Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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Comparative Study
Full endoscopic contralateral transforaminal discectomy for distally migrated lumbar disc herniation.
Discectomy of distally, inferiorly migrated disc herniations below midpedicle level of the vertebral body in the lower lumbar spine is known to be very difficult by endoscopy. The purpose of this study was to introduce the technical possibility of percutaneous endoscopic lumbar discectomy using a contralateral transforaminal approach for distally migrated disc herniation. ⋯ Percutaneous endoscopic lumbar discectomy using contralateral transforaminal approach can be a useful method in patients with distally migrated disc herniation, and endoscopic navigation of anterior epidural space from the contralateral foramen in the lower lumbar spine is technically possible.
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Total hip arthroplasty (THA) for the treatment of severe dislocation of the hip is a technically demanding procedure. In most previous reports, techniques and clinical outcomes using cementless prostheses are widely reported, but there have been few reports on the technique and outcomes using cemented prostheses. The purpose of this study was to evaluate the outcomes of a cemented THA with a simultaneous subtrochanteric femoral shortening transverse osteotomy in patients with Crowe type III or IV developmental dysplasia of the hip. ⋯ Our results in this study indicate that we should prevent instability at the transverse osteotomy site and an adequate intercalary cortical bone graft is needed to prevent nonunion in cemented THA combined with a subtrochanteric femoral shortening transverse osteotomy. We should apply this procedure with caution in patients, especially those who show less potential bone formation activity.
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Glial cells in the spinal cord of a lumbar radiculopathy model were investigated using immunohistochemical methods. Neuropathic pain is a consequence of neural plasticity. In models of neuropathic pain models, roles for glial cells in the development of pain behaviors have been reported. Accumulating evidence suggests that activation of p38 mitogen-activated protein kinase (p38) in glial cells contributes to the pathogenesis of neuropathic pain. We examined whether activation of glial cells is involved in the development of neuropathic pain-like behavior observed in a model of lumbar radicular pain that we developed. However, the pathogenesis of lumbar radiculopathy and in particular the effect of spinal glial activation on pain transmission in the dorsal horn of the spinal cord are still not fully known. ⋯ Constriction of the lumbar root activated microglia in the spinal cord at 1 and 7 days after surgery, and then returned to normal state at 28 days after surgery, while pain behavior continued. These findings suggest that development of lumbar radicular pain may be initiated by activation of microglia.