direct Attack ◽  
Fine Print

✓ In carefully selected cases of arterial aneurysms and deep-seated arteriovenous malformations (AVM), when direct attack may be dangerous or impossible, the authors advocate stereotaxic clipping. A special device and technique for its application are described. The instrument is introduced through a trephine opening and clipping is monitored by angiography. Successful results have been obtained in 10 operations performed on eight patients, three of whom had arterial aneurysms (two internal carotid and one anterior cerebral-anterior communicating) and five with AVM's.

The right hemisphere: neuropsychological functions

1986 ◽  
Vol 64 (5) ◽  
pp. 693-704 ◽  
Author(s):  
Kenneth M. Heilman ◽  
Dawn Bowers ◽  
Edward Valenstein ◽  
Robert T. Watson
Keyword(s):  
Emotional Disorders ◽  
Right Hemisphere ◽  
Content Type ◽  
Reading And Writing ◽  
The Past ◽  
Right Hemisphere Damage ◽  
Right Hemisphere Dysfunction ◽  
Neuropsychological Functions ◽  
The Right ◽  
Fine Print

✓ In the past two to three decades, clinicians and neuroscientists have been studying the functions of the right hemisphere. Neither hemisphere seems to be dominant in the absolute sense. Each appears to be specialized and is dominant for different functions. However, most functions require the cooperation of both hemispheres. When one is damaged, the other can often compensate for the damaged one. Lesions of the left hemisphere are associated with language (speech, reading, and writing) and praxic disorders, and lesions of the right hemisphere can result in visuospatial, attentional, and emotional disorders. The authors review some of the major behavioral disorders associated with right hemisphere dysfunction and concentrate on three major types of disorders — visuospatial, attentional, and emotional. Although not all the behavioral defects associated with right hemisphere damage can be subgrouped under these three types, they are the ones most often associated with right hemisphere lesions.

Results of applying ADCON-L gel after lumbar discectomy: the German ADCON-L study

2001 ◽  
Vol 95 (2) ◽  
pp. 179-189 ◽  
Author(s):  
Hans-Peter Richter ◽  
Erich Kast ◽  
Rainer Tomczak ◽  
Werner Besenfelder ◽  
Wilhelm Gaus
Keyword(s):  
Lumbar Disc ◽  
Animal Experiments ◽  
Treated Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Large Sample Size ◽  
Therapeutic Success ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Failed-back syndrome is still an unsolved problem. Use of ADCON-L gel, already commercially available, has been proven to reduce postoperative scarring in animal experiments. The authors of two controlled clinical studies have also shown positive results when applying the gel. They did not, however, establish patient-oriented endpoints. The authors report a study of ADCON-L in which they focus on patient-oriented endpoints. Methods. Patients with lumbar disc herniation were randomized to an ADCON-L—treated or control group. Therapeutic success was evaluated using the validated Hannover Questionnaire on Activities of Daily Living (FFbH) 6 months after surgery. The study took place between November 14, 1996, and April 20, 1998, in eight neurosurgical centers in Germany. A total of 398 patients was recruited; 41 patients dropped out during follow up. The mean functional FFbH score (100 points = all activities are possible without problem; 0 points = no activity is possible) was 78.5 points in the ADCON-L—treated group compared with 80 points in the control group. Furthermore, in terms of secondary outcome variables, the ADCON-L group did not have an advantage over the control group. Only the mean magnetic resonance imaging score showed a slight advantage of ADCON-L over the control group. Conclusions. The authors found no positive effect of treatment with ADCON-L gel in patients in whom one-level lumbar microdiscectomy was performed. Because of its rather large sample size and its homogeneity, the study had sufficient power to detect even small differences between the two groups.

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