Percutaneous endoscopic discectomy: clinical results and how it affects the quality of life.

STUDY DESIGN: Prospective study OBJECTIVE: To determine the clinical outcomes and the effect on quality of life of patients with endoscopic discectomy. SUMMARY OF BACKGROUND DATA: Percutaneous endoscopic discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and return to the work. METHOD: Fifty-five patients with percutaneous endoscopic discectomy performed from the year 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS), Medical Outcomes Study Short Form-36 (SF-36) scores and Pain Visual Analog Scale (VAS) and return to the work. RESULTS: The mean age was 35.6 years, the mean operative time was 60 minutes and the mean length of follow-up was 3 years. The mean hospital stay for endoscopic discectomy was 17 hours. There was statistical difference in the reduction of severity of back pain and lower-limb symptoms (NASS and VAS, P<0.05) at 6 months and 2 years. There was significant improvement in all aspects of the quality of life (SF-36, P<0.05) scores except for general health at 6 months and 2 years postoperation. The improvement in the SF-36 quality of life parameters correlated with the improvement in the NASS back disability and neurogenic symptoms and the VAS leg and back pain scores. The recurrence rate was 5% (3 patients). The 5% patients (3 patients) subsequently underwent lumbar fusion for persistent back pain. All patients returned to their previous occupation after surgery at a mean time of 24 days. CONCLUSIONS: Endoscopic discectomy is associated with improvement in back pain and lower-limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with shorter length of hospitalization and early return to work thus improving quality of life earlier.

Polyurethane grafts: a viable alternative for dialysis arteriovenous access?

Polyurethane grafts, promoted for their self-sealing properties and low complication rates, were recently introduced for hemodialysis access. We review our experience with this graft material to determine its complication and patency rates. Between January 1995 and December 1999, 118 patients, 75 female and 43 male, with a mean age of 51 years, had a total of 163 polyurethane arteriovenous grafts inserted. The grafts were mostly 6 mm in diameter (69.3%), placed in a loop configuration (91.4%) in the forearm (49.7%). The median follow-up period was 12 months. The grafts were first cannulated for hemodialysis at a median time of 19 days after implantation, with 12% used within 3 days. Thrombosis and infection were the most common complications at rates of 32.7% and 30.0%, respectively. Infection was the most common cause of graft loss (61.5%). These complications were amenable to salvage intervention. The 1-year primary and secondary patency rates were 73% and 86%, respectively; the 3-year secondary patency rate, 72%. The 1-year serviceability rate was 64%. With satisfactory patency rates and the advantage of its self-sealing properties permitting early cannulation, polyurethane grafts provide a viable alternative for hemodialysis access. Early recognition and appropriate management of complications can prolong graft survival.

Intermediate Results of the Prestige LP Cervical Disc Replacement: Clinical and Radiological Analysis With Minimum Two-Year Follow-up.

STUDY DESIGN: prospective study. OBJECTIVE: present results of Prestige LP artificial cervical disc replacement (ADR). SUMMARY OF BACKGROUND DATA: motion preservation with ADR can potentially reduce adjacent segment degeneration. METHODS.: Forty patients with 59 Prestige LP ADR were analyzed. Cervical range of motion, Neck Disability Index, Visual Analogue, Short Form-36, Modified American Academy of Orthopedic Surgeons, and Japanese Orthopedic Association scores and radiographs were evaluated. Clinical results were compared with anterior cervical discectomy and fusion. RESULTS: there were 21 females and 19 males. Mean age was 43.9 years. Mean follow-up was 2.9 years. Of the patients, 62.5% had single level replacement-mainly C56 level (56%); 52.5% had myelopathy and 47.5% radiculopathy; 50% of neural compression was due to herniated disc, 45% due to spondylosis, and 5% due to both. There was significant improvement in the American Academy of Orthopedic Surgeons and Visual Analogue scores (P < 0.05) at 6 months and 2 years. There was significant improvement in the Neck Disability Index from a mean of 42.2 preoperation to 16.4 at 6 months and 15.2 at 2 years (P < 0.05). The mean Japanese Orthopedic Association score improved significantly from 14.7 preoperation to 15.7 at 6 months and 15.6 at 2 years (P < 0.05). There was significant improvement in all aspects of the Short Form-36 scores except general health (P < 0.05) at 6 months and 2 years. There was no significant difference in the clinical outcomes between ADR and anterior cervical discectomy and fusion. Segmental alignment (mean 8°, 14°, and 13° lordotic at preoperation, 6 months, and 2 years postoperation, respectively) and global alignment (mean 15.7°, 16.2°, and 17.3° lordotic at preoperation, 6 months, and 2 years postoperation, respectively) were maintained. Dynamic radiographs showed significant segmental motion with a 6 month's mean motion of 11.1° and a 2-year mean motion of 13.9° (P < 0.05). CONCLUSION: prestige LP ADR showed significant improvement in clinical outcomes at 2 years. It restores segmental lordosis and preserves segmental motion up to 2 years postoperation.

Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion.

STUDY DESIGN: Prospective study. OBJECTIVE: Comparison of clinical and radiologic outcomes of minimally invasive (MIS) versus Open transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA: Open TLIF has been performed for many years with good results. MIS TLIF techniques have recently been introduced with the aim of smaller wounds and faster recovery. METHODS: From 2004-2006, 29 MIS TLIF were matched paired with 29 Open TLIF. Patient demographics and operative data were collected. Clinical assessment in terms of North American Spine Society, Oswestry Disability Index, Short Form-36, and Visual Analogue scores were performed before surgery, 6 months and 2 years after surgery. Fusion rates based on Bridwell grading were assessed at 2 years. RESULTS: The mean age for MIS and Open procedures were 54.1 and 52.5 years, respectively. There were 24 females and 5 males in both groups. Fluoroscopic time (MIS: 105.5 seconds, Open: 35.2 seconds, P < 0.05) and operative time (MIS: 216.4 minutes, Open: 170.5 minutes, P < 0.05) were longer in MIS cases. There was less blood loss in MIS (150 mL) versus Open (681 mL) procedures (P < 0.05). The total morphine used for MIS cases (17.4 mg) was less compared to Open (35.7 mg, P < 0.05). MIS (4 days) patients have shorter hospitalization compared to Open (6.7 days, P < 0.05). Both MIS and Open groups showed significant improvement in Oswestry Disability Index (P < 0.05), back pain and lower limb symptoms (North American Spine Society and Visual Analogue scores, P < 0.05), and Quality of Life scores (Short Form-36, P < 0.05) at 6 months and 2 years, but there was no significant difference between the 2 groups. Eighty percent of MIS and 86.7% of Open TLIF levels achieved grade 1 fusion (P > 0.05). CONCLUSION: MIS TLIF has similar good long-term clinical outcomes and high fusion rates of Open TLIF with the additional benefits of less initial postoperative pain, early rehabilitation, shorter hospitalization, and fewer complications.