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Chun Kee Chung - One of the best experts on this subject based on the ideXlab platform.
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minimally invasive cervical foraminotomy and Diskectomy for laterally located soft Disk Herniation
European Spine Journal, 2015Co-Authors: Sung Bae Park, Chun Kee Chung, Seung Heon Yang, Jookyung SungAbstract:Purpose The posterior cervical foraminotomy and Diskectomy (PCD) is a traditional surgical technique for patients with laterally located soft-Disk Herniation. Recently, tubular retractor-assisted posterior foraminotomy and Diskectomy (MTPF) and posterior percutaneous endoscopic cervical foraminotomy and Diskectomy (PPECD) have been introduced, but a comparative study has not yet been performed. Methods Patients with foraminal soft-Disk Herniation and a follow-up period of [2 years were retrospectively reviewed; 22 patients underwent a MTPF and 22 patients underwent a P-PECD. The primary end-point was an improvement of arm pain more than 4.3. The clinical parameters (age, sex, disability index, neck and arm pain), radiological parameters (cervical curvature, segmental angle, anterior-/posterior-Disk height and amount of facet joint removal) preoperatively and at postoperative month 24 and the surgical methods were considered as covariates. Results Successful outcome was achieved in 19/22 (87 %) of the patients after both MTPF and a P-PECD. Preoperative SA showed trend (P = 0.08; OR 1.2; 95 % CI 0.98–1.4) and the cut-off SA was 1.45 (sensitivity 80 %, specificity 73 %). The length of the facet joint’s removal was 0.02–2.49 mm (0.1–15.2 %) with no difference between the MTPF and P-PECD. The surgical method was not a significant factor. Conclusions For patients with foraminal soft-Disk Herniation, either MTPF or P-PECD, may be regarded as an alternative options to open surgery. Preoperative kyphotic SA (cut-off value 1.45) seemed to be associated with poor outcome and this may be considered in selecting surgical methods.
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surgical outcome of percutaneous endoscopic interlaminar lumbar discectomy for highly migrated Disk Herniation
Journal of Spinal Disorders & Techniques, 2012Co-Authors: Chun Kee ChungAbstract:Study Design: Technical report. Objective: To present a detailed surgical technique for percutaneous endoscopic interlaminar discectomy (PEID) for highly migrated Disk Herniation. Summary of Background Data: Percutaneous lumbar endoscopic discectomy for highly migrated Disk Herniation is still challenging even for an experienced surgeon. Because of the risk of failure and technical difficulty, open discectomy is recommended for a high-grade migration. However, past reports focused on the transforaminal approach (percutaneous endoscopic transforaminal discectomy) and may give a biased impression. We may overlook the merit of PEID. The surgical procedure for PEID is similar to a traditional open discectomy and the range of approach could be widened by the inclined introduction and pivoting motion of an endoscope. Methods: Eighteen consecutive patients (M:F=12:6; age, 56±15 y) with highly migrated Disk Herniation were enrolled for the present study. The Disk material was migrated superiorly in 7 patients (L4–5, 4; L5–S1, 2; L2–3, 1) and inferiorly in 11 patients (L4–5, 6; L3–4, 4; L5–S1, 1). PEID was applied in 17 patients and PETD was performed for L2–3 Disk Herniation. The follow-up period was 16±12 months. The outcome was graded using the MacNab criteria. Results: Complete removal of the Disk material was confirmed with magnetic resonance imaging in 16 patients (success rate 89%). Revision operation was necessary in 2 patients with inferior migration from L4–5. The residual Disk was removed through the L5–S1 laminar window 2 days after surgery with excellent outcome at the last follow-up. The outcome at the last follow-up was excellent in 12 patients, good in 3, fair in 2, and poor in 1. Dural tear was suspected in 1 patient without any further problems and there was no recurrence during follow-up. Conclusions: PEID may be applied comfortably even for less-experienced surgeons because of the familiar anatomy with open surgery.
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surgical outcome of percutaneous endoscopic interlaminar lumbar Diskectomy for recurrent Disk Herniation after open Diskectomy
Journal of Spinal Disorders & Techniques, 2012Co-Authors: Chun Kee Chung, Tae Ahn Jahng, Hee Jin YangAbstract:Abstract Technical report. To present a detailed surgical technique of percutaneous endoscopic interlaminar Diskectomy (PEID) for recurrent lumbar Disk Herniation and present features of postoperative magnetic resonance images that were unavailable in previous studies. Revision lumbar Diskectomy is troublesome because of the difficulty in dissecting a surgical scar. Endoscopic Diskectomy is regarded as an alternative method with comparable clinical outcome and less complication. Technically, a transforaminal approach is similar to a virgin operation, whereas an interlaminar approach is not, because of the scar tissue. There have been only 2 papers describing a PEID surgical procedure. Sharing details of the surgical technique is important in furthering the adoption of this technique, when it is indicated. We operated on 10 patients (M:F=6:4; mean age, 61.2±11.6 y) with PEID for recurrent lumbar Disk Herniation after open Diskectomy. The level operated was L5-S1 in 5 cases, L4-5 in 4, and L2-3 in 1. During operation, we dissected the scar tissue from the medial facet joint with a working channel and removed the reherniated Disk material after retraction of the scar tissue and the neural tissue together. Dissection of the scar tissue from the neural tissue was not attempted. The follow-up period was 14.4±9.9 months. In all 10 patients, the reherniated Disk materials were removed successfully. There was no incidence of dural tear. Postoperative magnetic resonance imaging showed good decompression with thecal sac reexpansion irrespective of the attached scar tissue, except in 1 patient. Excellent or good outcome by Macnab criteria was obtained in 6 of 10 patients, fair outcome in 2, and poor in 2 patients. Rerecurrence occurred in 1 patient 1 year after the surgery. PEID with dissection of the scar tissue from the medial facet joint rather than from the neural tissue may be an effective alternative surgical method for recurrent Disk Herniation.
Jonathan M Levine - One of the best experts on this subject based on the ideXlab platform.
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naturally occurring Disk Herniation in dogs an opportunity for pre clinical spinal cord injury research
Journal of Neurotrauma, 2011Co-Authors: Jonathan M Levine, Gwendolyn J Levine, B F Porter, Kimberly Topp, Linda J NoblehaeussleinAbstract:Traumatic spinal cord injuries represent a significant source of morbidity in humans. Despite decades of research using experimental models of spinal cord injury to identify candidate therapeutics, there has been only limited progress toward translating beneficial findings to human spinal cord injury. Thoracolumbar intervertebral Disk Herniation is a naturally occurring disease that affects dogs and results in compressive/contusive spinal cord injury. Here we discuss aspects of this disease that are analogous to human spinal cord injury, including injury mechanisms, pathology, and metrics for determining outcomes. We address both the strengths and weaknesses of conducting pre-clinical research in these dogs, and include a review of studies that have utilized these animals to assess efficacy of candidate therapeutics. Finally, we consider a two-species approach to pre-clinical data acquisition, beginning with a reproducible model of spinal cord injury in the rodent as a tool for discovery with validation in pet dogs with intervertebral Disk Herniation.
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magnetic resonance imaging in dogs with neurologic impairment due to acute thoracic and lumbar intervertebral Disk Herniation
Journal of Veterinary Internal Medicine, 2009Co-Authors: Jonathan M Levine, Geoffrey T Fosgate, Annie V Chen, R Rushing, Peter P Nghiem, Simon R Platt, R S Bagley, Marc Kent, Daniel G Hicks, Benjamin D YoungAbstract:Background: Magnetic resonance imaging (MRI) is a correlate to physical examination in various myelopathies and a predictor of functional outcome. Objectives: To describe associations among MRI features, neurological dysfunction before MRI, and functional outcome in dogs with Disk Herniation. Animals: One hundred and fifty-nine dogs with acute thoracolumbar Disk Herniation. Methods: Retrospective case series. Signalment, initial neurological function as assessed by a modified Frankel score (MFS), and ambulatory outcome at hospital discharge and >3 months (long-term) follow-up were recorded from medical records and telephone interview of owners. Associations were estimated between these parameters and MRI signal and morphometric data. Results: Dogs with intramedullary T2W hyperintensity had more severe pre-MRI MFS (median 2, range 0–4) and lower ambulatory proportion at long-term follow-up (0.76) than those dogs lacking hyperintensity (median MFS 3, range 0–5; ambulatory proportion, 0.93) (P=.001 and .013, respectively). Each unit of T2W length ratio was associated with a 1.9 times lower odds of long-term ambulation when adjusted for pre-MRI MFS (95% confidence interval 1.0–3.52, P=.05). Dogs with a compressive length ratio >1.31 (which was the median ratio within this population) had more severe pre-MRI MFS (median 3, range 0–5) compared with those with ratios ≤1.31 (median MFS 3, range 0–4; P=.006). Conclusions and Clinical Importance: MRI features were associated with initial injury severity in dogs with thoracolumbar Disk Herniation. Based on results of this study, the T2W length ratio and presence of T2W intramedullary hyperintensity appear to be predictive of long-term ambulatory status.
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adverse effects and outcome associated with dexamethasone administration in dogs with acute thoracolumbar intervertebral Disk Herniation 161 cases 2000 2006
Javma-journal of The American Veterinary Medical Association, 2008Co-Authors: Jonathan M Levine, Gwendolyn J Levine, Sharon C Kerwin, Simon R Platt, Marc Kent, Lindsay Boozer, Scott J Schatzberg, Geoffrey T FosgateAbstract:Objective—To determine complications and neurologic outcomes associated with dexamethasone administration to dogs with surgically treated thoracolumbar intervertebral Disk Herniation, compared with dogs not receiving dexamethasone. Design—Retrospective case series. Animals—161 dogs with surgically confirmed thoracolumbar Disk Herniation. Procedures—Medical records from 2 hospitals were used to identify dogs that had received dexamethasone < 48 hours prior to admission (dexamethasone group dogs), dogs that received glucocorticoids other than dexamethasone < 48 hours prior to admission (other-glucocorticoid group dogs), and dogs that received no glucocorticoids (nontreatment group dogs). Signalment, neurologic injury grade, laboratory data, and complications were extracted from medical records. Results—Dexamethasone group dogs were 3.4 times as likely to have a complication, compared with other-glucocorticoid or nontreatment group dogs. Dexamethasone group dogs were 11.4 times as likely to have a urinary tr...
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evaluation of the success of medical management for presumptive cervical intervertebral Disk Herniation in dogs
Veterinary Surgery, 2007Co-Authors: Jonathan M Levine, Gwendolyn J Levine, Scott I Johnson, Sharon C Kerwin, Bianca Felicitas Hettlich, Geoffrey T FosgateAbstract:OBJECTIVE To determine the success of medical management of presumptive thoracolumbar Disk Herniation in dogs and the variables associated with treatment outcome. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n=223) with presumptive thoracolumbar Disk Herniation. METHODS Medical records from 2 clinics were used to identify affected dogs, and owners were mailed a questionnaire about success of therapy, recurrence of clinical signs, and quality of life (QOL) as interpreted by the owner. Signalment, duration and degree of neurologic dysfunction, and medication administration were determined from medical records. RESULTS Eighty-three percent of dogs (185/223) were ambulatory at initial evaluation. Successful treatment was reported for 54.7% of dogs, with 30.9% having recurrence of clinical signs and 14.4% classified as therapeutic failures. From bivariable logistic regression, glucocorticoid administration was negatively associated with success (P=.008; odds ratio [OR]=.48) and QOL scores (P=.004; OR=.48). The duration of cage rest was not significantly associated with success or QOL. Nonambulatory dogs were more likely to have lower QOL scores (P=.01; OR=2.34). CONCLUSIONS Medical management can lead to an acceptable outcome in many dogs with presumptive thoracolumbar Disk Herniation. Cage rest duration does not seem to affect outcome and glucocorticoids may negatively impact success and QOL. The conclusions in this report should be interpreted cautiously because of the retrospective data collection and the use of client self-administered questionnaire follow-up. CLINICAL RELEVANCE These results provide an insight into the success of medical management for presumptive thoracolumbar Disk Herniation in dogs and may allow for refinement of treatment protocols.
Jookyung Sung - One of the best experts on this subject based on the ideXlab platform.
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preoperative risk factors for recurrent lumbar Disk Herniation in l5 s1
Journal of Spinal Disorders & Techniques, 2015Co-Authors: Jookyung SungAbstract:Background Context:Although numerous studies have reported on recurrent lumbar Disk Herniation (rLDH), few have reported on recurrence of L5–S1 level.Purpose:We investigated whether the preoperative risk factors, such as Disk degeneration, Disk height, sagittal range of motion (sROM), width of L5 ve
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minimally invasive cervical foraminotomy and Diskectomy for laterally located soft Disk Herniation
European Spine Journal, 2015Co-Authors: Sung Bae Park, Chun Kee Chung, Seung Heon Yang, Jookyung SungAbstract:Purpose The posterior cervical foraminotomy and Diskectomy (PCD) is a traditional surgical technique for patients with laterally located soft-Disk Herniation. Recently, tubular retractor-assisted posterior foraminotomy and Diskectomy (MTPF) and posterior percutaneous endoscopic cervical foraminotomy and Diskectomy (PPECD) have been introduced, but a comparative study has not yet been performed. Methods Patients with foraminal soft-Disk Herniation and a follow-up period of [2 years were retrospectively reviewed; 22 patients underwent a MTPF and 22 patients underwent a P-PECD. The primary end-point was an improvement of arm pain more than 4.3. The clinical parameters (age, sex, disability index, neck and arm pain), radiological parameters (cervical curvature, segmental angle, anterior-/posterior-Disk height and amount of facet joint removal) preoperatively and at postoperative month 24 and the surgical methods were considered as covariates. Results Successful outcome was achieved in 19/22 (87 %) of the patients after both MTPF and a P-PECD. Preoperative SA showed trend (P = 0.08; OR 1.2; 95 % CI 0.98–1.4) and the cut-off SA was 1.45 (sensitivity 80 %, specificity 73 %). The length of the facet joint’s removal was 0.02–2.49 mm (0.1–15.2 %) with no difference between the MTPF and P-PECD. The surgical method was not a significant factor. Conclusions For patients with foraminal soft-Disk Herniation, either MTPF or P-PECD, may be regarded as an alternative options to open surgery. Preoperative kyphotic SA (cut-off value 1.45) seemed to be associated with poor outcome and this may be considered in selecting surgical methods.
Benjamin D Young - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance imaging in dogs with neurologic impairment due to acute thoracic and lumbar intervertebral Disk Herniation
Journal of Veterinary Internal Medicine, 2009Co-Authors: Jonathan M Levine, Geoffrey T Fosgate, Annie V Chen, R Rushing, Peter P Nghiem, Simon R Platt, R S Bagley, Marc Kent, Daniel G Hicks, Benjamin D YoungAbstract:Background: Magnetic resonance imaging (MRI) is a correlate to physical examination in various myelopathies and a predictor of functional outcome. Objectives: To describe associations among MRI features, neurological dysfunction before MRI, and functional outcome in dogs with Disk Herniation. Animals: One hundred and fifty-nine dogs with acute thoracolumbar Disk Herniation. Methods: Retrospective case series. Signalment, initial neurological function as assessed by a modified Frankel score (MFS), and ambulatory outcome at hospital discharge and >3 months (long-term) follow-up were recorded from medical records and telephone interview of owners. Associations were estimated between these parameters and MRI signal and morphometric data. Results: Dogs with intramedullary T2W hyperintensity had more severe pre-MRI MFS (median 2, range 0–4) and lower ambulatory proportion at long-term follow-up (0.76) than those dogs lacking hyperintensity (median MFS 3, range 0–5; ambulatory proportion, 0.93) (P=.001 and .013, respectively). Each unit of T2W length ratio was associated with a 1.9 times lower odds of long-term ambulation when adjusted for pre-MRI MFS (95% confidence interval 1.0–3.52, P=.05). Dogs with a compressive length ratio >1.31 (which was the median ratio within this population) had more severe pre-MRI MFS (median 3, range 0–5) compared with those with ratios ≤1.31 (median MFS 3, range 0–4; P=.006). Conclusions and Clinical Importance: MRI features were associated with initial injury severity in dogs with thoracolumbar Disk Herniation. Based on results of this study, the T2W length ratio and presence of T2W intramedullary hyperintensity appear to be predictive of long-term ambulatory status.
Yasusuke Hirasawa - One of the best experts on this subject based on the ideXlab platform.
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epidural hematoma of the lumbar spine simulating extruded lumbar Disk Herniation clinical discographic and enhanced magnetic resonance imaging features a case report
Spine, 1997Co-Authors: Nobuyoshi Watanabe, Taku Ogura, Kokuto Kimori, Hitoshi Hase, Yasusuke HirasawaAbstract:Study Design. This case report describes a patient with epidural hematoma of the lumbar spine and progressive intermittent claudication whose imaging findings were similar to those of a patient with extruded Disk Herniation. Objectives. To highlight the diagnosis and cause of the lumbar epidural hematoma. Summary of Background Data. The characteristics of imaging of lumbar epidural hematomas have been reported. To the authors' knowledge, a case of epidural hematoma with leakage of the contrast medium into the mass at discogram has never been reported. Methods. A case of a lumbar epidural hematoma with 10-15 minutes of intermittent claudication was described. There was no history of major trauma or coagulation disorders. Diagnosis was made using magnetic resonance imaging, myelography, discography, and computed tomography. The magnetic resonance image demonstrated a relatively large, rounded mass posterior to the Sl vertebral body with L5-S1 disc protrusion. A gadolinium-enhanced magnetic resonance image showed a rim-enhancing lesion. A discogram revealed leakage of the contrast medium into the mass. The mass was diagnosed as extruded Disk Herniation, and surgery was performed. Results. At surgery no evidence of obvious Disk Herniation was detected, but the encapsulated hematoma was found. Conclusions. A case of chronic lumbar epidural hematoma in which clinical and imaging findings were similar to those of an extruded lumbar Disk Herniation was reported. Clinical information and results of imaging studies should be analyzed carefully because the imaging findings of contained epidural hematomas are often quite specific to this condition and can be differentiated from those of extruded disc Herniations. Management of chronic lumbar epidural hematoma may be altered by a specific diagnosis.