Lumbar Discectomy Using Lagenbech Retractor, A Cost Effective Minimally Invasive Technique. Study of 520 Cases

Objective:  Conventional disc surgeries though have good results, may result in subsequent damage due to trauma to erector spinae, ligaments and bones.  Materials & Methods:  A total of 520 patients who underwent lumbar discectomy were studied. 388 were male and 132 were female. The mean age in this study was 35 years. Only patients with symptomatic posterolateral disc prolapse were included in the study. All patients were investigated with MRI or CT scan of lumbar spine. Only ten patients were investigated with myelography. The followup period was up to two years. Oswestry Disability Index of low backpain disability was also used as specific parameter in some of the cases. Results:  Overall success rate for pain relief was 93.8%. Only 13% had occasional pain on exertion. The hospital stay was < 2 days. The most common complication was recurrent sciatica (5.7%), and these patients reported within six to eight months postoperatively. Other complications encountered were operation on wrong level (1.34%) discitis (0.76%), dural tear (0.19%), nerve root injury (0.19%) and failed back syndrome (2.30%). Conclusion:  Author concludes that lumbar discectomy performed through a small (< 2.0 cm) incision using manual retraction with Lagenbech retractor, headlight and magnifying loupes is a safe and cost effective procedure with distinct advantages such as reduced hospital stay, minimal post-operative pain, early mobilization and good alternative to conventional laminectomy/discectomy procedures.&nbsp

The safety and efficacy of mesenchymal stem cells for prevention or regeneration of intervertebral disc degeneration: a systematic review

General Posters: abstract no. GP86INTRODUCTION: Mesenchymal stem cells (MSCs) have been used to halt the progression or regenerate the disc with hopes to prevent or treat discogenic back pain. However, the safety and efficacy of the use of MSCs for such treatment in animal and human models at short and long term assessment (i.e. greater than 48 weeks) have not been systematically addressed. This study addressed a systematic review of comparative controlled studies addressing the use of MSCs to that of no treatment/saline for the treatment of disc degeneration. METHODS: Online databases were extensively searched. Controlled trials in animal models and humans were eligible for inclusion. Trial design, MSC characteristics, injection method, disc assessment, outcome intervals, and complication events were assessed. Validity of each study was assessed addressing trial design. Two individuals independently addressed the aforementioned. RESULTS: Twenty-two animal studies were included. No human comparative controlled trials were reported. All three types of MSCs (i.e. derived from bone marrow, synovial and adipose tissue) showed successful inhibition of disc degeneration progression. From three included studies, bone marrow derived MSC showed superior quality of disc repair when compared to other treatments, including TGF-β1, NP bilaminar co-culture and axial distraction regimen. However, osteophyte development was reported in two studies as potential complication of MSC transplantation. CONCLUSIONS: Based on animal models, the current evidence suggests that in the short-term MSC transplantation is safe and effective in halting disc degeneration; however, additional and larger studies are needed to assess the long-term regenerative effects and potential complications. Inconsistency in methodological design and outcome parameters prevent any robust conclusions. In addition, randomized controlled trials in humans are needed to assess the safety and efficacy of such therapy.published_or_final_versio

Comparison Between Open Procedure and Tubular Retractor Assisted Procedure for Cervical Radiculopathy: Results of a Randomized Controlled Study

Posterior cervical foraminotomy is an effective surgical technique for the treatment of radicular pain caused by foraminal stenosis or posterolateral herniated discs. The present study was performed to compare the clinical parameters and surgical outcomes of open foraminotomy/discectomy (OF/OFD) and tubular retractor assisted foraminotomy/discectomy (TAF/TAFD) in the treatment of cervical radiculopathy. A total of 41 patients were divided into two groups: 19 patients in Group 1 underwent OF/OFD and 22 patients in Group 2 underwent TAF/TAFD. Among the various clinical parameters, skin incision size, length of hospital stay, analgesic using time, and postoperative neck pain (for the first 4 weeks after the operation) were favorable in Group 2. Surgical outcomes were not different between the two groups. In conclusion, TAF/TAFD should increase patient's compliance and is as clinically effective as much as the OF/OFD

Spine Surgery

We are very excited to introduce this new book on spinal surgery, which follows the curriculum of the EUROSPINE basic and advanced diploma courses. The approach we take is a purely case-based one, in which each case illustrates the concepts surrounding the treatment of a given pathology, including the uncertainties and problems in decision-making. The readers will notice that in many instances a lack of evidence for a given treatment exists. So decisions taken are usually not a clearcut matter of black or white, but merely different shades of gray. Probably in a lot of cases, there is often more than one option to treat the patient. The authors were asked to convey this message to the reader, giving him a guidance as what would be accepted within the mainstream. In addition, the reader is provided with the most updated literature and evidence on the topic. Most of the authors are teachers in the courses of EUROSPINE or other national societies with often vast clinical experience and have given their own perspective and reasoning. We believe that the readers will profit very much from this variety and bandwidth of knowledge provided for them in the individual chapters. We have given the authors extensive liberty as to what they consider the best solution for their case. It is thus a representative picture of what is considered standard of care for spine pathologies in Europe. We hope that this book will be an ideal complement for trainees to the courses they take. Munich, Germany Bernhard Meyer Offenbach, Germany Michael Rauschman

Alanyl-glutamine has no effect on epidural fibrosis in a post-laminectomy rat model

Epidural fibrosis following spinal surgery is common, and subsequent reoperations are more technically challenging with higher complication rates. A safe and effective therapeutic solution to this difficult clinical problem has yet to be realized. Previous research has demonstrated the effectiveness of alanyl-glutamine in reduction of peritoneal adhesions in a rat abdominal sepsis model. I hypothesized that alanyl-glutamine may be similarly efficacious in minimizing epidural fibrosis in a rat laminectomy model. Rats were randomized into three groups: no surgery, laminectomy/normal saline and laminectomy/alanyl-glutamine (1g/kg). The surgical groups underwent a lumbar laminectomy with instillation of either normal saline or alanyl-glutamine into the peridural space. Thirty days after surgery, the rats were euthanized and the spinal columns prepared for histological evaluation. A blinded veterinary pathologist and a less experienced student independently graded the extent and maturity of epidural fibrosis. The laminectomy model was an effective model for epidural fibrosis formation. Rats that underwent laminectomy demonstrated significant fibrosis compared to control animals (p<0.001). However, there was no significant difference in histological grade of fibrosis between normal saline and alanyl-glutamine treatment groups (p=0.83). Based on this study, alanyl-glutamine does not appear to have an effect in reducing epidural fibrosis at a histological level. It is possible that alanyl-glutamine may have an effect that is not detectable using this model, in which case further studies with a more sensitive model may be indicated. Resources may be better used elucidating the mechanism by which glutamine acts to reduce adhesions in the peritoneal model and further studies exploiting those mechanisms can be designed

Get Ready for 100 Years of Active Spine Life Using Percutaneous Endoscopic Spine Surgery (PESS)

Lumbar spinal stenosis is the most common indication for spinal surgery in patients older than 65 years. After the introduction of Kambin's safety triangle, percutaneous endoscopic spine surgery has started through transforaminal approach for discectomy and is now being extended to spinal stenosis through interlaminar approach, which is an important part of the degenerative spinal disease. With the increase in human longevity, the development of effective treatment for degenerative diseases is inevitable, and future percutaneous endoscopic spine surgery (PESS) will play a very important role in maintaining the health of this ‘super-aged’ population. Endoscopic techniques impart minimal approach related disruption of normal spinal anatomy and function while concomitantly increasing functional visualization and correction of degenerative stenosis. Advantages of full endoscopic spine surgeries are less soft tissue dissection, less blood loss, reduced hospital admission days, early functional recovery and enhancement in the quality of life. With proper training and advancement in equipment and technologies, percutaneous endoscopic spine surgery will be able to successfully treat the aging spine