The Orthopedic clinics of North America
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Orthop. Clin. North Am. · Jul 2007
Historical ArticleMinimally invasive spine surgery: a historical perspective.
Minimally invasive spine surgery has gained considerable momentum and increased acceptance among spine surgeons throughout the years. An understanding and awareness of the development of minimally invasive spine surgery and its role in the operative treatment of various spine conditions is imperative. This article provides a succinct historical perspective of the development of spine surgery from the more traditional, open procedures to the use of more "minimal access" or minimally invasive spine surgery procedures.
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Cervical microendoscopic foraminotomy/discectomy and cervical microendoscopic decompression of stenosis are highly effective, minimally invasive approaches to cervical radiculopathy due to foraminal osteophytes or lateral disc herniation and cervical spondylotic myelopathy, respectively. The operative technique utilized in each of these procedures is described in detail, together with the advantages of the minimally invasive technique over traditional open approaches. Complication avoidance and management is also discussed.
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Stroke is a leading cause of death and serious, long-term disability. Studies evaluating differences between men and women are lacking. Significant differences exist between men and women in terms of risk factors and susceptibility to stroke. ⋯ Women however, have a higher rate of arterial recanalization after intravenous tissue plasminogen activator used for the treatment of acute stroke. The data comparing the effectiveness of treatments for prevention of recurrent stroke between men and women is sparse. There have not been any studies comparing results of treatment of musculoskeletal impairments in men and women after stroke.
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High-field MRI is moving rapidly from the research realm to clinical use. This modality has intrinsic advantages in signal to noise ratio, which allows images that have im-proved resolution, are obtained faster, or have less noise. Perhaps most importantly these scanners will allow functional imaging to become a reality in the musculoskeletal system. Care must be used in protocols because of the energy deposition and worsened artifacts at higher fields.
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Ultrasonography is a useful imaging tool for various soft tissue and joint pathologies affecting the lower extremity. This article reviews the normal sonographic appearance of muscles, tendons, ligaments, nerves, bone, and cartilage. The ultrasound imaging appearance of various pathologic conditions affecting the hip, thigh, knee, lower leg, ankle,and foot are illustrated. The advantages of ultrasonography are highlighted.