La nucleoaspirazione secondo Onik nel trattamento dell'ernia discale lombare analisi multicentrica dei primi risultati su oltre 650 trattamenti

Gli autori espongono i risultati ottenuti applicando la nucleotomia percutanea secondo Onik al trattamento dell'ernia discale lombare. Le casistiche sommate complessivamente ammontano a oltre 600 pazienti. Nel complesso i risultati sono buoni o ottimi nel 72% circa dei casi. I risultati insoddisfacenti, considerando globalmente i modest e gli invariati, corrispondonoal 26% circa. Eccezionali le complicanze (meno dell' 1 %): 1 discite (risolta con intervento chirurgico). La metodica di Onik può già essere serenamente considerata una possibilitanon trascurabile nel campo vasto e variegato dei trattamentidisponibili per l'ernia discale lombare

The surgical treatment of thoracolumbar metastases

Between 1990 and June 1995 a total of 41 patients affected with vertebral metastases caused by neoplasm with different histotypes were treated at the Ist Clinical Orthopaedics and Traumatology Division at the University of Turin. A method proposed by J. Harms was used, nearly always involving a combined anterior and posterior surgical approach. At the Division of Orthopaedics of the Ospedale Maria Adelaide in Turin between 1993 and June 1995 a total of 16 patients affected with vertebral metastases caused by neoplasms of different histotypes were treated. Decompression and posterior stabilization alone using Diapason instrumentation was prevalently performed. Patients with a life expectancy of at least 6 months were treated. Follow-up was obtained by interviewing the patients over the phone during August of 1995. In the cases at the Ist Division of Orthopaedics the number of levels that were instrumented were on the average 2.5, at follow-up 83% of the patients stated that they were satisfied, while only 7.4% were unsatisfied. In the second series (Ospedale Maria Adelaide) the number of levels instrumented was on the average 8, at follow-up 62.5% of the patients said that they were satisfied, while 31.8% said that they were unsatisfied.

Spinal fusion in degenerative disc disease

Low back pain caused by degenerative disc disease is of such intensity in a low percentage of cases that surgery is indicated. Surgery must not only stabilize, but it must above all correct the deformity, recovering the disc space. Among all of the methods available circumferential fusion with a double combined approach, that is, anterior and posterior, is held to be the most effective.

Stenosis of the nerve root canal caused by disc resorption

Stenosis of the nerve root canal caused by isolated resorption of a lumbar disc is a frequently observed pathology, but one about which the orthopaedist still knows relatively little. Henry Crock was the first to reveal its principal pathogenetic factor, disc resorption, and to accurately describe the syndrome and its surgical treatment. A total of 22 patients operated according to Henry Crock's indications and followed-up after 2 years were reviewed. In 20 cases decompression alone was performed, while in 2 cases anterior fusion and MOSS instrumentation were associated. Of the 22 patients submitted to decompression 17 revealed complete regression of pain. Three cases failed: 1 patient had previously been treated with chymopapain, while 3 are awaiting anterior fusion to treat persistent lumbar pain. Follow-up is not sufficient for the two patients submitted to anterior fusion.

Experience with bipolar prosthesis in femoral neck fractures in the elderly and debilitated

Eighty-eight bipolar Bateman hip endoprostheses for medial femoral neck fractures were implanted. The average age of the patients was 75 years. Intrahospital results proved the morbidity and mortality rates to be well within acceptable limits. Thirty patients were followed during periods of 12-74 months (median, 33 months). According to Charnley evaluation, mobility was excellent and very good in 20 patients (86%). Good function was present in 63% of patients. The majority of patients belonged to category C as defined by Charnley. Mild pain was present in 19 patients (63%); in only two cases, involving severe rheumatoid arthritis, pain was clearly related to sinkage. Radiographically, no visible protrusion or socket wear was present. Periarticular ossification occurred in 19 patients, but this did not impair function.