Spine
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Various techniques of percutaneous lumbar disc surgery have become popular for treating lumbar disc herniations. There is a vast and increasing body of literature on this topic that consists mainly of retrospective, uncontrolled clinical studies, technical articles, and case reports. A literature analysis revealed two different techniques, both termed "percutaneous discectomy." One is the selective removal of nucleus pulposus from the herniation site with various manual and automated instruments under endoscopic control (percutaneous nucleotomy with discoscopy, arthroscopic microdiscectomy, percutaneous endoscopic discectomy); the other is the removal of nucleus pulposus from the center of the disc space with one single automated instrument (automated percutaneous lumbar discectomy) to achieve an intradiscal decompression. ⋯ There is no scientifically proven validity of automated percutaneous lumbar discectomy compared with standard surgical methods and chemonucleolysis. The majority of the articles analyzed did not fulfill the selection criteria of Spine. Additional prospective, randomized and controlled studies are needed to define the eventual role of percutaneous lumbar discectomy on a scientific basis.
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This study analyzed the precise two-dimensional location of the vertebral artery within cervical vertebrae as determined by measurements obtained from axial computed tomographic images of the cervical spine. ⋯ According to our measurements, the risk of vertebral artery laceration is greater at more cephalad vertebrae during lateral extension of central decompressive procedures and lateral nerve root decompression. Because of the variability of these parameters between individuals, accurate individual preoperative localization of the vertebral arteries is recommended.
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Biography Historical Article
Christian Georg Schmorl. Pioneer of spinal pathology and radiology.
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This study reviewed 36 retrospective patients who underwent surgeries for rare cervico-thoracic junctional problems. ⋯ In treating patients with cervico-thoracic problems, one should do careful clinical and radiologic survey to avoid missed or delayed diagnoses, and the surgeon must be thoroughly familiar with anterior and posterior landmarks and associated vital structures and remember that the cervico-thoracic junction is an area of potential instability particularly after trauma or laminectomy. Complications of surgery at the cervico-thoracic junction are frequent, and meticulous surgical techniques and postoperative care are important in the prevention of these complications.
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This study analyzed anatomic characteristics of cervical ventral rootlets. After total vertebrectomy, detailed morphology of the ventral rootlets was studied from the anterior. ⋯ Short C5 ventral rootlets appeared to become taut and easily injured by hemilateral anterior compression. Spinal cord lesion resulting from localized anterior compression at the single disc level might not play as important a role in the pathogenesis of dissociated motor loss of the deltoid muscle because of the wider spinal segments of C5 and C6.