The reported results for primary lumbar disc surgery in open standard technique are succesful in 80–95% of patients, while after repeated surgery range from 28 to 81%. The best clinical results occur when there is an indication of neurological impairment, nerve root compression and radiological confirmation. We report the results of a retrospective study on 54 patients, aged 30 – 65 years, who were presented with recurrence of symptoms and operated on for a 2nd or 3rd time after a previous discectomy, between the period 1990 to 2001.
The preoperative findings for the revision surgery were: Radiculopathy secondary to a new herniation, 14 patients. Due to recurrent disc prolapse at the same level, 9 patients. Due to lateral recess stenosis, 12 patients. Instability secondary to a previous wide laminectomy, 4 patients. No obvious cause, probably due to fibrosis, 5 patients. Multiple root syndrome due to a tumor, 1 patient. Cauda equina syndrome due to an hematoma 1 patient. The follow-up of the patients ranges between 1–12 years and the results of the revision surgery are classified according to Finnegan’s classification.
Forty-six patients rated the revision surgery worthwhile (85%).
Relief of pain more than 6 months after the previous surgery. Sciatica >
Low back pain. Nerve root compression from a new herniation in another level or recurrence at the same. Lateral recess stenosis. Good correlation of the clinical and radiological findings. The factors with bad prediction were The intra-operative fibrosis. Pain relief less than 6 months The bad psychological condition of the patients.
Instability of the thumb trapeziometacarpal joint is a major factor in the cause of degenerative disease. Surgically stabilized joint should be subject to less shear forces and hence, will be less likely to develop degenerative changes. The results of volar ligament reconstruction were assessed in 12 patients (8 men- 4 women). The average age at surgery was 35 years. All thumbs were radiographic stage I. All had failed conservative treatment with splinting and anti-inflammatory medication. Operativelly a strip of Flexor Carpi Radialis tendon was used for ligament reconstruction according to the technique described by Eaton, Glickel and Littler. The follow-up period averaged 7 years. At final follow-up 8 thumbs were stage I, 3 were stage II, and one was stage III. Ten patients were at least 90 % satisfied with the results of the surgery and only two had symptomatic thumb basal joint.
We reviewed the functional outcome of cominnuted intraarticular fractures of the distal humerus managed with internal fixation with plates and screws. 15 patients (10 men-5 women) were reviewed over a mean of 29 months postoperatively. The age of the patients at operation ranged from 18 to 72 years. Patients were treated within 7 days of injury, using a posterior approach,with or without olecranon osteotomy and with anterior transposition of the ulnar nerve. Bone grafting was used in 7 cases in addition to internal fixation. Postoperative mobilisation was prompt in all patients,who were meticously reviewed for : 1)Function of the upper extremity,with the aid of the scale of DASH (Disabilities of the arm,shoulder and hand), 2)Ulnar nerve (pain, sensitive and movement dissability, functionality), 3)Range of elbow motion, 4) strength of the muscles controlling the elbow, wrist and hand. 5)Post-operative radiographic appearance, 6)Subjective evaluation, 7)Complications. All the patients were satisfied with the outcome of the operation,as well as with the activities which could postoperatively be undertaken. The mean range of motion for elbow (flexion-extension) was 118° in average,while muscle strength for elbow motion was moderately reduced. No case of ulnar neuropathy was observed. On the other hand postoperative complications were considerably frequent, yet they were mild and subsided eventually without further operation.
