Minimally invasive techniques in spinal surgery: current practice.

Minimally invasive spinal surgery under arthroscopic or endoscopic magnification and illumination is emerging as an alternative, reliable method of treatment in a variety of spinal disorders. The operative techniques being used for discectomy and retrieval of herniated disc fragments or stabilization of unstable spinal motion segments are being utilized for visual diagnosis and debridement of infectious discitis and osteomyelitis transpedicular and transforaminal vertebral body biopsy, temporary diagnostic fixation of unstable lumbar motion segments, and transforaminal epidural steroid therapy.

Arthroscopic microdiscectomy: an alternative to open disc surgery.

Objective: To assess minimally invasive spinal surgery under endoscopic magnification and illumination (arthroscopic microdiscectomy) as a reliable alternative to open microsurgery for most herniated lumbar discs.

Method: A total of 600 cases are evaluated retrospectively in terms of patient selection and technique. One series of 300 operations was performed by a key academician in the development of arthroscopic microdiscectomy.

Red nucleus neurons of Bcl-2 over-expressing mice are protected from cell death induced by axotomy.

The Bcl-2 proto-oncogene regulates apoptosis and prevents cell death. We studied the effect of Bcl-2 gene over-expression on the survival of axotomized red nucleus (RN) neurons after unilateral hemisection at cervical segment 4/5 (C4/5) in mice. Seventy-five percent of RN neurons survived in Bcl-2 over-expressing mice 1 or 2 months after surgery compared with only 55% of RN neurons in wild-type mice.

A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy.

Background: The usefulness of video-assisted arthroscopic microdiscectomy for the treatment of a herniated lumbar disc has been studied previously. In the current prospective, randomized study, the results of this procedure were compared with those of conventional open laminotomy and discectomy.

Methods: Sixty patients who had objective evidence of a single intracanalicular herniation of a lumbar disc caudad to the first lumbar vertebra were randomized into two groups consisting of thirty patients each; Group 1 was managed with open laminotomy and discectomy, and Group 2 was managed with video-assisted arthroscopic microdiscectomy.

Arthroscopic microdiscectomy and selective fragmentectomy.

A prospective outcome study to determine the efficacy and complications associated with posterolateral arthroscopic discectomy was initiated in April 1988. One hundred seventy-five patients with symptoms consistent with a lumbar disc herniation and correlative imaging studies were treated operatively, and 169 were available for followup evaluation. Fifty-nine patients with a central herniation or a nonmigrated sequestered fragment were treated using bilateral biportal posterolateral access, whereas 116 patients with radiographic evidence of a paramedial, foraminal, or extra-foraminal herniation were treated using the unilateral uniportal approach.

Arthroscopic microdiscectomy: comparison of preoperative and postoperative imaging studies.

Forty-three patients with symptomatic lumbar disc herniations underwent paralumbar arthroscopic disc extraction by a uniportal or biportal approach and postoperative imaging studies. Thirty-one patients were subjected to immediate postoperative computed tomography (CT) at the operative site. The other 12 underwent magnetic resonance imaging (MRI at varying times postoperatively.

Arthroscopic discectomy of the lumbar spine.

Although open laminotomy remains an acceptable and, at times, necessary method of treatment for herniated intervertebral discs, spinal stenosis, and various intracanal spinal disorders, arthroscopic disc surgery is emerging as an alternative method of treatment for contained and nonmigrated sequestered herniated discs. Successful performance of arthroscopic disc surgery requires technical skill and a learning curve. Prudent patient selection, adherence to inclusion and exclusion criteria, and avoidance of entry into the spinal canal when possible will reduce the incidence of perineural and intraneural fibrosis and will ensure a satisfactory outcome.

Minimally invasive disc surgery. Nucleotomy versus fragmentectomy.

There is continued debate as to the optimum surgical management of a herniated disc with sciatica. There are proponents of conventional microdiscectomy as well as those who advocate minimally invasive approaches, including central disc decompression or nucleotomy as well as arthroscopic lumbar microdiscectomy and fragmentectomy. In this controversy (I), Dr.

Consensus summary of the diagnosis and treatment of lumbar disc herniation.

Clinicians must not simply decide that a patient with symptoms and a positive diagnostic test has a reason for a specific treatment, and likewise clinicians must not decide that a patient with symptoms and a negative test does not have a clinically important problem. We must also consider the sensitivity, specificity and predictive value of the diagnostic test and the individual characteristics of the patient. Treatment outcome depends on many factors.

History and current status of percutaneous arthroscopic disc surgery.

Study Design: The relevant literature and the author's experience with the management of lumbar disc herniation is reviewed.

Objectives: To describe the history of percutaneous arthroscopic discectomy, and to discuss the indications, the procedure's scientific validity, and its outcome.

Summary Of Background Data: In contrast to nuclear-debulking procedures, arthroscopic microdiscectomy is target-oriented and capable of retrieving the compressive elements in a carefully selected patient population.

Transforaminal arthroscopic decompression of lateral recess stenosis.

The purpose of this study was to evaluate the feasibility and efficacy of arthroscopic decompression of lateral recess stenosis, determine potential associated complications, and present an alternative method to access the lateral recess of the lumbar spine. Forty patients were selected in whom the authors found clinical and computerized tomography evidence of lateral recess stenosis and sequestered foraminal herniations. All 40 were treated with a posterolateral arthroscopic technique, and 38 were available for this follow-up evaluation.

Diagnostic and therapeutic spinal arthroscopy.

Minimally invasive spinal surgery is an attractive alternative method for the diagnosis and treatment of a variety of spinal disorders. Minimal insult to the soft tissue structures results in rapid recovery and an early return to a functional level. Arthroscopic debridement of intervertebral disc infections, arthroscopic interbody fusion, diagnostic temporary fixation of lumbar motion segments, and intradiscal and pedicular access to the vertebral body for biopsy purposes are making inroads in the field of minimally invasive spinal surgery.

Nucleus pulposus pulmonary embolism. A case report.

Study Design: This postmortem case report describes nucleus pulposus pulmonary embolism occurring in a human.

Objectives: Clinical, pathologic, and pathogenetic features of the case are discussed. Reference is made to warnings in the literature stressing the importance of avoiding, during radiologic procedures, any possibility of intrathecal ingress of iodinated, ionic, hyperosmolar contrast material.

Mechanism research of cryoanalgesia.

The sciatic nerves of rabbits were frozen at different temperatures (-20 degrees C, -60 degrees C, -100 degrees C, -140 degrees C, and -180 degrees C). The morphology and function of the frozen nerves were examined with light microscopy (hematoxylin and eosinophilin stain and a histochemical thiocholine method) and electron microscopy. The function of the nerve after freezing was assessed using short latency somatosensory evoked potentials, sensory conduction velocity, and electromyogram at various intervals after freezing.

Development of degenerative spondylosis of the lumbar spine after partial discectomy. Comparison of laminotomy, discectomy, and posterolateral discectomy.

Study Design: The development of degenerative spondylosis after successful operative decompression of the affected nerve root was prospectively evaluated in a comparative case series of 100 patients with a herniated lumbar nucleus pulposus.

Objectives: The objective of this study was to compare the relative incidence of degenerative spondyloarthrosis after successful posterior laminotomy and discectomy and posterolateral extradural discectomy for decompression of a compromised lumbar nerve root.

Summary Of Background Data: The relationship between the radiographic appearance of degenerative spondylosis and prior operative procedures has been controversial and at times contradictory.

The infra-aortic arteries of the spine: their variability and clinical significance.

The infra-aortic spinal arteries caudal to the aortic bifurcation were studied in 20 perinatal and adult cadavers to determine their import relative to extraforaminal approaches to the lower lumbar discs as well as their probable involvement in certain cases of radiculomedullary ischemia. Analysis of these specimens indicated that, despite considerable variation, the arteries to the L4-L5 and L5-S1 intervertebral foramens generally were not related to the disc dorsolateral zones where lateral surgical approaches are best accomplished. Also, the frequency in which the fourth as well as the fifth lumbar and all sacral segmental vessels were dependent on the posterior division of the hypogastric artery may help explain how spinal cord ischemia could occur in individuals with vulnerable cord vascular patterns and/or spinal arteriopathy after interruption of hypogastric artery blood flow during pelvic operations.

Arthroscopic microdiscectomy versus nucleotomy techniques.

Arthroscopic microdiscectomy represents an alternative method of treatment for herniated lumbar disc and its associated radiculopathy. In contrast to nucleotomy procedures that allow for only central evacuation of the nuclear mass, in arthroscopic microdiscectomy, the emphasis is placed on evacuation of the posterior collagenized fragments, which are responsible for mechanical compression of the nerve roots. Over a period of 10 years, 250 patients with unremitting sciatica due to herniated nucleus pulposus have been treated at the Graduate Hospital through a posterolateral approach via a 6.

Arthroscopic microdiscectomy of the lumbar spine.

Disc herniation in athletes is uncommon; however, it requires prompt diagnosis and treatment. Arthroscopic microdiscectomy is associated with minimal postoperative morbidity and it is particularly suitable for the surgical treatment of unremitting radiculopathy associated with herniated lumbar disc in athletes. The addition of the arthroscope and the deflecting instruments allows for visualization, identification, and extraction of posterior and posterolateral collagenized nuclear fragments that are believed to be the common cause of nerve root compression and sciatica following disc herniation.

Arthroscopic microdiscectomy.

Follow-up examinations performed a minimum of 2 years postoperatively showed that no neurovascular complications developed in 100 patients who underwent arthroscopic microdiscectomy for treatment of herniated discs at L3-4, L4-5, or L5-S1. By using a posterolateral approach, endoscopic control, and specially designed straight, upbiting, and deflectable forceps, it was possible to remove not only fragments located in the center of the nucleus, but also fragments that had migrated posteriorly and posterolaterally. Analysis of operative results by a modification of the Rush-Presbyterian-St.