Degenerative constrictions of the spinal canal with compression of neural elements arise as a result of bony,disk,capsular or ligament structures.The most frequent causes are disk herniations and spinal stenoses.The l...Degenerative constrictions of the spinal canal with compression of neural elements arise as a result of bony,disk,capsular or ligament structures.The most frequent causes are disk herniations and spinal stenoses.The lumbar and cervical spine is the most prominent cause.After conservative treatments have been exhausted,surgical intervention may be necessary.Today,microsurgical or microscopically-assisted decompression is regarded as the standard procedure for disk herniation and spinal stenosis in the lumbar region,while in the cervical spine,microsurgical or microscopically-assisted anterior decompression and fusion are standard.Both procedures demonstrate good clinical results but present problems associated with the operation.Decompressions in the area of the spine must be carried out under continuous visualization and must entail the possibility of adequate bone resection.Taking this into account,completely new endoscopes and instrument sets has been developed for full-endoscopic operations in tandem with the development of the lateral transforaminal and interlaminar approaches for the lumbar spine and the posterior,contralateral and anterior approaches for the cervical spine.The possibilities and results of comparable and established standard procedures have been used as a benchmark in the course of clinical validation.The development of surgically created approaches and the new rod lens endoscopes combined with appropriate instrument sets have laid the technical foundations for full-endoscopic operation in the lumbar spine on all primary and recurrent disk herniations inside and outside the spinal canal and on spinal stenoses.This development has also permitted resection of soft disk herniations in the cervical spine.The use of the relevant approaches depends on anatomical and pathological inclusion and exclusion criteria.The clinical results of standard procedures are achieved,which must be regarded as a minimum criterion for the introduction of new technologies.On the basis of evidence-based medicine(EBM) criteria,it can be established that using the full-endoscopic techniques developed,adequate decompression is achieved in the defined indications with reduced traumatization,improved visibility conditions and positive cost benefits.Today,fullendoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery.展开更多
PAGET＇S disease, also called osteitis deformans, is a metabolic bone disorder. It is characterized by increased bone resorption and the compensatory formation of new bones. The increased bone conversion and remodelin...PAGET＇S disease, also called osteitis deformans, is a metabolic bone disorder. It is characterized by increased bone resorption and the compensatory formation of new bones. The increased bone conversion and remodeling lead to the incrustation of woven bones and lamellar bones and finally result in the expansion, loosening, and excessive vascularization of the affected bones, rendering them susceptible to deformity and fracture. Paget＇s disease occurs much more commonly in Anglo-Saxons than in Asians and Africans.展开更多
Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods...Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods： This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association （JOA） score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results： There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions： The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.展开更多
文摘Degenerative constrictions of the spinal canal with compression of neural elements arise as a result of bony,disk,capsular or ligament structures.The most frequent causes are disk herniations and spinal stenoses.The lumbar and cervical spine is the most prominent cause.After conservative treatments have been exhausted,surgical intervention may be necessary.Today,microsurgical or microscopically-assisted decompression is regarded as the standard procedure for disk herniation and spinal stenosis in the lumbar region,while in the cervical spine,microsurgical or microscopically-assisted anterior decompression and fusion are standard.Both procedures demonstrate good clinical results but present problems associated with the operation.Decompressions in the area of the spine must be carried out under continuous visualization and must entail the possibility of adequate bone resection.Taking this into account,completely new endoscopes and instrument sets has been developed for full-endoscopic operations in tandem with the development of the lateral transforaminal and interlaminar approaches for the lumbar spine and the posterior,contralateral and anterior approaches for the cervical spine.The possibilities and results of comparable and established standard procedures have been used as a benchmark in the course of clinical validation.The development of surgically created approaches and the new rod lens endoscopes combined with appropriate instrument sets have laid the technical foundations for full-endoscopic operation in the lumbar spine on all primary and recurrent disk herniations inside and outside the spinal canal and on spinal stenoses.This development has also permitted resection of soft disk herniations in the cervical spine.The use of the relevant approaches depends on anatomical and pathological inclusion and exclusion criteria.The clinical results of standard procedures are achieved,which must be regarded as a minimum criterion for the introduction of new technologies.On the basis of evidence-based medicine(EBM) criteria,it can be established that using the full-endoscopic techniques developed,adequate decompression is achieved in the defined indications with reduced traumatization,improved visibility conditions and positive cost benefits.Today,fullendoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery.
文摘PAGET＇S disease, also called osteitis deformans, is a metabolic bone disorder. It is characterized by increased bone resorption and the compensatory formation of new bones. The increased bone conversion and remodeling lead to the incrustation of woven bones and lamellar bones and finally result in the expansion, loosening, and excessive vascularization of the affected bones, rendering them susceptible to deformity and fracture. Paget＇s disease occurs much more commonly in Anglo-Saxons than in Asians and Africans.
文摘Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods： This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association （JOA） score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results： There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions： The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.
