130,478 research outputs found
Microdiscectomy in treatment of herniated lumbar disc.
No full textThe authors studied 122 patients who had undergone microsurgery for herniated lumbar disc or isolated nerve root canal stenosis. The patients were reviewed one month and three months after surgery and then returned for a final evaluation after an average of 1.4 years. Intraoperative or postoperative complications occurred in 13 cases and consisted of misdiagnosis (discovered intraoperatively) of the level of the herniated disc (7 cases), dural laceration (3 cases), and discitis (3 cases). Limited discectomy was performed in 16 cases and complete discectomy in the others. Two patients who had undergone limited discectomy experienced recurrence; this did not occur when complete discectomy was performed. Discitis occurred in patients who had undergone complete discectomy. Most of the patients who underwent operation for disc herniation at one lumbar level with no complications began walking within 24 hours, and 72% were discharged within 36 hours. Eighty-five percent of the patients had a satisfactory result one month after surgery, and 91% had a satisfactory result at the final follow-up. There was no significant difference between patients with protruded herniation and patients with sequestered herniation. In the patients with nerve root canal stenosis the proportion of satisfactory results was 72% at one month and 88% at the final follow-up. The main advantage of microsurgery is the full illumination of the operative field, and this technique is strongly indicated in cases of single-level herniated disc. Over the short-term, microdiscectomy achieves a higher proportion of satisfactory results, requires a shorter hospitalization period, and allows an earlier return to work than traditional surgery. However, no significant difference was found between microsurgery and traditional surgery over the long-term
DEGENERATIVE SPONDYLOLISTHESIS.II. SURGICAL TREATMENT
No full textThe authors analyze the results of operative treatment in 32 cases of degenerative spondylolisthesis with various degrees of compression of the nervous structures. Five types of surgery were performed: unilateral laminotomy; bilateral laminotomy with or without transverse process fusion; bilateral laminectomy with or without spinal fusion; and laminectomy, spinal fusion, and interspinous wiring. Satisfactory results were achieved in 84% of the cases. Seventy-six percent of the patients had further vertebral displacement, and 81% showed varying degrees of articular process regeneration more than two years after surgery; these findings concern both patients who had been treated with spinal fusion and those who had not. Bilateral laminotomy is indicated in patients with isolated nerve root canal stenosis; as the olisthesis is mild and lateral flexion-extension radiographs show no vertebral hypermobility, spinal fusion is not necessary. When central spinal canal stenosis is present, bilateral laminectomy, extensive lateral decompression, and spinal fusion are recommended. Interspinous wiring may be useful for immediate vertebral stabilization
POSTOPERATIVE INTERVERTEBRAL DISCITIS.EVALUATION OF 12 CASES AND STUDY OF ESR IN THE NORMAL POSTOPERATIVE PERIOD
No full textAbstract
Twelve cases of intervertebral discitis following lumbar discectomy were evaluated and ESR was assessed in 70 patients operated on and without evidence of postoperative infection. Six of the intervertebral discitis patients were studied retrospectively and 6 prospectively. In the retrospective group, patients reported that symptoms appeared on average 15 days after the operation. Antibiotic treatment generally began 31 days after the operation and lasted 62 days; symptoms regressed after 3.9 months. All patients showed long-term radiographic vertebral changes and osteolysis in the cases treated later. In the prospective group, the first symptoms appeared on average 5 days after the operation, treatment started after 8 days and lasted 41 days. Symptoms regressed after 1.8 months. There were only 3 cases of vertebral radiographic changes. In both groups, ESR was always more than 70. The most useful diagnostic imaging tests were conventional tomography and MRI. Needle biopsy had no effect on the length of treatment. In 14% of patients without infective complications, ESR increased noticeably a week after the operation but, in contrast to the intervertebral discitis patients, it did not then continue to increase. Close post-operative observation permitted early detection of intervertebral discitis. Early and high-dose antibiotic treatment, even if unspecific, can resolve this infection in a few weeks
The indications to multiple laminotomies and total laminectomy in central lumbar stenosis.
No full text
Fattori predisponenti alla sindrome da attrito coraco-acromiale. Studio anatomico su scapole secche.
No full textReformation of laminae and articular processes after decompressive surgery for lumbar stenosis.
No full text
- …
