Long-Term Outcomes Following Lumbar Nucleus Replacement.

BACKGROUND: Nucleus replacement devices are designed to replace the native pain-generating lumbar nucleus while preserving the annulus fibrosus, endplates, and natural motion. The DASCOR Disc Arthroplasty Device seemed to perform well clinically but was discontinued in 2009. While there are no commercially available NRDs today, the potential advantages of using such devices have prompted a renewed interest in further developing the technology and assessing long-term outcomes for the DASCOR device. METHODS: A retrospective review of hospital records from a single institution was performed to identify all patients that underwent implantation of a DASCOR device between 2006 and 2009. Clinical outcome and imaging data were gathered to assess device performance of the DASCOR device over an extended period of time. Clinical data were assessed using a visual analog scale for back pain (VAS), Oswestry Disability Index (ODI) scores, and analgesic medication use score (ANS). Magnetic resonance images were systematically evaluated at the index and adjacent disc levels: disc height, Modic changes, Pfirrmann grade, and any implant-associated findings. RESULTS: Twenty-six patients received DASCOR implants. Follow-up data were available for 22 patients. The mean age at time of implantation was 34.9 years. Long-term data were available for 14 patients (mean, 11.5 years) with a mean improvement in VAS of 4.0 +/- 2.8 (P < 0.0001), ODI 33.4 +/- 18.4 (P < 0.0001), and ANS 0.5 (P = 0.07) compared to baseline values, while 46% developed radiological adjacent segment degeneration on MRI and 54% did not. In total, 6 patients underwent revision surgery at the index level and 3 underwent surgery at adjacent lumbar levels. CONCLUSIONS: While any conclusions should be interpreted with caution, there was a subgroup of patients that had excellent clinical and radiological outcomes. Additional studies on this device or other similar devices would add to our knowledge regarding ideal treatment of discogenic low back pain in younger patients. CLINICAL RELEVANCE: Treatment of discogenic low back pain. LEVEL OF EVIDENCE: 4.

Use of a novel mechanical rinsing and aspiration thrombectomy device for treatment of deep venous and arteriovenous graft thrombosis.

The KPS Rinspirator (Kerberos Proximal Solutions, Cupertino, Calif.) is a new thrombectomy device that operates by manually controlled, simultaneous, intravessel infusion and aspiration of fluid to cause localized clot dissolution. We evaluate the ability of the KPS Rinspirator to treat acute (<3 days) and subacute (3-7 days) deep venous and arteriovenous graft thrombosis in 4 patients and 13 vessels (2 arteriovenous grafts and 11 deep veins). Technical and clinical success was achieved in the two patients with acute arteriovenous graft thromboses. Therefore, in our experience, successful "rinspiration" was achieved in acute thrombosis of arteriovenous grafts.

Intentional retrieval of viabil stent-grafts from the biliary system.

The present report describes the intentional retrieval of six Viabil stent-grafts from the biliary system. The six stent-grafts were successfully removed from five patients with a mean time from placement to retrieval of 38 days. Successful retrieval was independent of underlying disease etiology and included strictures associated with benign disease, malignant disease, disease of unknown etiology, and stent-graft misplacement. There were no complications resulting from stent-graft retrieval. Intentional removal of Viabil stent-grafts is technically feasible. Further study is necessary to establish its potential role in the management of biliary disease.