We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, compar...We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, comparing this procedure (from a technical point of view) with the muscle-preserving interlaminar decompression (MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and legs pain and the Oswestry Disability Index (ODI) for the degree of disability. Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12 months. A statistically significant improvement of LBP, legs pain and ODI was globally observed. At latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients with spondylolisthesis significantly decreased their disability. No major complications occurred. Two cerebrospinal fluid (CSF) collections were treated conservatively. No wound infection occurred. No progression of spondylolisthesis was observed. No reoperation was needed. Although efficacious in patients with lumbar spinal stenosis, MILD and ULBD can have both some limitations. MILD has been found to decrease lumbar function in multilevel decompression (increasing sagittal translation and lumbar lordosis probably due to the removal of half of the spinous processes) and ULBD shows some disadvantages due to the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure. The minimal invasive bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and interspinous ligaments and the spinous processes are preserved) allows wide access (bilateral exposure) with minimal invasiveness and very low morbidity in patients with lumbar spinal stenosis at one or more levels.展开更多
BACKGROUND Currently,open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture.However,open reduction is associated with a high risk of complications.This ca...BACKGROUND Currently,open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture.However,open reduction is associated with a high risk of complications.This case of forearm double fracture involved a patient treated using an Acumed intramedullary nail.The patient experienced good follow-up outcomes.The Acumed forearm intramedullary nail enables early functional exercise and hastens healing of the fracture.Few studies have reported on the use of this approach for the treatment of fractures.CASE SUMMARY A 23-year-old male patient was admitted to hospital after 5 h of pain,swelling,and limited activity of left forearm caused by a careless fall.Physical examination showed stable basic vital signs,swelling of the left forearm,and severe pain when pressing on the injured part of the forearm.Further,friction was felt at the broken end of the bone;the skin was not punctured.Movement of the left hand was normal,and the left radial artery pulse was normal.Three-dimensional computed tomography examination showed an ulna fracture of the left forearm and comminuted fracture of the radius.The fracture was located in the upper third of the radius,with significant displacement on the fracture side.Clinical diagnosis further confirmed the left radius comminuted fracture and ulna fracture.After analyzing the fracture pattern,age,and other patient characteristics,we chose an Acumed nail for treatment and achieved good follow-up outcomes.CONCLUSION Acumed forearm intramedullary nail for fixation of ulna and radius fracture reduced complication risk and resulted in good follow-up outcomes.展开更多
文摘We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, comparing this procedure (from a technical point of view) with the muscle-preserving interlaminar decompression (MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and legs pain and the Oswestry Disability Index (ODI) for the degree of disability. Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12 months. A statistically significant improvement of LBP, legs pain and ODI was globally observed. At latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients with spondylolisthesis significantly decreased their disability. No major complications occurred. Two cerebrospinal fluid (CSF) collections were treated conservatively. No wound infection occurred. No progression of spondylolisthesis was observed. No reoperation was needed. Although efficacious in patients with lumbar spinal stenosis, MILD and ULBD can have both some limitations. MILD has been found to decrease lumbar function in multilevel decompression (increasing sagittal translation and lumbar lordosis probably due to the removal of half of the spinous processes) and ULBD shows some disadvantages due to the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure. The minimal invasive bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and interspinous ligaments and the spinous processes are preserved) allows wide access (bilateral exposure) with minimal invasiveness and very low morbidity in patients with lumbar spinal stenosis at one or more levels.
文摘BACKGROUND Currently,open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture.However,open reduction is associated with a high risk of complications.This case of forearm double fracture involved a patient treated using an Acumed intramedullary nail.The patient experienced good follow-up outcomes.The Acumed forearm intramedullary nail enables early functional exercise and hastens healing of the fracture.Few studies have reported on the use of this approach for the treatment of fractures.CASE SUMMARY A 23-year-old male patient was admitted to hospital after 5 h of pain,swelling,and limited activity of left forearm caused by a careless fall.Physical examination showed stable basic vital signs,swelling of the left forearm,and severe pain when pressing on the injured part of the forearm.Further,friction was felt at the broken end of the bone;the skin was not punctured.Movement of the left hand was normal,and the left radial artery pulse was normal.Three-dimensional computed tomography examination showed an ulna fracture of the left forearm and comminuted fracture of the radius.The fracture was located in the upper third of the radius,with significant displacement on the fracture side.Clinical diagnosis further confirmed the left radius comminuted fracture and ulna fracture.After analyzing the fracture pattern,age,and other patient characteristics,we chose an Acumed nail for treatment and achieved good follow-up outcomes.CONCLUSION Acumed forearm intramedullary nail for fixation of ulna and radius fracture reduced complication risk and resulted in good follow-up outcomes.
