Pub Date : 2018-10-23DOI: 10.4172/2165-7939-C1-008
pDavid Zimmermanp
{"title":"Did we close the gate","authors":"pDavid Zimmermanp","doi":"10.4172/2165-7939-C1-008","DOIUrl":"https://doi.org/10.4172/2165-7939-C1-008","url":null,"abstract":"","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-23DOI: 10.4172/2165-7939-C1-009
P. Rajadurai, S. Leep
{"title":"A curious case of delayed cerebrospinal fluid leak in a 17 year old girl","authors":"P. Rajadurai, S. Leep","doi":"10.4172/2165-7939-C1-009","DOIUrl":"https://doi.org/10.4172/2165-7939-C1-009","url":null,"abstract":"","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-23DOI: 10.4172/2165-7939-C1-007
pMohammad Alfawarehp
{"title":"Spine osteotomy in deformity","authors":"pMohammad Alfawarehp","doi":"10.4172/2165-7939-C1-007","DOIUrl":"https://doi.org/10.4172/2165-7939-C1-007","url":null,"abstract":"","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-15DOI: 10.4172/2165-7939.1000417
M. B. Balioğlu, D. Kargın, A. Albayrak, Y. Atici, A. Öner, M. Kaygusuz
Objective: Scoliosis with associated intraspinal anomalies may be treated either before the correction of spinal deformities or during the same session. Our study elucidates the impact of the timing of single- or two-stage neurosurgical and deformity treatment of intraspinal pathologies with the outcomes of serious spinal deformities and discusses the preferable method.Methods: Patients who were operated either concurrently or in two stages, due to intraspinal anomalies associated with rigid spinal deformities, were radiologically and clinically examined. Patients’ ages during the neurosurgical treatment and at the time of deformity treatment, period between two surgeries, follow-up period, clinical and radiological results and encountered complications were recorded.Results: Nineteen patients (13 females, 6 males) underwent surgery for spinal deformities associated with intraspinal pathologies between 2007 and 2014. Fifteen (78.9%) patients underwent a two-stage surgery and four (21.1%) patients’ concurrent surgeries. Mean age of the patients at the time of intraspinal pathology surgery was 8.6 ± 6.9 years and at posterior spinal fusion (PSF) 13.4 ± 3.9 years. The period between the two surgeries was 54.2 ± 67.5 months on average and the mean follow-up period was 39.8 ± 22.2 months. The anteroposterior Cobb’s angle was measured as 68.2° ± 27.1° preoperatively and 29.1° ± 18.7° at final examination (p=0.00). Visual analog scale score was 8.1 ± 1 preoperatively and 1.1 ± 0.2 at the final follow-up (p=0.00).Conclusion: The etiology, extent of deformity, curve progression and patient’s age were indicative in the surgical treatment of intraspinal pathologies and spinal curves. Concurrent surgical interventions may be recommended to avoid additional complications and for quicker recovery.
{"title":"Surgical Treatment Approaches in Severe Spinal Deformities Associated with Intraspinal Pathologies","authors":"M. B. Balioğlu, D. Kargın, A. Albayrak, Y. Atici, A. Öner, M. Kaygusuz","doi":"10.4172/2165-7939.1000417","DOIUrl":"https://doi.org/10.4172/2165-7939.1000417","url":null,"abstract":"Objective: Scoliosis with associated intraspinal anomalies may be treated either before the correction of spinal deformities or during the same session. Our study elucidates the impact of the timing of single- or two-stage neurosurgical and deformity treatment of intraspinal pathologies with the outcomes of serious spinal deformities and discusses the preferable method.Methods: Patients who were operated either concurrently or in two stages, due to intraspinal anomalies associated with rigid spinal deformities, were radiologically and clinically examined. Patients’ ages during the neurosurgical treatment and at the time of deformity treatment, period between two surgeries, follow-up period, clinical and radiological results and encountered complications were recorded.Results: Nineteen patients (13 females, 6 males) underwent surgery for spinal deformities associated with intraspinal pathologies between 2007 and 2014. Fifteen (78.9%) patients underwent a two-stage surgery and four (21.1%) patients’ concurrent surgeries. Mean age of the patients at the time of intraspinal pathology surgery was 8.6 ± 6.9 years and at posterior spinal fusion (PSF) 13.4 ± 3.9 years. The period between the two surgeries was 54.2 ± 67.5 months on average and the mean follow-up period was 39.8 ± 22.2 months. The anteroposterior Cobb’s angle was measured as 68.2° ± 27.1° preoperatively and 29.1° ± 18.7° at final examination (p=0.00). Visual analog scale score was 8.1 ± 1 preoperatively and 1.1 ± 0.2 at the final follow-up (p=0.00).Conclusion: The etiology, extent of deformity, curve progression and patient’s age were indicative in the surgical treatment of intraspinal pathologies and spinal curves. Concurrent surgical interventions may be recommended to avoid additional complications and for quicker recovery.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42464469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-27DOI: 10.4172/2165-7939.1000413
A. Yeung
The Practice of Medicine will always be an art based on science. The human body is more complex and not like a mathematical formula. History has shown that concepts in medicine, judged by “key opinion” leaders, currently depend on scientific publications that affect medical treatment through the medical literature. Strict adherence to Cochrane criteria and old “evidence based” concepts are used for scientific dissemination and publication, but also used for insurance reimbursement in the United States. Health care is becoming more and more supported by government subsidy and payment is dependent on guidelines established by each payer. The ability of innovative and valuable level five expert EBM opinions to get published for dissemination to the scientific community can be difficult for researchers because institutional support or NIH funding is the usual pathway. If there is no institutional support, researchers must pay fees to get their work published in open access Journals. It may be the time to consider “innovative disruption” as a form of evidence based medicine to mitigate the unsustainable increasing cost of health care for spine treatment. Endoscopic spine surgery fits consideration as an innovative disruptive procedure. Patients seeking advice from their chosen physician or health care provider for their physical complaints are for conditions that are based on the Physiology and Patho-anatomy causing their symptoms. In spinal conditions, while most patients are not taken seriously until they complain of “debilitating” pain, symptomatic conditions that can be resolved with tincture of time and/or supportive modalities are supported by allopathic as well as homeopathic and naturopathic physicians. Surgical or invasive procedures are usually reserved for more specific allopathic conditions. These conditions may cause not just pain, but numbness, a change in sensation, weakness, or only intermittent debilitation. The symptoms may also reflect separate and concomitant symptoms that can be confusing when the physician focuses on a single source of the symptom. Extensive experience and perseverance with techniques that work for the clinician is valuable when there is a database large enough to be studied and mined, to demonstrate statistical significance. Such is the case with procedures that can be validated by endoscopic imaging to evaluate, and validate the complaint by the ultimate result: symptom resolution. Traditional radiologic Imaging by itself, however, is inadequate to explain complaints of symptoms that may or may not be debilitating in the physician’s judgment, and the patient may be simply dismissed or prescribed a drug to mitigate the complaint. This has, in many ways, contributed to the myriad of pharma solutions to every symptom complaint in allopathic medicine. A myriad of Naturo-pathic remedies are also marketed and sold over the counter, supported by millions of symptom sufferers who do not expect insurance reimbursement.
{"title":"Lessons Learned from 27 Years’ Experience and Focus Operating on Symptomatic Conditions of the Spine under Local Anesthesia:The Role and Future of Endoscopic Spine Surgery as a “Disruptive Technique” for Evidenced Based Medicine.","authors":"A. Yeung","doi":"10.4172/2165-7939.1000413","DOIUrl":"https://doi.org/10.4172/2165-7939.1000413","url":null,"abstract":"The Practice of Medicine will always be an art based on science. The human body is more complex and not like a mathematical formula. History has shown that concepts in medicine, judged by “key opinion” leaders, currently depend on scientific publications that affect medical treatment through the medical literature. Strict adherence to Cochrane criteria and old “evidence based” concepts are used for scientific dissemination and publication, but also used for insurance reimbursement in the United States. Health care is becoming more and more supported by government subsidy and payment is dependent on guidelines established by each payer. The ability of innovative and valuable level five expert EBM opinions to get published for dissemination to the scientific community can be difficult for researchers because institutional support or NIH funding is the usual pathway. If there is no institutional support, researchers must pay fees to get their work published in open access Journals. It may be the time to consider “innovative disruption” as a form of evidence based medicine to mitigate the unsustainable increasing cost of health care for spine treatment. Endoscopic spine surgery fits consideration as an innovative disruptive procedure. Patients seeking advice from their chosen physician or health care provider for their physical complaints are for conditions that are based on the Physiology and Patho-anatomy causing their symptoms. In spinal conditions, while most patients are not taken seriously until they complain of “debilitating” pain, symptomatic conditions that can be resolved with tincture of time and/or supportive modalities are supported by allopathic as well as homeopathic and naturopathic physicians. Surgical or invasive procedures are usually reserved for more specific allopathic conditions. These conditions may cause not just pain, but numbness, a change in sensation, weakness, or only intermittent debilitation. The symptoms may also reflect separate and concomitant symptoms that can be confusing when the physician focuses on a single source of the symptom. Extensive experience and perseverance with techniques that work for the clinician is valuable when there is a database large enough to be studied and mined, to demonstrate statistical significance. Such is the case with procedures that can be validated by endoscopic imaging to evaluate, and validate the complaint by the ultimate result: symptom resolution. Traditional radiologic Imaging by itself, however, is inadequate to explain complaints of symptoms that may or may not be debilitating in the physician’s judgment, and the patient may be simply dismissed or prescribed a drug to mitigate the complaint. This has, in many ways, contributed to the myriad of pharma solutions to every symptom complaint in allopathic medicine. A myriad of Naturo-pathic remedies are also marketed and sold over the counter, supported by millions of symptom sufferers who do not expect insurance reimbursement. ","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46908682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-08DOI: 10.4172/2165-7939.1000412
Zhang Jian-jun, Cui Hong-Peng, Ding Yu, Fu Ben-sheng, Zhu Kai, Lu Zheng-Cao
Objective: To evaluate the feasibility and clinical effect of endoscopic foraminoplasty and neuro-ventral decompression for the treatment of lumbar disc herniation combining with lateral recess stenosis. Method: From June 2015 to August 2016, thirty patients with typical radicular symptoms and neurogenic intermittent claudication were treated. There were 17 cases with lumbar disc herniation with lateral recess stenosis at L4/L5 and 13 cases at L5/S1. The mean course of disease was 10.6 ± 6.1 months. The preoperative and postoperative visual analogue scales (VAS) were used to assess the intensity of pain. The outcomes were evaluated by Oswestry disability index (ODI) and Japanese Orthopaedic Association Scores (JOA). Clinical signs were observed and compared before and after the operation. These patients had undergone the normalized endoscopic foraminoplasty for spinal canal decompression and discectomy to decompress the traversing and exiting nerve. Result: Based on MacNab's criteria assessment, 17 patients (56.7%) showed excellent, 9 (30.0%) good, 4 (10%) fair, and 0 (0%) poor results. Our results demonstrated that normalized endoscopic foraminoplasty for the treatment of lumbar disc herniation combined with lateral recess stenosis can significantly improve the VAS, ODI and JOA score at each time point postoperatively compared with preoperative parameters (P<0.05). There were no significant differences in the VAS, ODI and JOA scores at each postoperative time point compared with immediate postoperative assessment. Conclusion: The endoscopic foraminoplasty and neuro-ventral decompression is safe, and efficacious for the treatment of lumbar disc herniation with concomitant lateral recess stenosis. Careful selection of surgical indication, and normalized, skilled surgical techniques are the key to the successful clinical outcome
{"title":"Endoscopic Foraminoplasty and Neuro-Ventral Decompression for the Treatment of Lumbar Disc Herniation Combining with Lateral Recess Stenosis","authors":"Zhang Jian-jun, Cui Hong-Peng, Ding Yu, Fu Ben-sheng, Zhu Kai, Lu Zheng-Cao","doi":"10.4172/2165-7939.1000412","DOIUrl":"https://doi.org/10.4172/2165-7939.1000412","url":null,"abstract":"Objective: To evaluate the feasibility and clinical effect of endoscopic foraminoplasty and neuro-ventral decompression for the treatment of lumbar disc herniation combining with lateral recess stenosis. Method: From June 2015 to August 2016, thirty patients with typical radicular symptoms and neurogenic intermittent claudication were treated. There were 17 cases with lumbar disc herniation with lateral recess stenosis at L4/L5 and 13 cases at L5/S1. The mean course of disease was 10.6 ± 6.1 months. The preoperative and postoperative visual analogue scales (VAS) were used to assess the intensity of pain. The outcomes were evaluated by Oswestry disability index (ODI) and Japanese Orthopaedic Association Scores (JOA). Clinical signs were observed and compared before and after the operation. These patients had undergone the normalized endoscopic foraminoplasty for spinal canal decompression and discectomy to decompress the traversing and exiting nerve. Result: Based on MacNab's criteria assessment, 17 patients (56.7%) showed excellent, 9 (30.0%) good, 4 (10%) fair, and 0 (0%) poor results. Our results demonstrated that normalized endoscopic foraminoplasty for the treatment of lumbar disc herniation combined with lateral recess stenosis can significantly improve the VAS, ODI and JOA score at each time point postoperatively compared with preoperative parameters (P<0.05). There were no significant differences in the VAS, ODI and JOA scores at each postoperative time point compared with immediate postoperative assessment. Conclusion: The endoscopic foraminoplasty and neuro-ventral decompression is safe, and efficacious for the treatment of lumbar disc herniation with concomitant lateral recess stenosis. Careful selection of surgical indication, and normalized, skilled surgical techniques are the key to the successful clinical outcome","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"7 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2018-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45851673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-03-24DOI: 10.4172/2165-7939.1000411
T. Chabra, J. Dheenadhayalan, S. Rajasekaran
We report a case of 42-year-old male traumatic paraplegic (D9 level, ASIA A) with inability to sit in the bed and wheelchair which interfered in his rehabilitation because of myositis ossificans at bilateral hips which was confirmed clinically and radiologically. He underwent excision arthroplasty bilateral hips following which his sitting restored and patient independently used wheelchair and successfully earned his livelihood.
{"title":"Surgical Management of a Traumatic Paraplegic with Severe Myositis Ossificans Bilateral Hip: A Case Report","authors":"T. Chabra, J. Dheenadhayalan, S. Rajasekaran","doi":"10.4172/2165-7939.1000411","DOIUrl":"https://doi.org/10.4172/2165-7939.1000411","url":null,"abstract":"We report a case of 42-year-old male traumatic paraplegic (D9 level, ASIA A) with inability to sit in the bed and wheelchair which interfered in his rehabilitation because of myositis ossificans at bilateral hips which was confirmed clinically and radiologically. He underwent excision arthroplasty bilateral hips following which his sitting restored and patient independently used wheelchair and successfully earned his livelihood.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"7 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2018-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43434835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-03-16DOI: 10.4172/2165-7939.1000410
A. Verma, Alok Kumar
Spinal cord injury without radiographic abnormality (SCIWORA) is rare in adults. It is of considerable importance owing to the potential problem of management inherent in the diagnosis. We report a rare case of young female who developed quadriplegia as an outcome of accidental hanging. Her initial radiological investigation were normal but subsequent magnetic resonance imaging revealed intramedullary signal changes from C2 vertebral body level extending up to C3 level without vertebral or ligamental involvement. The patient was recuperated near completely with traditionalist treatment measures including bed rest and methylprednisolone. Routine radiographs and sometimes even computerized tomography can miss this injury and SCIWORA ought to be suspected in these instances of spinal damage giving neurological deficit.
{"title":"Accidental Hanging Leading to Spinal Cord Injury without Radiological Abnormality - A Case Report from Rural India","authors":"A. Verma, Alok Kumar","doi":"10.4172/2165-7939.1000410","DOIUrl":"https://doi.org/10.4172/2165-7939.1000410","url":null,"abstract":"Spinal cord injury without radiographic abnormality (SCIWORA) is rare in adults. It is of considerable importance owing to the potential problem of management inherent in the diagnosis. We report a rare case of young female who developed quadriplegia as an outcome of accidental hanging. Her initial radiological investigation were normal but subsequent magnetic resonance imaging revealed intramedullary signal changes from C2 vertebral body level extending up to C3 level without vertebral or ligamental involvement. The patient was recuperated near completely with traditionalist treatment measures including bed rest and methylprednisolone. Routine radiographs and sometimes even computerized tomography can miss this injury and SCIWORA ought to be suspected in these instances of spinal damage giving neurological deficit.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2018-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45926842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-02-28DOI: 10.4172/2165-7939.1000407
A. Yeung, Vit Kotheeranurak
Anthony T. Yeung M.D., has reported his 5-10-year results in a preliminary review of endoscopic transforaminal of isthmic and degenerative spondylolisthesis decompression causing sciatica and back pain at international spine meetings. Fifty-five patients from January 2002-December 2012 served as the database for the clinical presentation in patients who specifically chose to stage Yeung’s endoscopic transforaminal decompressive procedure over fusion. The patients were specifically evaluated for endoscopic spine surgery in a shared clinical decision. This more focused article is subdivided with stratified indications to degenerative spondylolisthesis only, omitting isthmic spondylolisthesis since isthmic spondylolisthesis is traditionally the surgical option of choice for patients who elected to undergo surgical intervention as the standard surgical option versus continuing with non-surgical care. Disc protrusions associated with degenerative spondylolisthesis, disc herniation, patients with concomitant stenosis, who did well with the first study on both degenerative and isthmic spondylolisthesis were analyzed from the first database and stratified for degenerative spondylolisthesis. The patients of the original 10-year follow-up study were 100% satisfied with their decision to try the endoscopic surgery first, even when they subsequently opted for fusion since it would not interfere with a fusion as a secondary staged procedure. There was no attempt to stratify the first patient group who wanted to stage their surgical options, even if fusion became necessary for their pain and activity requirements. In this 10-year study 33% eventually opted to undergo fusion in order to get more symptom relief. Transforaminal foraminoplasty also provided some unanticipated back pain relief as well. When dorsal endoscopic ablation of the medial branch of the dorsal ramus was later added to the endoscopic procedure to address axial back pain, even better clinical outcomes were obtained by this focused study on degenerative spondylolisthesis, with or without disc protrusion and stenosis.
Anthony T.Yeung医学博士在国际脊椎会议上报道了他在一项关于内镜下经椎间孔峡部和退行性滑脱减压导致坐骨神经痛和背痛的5-10年研究结果。自2002年1月至2012年12月，共有55名患者作为临床表现的数据库，这些患者专门选择在融合术后进行Yeung的内窥镜经孔减压手术。在共同的临床决策中，对患者进行了专门的脊柱内窥镜手术评估。这篇更为集中的文章只对退行性滑脱进行了分层适应症细分，省略了峡部滑脱，因为峡部滑脱传统上是选择手术干预作为标准手术选择的患者的手术选择，而不是继续非手术治疗。从第一个数据库中分析与退行性滑脱相关的椎间盘突出、椎间盘突出和伴行狭窄的患者，这些患者在退行性滑脱和峡部滑脱的第一项研究中表现良好，并对退行性滑脱进行分层。最初的10年随访研究的患者对他们首先尝试内窥镜手术的决定100%满意，即使他们后来选择了融合，因为这不会干扰作为二级手术的融合。即使融合对他们的疼痛和活动需求是必要的，也没有试图对第一个想要分期手术选择的患者组进行分层。在这项为期10年的研究中，33%的患者最终选择接受融合治疗，以获得更多的症状缓解。椎间孔成形术也提供了一些意想不到的背痛缓解。当背侧支内侧支的背侧内镜消融后来被添加到内镜手术中以解决轴性背痛时，通过这项针对退行性脊椎滑脱（伴有或不伴有椎间盘突出和狭窄）的重点研究，获得了更好的临床结果。
{"title":"Transforaminal Endoscopic Decompression of the Lumbar Spine for Stable Degenerative Spondylolisthesis as the Least Invasive Surgical Treatment Using the YESS Surgery Technique","authors":"A. Yeung, Vit Kotheeranurak","doi":"10.4172/2165-7939.1000407","DOIUrl":"https://doi.org/10.4172/2165-7939.1000407","url":null,"abstract":"Anthony T. Yeung M.D., has reported his 5-10-year results in a preliminary review of endoscopic transforaminal of isthmic and degenerative spondylolisthesis decompression causing sciatica and back pain at international spine meetings. Fifty-five patients from January 2002-December 2012 served as the database for the clinical presentation in patients who specifically chose to stage Yeung’s endoscopic transforaminal decompressive procedure over fusion. The patients were specifically evaluated for endoscopic spine surgery in a shared clinical decision. \u0000This more focused article is subdivided with stratified indications to degenerative spondylolisthesis only, omitting isthmic spondylolisthesis since isthmic spondylolisthesis is traditionally the surgical option of choice for patients who elected to undergo surgical intervention as the standard surgical option versus continuing with non-surgical care. Disc protrusions associated with degenerative spondylolisthesis, disc herniation, patients with concomitant stenosis, who did well with the first study on both degenerative and isthmic spondylolisthesis were analyzed from the first database and stratified for degenerative spondylolisthesis. The patients of the original 10-year follow-up study were 100% satisfied with their decision to try the endoscopic surgery first, even when they subsequently opted for fusion since it would not interfere with a fusion as a secondary staged procedure. There was no attempt to stratify the first patient group who wanted to stage their surgical options, even if fusion became necessary for their pain and activity requirements. \u0000In this 10-year study 33% eventually opted to undergo fusion in order to get more symptom relief. Transforaminal foraminoplasty also provided some unanticipated back pain relief as well. When dorsal endoscopic ablation of the medial branch of the dorsal ramus was later added to the endoscopic procedure to address axial back pain, even better clinical outcomes were obtained by this focused study on degenerative spondylolisthesis, with or without disc protrusion and stenosis.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46788626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-20DOI: 10.4172/2165-7939.1000406
M. Shibayama, G. Li, K. Shimizu, Y. Miura, Nakamura Shu, Yamada Minoru, Z. Ito, F. Ito
The standard treatment for lumbar pyogenic spondylodiscitis is an intravenous antibiotic. If conservative treatment fails, surgery is indicated. However, many patients suffer from residual lumbago after prolonged conservative treatment, and invasive surgery is problematic in poorly conditioned patients. We developed a new treatment in which intravenous antibiotics are supplemented by multiple injections of antibiotic directly into the infected disc. Here we report our experience with twenty adult patients. Shortly after infection was diagnosed, we performed the needle biopsy that we reported followed by direct antibiotic injection into the infected disc. Antibiotic was injected twice weekly until inflammation subsided. The average number of injections was 6.8. Infection was eradicated in all cases. Surgery was needed in two cases (10%): one because of acute paralysis and one because of residual sciatica. We observed no adverse effects. Excluding two cases who died of cancer, we obtained excellent (n=12) or good (n=3) results (83%) in a total of 18 patients evaluated according to Macnab's lumbago criteria at an average of 27.5 months follow-up. The disc height was retained in ten cases during the initial two months of treatment: nine of these patients showed excellent results on Macnab's lumbago scale. We conclude that supplementing standard systemic antibiotic therapy with multiple injections of antibiotic directly into the infected disc provides a safe and effective method of eradicating lumbar pyogenic spondylodiscitis. This treatment also provides an excellent chance of maintaining the disc height, which leads to less residual lumbago.
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