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Prosthetic Lumbar disc replacement for degenerative disc disease  [cached]
Kulkarni Arvind,Diwan Ashish
Neurology India , 2005,
Abstract: Mechanical articulated device to replace intervertebral disc as a treatment for low back pain secondary to disc degeneration has emerged as a promising tool for selected patients. The potential advantages are prevention of adjacent segment degeneration, maintenance of mobility as well as avoidance of all the complications associated with fusion. The short-term results have been comparable to that of fusion, a few mid-term results have shown mixed outcome, but information on long-term results and performance are not available at present. The rationale for lumbar disc arthroplasty, indications, contraindications, the various artificial devices in the market and the concepts intrinsic to each of them, basic technique of insertion, complications are discussed and a brief summary of our experience with one of the devices is presented.
Spine imaging after lumbar disc replacement: pitfalls and current recommendations
Yohan Robinson, Bengt Sandén
Patient Safety in Surgery , 2009, DOI: 10.1186/1754-9493-3-15
Abstract: Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures.Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI.Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.Total disc replacement (TDR) is an evolving surgical option for patients with degenerative disc disease [1,2]. The appearance of disc arthroplasty has required radiologists to contend with a new entity of spinal implants. Many fusion devices are made of titanium or carbon, howewer the currently available lumbar TDR-implants are made of stainless steel, which obscures imaging when using MR-diagnostics (Table 1).It is widely accepted that lumbar disc arthroplasty is associated with several access- and implant-associated complications. Unfortunately imaging modalities after TDR cannot simply be transferred from fusion patients. In this review the complications following total disc replacement are discussed and guidelines for imaging following lumbar disc arthroplasty are provided.All commercially available lumbar artifical discs are composed of a stainless steel core with titanium surfacing (Table 2). This has implications on the accuracy
Artificial cervical disc replacement: Principles, types and techniques  [cached]
Sekhon L,Ball J
Neurology India , 2005,
Abstract: Cervical arthroplasty after anterior decompression with insertion of a prosthetic total disc replacement has been suggested as an alternate to anterior cervical fusion. Currently there are four cervical arthroplasty devices available on the market whose results in clinical use have been reported. Each device varies in terms of materials, range of motion, insertion technique and constraint. It is not known which device is ideal. Early studies suggest that in the short term, the complication rate and efficacy is no worse than fusion surgery. Long-term results have not yet been reported. This review examines the current prostheses available on the market as well as discussing issues regarding indications and technique. Pitfalls are discussed and early experiences reviewed. In time, it is hoped that a refinement of cervical arthroplasty occurs in terms of both materials and design as well as in terms of indications and clinical outcomes as spinal surgeons enter a new era of the management of cervical spine disease.
Posterior Transpedicular Dynamic Stabilization versus Total Disc Replacement in the Treatment of Lumbar Painful Degenerative Disc Disease: A Comparison of Clinical Results  [PDF]
Tunc Oktenoglu,Ali Fahir Ozer,Mehdi Sasani,Yaprak Ataker,Cengiz Gomleksiz,Irfan Celebi
Advances in Orthopedics , 2013, DOI: 10.1155/2013/874090
Abstract: Study Design. Prospective clinical study. Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease. Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery. Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups. Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques. Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications. 1. Introduction Currently, one of the most important causes of chronic low back pain is thought to be a painful disc [1–3]. Some biomechanical and biochemical changes play a role in intervertebral disc degeneration; on the other hand intrinsic, extrinsic, and genetic factors are also important. Compression of the spine, torsional injuries, overload, and congenital anomalies have been shown to contribute to disc degeneration with applying excessive pressure onto intervertebral discs [4–10]. Despite numerous research studies, the etiology and physiopathology of disc degeneration remain unknown [2]. Annular tears resulting from degeneration of the annulus fibrosis, that contains pain receptors and internal disc ruptures, are the most common cause of pain [11–13]. Today, it is believed that degenerative disc disease (DDD) might cause instability in spine segments, and it is widely accepted that progressive back pain results due to this instability [14–16]. In fact, segmental instability begins when disc height deterioration is initiated by the progression of intervertebral disc degeneration. Instability as a consequence of disc degeneration has been described by Frymoyer [14, 15] as primary segmental
The Charité III Artificial Disc lumbar disc prosthesis: assessment of medium-term results
G. Gioia,D. Mandelli,F. Randelli
Journal of Orthopaedics and Traumatology , 2007, DOI: 10.1007/s10195-007-0080-1
Abstract: The intervertebral disc prosthesis seems to have gained its place in spinal surgery. The first 45 disc replacements (36 patients) performed at our institution have been followed for 5–9 years with standard radiography, CT, MRI and clinical evaluation. Two prostheses failed and needed further surgery. The mean Oswestry Disability Index score dropped from 44% to 9% and the pain score recorded on a visual analogic scale (VAS) dropped from 8 to 1.4. 92% of patients had excellent or good results and gave a positive answer to the question “Would you be ready to sustain again this same surgical procedure?” In 4 cases, a tendency towards prosthesis subsidence was observed. With time, 6 patients showed periprosthetic calcifications. One patient developed retrograde ejaculation. In conclusion, intervertebral disc prosthesis is a well established procedure that achieves good mid-term results, but doubts still remain about the longterm outcome. Care about right indication, eventual complications and assessment of long-term results are key points for the future of this procedure.
Clinical study to evaluate the safety and effectiveness of the Aesculap Activ-L? artificial disc in the treatment of degenerative disc disease
James J Yue, Fred F Mo
BMC Surgery , 2010, DOI: 10.1186/1471-2482-10-14
Abstract: The study proposed is a prospective, randomized, single-masked, controlled, multi-center clinical trial consisting of an estimated 414 subjects with single-level DDD of the lumbar spine (L4/L5, or L5/S1) who have failed to improve with conservative treatment for at least six months prior to enrollment. After enrollment, subjects will be randomized in a 2:1 ratio to either the Activ-L Disc (investigational device) or the control (Charité or ProDisc-L). Radiographic endpoints will be evaluated by an independent reviewer at an imaging core laboratory. Each subject will be followed for 5 years post-treatment.The safety and effectiveness of the Activ-L Artificial Disc for treatment of single-level degenerative disc disease of the lumbar spine will be equivalent to Charité? Artificial Disc [DePuy Spine] or ProDisc-L? Total Disc Replacement [Synthes Spine] at 24 months.Current Controlled Trials NCT00589797.Lower back pain is a leading cause of physician patients report back pain annually in the U.S. Conservative treatment ultimately fails in over 4.5 million patients, and of these, some 500,000 undergo surgery of the lumbar spine, of which 200,000 are fusions [1-5].One of the primary causes of lower back pain is degeneration of the intervertebral disc. Disc degeneration may result in rupture or herniation, spinal instability, articular facet syndrome, or painful impingement on the nerves enclosed in the spinal visits in the United States, second only to the common cold. The resultant pain may also lead to significant disability.Spinal fusion effectively eliminates the motion segment between two vertebrae by use of a bone graft, thereby providing improved stability and decreased pain. The success rate in spinal fusion has proven highly variable; averaging approximately 60 to 70% [2]. The use of internal fixation generally increases the fusion rate but also increases the stiffness of the fused area. This may lead to increased stress on the adjacent nonfused segments and, in
Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry
Thomas Zweig, Christoph Hemmeler, Emin Aghayev, Markus Melloh, Christian Etter, Christoph R?der
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-275
Abstract: Between March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D).Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling.Demographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower.Despite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because patients with higher preoperative leg pain levels benefit from a relatively greater leg pain alleviation. The group with absence of HNP but presence of radiculopathy showed considerably less benefits from the operation, which is probably related to ongoing degenerative processes of the posterior segmental structures. This observational multicenter study suggests that the diagnoses HNP and radiculopathy, combined or alone, may not have to be considered as absolute or relative contraindications for mono-segmental lumbar TDR anymore, whereas patients without HNP but with radiculopathy seem to be suboptimal
Lumbar Disc Herniation in Pediatric  [PDF]
Mostafa Abd Elsamea, Mohamed Shaban, Ahmed Taha, Samer Elshora
Open Journal of Modern Neurosurgery (OJMN) , 2018, DOI: 10.4236/ojmn.2018.82019
Abstract: Lumbar disc herniation is a common complaint among adults with degenerated lumbar intervertebral discs, however its incidence in childhood and adolescence is abundant. Findings recommended that pediatric lumbar disc herniation is dissimilar in numerous way from that in adults. It was confirmed that pediatric patients respond to conventional management less than adults, also the consequence of the operation continued to be acceptable for at least 10 years after the first surgery even though it seems to decline somewhat. This retrospective study was undertaken to determine the clinical outcome and the feature of lumbar disc prolapse in pediatric patients. 12 patients younger than 18 years were operated for lumbar disc prolapse in the period from 2012-2016. Patients preoperative data and radiological imaging, operative and postoperative follow up were reviewed. 12 patients were included in this study, 10 were male and 2 females, the average age was 15 years (ranging between 12 - 18 years). The average duration of the symptoms was 11 months. The average follow up was 14 months. All patients had a sciatica prior to surgery, 35% had motor deficit, and 60% had parasthesia. Conservative treatment failed in all patients. After surgery and follow up, improvement occurs in about 80% of patients, ranging from excellent to good, and 20% of patients with fair outcome. According to Pain Visual Analogue Scale, leg pain reduced from 90 - 30 and back pain from 80 - 35. Conclusion: Pediatric lumbar disc herniation is an uncommon object leading to hospitalization. About 0.1% - 0.2% of children and adolescence surgery for lumbar disc herniation in pediatric does not lead to chronic back pain or interfere with physical activity and is related to the excellent short consequence.
LUMBAR DISC FENESTRATION
RIAZ UR REHMAN,AZMATULLAH KHATTAK
The Professional Medical Journal , 2011,
Abstract: Know the efficacy of disc excision by fenestration method for the relief of lumbar radicular pain in patients withprolapsed intervertebral disc. Study Design: Descriptive study. Setting: Department of neurosurgery of Hayatabad Medical Complex,Peshawar. Period: October 2008 to September 2010. Patients and Methods: All those patients were included in whom straight leg raising(SLR) sign was less than 60 degree and prolapsed L4-5 or L5-S1 disc on MRI. Patients with multiple level discs, previous history of spinesurgery, evidence of lumbar stenosis and cauda equina syndrome were excluded from this study. All patients were operated in knee-chestposition under general anesthesia. Efficacy of disc excision was measured using Dennis pain scale. Findings were documented on the day ofdischarge. Statistical analysis was performed with SPSS (version 10). Results: One hundred and nine patients were studied. Sixty were maleand fifty nine were female patients. Age rang was from 19 to 52 years with mean age 34.31 years. The most common level of involvement was L4 -L 5 (n=67) followed by L 5 -S 1 (n=42) . Sixty five patients had left sided symptoms while forty four had right sided. Majority of patientspresented in Dennis pain scale 4 i.e. 66.97% (n=73). Twenty patients (18.36%) were in P3 and 16 patients (14.67%) were in Dennis pain scale 5.Complete pain relief (P1) , three weeks after disc excision ,was achieved in 90 (82.57%) patients .Fourteen patients(12.85%) were in P2 andfive(4.58%) patients in P3 according to Dennis pain scale. No patients in this study deteriorated after surgery. Conclusions: Surgical treatmentprovides quick pain relief in selected patients with prolapsed intervertebral disc. Fenestration with disc excision is quite a reasonable method tosurgically treat the indicated cases of prolapsed disc. Fenestration offers complete visualization of nerve root and complete removal of theoffending disc. This procedure does not need greater know-how, expertise in instrumentation and techniques.
Artificial cervical disc replacement - An update  [cached]
Mehren C,Mayer H
Neurology India , 2005,
Abstract:
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