Nucleoplasty – General Overview

The management of disc protrusion is multidisciplinary. In the midway between conservative treatment and open surgery are minimal invasive procedures.Nucleoplasty is a new treatment of discogenic leg pain using bipolar radiofrequency device for vaporising a small volume of nucleus pulposus. Percutaneous removal of nuclear tissue is thought to lower nuclear pressure, thereby reducing nerve root tension and allowing retraction of the protrusion.Causes of discogenic pain are discussed. Indications of the procedure and surgical technique and the literature results are presented

Endovascular treatment of an open cervical fracture with carotid artery tear

The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report

Outcomes of decompression surgery for lumbar spinal stenosis in elderly diabetic patients

The purpose of this study was to assess and compare the outcome of surgical decompression for spinal stenosis in diabetic and non-diabetic elderly patients. This is a retrospective chart analysis conducted in a university affiliated referral hospital. The participants were consecutive patients, age 65 and older, undergoing laminectomy for spinal stenosis during 1990–2000. We assessed patients’ clinical and demographic data, procedures, perioperative complications, preoperative and postoperative pain intensity, basic activities of daily living (BADL), patients’ satisfaction, the need for repeated surgery, and overall mortality. A total number of 62 elderly diabetic group (DG) patients undergoing decompression surgery for spinal stenosis were compared with a sex and age-matched non-diabetic control group (CG) at baseline, and a mean of 40.3 months thereafter. We found that the DG patients had more pain (p=0.042), and suffered more frequently from neurogenic claudication (p=0.0018), motor weakness (p=0.021) and numbness of the affected limb (p=0.0069) than the CG patients. Nocturnal pain was reported in 24% of the DG patients. Pain relief was successfully achieved in both groups (p<0.001), but the patients’ satisfaction was greater in the non-diabetic patients (p=0.0067). Revision surgery was more frequently performed in the DG than the CG (non-significant difference), and the time interval for such a second intervention was shorter (p=0.04) in the DG. A higher rate of post-operative complications was observed in the DG (p<0.0001). It is concluded that surgical treatment of elderly diabetic patients suffering from spinal stenosis improves BADL and ameliorates pain, but the results remain worse than those observed in non-diabetics. The outcome of diabetic patients depends upon the presence of other comorbidities, concurrent diabetic neuropathy, duration of diabetes and insulin treatment. Successful postoperative pain reduction remained the strongest factor associated with patients’ satisfaction