Background:Cervical Deuk Laser Disc Repair® is a novel full-endoscopic, anterior cervical, trans-discal, motion preserving, laser assisted, nonfusion, outpatient surgical procedure to safely treat symptomatic cervical disc diseases including herniation, spondylosis, stenosis, and annular tears. Here we describe a new endoscopic approach to cervical disc disease that allows direct visualization of the posterior longitudinal ligament, posterior vertebral endplates, annulus, neuroforamina, and herniated disc fragments. All patients treated with Deuk Laser Disc Repair were also candidates for anterior cervical discectomy and fusion (ACDF).Methods:A total of 142 consecutive adult patients with symptomatic cervical disc disease underwent Deuk Laser Disc Repair during a 4-year period. This novel procedure incorporates a full-endoscopic selective partial decompressive discectomy, foraminoplasty, and posterior annular debridement. Postoperative complications and average volume of herniated disc fragments removed are reported.Results:All patients were successfully treated with cervical Deuk Laser Disc Repair. There were no postoperative complications. Average volume of herniated disc material removed was 0.09 ml.Conclusions:Potential benefits of Deuk Laser Disc Repair for symptomatic cervical disc disease include lower cost, smaller incision, nonfusion, preservation of segmental motion, outpatient, faster recovery, less postoperative analgesic use, fewer complications, no hardware failure, no pseudoarthrosis, no postoperative dysphagia, and no increased risk of adjacent segment disease as seen with fusion.
Background:Deuk Laser Disc Repair® is a new full-endoscopic surgical procedure to repair symptomatic cervical disc disease.Methods:A prospective cohort of 66 consecutive patients underwent cervical Deuk Laser Disc Repair® for one (n = 21) or two adjacent (n = 45) symptomatic levels of cervical disc disease and were evaluated postoperatively for resolution of headache, neck pain, arm pain, and radicular symptoms. All patients were candidates for anterior cervical discectomy and fusion (ACDF) or arthroplasty. The Mann–Whitney Wilcoxon test was used to calculate P values.Results:All patients (n = 66) had significant improvement in preoperative symptoms with an average symptom resolution of 94.6%. Fifty percent (n = 33) had 100% resolution of all preoperative cervicogenic symptoms. Only 4.5% (n = 3) had less than 80% resolution of preoperative symptoms. Visual analog scale (VAS) significantly improved from 8.7 preoperatively to 0.5 postoperatively (P < 0.001) for the cohort. Average operative and recovery times were 57 and 52 minutes, respectively. There were no perioperative complications. Recurrent disc herniation occurred in one patient (1.5%). Average postoperative follow-up was 94 days and no significant intergroup difference in outcomes was observed (P = 0.111) in patients with <90 days (n = 52) or >90 days (n = 14, mean 319 days) follow-up. No significant difference in outcomes was observed (P = 0.774) for patients undergoing one or two level Deuk Laser Disc Repair®. Patients diagnosed with postoperative cervical facet syndrome did significantly worse (P < 0.001).Conclusion:Deuk Laser Disc Repair® is a safe and effective alternative to ACDF or arthroplasty for the treatment of one or two adjacent symptomatic cervical disc herniations with an overall success rate of 94.6%.
Background:Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD.Materials and Methods:Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS).Results:The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge.Conclusion:Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.
Introduction C1-C2 fusion with instrumentation is an established treatment for C1-C2 instability due to trauma or inflammatory disease. C1-C2 fusion for debilitating occipitocervical pain secondary to C1-C2 osteoarthritis has been reported in a small number of patients. Here we report the successful treatment of three patients that underwent C1-C2 instrumented fusion using a modified Harm's technique for medically refractory occipitocervical pain. Materials and Methods Between August 2012 and July 2015, three consecutive patients with debilitating, unilateral occipitocervical pain and radiographic C1–2 osteoarthritis, underwent posterior instrumented C1-C2 arthrodesis using bilateral polyaxial C1 lateral mass and C2 pedicle screw and rod constructs (modified Harms technique). All three patients failed preoperative conservative treatment including therapy, medical management and interventional pain management including facet joint injections. In all three patients, the source of occipitocervical pain was confirmed preoperatively with direct C1-C2 joint injection using 0.5ml of a mixture of 2% lidocaine/0.5% Marcaine/10mg kenalog. All three patients had immediate but temporary relief of their occipitocervical pain from the diagnostic C1-C2 joint injection. Preoperative CT scan confirmed the presence of C1-C2 osteoarthritis on the symptomatic side. Outcome measures include pre and postoperative VAS, patient reported resolution of pain, hospital LOS, EBL and complications. Results Each of the three patients surgically treated had complete resolution (100%) of their preoperative occipitocervical pain beginning immediately after instrumented posterior fusion of C1–2. Average VAS improved from 8.3 preoperatively to 0.0 postoperative for the cohort. Average follow up is 33 months. Average age for the group at the time of surgery was 75 years old and the M:F ratio is 1:2. Hospital LOS was 1 day for each patient. EBL was 45ml on average with a range of 15ml - 75ml. There were no postoperative complications. Conclusions Instrumented posterior C1-C2 fusion, using a modified Harms technique, is a safe and effective treatment for refractory occipitocervical pain secondary to C1-C2 osteoarthritis. The source of pain should be confirmed preoperatively with both CT scan and diagnostic joint injection.
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