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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Comparative Study
The range and nature of flexion-extension motion in the cervical spine.
The full flexion to full extension angular ranges of motion (ROM) from C2 to C7 were measured for 78 normal subjects and 50 cervical myelopathic cases to examine the cervical motions for these two groups in a Chinese population. ⋯ This work suggests that the reduction in total angular ROM concomitant with aging results in the emphasis of cervical flexion-extension motion moving from C5:C6 to C4:C5, both in normal cases and those suffering from cervical myelopathy.
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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.