Effectiveness of an Annular Closure Device to Prevent Recurrent Lumbar Disc Herniation: A Secondary Analysis With 5 Years of Follow-up.

Importance: Patients with large annular defects following lumbar microdiscectomy for disc herniation are at increased risk for symptomatic recurrence and reoperation.

Objective: To determine whether a bone-anchored annular closure device in addition to lumbar microdiscectomy resulted in lower reherniation and reoperation rates vs lumbar microdiscectomy alone.

Design, Setting, And Participants: This secondary analysis of a multicenter randomized clinical trial reports 5-year follow-up for enrolled patients between December 2010 and October 2014 at 21 clinical sites.

Spinal Arachnoiditis Ossificans: A Case-Based Update.

Arachnoiditis ossificans is a rare disease, characterized by intradural ossifications, representing the end stage of chronic adhesive arachnoiditis. We describe the case of a 55-year-old patient who developed symptoms of a cauda equina syndrome after an open microdiscectomy at the L5 to S1 segment. A subsequent exploratory surgery revealed an intradural concentric bony structure with partly incorporated and partly adherent nerve roots.

Risk factors for early reherniation after lumbar discectomy with or without annular closure: results of a multicenter randomized controlled study.

Background: Reherniation after lumbar discectomy is classified as a failure and occurs in 3 to 18% of cases. Various risk factors for reherniation such as age, sex, body mass index, smoking, and size of annular defect have been reported. The aim of this study was to identify risk factors for early reherniation after one-level lumbar discectomy with or without annular closure within 3 months after surgery.

Reoperation After Primary Lumbar Discectomy with or without Implantation of a Bone-Anchored Annular Closure Device: Surgical Strategies and Clinical Outcomes.

Objective: To determine whether presence of a bone-anchored annular closure device (ACD) impacts reoperation strategies and subsequent outcomes.

Methods: Patients with large annular defects after single-level limited lumbar discectomy were randomly allocated to receive an ACD or discectomy alone (controls) and were followed for at least 3 years.

Results: Among 550 patients, reoperation risk was lower with ACD (11.

Challenges in the Analysis of Longitudinal Pain Data: Practical Lessons from a Randomized Trial of Annular Closure in Lumbar Disc Surgery.

To analyze leg pain severity data from a randomized controlled trial (RCT) of lumbar disc surgery using integrated approaches that adjust pain scores collected at scheduled follow-up visits for confounding clinical events occurring between visits. Data were derived from an RCT of a bone-anchored annular closure device (ACD) following lumbar discectomy versus lumbar discectomy alone (Control) in patients with large postsurgical annular defects. Leg pain was recorded on a 0 to 100 scale at 6 weeks, 3 months, 6 months, 1 year, and 2 years of follow-up.

Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial.

Background Context: Patients with large annular defects after lumbar discectomy for disc herniation are at high risk of symptomatic recurrence and reoperation.

Purpose: The present study aimed to determine whether a bone-anchored annular closure device, in addition to lumbar microdiscectomy, resulted in lower reherniation and reoperation rates plus increased overall success compared with lumbar microdiscectomy alone.

Design: This is a multicenter, randomized superiority study.

Endplate changes following discectomy: natural history and associations between imaging and clinical data.

Purpose: Some patients will experience post-operative back pain following lumbar discectomy, and the potential sources for that pain are poorly understood. One potential source is the vertebral endplates. The goal of this study was to document the changes that occur in lumbar endplates following discectomies, and to assess associations between endplate changes and clinical outcomes.

Protecting facet joints post-lumbar discectomy: Barricaid annular closure device reduces risk of facet degeneration.

Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH). Although the majority of patients experience successful outcomes, a significant fraction will experience a recurrence of their back pain due to facet joint degeneration. Facet joint degeneration after discectomy may be the result of excessive nuclear removal, disc space narrowing, and annular injury.

A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss.

Study Design: Prospective cohort study.

Objective: We performed a prospective cohort study with standardized postoperative lumbar imaging every 3 months for a year then annually to assess the incidence and factors associated with same-level recurrent disc herniation.

Summary Of Background Data: The true incidence of same-level recurrent disc herniation after lumbar discectomy is unclear.

Long term experience of gamma knife radiosurgery for benign skull base meningiomas.

Objectives: As most reports on the gamma knife have related only to short or mid-term results, we decided to evaluate the effectiveness and toxicity of radiosurgical treatment for benign skull base meningiomas in 200 patients with a follow up of 5-12 years to define the role of gamma knife radiosurgery (GKRS) for basal meningiomas and to provide further data for comparison with other treatment options.

Methods: In total, 99 patients were treated with a combination of microsurgical resection and GKRS. In 101 patients, GKRS was performed as the sole treatment option.

Intraspinal synovial cyst at the craniocervical junction.

A cystic lesion adjacent to the dens with compression of the lower portion of the medulla oblongata was found on MRI in a 75-year-old male patient with a 2-month history of occipital pain and gait disturbance. Clinically, the patient showed mild tetraparesis, signs of spinal ataxia and symmetrical hyperreflexia. Following subtotal removal of the cyst via left-sided suboccipital craniotomy and left-sided hemilaminectomy of C1 the lesion was classified as synovial cyst on histopathological examination.

Endoscopic percutaneous transforaminal treatment for herniated lumbar discs.

Background: The prevailing percutaneous treatment options for herniated non-contained lumbar discs have not reliably achieved the same good results as the conventional microsurgical techniques. In this study we evaluated clinical outcome and complication rate following endoscopic percutaneous transforaminal treatment of extruded or sequestrated herniated lumbar discs in 122 patients with a follow-up period of more than one year.

Method: Between October 1997 and December 2000, 86 male and 36 female patients with a median age of 55 years (range 18 to 89 years) underwent endoscopic treatment for non-contained herniated lumbar discs at our department.

The role of Gamma Knife radiosurgery in the management of glomus jugular tumours.

Background: Glomus jugular tumours are usually managed by microsurgical resection and/or radiotherapy with considerable risk for treatment-related morbidity. The role of Gamma Knife Radiosurgery (GKRS) in the management of these lesions remains to be defined.

Method: Between May 1992 and November 2000, 19 patients with glomus tumours underwent GKRS at our department.

Cranial nerve preservation after radiosurgery of vestibular schwannomas.

Radiosurgery is a management approach used to treat patients with vestibular schwannomas. The goals are long-term tumour growth control, maintenance of cranial nerve function and prevention of new deficiencies. We sought to determine long-term outcomes measuring the potential benefits against the neurological risks of primary radiosurgery.

Preservation of cranial nerve function following Gamma Knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years.

Introduction: Microsurgical excision with preservation of juxtaposed neurovascular structures is considered the treatment of choice for skull base meningiomas, but there exists a great controversy regarding surgical resectability, potential risk for subsequent postoperative Cranial Nerve Deficit (CND) and the role of adjuvant or adjunctive treatment options. In this study we evaluated the effect of Gamma Knife Radiosurgery (GKRS) in 121 patients with benign basal meningiomas after a follow-up of 5 to 9.8 years.

Long term results of radiosurgery for vestibular schwannomas.

Unlabelled: Radiosurgery is either a primary or an adjunct management approach used to treat patients with vestibular schwannomas. The goals are long-term tumour growth control, maintenance of cranial nerve function and prevention of new neurologic deficiencies. We sought to determine long-term outcomes measuring the potential benefits against the neurological risks of radiosurgery.

Right hemispheric frontal lesions as a cause for anorexia nervosa report of three cases.

Object: Aetiology and pathogenesis of eating disorders is a matter of controversy. In some cases they can occur in association with tumours involving the temporal cortex, in temporal lobe epilepsy or in the advanced state of degenerative diseases involving temporal structures. We report about three patients with right frontal intracerebral lesions, one oligo-astrocytoma and two vascular malformations, associated with partial seizures and anorexia nervosa.

[Therapy of neurotrophic keratopathy in trigeminal schwannoma with radiosurgery].

Background: We present a patient with neurotrophic keratopathy due to a trigeminal nerve neurinoma, who was successfully treated by radiosurgery.

Patient: A patient was referred to us with recurrent corneal erosions of unknown origin in his left eye. In addition, he suffered from mild hypoesthesia in the distribution of the first branch of the trigeminal nerve.

The role of gamma knife radiosurgery in children.

Objects: Despite advances in microneurosurgery, the surgical management of deep-seated lesions is still associated with a high risk. Gamma knife radiosurgery (GKRS), however, has improved the outcome of cerebral tumors and arteriovenous malformations (AVMs) in delicate areas.

Methods: Between March 1992 and June 1998, 50 children (age 1-16 years) with intracranial lesions were treated with GKRS.

Radiosurgery as alternative treatment for skull base meningiomas.

The effect of radiosurgical treatment of skull base meningiomas in 197 patients with a follow-up of at least 2 years was evaluated. Ninety-two of these patients had combined surgical and radiosurgical treatment, while Gamma Knife Radiosurgery (GKRS) was performed as primary treatment in 105 patients. Follow-up was available in 164 patients with intervals of 25-97 months (median 55 months) after GKRS.

Staged radiosurgical treatment for large benign cerebral lesions.

Object: Large brain lesions are considered unamenable to gamma knife treatment because of possible adverse effects. The proximity of eloquent brain to a target location, including some arteriovenous malformations (AVMs), still poses a challenge to the neurosurgeon. Because meningiomas and AVMs often show a slow or absent growth rate, partial radiosurgical treatment in cases with risk of unacceptable surgery-related morbidity is an alternative.

Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases.

Objective: Synovial cysts of the vertebral facet joints are a source of nerve root compression. Different surgical procedures are in use, but no consensus has been formed so far as to which method should be used in synovial cysts. To clarify the role of surgical management, the efficacy of operative procedures and factors influencing the outcome in our own series of 19 patients treated between 1994 and 1998 were analysed.

Lumbar disc herniation mimicking meralgia paresthetica: case report.

Background: Meralgia paresthetica, a syndrome of pain and/or dysesthesia in the anterolateral thigh, is normally caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at the anterior superior iliac spine. In a few cases compression of the nerve in the retroperitoneum has been reported to mimic meralgia paresthetica.

Case Description: A 67-year-old woman presented with a 5-year history of permanent paresthesia in the anterolateral thigh.