Surgical technology international
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Until relatively recently, few procedures have been developed that restore significant motor and sensory function in individuals with obsolete (ie, chronic), complete spinal cord injury (SCI). Building upon the methodology used to treat brachial root avulsion, the authors have developed peripheral nerve-rerouting procedures that have restored some function in hundreds of patients with such SCI. ⋯ This Chapter summarizes more than a dozen rerouting procedures, which restore function that range from breathing to toe sensation. This summary discusses the indications and criteria for choosing the best donor nerve based on the specific injury level, and emphasizes major procedural features such as the use of selected interfascicular anastomosis, modified end-to-side suture techniques, vascularized donor nerves, a muscle trigger for the synchronized contraction of congenerous muscles, and reconstruction procedures to restore donor-nerve function.
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Review
Minimally invasive therapeutic interventional procedures in the spine: an evidence-based review.
This chapter evaluates the current evidence on common minimally invasive therapeutic spinal procedures based on the Levels of Evidence and Grades of Recommendation developed by the Centre for Evidence-Based Medicine (Oxford, United Kingdom). The results of the evaluation of current clinical evidence allow the following recommendations to be made: epidural adhesiolysis performed repeatedly every 3 months to 4 months is effective in the "post lumbar laminectomy" syndrome; epidural steroid injections may provide only short-term relief from pain in lumbar radiculopathy but have no long-term effect; selective nerve root injections of corticosteroids have no therapeutic effect on the long-term natural history of radiculopathy symptoms; intra-articular facet joint injections of corticosteroids have no therapeutic effect on lower back pain (grade of recommendation: A). ⋯ Finally, there is limited evidence (grade of recommendation: C) of the value of medial branch (facet) neurotomy, sacroiliac joint injection of steroids, and intradiscal electrothermal therapy, as well as of the advantages of percutaneous endoscopic lumbar discectomy over open microdiscectomy. As the level of evidence is generally low, more prospective randomized-controlled studies are needed to establish the value of the considered methods.
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Comparative Study
Perioperative complications of minimally invasive surgery (MIS): comparison of MIS and open interbody fusion techniques.
The risk of perioperative complications while adopting minimally invasive spine surgery techniques may slow the acceptance of this technology. We assess the perioperative complication rate with minimally invasive single- and two-level interbody fusions and compare this incidence with a contemporaneous cohort of open single- and two-level open interbody fusions, with all procedures completed by a single surgeon in a single practice group. We compiled all open and MIS interbody fusion cases completed during the study period. ⋯ Limiting our analysis to severe complications yielded rates of 7% and 21% for the two groups, also not significantly divergent. Perioperative complications are not more common in well-selected MIS patients. Allowing for proper patient selection, MIS techniques have a favorable complication profile.
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Laparoscopic removal is widely accepted as the treatment of choice for dermoid tumors. However, the spillage of dermoid content with the laparoscopic approach is very high compared to laparotomy. The potential malignancy of dermoid tumors and the rare, but difficult to treat, chemical peritonitis in cases of spillage of dermoid content should lead to an adaptation of procedures during an endoscopic operation on a dermoid tumor to comply with the precautions of the "open" technique. ⋯ Histologically, there was also no carcinoma in any of the examined dermoid tumors. By adapting the endoscopic dermoid surgery to the precautions established in an open surgery technique using gasless lift-laparoscopy, ruptures and cell spilling can be avoided to a large extent but not completely excluded. Compared with other methods, the number of ruptures and spillage of dermoids by organ-preserving treatment as well as ovariectomy is lowest using a lift-laparoscopic procedure.