International journal of clinical and experimental medicine
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The aim of the study was to investigate the changes of the lumbar intervertebral disc degeneration by magnetic resonance imaging (MRI) after the implantation of interspinous device and the fusion of the adjacent segment. A total of 62 consecutive patients suffering L5/S1 lumbar disc herniation (LDH) with concomitant disc space narrowing or low-grade instability up to 5 mm translational slip in L5/S1 level were treated with lumbar interbody fusion (LIF) via posterior approach. Thirty-four of these patients (Coflex group) received an additional implantation of the interspinous spacer device (Coflex™) in the level L4/L5, while the rest of 28 patients (fusion group) underwent the fusion surgery alone. ⋯ Although both Coflex and fusion group showed improvements of the clinical outcomes assessed by the Oswestry Disability Index (ODI) after surgery, patients in Coflex group had more significant amelioration (P < 0.05) compared to fusion group. During follow up, the postoperative disc degeneration changes in Coflex group assessed by the relative signal intensity (RSI) differed from those in fusion group (P < 0.05). The supplemental implantation of Coflex™ after the fusion surgery could delay the disc degeneration of the adjacent segment.
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The placement of a laryngeal mask airway (LMA) changes the relative positions of the common carotid artery (CCA) and right internal jugular vein (IJV), thereby affecting venipuncture via the right IJV. Therefore, we went on to determine the optimal site for puncturing the IJV after LMA-Supreme™ placement. In this study, forty-six patients were placed with a LMA-Supreme™ (size 3 or 4), and the right IJV was punctured at either of the three points (anterior, middle or posterior point). ⋯ Overlap between the right IJV and CCA at the anterior and middle points was significantly increased after size 3 LMA-Supreme™ placements; Size 4 masks decreased the CCA diameters at the middle and posterior points, and significantly increased overlap between the right IJV and CCA at all the three points; IJV punctures performed after placement of size 3 LMA-Supreme™ had higher success rate than those performed after placement of size 4 masks, and were less likely to result in accidental arterial puncture. In conclusion, our study demonstrated that placement of size 3 LMA-Supreme™ caused little change in overlapping between the right IJV and CCA and the incidence of accidental arterial puncture; particularly for punctures performed at the posterior point. Therefore, we recommend venipuncture at the posterior point after placement of a LMA-Supreme™.
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There has been a large series in the literature reporting on results of osteotomy for the correction of kyphotic deformity secondary to post-traumatic thoracolumbar fracture. However, there are few reports on using intraoperative, full rotation, three dimensional image (O-arm)-based navigation, transpedicular wedge osteotomy for the correction of kyphotic deformity in old thoracolumbar fracture. A 45-year-old woman with L1 old fracture, presented to us with a Cobb angle of 45 degrees. ⋯ The location, angle and depth of osteotomy, as well as screw fixation were performed using a guide tube while referring to the reconstructed 3D-anatomical views. The surgery was successful without nervous and vascular injuries. Using intraoperative, full rotation, three dimensional image (O-arm)-based navigation, the transpedicular wedge osteotomy is a safe and effective treatment for kyphosis after the thoracolumbar fracture, which can insert the pedicular screw accurately, trace the real-time wedge osteotomy and reduce the loss of correction of kyphotic deformity.
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Spinal cord stimulation (SCS) is sometimes preferable in some refractory chronic lower back pain (LBP) pathologies. SCS involves an insertion of electrode leads into the epidural space in the prone position under local anesthesia, followed by neurostimulator implantation under local/general anesthesia. These continuous procedures can cause transient post-operative LBP exacerbation and to make temporary pockets that will store redundant leads in it with some risk of subcutaneous irritation and infection in addition to making extra incisions. We introduce a modified simpler method for SCS implantation, systematically designed to be performed only under local anesthesia in a decubitus, non-prone position. ⋯ The modified SCS insertion method enabled us to achieve both intraoperative pain relief and complete SCS implantation in a minimally invasive manner.
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The aim of the present study was to explore a novel insight to determine the positive end expiratory pressure (PEEP) for sustained ventilation after lung recruitment in an acute respiratory distress syndrome (ARDS) model. Continuous infusion of oleic acid was performed to establish a ARDS model. Pressure control ventilation (PCV) was applied for lung recruitment with PEEP of 20 cm H2O. ⋯ Static compliance (Cst) and dynamic compliance (Cdyn) were also significantly increased after application of different levels of PEEP ventilation after lung recruitment (P<0.05). There was no significant statistic difference on most hemodynamic parameters (P>0.05) between various levels of PEEP. The application of different PEEP levels around the defined optimal PEEP had an obvious improvement on respiratory mechanics and gas exchange for collapsed lung tissue without influencing the hemodynamics.