Total lumbar facetectomy without fusion: short and long term follow-up in a single surgeon series.

BACKGROUND: Total lumbar facetectomy may be advantageous for exposure or to completely free a constricted nerve root. OBJECTIVE: We retrospectively reviewed a single surgeon series without fusion for short and long term outcomes regarding radicular pain relief, subsequent relevant surgeries, and any identifiable instability. METHODS: All operations in which a single, total lumbar facetectomy was performed were reviewed. A total of 222 patients were identified with a minimal follow-up of 3 months; 187 (84.2%) were available for long term follow-up ≥1 year by continued accessible health care records, correspondence, or mailed questionnaire. RESULTS: Short term success (3-month follow-up) for radicular pain relief in 222 patients found the following results: 176 patients (79.3%) had no pain or minimal pain, and 16 patients (7.2%) were improved, and thus resulting in 192 (86.5%) with no pain, or improved radicular pain. 30 patients (13.5%) were postoperative failures at 3 months. Long term follow-up ≥1 year was available for 187 patients (84.2%); (range 1-17 years; mean 7 years); found the following results: 23/30 (76.6%) short term surgical failures remained failures in long term follow-up with (7 patients) or without (16 patients) further surgery of any kind; 13/16 improved patients at long term follow-up remained improved (6), were pain free (6), or worse (1); 19/151 no or minimal pain patients at long term follow-up recurred or worsened by 1 year or longer, 12/19 pursued a second surgery with (9) or without (4) fusion and many improved. A total of 13 patients had a subsequent fusion operation (6.95%). DISCUSSION: Most patients do well in the short term for radicular pain relief. Most patients continue to do well in long term follow-up. Surgically induced clinical instability is uncommon in this highly selected series.

Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period.

OBJECTIVE: To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade. PATIENTS AND METHODS: We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications. RESULTS: Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%). CONCLUSION: In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.

Dyna-CT as an imaging adjunct to routine percutaneous balloon compression for trigeminal neuralgia.

OBJECTIVE AND IMPORTANCE: Intraprocedural three-dimensional (3D) axial tomography reconstructions have improved aneurysm detection, pedicle screw placement and more, resulting in less morbidity and improved outcomes. Currently, relative to balloon compression for trigeminal neuralgia, we are dependent upon lateral 2-dimensional imaging for the classic 'pear shape' imaging to determine correct positioning. CLINICAL PRESENTATION: Our patient was a 97-year-old woman with a 4-year history of V2 and V3 intermittent severe pain with typical features of trigeminal neuralgia. INTERVENTION: After induction of anesthesia on the Dyna-CT (Siemens) angiogram table, Meckl's cave was accessed as guided by fluoroscopy, a 4-French Fogarty catheter was introduced, and its balloon was inflated tightly for 90 s with soluble contrast agent to compress the gasserian ganglion. As would be done for 3D angiogram, the Dyna-CT was used to perform image acquisition for image reconstruction. Two additional cases are supplied to show the variability of volume filling of the balloon compression. CONCLUSION: We speculate that 3D reconstructions of percutaneous balloon compression of the trigeminal ganglion may aid in the identification of an ideal balloon configuration of a volume which could impact the outcome, or perhaps reduce complications such as masseter weakness or dysesthesias. Here we show the first clinical images available demonstrating volumetric reconstruction of a balloon compression for trigeminal neuralgia utilizing Dyna-CT.