A prospective cohort study.
To evaluate whether an annular closure device could be implanted safely to reduce same-level recurrent disk herniation, or attenuate disk height loss and improve the ...outcome after lumbar discectomy.
Same-level recurrent disk herniation, disk height loss, and progressive degeneration are common complications and sequelae after lumbar discectomy. Techniques to reduce these consequences may improve outcomes.
Forty-six consecutive patients undergoing lumbar discectomy for single-level herniated disk at 2 institutions were followed prospectively with clinical and radiographic evaluations at 6 weeks and 3, 6, 12, and 24 months (control cohort). A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed similarly. Incidence of recurrent disk herniation, disk height loss, the leg and back pain visual analog scale (VAS), and the Oswestry Disability Index were assessed at each follow-up.
Cohorts were well matched at baseline. By 2 years of follow-up, symptomatic recurrent same-level disk herniation occurred in 3 (6.5%) patients in the control cohort versus 0 (0%) patients in the annular repair cohort (P=0.27). A trend of greater preservation of disk height was observed in the annular repair versus the control cohort 3 months (7.9 vs. 7.27 mm, P=0.08), 6 months (7.81 vs. 7.18 mm, P=0.09), and 12 months (7.63 vs. 6.9 mm, P=0.06) postoperatively. The annular closure cohort reported less leg pain (VAS-LP: 5 vs. 16, P<0.01), back pain (VAS-BP: 13 vs. 22, P<0.05), and disability (Oswestry Disability Index: 16 vs. 22, P<0.05) 1 year postoperatively.
Implantation of a novel annular repair device was associated with greater maintenance of disk height and improved 1-year leg pain, back pain, and low-back disability. Recurrent disk herniation did not occur in any patient after annular repair. Closure of annular defect after lumbar discectomy may help preserve the physiological disk function and prevent long-term disk height loss and associated back and leg pain.
We describe a case of acute obstructive hydrocephalus as a consequence of compression of the brainstem by a large aneurysm of the basilar artery (BA) in a 62-year-old male. After the insertion of the ...ventriculoperitoneal shunt (VPS), we encountered the "locked-in syndrome" clinical condition. "Locked-in syndrome" is a clinical state characterized by quadriplegia and anarthria with preserved consciousness, most commonly caused by ischemia in the ventral part of pons.
Transthoracic computed tomography-guided core needle biopsy (TTNB) is a well-established method for diagnosing focal pulmonary lesions. However, the dangers associated with this method as well as the ...significant number of complications caused by it cannot be ignored. Systemic air embolism is a rare but potentially fatal complication that can accompany transthoracic needle biopsies of pulmonary lesions. In this study, we report nonfatal systemic air embolism as a complication of a transthoracic needle core biopsy of a subpleural nodule in the right upper pulmonary lobe of a patient with hemoptysis. Although extremely rare, the complication may result in a transient myocardial ischemia, which is presented with a transient depression of the ST segment.
Same-level recurrent disc herniation is a well-defined complication following lumbar discectomy. Reherniation results in increased morbidity and health care costs. Techniques to reduce these ...consequences may improve outcomes and reduce cost after lumbar discectomy. In a prospective cohort study, we set out to evaluate the cost associated with surgical management of recurrent, same-level lumbar disc herniation following primary discectomy.
Forty-six consecutive European patients undergoing lumbar discectomy for a single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations. A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed at the same hospitals and same follow-up intervals. Cost estimates for reherniation were modeled on Medicare national allowable payment amounts (direct cost) and patient work-day losses (indirect cost).
Annular closure and control cohorts were matched at baseline. By 2 years follow-up, symptomatic recurrent same-level disc herniation occurred in three (6.5%) patients in the control cohort versus zero (0%) patients in the annular closure cohort. For patients experiencing recurrent disc herniation, mean estimated direct and indirect cost of management of recurrent disc herniation was $34,242 and $3,778, respectively. Use of an annular closure device potentially results in a cost savings of $222,573 per 100 primary discectomy procedures performed (or $2,226 per discectomy), based solely on the reduction of reoperated reherniations when modeled on U.S. Medicare costs.
Recurrent disc herniation did not occur in any patients after annular closure within the 12-month follow-up. The reduction in the incidence of reherniation was associated with potentially significant cost savings. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the associated morbidity and health care costs associated with this complication.
Summary
We have a 30-year-old female patient suffering from secondary hydrocephalus. She has had a ventriculoperitoneal shunt (VPS) implanted following a rupture and a successful clipping of the ...aneurysm of the anterior communicating artery (ACoA). Three weeks after implanting of the VPS, respiratory and abdominal difficulties with febrility appeared. We diagnosed cerebrospinal fluid liver pseudocyst using ultrasound (US) and computer tomography scan (CT). Given that we found bacteria in the cerebrospinal fluid (CSF), we converted VPS into an external ventricular drain (EVD). After that, we conducted a US-guided punction and drainage of the CSF liver pseudocyst. The subsequent CT of abdomen showed a regression of the cystic form. The patient died following the septic condition with multiple organ failures (MOF) a month after the cerebrospinal fluid liver pseudocyst diagnosis.The perforation of parenhimatose abdominal organs with distal part of VPS is a rare complication which is most likely a consequence of a shunt infection and of an immunological reaction that took place during the process of localizing an infection.
Annular Reinforcement Device represents a modification of operative treatment of intervertebral disk herniation. It is a prosthesis that is anchored into the body of the vertebra. The intradiscal ...part of the implant is placed in the inner part of the annulus fibrosus defect. The aim of this technique is to reduce the incidence of reherniation and the degree of intervertebral space collapse, which is the most frequent adverse effect of diskectomy. Clinical outcomes of the treatment group indicated a statistically significant improvement with respect to the control group. Furthermore, over the period of two years, no cases of symptomatic reherniation were recorded. Considering that no serious complications occurred during the procedures, it would appear that this is an implant that, given its encouraging results, should be further verified in carefully designed future studies.
Križobolja i lumboishijalgija su značajni zdravstveni problemi današnjice. Bolesnici s navedenim tegobama često izostaju s posla, a troškovi operacijskog liječenja iznimno su visoki. Adekvatna ...dijagnostika križobolje i lumboishijalgije podrazumijeva detaljno poznavanje anatomije kralježnice i živčanih struktura, kao i rukovanje pomičnim RTG uređajem. Svrha je ovih procedura primjenom kratkodjelujućeg lokalnog anestetika anestezirati pojedine živčane završetke, a u slučaju provokativne diskografije provocirati bol, kako bi se sa sigurnošću potvrdilo koje su anatomske strukture uzrok bolova. To je potrebno stoga što križobolju mogu uzrokovati različite bolesti kralježnice. Najčešće su degenerativne promjene u intervertebralnom disku, promjene malih zglobova, oštećeni sakroilijakalni zglob ili hernijacija diska. Shodno ovome, a ovisno o različitim anatomskim strukturama koje mogu biti izvor bolova, postoji više dijagnostičkih minimalno invazivnih procedura. Svaka dijagnostička procedura, s kojom se egzaktno utvrdi uzrok križobolje ili lumboishijalgije, bolesnika posljedično potvrđuje kao dobrog kandidata za minimalno invazivni terapijski zahvat.
Križobolja i lumboishijalgija značajni su javnozdravstveni problemi modernoga doba. Troškovi operacijskog liječenja često su iznimno visoki, a radno sposobni ljudi s ovim bolestima često izostaju s ...radnoga mjesta. Minimalno invazivno liječenje križobolje i lumboishijalgije podrazumijeva detaljno poznavanje anatomije kralježnice i živčanih struktura, kao i rukovanje pokretnim RTG uređajem. Križobolju i lumboishijalgiju mogu uzrokovati degenerativne promjene u intervertebralnom disku, promjene zigapofizealnih (fasetnih) zglobova, oštećeni sakroilijakalni (SI) zglob ili hernijacija diska, kao najčešći uzrok stenoze spinalnog kanala. Svaka minimalno invazivna dijagnostička procedura, s kojom se egzaktno potvrdi uzrok križobolje ili lumboishijalgije, bolesnika posljedično predodređuje za specifični minimalno invazivni terapijski zahvat. Kod bolova u slabinskoj kralježnici uzrokovanih degenerativnim promjenama u intervertebralnom disku bolesniku se preporučuje jedna od metoda anuloplastike. Ako je križobolja uzrokovana degenerativnim promjenama fasetnih zglobova ili promjenama u SI zglobu, tada se primjenjuju procedure radiofrekventne neuroablacije. U slučajevima kada su križobolja i lumboishijalgija uzrokovane stenozom spinalnog kanala, bolesniku se preporučuju epiduralne steroidne injekcije ili perkutana laserska dekompresija diska. Svrha je ovih procedura, primjenom dugodjelujućih kortikosteroida i kratkodjelujućeg lokalnog anestetika, te primjenom radiofrekventne struje ili primjenom energije lasera, bolesnika na duže vrijeme osloboditi bolova i tako mu poboljšati kvalitetu života, a istovremeno prevenirati ili barem odgoditi velik operacijski zahvat.
Bol je neugodan individualni osjećaj koji je teško definirati, stoga svatko od nas doživljava i podnosi bol drugačije. Definicija Svjetskog udruženja za bol (IASP) kaže: “Bol je neugodan emocionalni ...i osjetni doživljaj povezan sa stvarnim ili potencijalnim oštećenjem tkiva.” U ovom članku ukratko se prikazuje patofiziologija i percepcija bola u perifernom i središnjem živčanom sustavu.
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