Pain physician
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Percutaneous transforaminal techniques for the treatment of lumbar disc herniation have markedly evolved. Percutaneous endoscopic lumbar discectomy (PELD) for L5-S1 disc herniation is regarded as challenging due to the unique anatomy of the iliac crest, large facet joint, and inclinatory disc space. Among these, the iliac crest is considered a major obstacle. There are no studies regarding the height of the iliac crest and their appropriate procedures in PELD. ⋯ In high iliac crest cases where the iliac crest is above the mid L5 pedicle in lateral radiography, foraminoplasty may be considered for transforaminal access of L5-S1 disc herniation. Conventional transforaminal access can be utilized with ease in low iliac crest cases where the iliac crest is below the mid-L5 pedicle.
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There is experimental evidence that dexmedetomidine has neuroprotective effects. So, it could be expected that its intrathecal or epidural administration presents no harm. However, whether dexmedetomidine is neurotoxic to the spinal cord remains to be fully elucidated. ⋯ On the basis of the present results, dexmedetomidine administered in the subarachnoid space in a single dose of 10 µg is capable of producing histological changes over the meninges of rabbits.