Microsurgical cordotomy in 20 patients with epi-/intradural fibrosis following operation for lumbar disc herniation

Summary Using an improved microsurgical technique, cordotomy was carried out by the cervicothoracic route in 20 patients with persistent radicular pain due to epi-/intradural fibrosis following operation for lumbar disc herniation. 65% of them had good long-term results with respect to radicular pain (follow-up period 6–132 months; mean 66 months). Permanent severe motor impairment was not observed. In patients with severe pain of benign organic origin microsurgical cordotomy can be considered as a last resort.     

Continuous blockade of the lumbar plexus after knee surgery: a comparison of the plasma concentrations and analgesic effect of bupivacaine 0.250% and 0.125%

In 20 patients a continuous block of the lumbar plexus was administered after knee-joint surgery, and the analgesic effect of two different concentrations of bupivacaine was compared. The same volume of bupivacaine was given to both groups of patients: a bolus dose of 0.4 ml/kg, 0.5% or 0.25%, followed by infusion of 0.14 ml/kg/h, 0.25% or 0.125%, respectively, via a catheter placed in the neurovascular fascial sheath of the femoral nerve according to the "3-in-1 block" technique. The median morphine consumption during the first 16 h postoperatively was 6.0 mg when bupivacaine 0.5/0.25% was used and 9.5 mg when 0.25/0.125% was used. This difference is not significant. The visual analogue pain scores were also similar in the two groups (P greater than 0.05). All plasma concentrations were below 4 micrograms/ml, the highest concentration measured being 3.6 micrograms/ml. It is concluded that when used for a continuous block of the lumbar plexus after knee-joint surgery, bupivacaine in a concentration of 0.125% offers the same pain relief as a concentration of 0.25%, and the risk of toxic reactions is reduced.     

The R-zero line: a new kinematic concept of the lumbar spine

Summary A new kinematic concept is described that relates to the notion that the lumbar spine behaves as a complete structure. This concept is called the R-zero line and represents kinematically the neutral position of the lumbar spine between anteflexion and retroflexion. The clinical significance of this parameter is evaluated in normal individuals and in patients with a symptomatic herniated disc at L4–5, with a symptomatic herniated disc at L5–S1, and with spondylolysis/spondylolisthesis. The results of this study show that the R-zero line has a characteristic configuration in all four test groups.     

Percutaneous endoscopic lumbar discectomy (PELD)

Percutaneous endoscopic lumbar discectomy (PELD) is a new technique for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. The technique was introduced in Germany by the authors in April 1987. The method is indicated in patients with non-equestrated lumbar disc herniation with an intact lorsal longitudinal ligament. In local anesthesia, a working cannula (OD 5 mm) is placed at the dorsal lateral border of the disc. The disc space is opened with anulus trephines and the nucleus pulposus is removed with rigid and flexible forceps as well as with automated shaver systems under intermittent endoscopic control (discoscopy). The procedure is performed in local anesthesia. The results of the first thirty patients with a follow-up time between 6 months and 17 months could be graded as excellent in 13 cases, as good in 9 cases, as fair in 6 cases, and as bad in 2 cases. The relief of symptoms as judged by the patients was between 70–100 percent in the majority of the cases. Three patients had to be reoperated at the same level and site, because of either persistent or recurrent sciatica. The performance in local anesthesia, the atraumatic extraspinal approach, the reduced time of hospitalization and post-operative morbidity as well as the reduced time of work incapability are the main advantages of this new method.     

骶管阻滞配用周围神经阻滞治疗腰椎间盘突出症的疗效

[目的 ]探讨非手术方法治疗腰椎间盘突出症的疗效 .[方法 ]将 98例腰椎间盘突出症患者分成腰痛组和腿痛组 ,前者采用骶管阻滞加严氏椎间隙阻滞法 ,后者采用骶管阻滞加腰大肌肌沟阻滞法 .[结果 ]两组治疗前后分值相比较均有显著性差异 ,其优良率分别为 88%和 84% .[结论 ]采用骶管阻滞加严氏椎间隙阻滞或腰大肌肌沟阻滞法治疗腰椎间盘突出症具有疗效     

经皮腰椎间盘切除术治疗复发性腰椎间盘突出症

目的：总结经皮腰椎间盘切除术治疗传统后路术后复发性腰椎间盘突出症的经验。方法：分析１９９５年１月至１９９８年１２月采用经皮腰间盘切除术治疗１９例复发性腰椎间盘突出症的临床资料。结果：穿刺成功率１００％,术后随访１０～３２月,平,平均２１月,优１１例、良５例,可２例,差１例,优良率８４．２％。结论：在具有再次开放手术适应症的复发性腰椎间盘突出症中,初次手术行单节段半椎板、全椎板切除和开窗术者中一侧单     

腰椎间盘突出症继发马尾神经综合征手术治疗的疗效

目的：研究腰椎间盘突出症继发马尾神经综合征手术治疗的疗效。方法：对６７例腰椎间盘突出症并发马尾神经综合征的患者发病因素、病程、影像学的表现特征、手术时机的选择同其治疗的随访结果进行综合分析。随访时间３个月至３．５年,平均１年４个月。结果：急性发病的患者其手术时机的选择同患者功能恢复的优良率有关,发病１周、２周、１个月、１个月以上疗效优良率分别为７２．２２％,６３．６４％,５０．００％,３３．３３％     

腰椎间盘突出症患者术前焦虑及影响因素研究

目的　探讨腰椎间盘突出症患者术前焦虑的发生情况及相关因素。方法　应用状态—特质焦虑问卷 (STAI)、社会支持评定量表 (SSRS)、生活事件量表 (L ES)等对 80例腰椎间盘突出症患者进行测查。结果　腰椎间盘突出症患者术前状态焦虑问卷 (S- AI)分值明显高于正常人群 (49.5 5± 8.18Vs39.31± 8.6 6 )。逐步回归分析发现 ,影响患者术前焦虑的主要因素为性格内向、社会支持状况差、负性生活事件多、担心手术效果不好、担心手术医生责任心不强等。结论　腰椎间盘突出症患者术前有明显的焦虑情绪 ,其发生受多种因素的影响。     

牵引推拿复位术治疗中央型腰椎间盘突出症的临床研究

通过对 5 6例中央型腰椎间盘突出症 6 2个椎间盘治疗前后的大小、形态量化的分析 ,认为牵引推拿复位术的作用机制是通过椎间盘的还纳和椎间盘的变形 ,改变了神经根与突出物的位置关系 ,松解粘连 ,解除压迫。对回纳变形机制进行了分析 ,认为要使椎间盘回纳 ,突出的髓核必须具有一定流动性 ,再借助完整的纤维和后纵韧带的张力及手法的压力 ,共同协调作用 ,方能实现。     

新型短节段内固定器治疗腰椎滑脱症的临床应用

目的：探讨新型短节段内固定器治疗腰椎滑脱症的临床应用价值。方法：对１８例腰椎滑脱的脊椎应用新型内固定器进行复位、固定,恢复脊椎的正常解剖结构,并自髂嵴后部取骨行横突间植骨融合。结果：术后随访１２￣２４个月,平均１８个月,滑脱复位率达９０％,４￣５月后达到骨性愈合,无螺钉松动,拨出,断裂及脊住骨滑脱现象。结论：新型短节段内固定器治疗腰椎滑脱症复位率高,固定螺钉松动,拨出,断裂及再滑脱等并发症少,疗效