RESUMO
We describe a modified technique of micro-decompression of the lumbar spine involving the use of an operating microscope, a malleable retractor and a high-speed burr, which allows decompression to be performed on both sides of the spine through a unilateral, hemi-laminectomy approach. The first 100 patients to be treated with this technique have been evaluated prospectively using a visual analogue score for sciatica and back pain, the MacNab criteria for patient satisfaction, and functional assessment with the Oswestry Disability Index. After a period of follow-up from 12 months to six years and four months, sciatica had improved in 90 patients and back pain in 84 patients. Their result was graded as good or excellent by 82 patients according to the MacNab criteria, and 75 patients had subjective improvement in their walking distance. Late instability developed in four patients. Lumbar micro-decompression has proved to be safe, with few complications. Postoperative instability requiring fusion was uncommon, and less than using traditional approaches in published series.
Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Métodos Epidemiológicos , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Ciática/etiologia , Ciática/cirurgia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Resultado do TratamentoAssuntos
Vértebras Cervicais , Osteomielite/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Bacteriemia/etiologia , Biópsia , Vértebras Cervicais/patologia , Humanos , Veias Jugulares , Imageamento por Ressonância Magnética , Masculino , Cervicalgia/etiologia , Osteomielite/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Knee dislocations of morbidly obese patients after a trivial fall are not uncommon. We report a case of closed reduction for a dislocated right knee of a 26-year-old obese woman. After closed reduction under general anaesthesia, her knee was supported by pillows in 30 degrees flexion. No external splint was used because of the enormous size of the leg. At day 4 after reduction, the patient had numbness over the dorsum of the right foot and was unable to dorsiflex. She was diagnosed as having peroneal nerve palsy and was fitted with a foot drop splint. One week after reduction, she started active, assisted knee mobilisation and tip-toe weight bearing. At 24 months after reduction, the patient was able to walk unaided and had 100 degrees of knee flexion. She had a good foot function and a grade II in the Lachman's test, with no varus or valgus instability. This case highlights the importance of early mobilisation, which can result in good outcome even without operative treatment.