Articles: surgery.
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Biochemical mechanisms to explain pain generation began relatively recently. Evaluating pain originating from the spine can be challenging because no historical or physical examination findings are sufficiently sensitive or specific for identifying each of the myriad of potential pain generators. These discrete anatomic structures include the nerve root, disc annulus, posterior longitudinal ligament, sacroiliac joint, and facet joint. ⋯ However, this test may not be necessary in the patient when the specific radiculopathy level diagnosis is apparent; this is the case when a characteristic history and physical examination have a corroborative single-level imaging lesion. Determining which level is generating symptoms has implications for subsequent physical therapy, therapeutic injections, and surgery. This review of selective nerve root blocks describes the relevant anatomy, pathophysiology, rationale, clinical utility, and complications.
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1) To describe injuries experienced by the male prisoner population in the Kingston, Ontario area, and to compare them with those observed in the general population; and 2) to compare the incidence and patterns of prisoner injuries seen in emergency departments (EDs) before and after the introduction of a prison injury triage system. ⋯ The introduction of the new triage system appeared to be associated with a decrease in the total number of ED visits by prisoners. The relative acuity of prisoner injuries seen in the EDs appeared to increase following introduction of the triage system.
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The aim of the present study was to outline a new surgical technique and describe how, in a clinical setting, computer-generated image-guidance can assist in the planning and accurate placement of transarticular C1/C2 screws inserted using a minimally invasive exposure. Forty-six patients with atlanto-axial instability due to rheumatoid arthritis underwent posterior stabilisation with transarticular screws. This was achieved with a minimal posterior exposure limited to C1 and C2 and percutaneous screw insertions via minor stab incisions. ⋯ This technique for placing transarticular screws is accurate and safe. It allows a minimally invasive approach to be followed. Image guidance is a useful adjunct for the surgeon undertaking complex spinal procedures.
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The ability to perform abdominal cosmetic surgery in the ambulatory setting provides a more comfortable environment for the patient, ease of scheduling for the physician, and decreased costs. Avoiding the use of general anesthesia allows for quicker recovery, shorter length of hospital stay, and decreased rate of postoperative complications. The authors report 106 consecutive abdominoplasties, including fascial plication when indicated, using local anesthesia, with procedural sedation and analgesia. ⋯ Although the extent of the surgery remains the same, this approach provided patients with an easier postoperative experience. In summary, abdominoplasty, including full fascial plication of the rectus and external oblique aponeurosis, can be performed safely and comfortably under local anesthesia with procedural sedation and analgesia. Patients are comfortable, recover quickly, and are very satisfied with their surgical result and overall experience.