Study Design: A prospective cohort study in a high-flow spine center in Germany. Objectives: This study aimed to evaluate clinical outcomes and complications of the trans-tubular translaminar microscopic-assisted percutaneous nucleotomy in cases of cranially migrated lumbar disc herniations (LDH). Methods: Between January 2013 and January 2018, 66 consecutive patients with cranio-laterally migrated LDH were operated upon. The following outcome measures were evaluated: (1) Visual Analog Scale (VAS) for leg and back pain; (2) Oswestry Disability Index (ODI) and Macnab´s criteria. All patients were operated upon with trans-tubular Translaminar Microscopic-assisted Percutaneous Nucleotomy (TL-MAPN). Perioperative radiographic and clinical evaluations were reported. The mean follow-up period was 32 months. Results: The mean age was 59 years. L4/L5 was the commonest affected level (27 patients). The mean preoperative VAS for leg pain was 6.44 (±2.06), improved to 0,35 (±0.59) postoperatively. Dural injury occurred in 1 patient, treated with dural patch. Improved neurological function was reported in 41/44 Patients (neurological improvement rate of 93%) at the final follow up. There was a significant improvement in the mean ODI values, from 50.19 ± 4.92 preoperatively to 10.14 ± 2.22 postoperatively (P < 0.001). Sixty four out of 66 patients (96%) showed an excellent or good functional outcome according to Macnab´s criteria. No recurrent herniations were observed. Conclusion: The translaminar approach is a viable minimal invasive technique for cranially migrated LDH. The preservation of the flavum ligament is one of the main advantages of this technique. It is an effective, safe and reproducible minimally invasive surgical alternative in treatment of cranially migrated LDHs.
Introduction
Cement augmentation techniques are standard treatment for cases of osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with decreased rates of cement leak. Cases with posterior wall fractures are relative contraindications for both techniques. The aim of this study was to evaluate the results of balloon kyphoplasty in cases of osteoporotic fractures with posterior wall involvement
Patients and Methods
Forty-eight patients with osteoporotic fractures with injury of the posterior vertebral wall were included. Fractures between T4 and L5 were included. Cases with posterior ligamentous complex injury were excluded. Preoperative evaluation included plain X-rays, CT, MRI, and laboratory diagnosis of osteoporosis. All cases were operated upon with balloon kyphoplasty. Bilateral (bi-pedicular) approach was used in all cases. Injected cement volume and incidence of cement leak were evaluated. The minimum follow-up period was 6 months.
Results
18 males and 30 females were operated upon. The average age was 72.4 years. The most common affected vertebra was T12 in 19 patients. The average volume of injected cement was 6.2 ml. Posterior cement leak (in spinal canal) occurred in 2 cases and was asymptomatic. There were no neurologic or embolic complications.
Conclusion
Balloon kyphoplasty is safe in cases of osteoporotic fractures with posterior wall fractures. Type A3 and A4 fractures (according to AO classification) were not associated with increased incidence of cement leak in spinal canal. The volume of injected cement should not exceed the volume injected to inflate the ballon.
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