To describe the details of the foraminoplastic superior vertebral notch approach (FSVNA) with reamers in percutaneous endoscopic lumbar discectomy (PELD) and to demonstrate the clinical outcomes in limited indications of PELD. Retrospective data were collected from 64 patients who underwent PELD with FSVNA from August 2012 to April 2014. Inclusion criteria were high grade migrated disc, high canal compromised disc, and disc protrusion combined with foraminal stenosis. The clinical outcomes were assessed using by the visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. Complications related to the surgery were reviewed. The procedure used a unique approach, using the superior vertebral notch as the target and performing foraminoplasty with only reamers under C-arm control. The mean age of the 55 female and 32 male patients was 52.73 years. The mean F/U period was 12.2±4.2 months. Preoperative VAS (8.24±1.25) and ODI (67.8±15.4) score improved significantly at the last follow-up (VAS, 1.93±1.78; ODI, 17.14±15.7). Based on the modified MacNab criteria, excellent or good results were obtained in 95.3% of the patients. Postoperative transient dysthesia (n=2) and reoperation (n=1) due to recurred disc were reported. PELD with FSVNA could be a good method for treating lumbar disc herniation. This procedure may offer safe and efficacious results, especially in the relatively limited indications for PELD.
Objective : So called "minimally invasive procedures"have evolved from chemonucleolysis, automated percutaneous discectomy, arthroscopic microdiscectomy that are mainly working within the confines of intradiscal space to transforaminal endoscopic technique to remove herniated epidural disc materials directly. The purpose of this study is to assess the result of endoscopic spinal surgery and favorable indications in the thoracolumbar spine. Methods : The records of 71 patients, 73 endoscopic procedures, were retrospectively analysed. Yeung Endoscopic Spine Surgery system with 7 mm working sleeve and 25°viewing angle was used. The mean follow up period was 6 months (range,3-9). Results : Operated levels were from T12-L1 disc down to L5-L6 or S1 disc. Of 71 cases, 2 patients underwent transforaminal endoscopic surgery twice due to recurrence after initial operation. MacNab's criteria was used to assess the outcome. Favorable outcome, excellent or good, was seen in 78% (57 procedures) of the patients. Among 11 fair outcomes, only 1 procedure was followed by secondary open procedure, laminectomy with discectomy. Two of 5 poor outcomes were operated again by same procedure which resulted in fair outcomes. One patient with aggravated cauda equina syndrome remained poor and a lumbar fusion procedure was performed in other patient with poor outcome. There were 2 postoperative discitis that were treated with conservative care in one and anterior lumbar interbody fusion in the other. Conclusion : Evolving technology of mechanical, visual instrument enables minimal invasive procedure possible and effective. The transforaminal endoscopic spinal surgery can reach as high as T12-L1 disc level. The rate of favorable outcome is mid-range among reported endoscopic lumbar surgery series. Authors believe that the outcome will be better as cases accumulate and will be able to reach the rate of standard open microsurgery.
Actual expense medical insurance can be said to be the “second health insurance” that compensates for medical expenses actually borne by the insured among medical expenses incurred when the insured receives treatment at a medical institution due to illness or injury. In line with the effectiveness of such loss medical insurance, there are also a wide variety of issues and practical disputes surrounding it, especially in recent years, disputes related to the self-burden ceiling to be dealt with in this paper. Depending on the patient's income level, the National Health Insurance Service returns the excess amount to the subscriber through pre-payments and post-refund if the health insurance's self-payment exceeds the upper limit for each individual. In particular, disputes arose frequently over what would be the liability for compensation in indemnity medical insurance before October 2009, when post-refund was not stipulated as an exemption. In this regard, the Supreme Court's recent ruling on 2022da304332 on March 30, 2023 (the Seoul Central District Court's ruling on November 15, 2022na77212) does not constitute an insurance accident, that is, an out-of-pocket cost, regardless of the timing of implementation of the out-of-pocket limit system. Nevertheless, there is still controversy over whether the upper limit can be deducted before or after the revision of the terms and conditions, whether the terms and conditions stipulated after October 2009 are unfairly disadvantageous to the customer, and whether the terms and conditions are subject to explanation. Above all, it will be a key issue in determining the liability for compensation for practical issues, including post-refunds, depending on whether the nature of loss medical insurance is considered personal insurance, non-life insurance, or both. In consideration of this, we would like to analyze the lower court's ruling, including the Supreme Court's ruling on the self-burden ceiling, review various issues derived here and recent issues related to the liability for compensation of loss medical insurance, and consider the responsibility for compensation and improvement.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.