Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation based on image analysis and clinical findings: A retrospective review of 345 cases.

The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective review aims to assess the safety and effectiveness of PELD for treating L5-S1 disc herniation with a range of characteristics and to determine the prevalence of lumbosacral transitional vertebrae (LSTV) anatomical anomalies to facilitate pre-surgical planning. From July 2005 to June 2019, 345 patients with L5-S1 disc herniations were treated with PELD. The primary outcome was 1-year postoperative visual analogue scale scores for low back and lower limb pain. The secondary outcomes included the surgical approach used, lumbosacral bony anomalies, presence of a ruptured disc or severely calcified disc, pediatric lumbar disc herniation, recurrent disc herniation management, and the long-term outcome. visual analogue scale scores for most patients were significantly improved after surgery. The prevalence of LSTVs was 4.05% (14/345 patients) in lumbar sacralization and 7.53% (26/345 patients) in sacral lumbarization. The prevalence of ruptured and severely calcified discs was 18.55% (64/345) and 5.79% (20/345), respectively. The prevalence of pediatric lumbar disc herniation was 2.02% (7/345). The recurrence rate was 4.34% (15/345). Two durotomy cases without sequelae and 8 cases of lower limb dysesthesia lasting longer than 3 months postoperatively were reported. PELD is safe and effective for treating L5-S1 disc herniation, including cases complicated by calcified lumbar disc herniation, disc rupture with migration, and the presence of LSTV. Appropriate imaging is essential to identify case-specific factors, including the prevalent LSTV anatomical anomalies, before surgery.

Hemostasis Evaluation of Antibacterial and Highly Absorbent Composite Wound Dressings in Animal Hemostasis Models.

To reduce the bleeding time and to shorten the surgery time are vital to patients' prog-nosis, therefore, in this study, high moisture absorption nonwoven composites are proposed to attain hemostasis in time. Polyacrylate fiber and Tencel® fibers at different blending ratios (10:90, 20:80, 30:70, 40:60, and 50:50) are used to form PT composite nonwoven. Next, composed of a 50:50 ratio, PT composite nonwoven exhibits the maximal vertical wicking height of 4.4 cm along the cross direction. Additionally, the UV-Vis absorption spectra analysis shows that at absorption waves of 413-415 nm, the occurring of distinct peaks suggests the presence of nanoparticles. The XRD patterns indicate the presence of silver nanoparticles with corresponding crystal planes of characteristic peaks at (111), (200), and (220). Polyacrylate/Tencel® nonwoven composites exhibit comparable adsorption capacity of blood and water molecules. In particular, 30PT composite nonwoven outperforms the control group, exhibiting 3.8 times and 4.7 times greater the water absorption and blood absorption, respectively. Moreover, a great number of red blood cells with a size of 4-6 µm agglomerate among fibers as observed in SEM images, while 6hr-PT composite dressing demonstrates the optimal antibacterial efficacy against Escherichia coli and Staphylococcus aureus, proven by the zone of inhibition being 1.9 mm and 0.8 mm separately. When in contact with plasma, hemostasis composites have plasma hemostasis prothrombin time of 97.9%, and activated partial thromboplastin time of 96.7%. As for animal hemostasis model, the arteria over the rats' thigh bones is cut open perpendicularly, generating mass arteria hemorrhage. To attain hemostasis, it takes 46.5% shorter time when using composite dressings (experimental group) than the control group.

The Surgical Treatment Principles of Atlantoaxial Instability Focusing on Rheumatoid Arthritis.

OBJECT: This retrospective review was conducted to determine the surgical treatment principle for rheumatoid arthritis (RA) patients with atlantoaxial instability (AAI). METHODS: Thirteen patients with AAI, including 5 RA patients, received preoperative computed tomography- (CT-) based image-guided navigation system (IGS) in C1 lateral mass-C2 pedicle screw-rod system fixation (LC1-PC2 fixation). These 13 patients were analyzed for 52 screws inserted into C1 and C2. We defined these patients as non-RA group (8 patients, 32 screws) and RA group (5 patients, 20 screws). The neurological status for RA group was evaluated using the Ranawat classification. The causes of AAI, surgical indications, complications, surgical method revolution, and CT-based navigation application are discussed. RESULTS: None of the 13 patients expressed neurological function deterioration. The non-RA group screw accuracy was 100%. In the RA group, 1 RA patient developed left C2 screw loosening at 1(+) months after operation due to screw malposition. The screw accuracy for this group was 95%. CONCLUSIONS: Higher intraoperative surgical complication rate was described in RA patients. Preoperative CT-based IGS in LC1-PC2 fixation can provide good neurological function and screw accuracy results. However, for higher screw accuracy in RA patients, intraoperative CT-based IGS application may be considered.

Hybrid surgery for symptomatic chronic total occlusion of carotid artery: a technical note.

BACKGROUND AND IMPORTANCE: Although medical treatment has been considered a dogma for chronic total occlusion (CTO) of the carotid artery, use of endovascular recanalization has also been reported. However, there are some difficulties in performing endovascular recanalization. We present the novel technical details and advantages of hybrid surgery for recanalization of symptomatic CTO of the internal carotid artery (ICA). CLINICAL PRESENTATION: Three cases with recurrent ischemic attacks due to thrombotic occlusion of the right ICA above the bifurcation were successfully treated by this hybrid surgery, combining endarterectomy of the proximal ICA with endovascular angioplasty of the distal ICA. Using this hybrid technique, complete recanalization was achieved in all 3 cases. Follow-up computed tomography angiography with perfusion imaging showed improved brain perfusion. At 6-month follow-up, ischemic symptoms had not recurred. CONCLUSION: We consider this hybrid surgery to be a feasible and good alternative surgical procedure for the treatment of CTO of the internal carotid artery.