A case of intradural lumbar disc herniation

Lumbar disc herniation into the dural space is a rare phenomenon of degenerative lumbar disc disease and its pathogenesis remains unclear. Intraoperative ultrasonography and histopathological examination of resected specimen aids in diagnosis of intradural disc herniation.Prompt surgery is recommended as postoperative outcome of the patient at our setting was favourable.

Ultrasound in pediatric surgery; intraoperative applications of the growing technology

Background Ultrasonography is increasingly used in pediatric surgery. Intraoperatively, ultrasonography can be used to confirm the preoperative diagnosis, guide the surgical approach, and enhance decision-making. We aimed to report our experience with intraoperative ultrasonography in different neonatal and pediatric procedures. So, a retrospective study was designed. It included all pediatric patients who had intraoperative ultrasound between January 2018 and October 2020 in a single center. Results We used intraoperative ultrasonography in 208 pediatric patients for various types of surgery. The authors compared ultrasound-guided central line insertion (n = 139) to the landmark method (n = 153). The number of trials was significantly lower in the ultrasound-guided method (P < 0.001). Conversion to cut-down was significantly lower with the ultrasound-guided technique (4 (2.8%) vs. 13 (8.5%); P = 0.047) and insertion-related complications were lower with ultrasound (0 vs 13 (8.5%); P < 0.001). We used ultrasound-guided sclerotherapy for cystic hygroma in 15 patients. Nine patients had successful treatment with a single injection (60%). Conclusion The application of intraoperative ultrasound in pediatric patients is increasing in our institution. The technique is safe and could effectively reduce central line insertion complications and enhance cystic hygroma sclerotherapy’s success with a single injection. Ultrasonography should be an essential part of residents’ and fellows’ training in pediatric surgery.

Spinal Canal Decompression for Stage III Kummell’s Disease With “Compressing the Posterior Wall of the Vertebral Body” Guided by Intraoperative Ultrasonography - a Preliminary Clinical Study

Background: There is a lot of controversy regarding the treatment of patients with stage III Kummell’s disease (KD). The purpose of this study is to determine feasibility, efficacy and safety of spinal canal decompression via “compressing the posterior wall of the vertebral body”, guided by real time intraoperative ultrasonography guidance for patients with stage III KD.Methods: We conducted a retrospective study of 11 patients with stage III KD associated with neurological deficits who underwent surgical treatment in The Second Hospital, Cheeloo College of Medicine, Shandong University, from September 2017 to January 2019. All patients underwent spinal canal decompression using a special L-shaped compressor (angular compressor) guided by real time ultrasonography to squeeze and compress the posterior wall of vertebral body, supplemented by internal fixation and posterior fusion. The primary goal was to determine feasibility, safety and efficacy. Therefore, operating time, Intraoperative blood loss, complications and JOA score, local Cobb angle, ODI score of pre- and post-operative were evaluated.Results: 11 patients (4 males and 7 females) with an average age of 70.2±3.2 years (63-76 years) were included in the study. Mean follow-up period was 17.4 months (12-24 months). Mean operating time was 151±18 min and mean intraoperative blood loss was 202±40ml. Before and after surgery, the local Cobb angle (34.3 °±5.4 °, 11.0 °±4.6 °, respectively), JOA score (12.8±2.1, 22.1±1.9, respectively) and ODI scores (71.4±6.4, 25.5±5.2, respectively) significantly improved (P <0.05). As a complication, one patient developed CSF leakage after surgery, while in another case transient MEP signal change occurred intraoperatively without neurological deficit after surgery.Conclusion: Spinal canal decompression by tamping the retropulsed vertebral body anteriorly, guided by intraoperative ultrasonography can effectively relieve neural compression, significantly shorten operation time, reduce intraoperative blood loss, and have fewer complications for patients with stage III KD, compared with previously reported data. In our opinion, it therefore represents a low risk, minimally invasive, yet effective treatment strategy in this selected group of patients.Trial registration: This study was retrospectively registered in Chinese Clinical Trial Registry.Unique Identifying number: ChiCTR2000040490.