Aim. The aim of this study was to compare the complication rate of traditional minimally invasive anterior with the new minimally invasive lateral trans-psoatic retroperitoneal approaches to the intervertebral discs at levels T12-L5. Methods. A review of all cases of minimally invasive anterior (ALIF) and lateral (XLIF) intervertebral disc surgery at levels T12-L5, treated at the Department of Neurosurgery from January 1996 to September 2011. The ALIF group consisted of 120 and the XLIF group consisted of 88 patients. Preoperative diagnoses were: degenerative disc disease, failed back surgery syndrome, spondylolisthesis, retrolisthesis and posttraumatic disc injury. The surgical steps are described. All surgical intraoperative and postoperative complications directly related to the spinal surgery were prospectively documented. The outcome measure was rate of complications. Results. In the ALIF group there were no major complications, only 35 minor intra-and postoperative complications in 32 patients (26.6%). The main complication was lumbar post-sympathectomy syndrome in 19 patients (15.8%). In the XLIF group there were 26 complications in 22 patients (25%). One major intraoperative complication was partial and transient injury to the L5 nerve root (1.1%). There were 25 minor postoperative complications in the XLIF group in 21 patients (23.9%), mainly transient pain of the left groin or anterior thigh in 11 patients (12.5%) or numbness in the same dermatomas in 9 patients (10.2%). Statistically there was no difference between the ALIF and XLIF groups in complication rate. Conclusion. Anterolateral and lateral retroperitoneal minimally invasive approaches to levels T12-L5 disc spaces are safe procedures with only minor complications and one exception. The rate of complications was similar in both groups. In the case of ALIF, the particular complication was post-sympathectomy syndrome. The main complication of XLIF was transient nerve root injury in one patient due to underestimation of the procedure in the outset. Intraoperative neuromonitoring during XLIF surgery is fully recommended.
Usually, pneumoperitoneum is a serious condition suggesting a perforation of the abdominal viscus. Nonsurgical pneumoperitoneum accounts for approximately 10% of all cases. The authors present a case of postcoital pneumoperitoneum after a hysterectomy. A 46-year-old woman presented to the emergency department 4 months after an abdominal hysterectomy with complaints of abdominal discomfort and radiographic evidence of free air under the diaphragm. The clinical finding did not support the radiographic evidence. An unclear peptic ulcer history led us at first to mistakenly diagnose a covered perforation of gastroduodenal ulcer. Diagnostic perplexity forced us to perform a laparoscopy after 30 h. The abdominal cavity was surprisingly normal, and no perforation was found. Nonsurgical postcoital pneumoperitoneum is rare. We solved such a case for the first time. By means of laparoscopy, we could exclude perforation of the viscus and peritonitis, and the operation was carried out in a minimally invasive way.
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