Mini-open anterior spine surgery for anterior lumbar diseases

Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering the physiological loading, back muscle function, etc. Therefore, we aimed to introduce the modified “mini-open anterior spine surgery” (MOASS) and to evaluate the feasibility, effectiveness and safety in the treatment of various anterior lumbar diseases with this technique. A total of 61 consecutive patients (46 female, 15 male; mean age 58.2 years) from 1997 to 2004 were included in this study, with an average follow-up of 24–52 (mean 43) months. The disease entities included vertebral fracture (20), failed back surgery (13), segmental instability or spondylolisthesis (10), infection (8), herniated disc (5), undetermined lesion for biopsy (4), and hemivertebra (1). Lesions involved 13 cases at T12–L1, 18 at L1–L2, 18 at L2–L3, 22 at L3–L4 and 11 at L4–L5 levels. All patients received a single stage anterior-only procedure for their anterior lumbar disease. We used the subjective clinical results, Oswestry disability index, fusion rate, and complications to evaluate our clinical outcome. Most patients (91.8%) were subjectively satisfied with the surgery and had good-to-excellent outcomes. Mean operation time was 85 (62–124) minutes, and mean blood loss was 136 (minimal-250) ml in the past 6 years. Hospital stay ranged from 4–26 (mean 10.6) days. Nearly all cases had improved back pain (87%), physical function (90%) and life quality (85%). Most cases (95%) achieved solid or probable solid bony fusion. There were no major complications. Therefore, MOASS is feasible, effective and safe for patients with various anterior lumbar diseases.     

Revision anterior shoulder repair for recurrent anterior glenohumeral instability

Although the operative management of recurrent anterior glenohumeral instability has received significant attention in literature, the outcome of revision anterior shoulder repair is much less frequently reported. We report the results of our experience with this challenging problem. Retrospective chart review identified 29 patients who underwent revision anterior shoulder repair. Prior procedures included eight Bankart repairs, seven capsular shifts, 10 combined Bankart and capsular shift procedures, three Putti-Platt procedures, two staple capsulorrhaphies, two Bristow procedures, seven arthroscopie procedures, and one Magnuson-Stack. The average age of the patients was 31.6 years (range: 18 to 52 years) and the dominant extremity was involved in 69%. Findings at the time of revision anterior shoulder repair included 22 patients with capsulolabral detachment, 24 with capsular redundancy, and 14 with rotator interval defects. Twenty-three of the 29 patients were available for at least a two-year follow-up. Twenty-one (91%) remain stable. One patient was non-compliant with the postoperative immobilization and re-dislocated within the first month. The second patient, who had a prior Bankart procedure followed by a capsular shift two years later, underwent a capsular shift for significant capsular laxity. He re-dislocated approximately 15 months postoperatively. Our success rate of 91% in this small series approaches the results of primary open repair for recurrent glenohumeral instability. To achieve a successful outcome, it is essential to address all pathology at the time of revision repair.     

Microscopic anterior foraminal decompression combined with anterior lumbar interbody fusion

Background context

Anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) provides successful surgical outcomes to isthmic spondylolisthesis patients with indirect decompression through foraminal volume expansion. However, indirect decompression through ALIF followed by PPF may not obtain a successful surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or foraminal sequestrated disc herniation. Thus far, there has been no report of foraminal decompression through anterior direct access in the lumbar spine.

Purpose

This study aims to describe the new surgical technique of microscopic anterior foraminal decompression and to analyze the clinical outcomes and radiologic results of the microscopic anterior decompression during ALIF followed by PPF.

Study design/Setting

We conducted a multisurgeon, retrospective, clinical series from a single institution.

Patient sample

This study was carried out from March 2007 to July 2010 and included 40 consecutive patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by posterior osteophyte or foraminal sequestrated disc herniation undergoing microscopic anterior foraminal decompression during ALIF followed by PPF.

Outcome measures

The visual analog scales (VAS) of back and leg pain and the Oswestry disability index were measured preoperatively and at the last follow-up.

Methods

Postoperative computed tomography and magnetic resonance imaging measured whether decompression of neural structure had been made and morphometric change of the foramen and the amount of resected bone. Moreover, segmental lordosis, whole lumbar lordosis, disc height, and degree of listhesis were measured through X-ray examination before the operation and at the last follow-up; we also verified whether fusion had been achieved.

Results

Successful decompression was confirmed in both patients with foraminal stenosis caused by posterior osteophyte and those with foraminal sequestrated disc herniation. Clinically, compared with before the surgery, the VAS (leg and back) and the Oswestry disability index significantly decreased at the last follow-up (p=.000). With regard to radiology, at the last follow-up all patients had bone fusion on X-ray examination, and an increase in disc height, a reduction in the degree of listhesis, an increase in segmental lordosis, and an increase in whole lumbar lordosis were significant in both groups (p=.000) compared with before the surgery. Foraminal volume, foraminal width, and foraminal height also significantly increased postoperatively compared with before the operation (p=.000). The height, width, and dimension of resected body were 4.61±1.05 mm, 7.92±1.42 mm, 17.15±4.96 mm², respectively, in patients with foraminal stenosis caused by a posterior osteophyte, and 3.88±0.92 mm, 6.8±1.29 mm, and 13.12±2.25 mm², respectively, in patients with foraminal sequestrated disc.

Conclusions

The microscopic anterior foraminal approach provides successful foraminal decompression. Combined with ALIF and PPF, this approach shows a good surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or those with foraminal sequestrated disc herniation.     

Peripheral anterior synechiae formation with anterior chamber intraocular lenses.

In a cross-sectional study, 88 eyes with anterior chamber intraocular lenses (AC-IOLs) were evaluated by goniophotography by one masked observer for the presence of peripheral anterior synechiae (PAS) and by another masked observer for the length of the AC-IOL. Sixty-eight of the 88 lenses had PAS which were strongly correlated with the lens being oversized (P less than .001). However, differences in haptic style or lens rigidity were not associated with the presence of PAS.     

Laparoscopic anterior fundoplication

Laparoscopic fundoplication has become the standard surgical method of treating gastro-oesophageal reflux disease. Although Nissen total fundoplication is the most commonly performed procedure, partial fundoplication, either anterior or posterior, is becoming more acceptable because of a suggested lower risk of long term side effects. This article describes a technique of laparoscopic anterior fundoplication.     

Meningocele sacralis anterior

Ohne Zusammenfassung Mit 3 Abbildungen.     

Laparoscopic anterior gastroplasty

Background: The treatment of the morbidly obese patient is difficult because compliance with dietary regimens is poor. As a result, most weight reduction programs fail very quickly. Surgical treatment, on the other hand, provides a reliable method for sustained weight reduction. The most frequently performed procedure has been the vertical banded gastroplasty. Adaptation of the standard open procedure to laparoscopic techniques has been technically difficult and imprecise. We have developed, in the laboratory, an anterior wall banded gastroplasty that can be performed precisely and reproducibly using laparoscopic techniques. Methods: Five Yorkshire pigs were used in attempt to laparoscopically perform the standard vertical banded gastroplasty. The procedure was difficult and was associated with a risk of staple line leak and with bleeding along the lesser curvature of the stomach. Furthermore, a reproducible pouch of proper dimension could not be created reliably. Fifteen animals were then used to develop a new technique using a small gastric pouch based on the anterior gastric wall. Results: A reproducible pouch, 4 cm in length, was created over an 18-Fr nasogastric tube. A standard polyproylene band of 5.2 cm in length was utilized at the gastric pouch outlet. Conclusions: This operation can be reproduced accurately and has not demonstrated any leaks on postmortem examination. Received: 14 July 1997/Accepted: 4 February 1998     

髋臼前柱骨折与前壁骨折的诊断和治疗

目的：探讨髋臼前柱骨折与前壁骨折的诊断和治疗方法。方法：自1994年5月-2003年12月共收治髋臼前柱骨折和前壁骨折(A3型)31例，其中A3—1型5例，A3—2型9例，A3—3型17例。其中13例采用非手术治疗，18采用手术治疗。手术入路：髂腹股沟入路13例，髂股入路5例。结果：随访1～4年，平均2年。结果手术治疗组关节功能表现优良者17例，可1例。非手术治疗组关节功能表现优良者10例，可2例，差1例。结论：骨折块较大、移位比较严重且伴有髋关节前脱位的髋臼前壁骨折需要手术治疗。高位型前柱骨折多数需要行手术治疗。低位型前柱骨折多数行非手术治疗，少数移化非常严重的骨折需要行手术治疗。     

腹腔镜直肠癌根治术——直肠前间隙的分离与解剖

结直肠癌是在亚洲最为常见的恶性肿瘤之一,随着社会发展及中国人群饮食结构的变化,直肠癌发病率逐年上升。既往研究提示,直肠癌其最有效治疗手段为手术治疗,而腹腔镜下手术治疗为当今首选治疗方式之一。而腹腔镜直肠癌根治术其主要手术难点为血管根部淋巴结清扫、分支血管的解剖及保护及骶前直肠间隙的解剖分离等。本次视频其主要目的为讲解头侧中间联合入路下腹腔镜下直肠癌根治术,并重点讲解腹腔镜下直肠前间隙的分离与解剖等。     

Distal anterior cerebral artery aneurysms: bifrontal basal anterior interhemispheric approach

BACKGROUND: Distal anterior cerebral artery (DACA) aneurysms are uncommon. Most authors have reported technical difficulties during surgery for these aneurysms, and a variety of surgical approaches have been advocated. METHODS: Over a period of 5 years (1999-2003), 67 patients with DACA aneurysms were operated. Twenty-eight of these were operated on through the bifrontal basal anterior interhemispheric approach. Of the 28 patients, 68% were in poor clinical grade (Hunt and Hess grade III-V) and 89.3% had a Fisher grade III and IV on computed tomography scan. A surgical trajectory about 2 to 3 cm superior to the anterior cranial fossa floor led directly to the aneurysm. Proximal control was achieved before aneurysm dissection and parallel clipping. RESULTS: Good outcome (Glasgow Outcome Scale V and IV) was seen in 57.19 of the patients, 14.3% had a poor outcome, and 28.6% died. The cause of death in most patients was found to be a poor clinical grade, postoperative infarct, or presence of multiple aneurysms. CONCLUSIONS: The advantages of the bifrontal basal anterior interhemispheric approach were the following: (a) It provided the shortest and a direct trajectory to the aneurysm. (b) Proximal control of the parent A(2) vessels could be easily achieved. (c) Release of cerebrospinal fluid from basal cisterns could be done, if necessary. (d) There was a minimal distortion of or traction over the aneurysm.     

颈前路可控前移融合术在颈椎前路翻修手术中的应用

对于脊髓型颈椎病、颈椎后纵韧带骨化症（ossification of the posterior longitudinal ligament,OPLL）等神经压迫性疾病,大多数患者在手术减压后症状可得到长期缓解。然而,少部分患者因术后神经压迫症状持续、反复或加重需要诉诸翻修手术。压迫残留是颈椎翻修手术的重要原因,其相关的翻修率为6.6％~9.2％,为颈椎术后翻修原因第二位,仅次于远期的相邻节段病。造成前路术后压迫残留主要的3种因素是：椎体后缘骨赘切除不彻底、两侧减压范围过小和减压节段偏少,为彻底去除压迫物,原则上宜行前路翻修直接解除压迫。一般来说,压迫残留范围小于3个椎体水平者可选择ACDF或ACCF手术翻修。但是其需要破坏已融合骨质、取出原有内固定再放入新的内固定,过程较为繁琐,尤以取出内固定的操作为著。如压迫范围大于3个椎体,同时颈椎前凸存在,可选择后路减压。根据有无颈椎不稳表现,可选择椎板切除+融合手术或椎板成形术,手术安全性和疗效比较满意。但是,后路手术无法直接处理残留的压迫,对合并颈椎后凸畸形者需考虑复杂耗时的前后联合入路。颈前路可控前移融合术（anterior controllable antedisplacement and fusion,ACAF）在治疗颈椎后纵韧带骨化症方面取得了比较良好的临床疗效。同时在前期研究中,已有个案报道利用ACAF手术翻修颈椎后路手术的良好效果。本研究回顾性分析在我院采用ACAF术翻修的12例颈椎前路术后患者临床资料,探讨该技术在颈椎前路术后翻修中的安全性和可行性,并评价其临床疗效,以供临床参考。     

钛网并前路钢板在颈前路手术中的应用

目的探讨钛质外科网及带锁钢板在颈椎病损手术治疗中的应用价值。方法对48例颈前路减压术临床资料进行回顾性研究,按JOA评分评定手术效果,颈椎正侧位及屈伸位X线检查判断融合效果。结果JOA评分从术前11.08分±1.68分提高到术后13.56分±1.65分,无一例患者症状加重;按照上海长征医院CSM标准评定,优良率达87.5%。椎体间隙高度得以恢复,植入物无移位脱落,钛钢板及螺钉无移位及松动,植骨融合良好。结论钛质外科网包容自体椎体骨颗粒行植骨融合结合前路钢板固定术可代替自体髂骨融合术,治疗效果肯定,可缩短手术时间,避免取髂骨所致并发症。