Radical Decompression Research Articles

Compressed development, decompression, and diverging convergence in South Korea: which varieties of capitalism in contemporary Korea?

South Korea has achieved compressed growth and convergence of its income level to that of typical advanced economies. This paper adopts a narrow definition of compressed development as a form of late development that lacks political democracy and open markets, and then defines decompression as the process of democratization and economic liberalization. This paper applies this framework of “compressed development, decompression, and diverging convergence” to analyze the dynamics of Korean capitalism since the 1980s after the death of the modernizer-dictator, President Park. First, the middle class emerged in Korea in the 1980s as a result of compressed growth since the 1960s and served as a key intermediary in linking economic growth to democratization. The process of political decompression, or democratization, was peaceful because it was demanded and led not by the working class but by the middle class. Second, an ill-managed first wave of economic decompression (liberalization) led to a financial crisis, and then, the post-crisis reforms (the second, more radical decompression) imposed by the IMF planted the institutional seeds for convergence with Anglo-American capitalism. Third, Korea is experiencing the end of the East Asian miracle, as evidenced by slowing growth and rising inequality, and is undergoing a multifaceted convergence toward different varieties of capitalism. In terms of life expectancy and crime rates, Korea joins Japan, Italy, and Spain in the “safe capitalism” group, while it is an extreme outlier in terms of its large gender wage gap and long working hours. In terms of unemployment and long-term employment rates, Korea is closer to the Anglo-American model, but closer to Europe in terms of the degree of active (or passive) labor market policies and legal protection against layoffs. Korea seems to be realizing “divergent convergence” as it remains distinct from any particular form of Western capitalism.

Radical decompression without fusion for L5 radiculopathy due to foraminal stenosis.

The highest incidence of lumbar foraminal stenosis (LFS) occurs in the L5-S1 segment and its anatomical features differ from those of other segments. Few previous reports have exhaustively assessed surgical outcomes after decompression surgery, limiting the materials to patients with LFS at the L5-S1 segment. We aimed to prospectively investigate instability and neurological improvement following our novel surgical technique for LFS at L5-S1, named "radical decompression" of the nerve root. Patients with foraminal stenosis at L5-S1 who underwent surgery using our technique were prospectively evaluated two years postoperatively. The Japanese Orthopaedic Association (JOA) score and the JOA Back Pain Evaluation Questionnaire (JOABPEQ) were evaluated preoperatively and two years postoperatively. The following radiological parameters at L5-S1 were measured: lateral translation, sagittal translation, the difference in sagittal translation (DST) between flexion and extension, disc wedging angle, lordotic angle, the difference in lordotic angle (DLA) between flexion and extension, and disc height. Pre- and postoperative data were compared using paired t-tests. In addition, the patients were classified into a disc group (Group D) and a non-disc group (Group ND) according to whether a discectomy was performed intraoperatively. Changes in each parameter before and after surgery were compared between the groups. Twenty-eight patients were included in this analysis. The JOA scores improved in all patients. The mean preoperative and two-year postoperative JOA scores were 14.5±3.2 (range, 8-21) and 24.3±3.3 (range, 18-29), respectively (P<0.01). All JOABPEQ categories improved two years postoperatively (P<0.05). None of the patients underwent revision surgery. No significant changes were observed in any of the radiological parameters. No significant differences in the changes in each parameter before and after surgery were found between groups D and ND. Our surgical technique resulted in good neurological recovery and was associated with a low risk of postoperative segmental instability, regardless of additional discectomy.

Chiari 1 Malformation and Epilepsy in Children: A Missing Relationship.

Purpose: Once believed a result of pathophysiological correlations, the association between Chiari 1 malformation (CM1) and epilepsy has since been considered as a coincidence, due to missing etiologic or clinical matching points. At present, the problem is being newly debated because of the increasing number of CM1 diagnoses, often among children with seizures. No specific studies on this topic are available yet. The present study aimed at updating the information on this topic by reporting on a series of children specifically enrolled and retrospectively analyzed for this purpose. Methods: All children admitted between January 2015 and June 2020 for epilepsy and CM1 were considered (Group 1). They were compared with children admitted in the same period for symptoms/signs related to CM1 and/or syringomyelia (Group 2). Syndromic patients were excluded, as well as those with tumoral or other overt intracranial lesions. All patients received a complete preoperative work-up, including MRI and EEG. Symptomatic children with CM1/syringomyelia were operated on. The pertinent literature was reviewed. Results: Group 1 was composed of 29 children (mean age: 6.2 years) showing CM1 and epilepsy with several types of seizures. A share of 27% had CM1-related symptoms and syringomyelia. The mean tonsillar ectopia was 7.5 mm. Surgery was performed in 31% of cases. Overall, 62% of children are currently seizure-free (including 5/9 children who were operated on). Tonsillar herniation and syringomyelia regressed in 4/9 cases and 4/8 cases, improved in 4/9 cases and 3/8 cases, and remained stable in 1/9 and 1/8 cases, respectively. CM1 signs/symptoms regressed completely in 6/8 cases and improved or remained stable in one case in each of the two remaining patients. Group 2 consisted of 77 children (mean age: 8.9 years) showing symptoms of CM1 (75%) and/or syringomyelia (39%). The mean tonsillar ectopia was 11.8 mm. Non-specific EEG anomalies were detected in 13 children (17%). Surgery was performed in 76.5% of cases (18 children were not operated on because of oligosymptomatic). Preoperative symptoms regressed in 26%, improved in 50%, remained stable 22%, and worsened in 2%; CM1 radiologically regressed in 39%, improved in 37%, remained unchanged in 22%, and worsened in 2%; and syringomyelia/hydromyelia regressed in 61%, improved in 30%, and was stable in 9%. No statistically significant differences between the two groups were detected regarding the M/F ratio, presence of syringomyelia/hydromyelia, or CM1/syringomyelia outcome; moreover, no correlation occurred between seizure-free condition and PF decompression in Group 1, or between disappearance of EEG anomalies and PF decompression in Group 2. A significant difference between the two groups was noticed regarding the mean age at admission (p = 0.003), amount of tonsillar herniation (p < 0.00001), and PF decompression (p = 0.0001). Conclusions: These findings do not support clinical correlations between CM1 and epilepsy. Their course depends on surgery and antiepileptic drugs, respectively. The analysis of the literature does not provide evidence of a relationship between seizures and cerebellar anomalies such as CM1. Rather than being linked to a syndrome that could explain such an association, the connection between the two now has to be considered to be random.

Laparoscopic Distal Splenorenal Anastomosis

Introduction: Esophagogastric bleeding is the most formidable complication of the portal hypertension syndrome. At acute bleeding from varicose veins of the esophagus and stomach, mortality reaches 40 to 50% and is accompanied with the high risk of early hemorrhage recurrence in 30-50 % of survivors. Portosystemic shunt surgery provides for radical decompression of the portal vein system and reliably prevent hemorrhage recurrence. Purpose: To assess the possibility and efficacy of the Distal Splenorenal Anastomosis (DSRA) with a minimally invasive laparoscopic approach. Methods: The study included 28 patients with portal hypertension syndrome who underwent laparoscopic DSRA. By the Child-Pugh scale, class A was 42.9%, class B - 57.1%. The indication for surgical decompression of the portal system was the ineffectiveness of repeated sessions of endoscopic ligation with recurrence of varicose veins of the esophagus (21.5%) and/or bleeding from them (46.4%) or the presence of varicose veins of the stomach (32.1%). Results: Mean surgery time was 294±86 minutes. The maximum blood loss was 211±55 ml. The access conversion was performed in 10.7% of cases. In the postoperative period, the patients were in ICU for 1-2 days. The hospital stay and in-patients treatment duration was 9.4±2.5 days. Both in the early and in the long-term follow-up, there were no cases of gastroesophageal bleeding and shunt thrombosis. The portosystemic encephalopathy developed in 12% of cases. The surgical decompression of the portal system was featured by a decrease in the degree of esophagus varication in the long-term period. The maximum follow-up period was 46 months. Conclusion: Minimally invasive laparoscopic DSRA in patients with portal hypertension syndrome is a possible, safe and effective alternative treatment option.

Comprehensive treatment of tuberculous spondylitis with short course pre-operative anti-tuberculosis therapy

The objective: to increase the effectiveness of treatment of patients with tuberculous spondylitis by using short course pre-operative anti-tuberculosis therapy.Subjects and methods. Experimental and clinical studies have been performed. The experiment was carried out on 40 guinea pigs by making a model of tuberculous spondylitis in 30 of them. In the clinic, the effectiveness of short course pre-operative anti-tuberculosis therapy with second line drugs, radical decompression plastic interventions using a sliding titanium cage was studied in 30 patients with tuberculous spondylitis versus 30 patients in whom classical methods of preparation and surgical intervention were used.Results. The created model of experimental tuberculous spondylitis made it possible to study parameters of the clinical and morphological course of the disease. The results obtained substantiated the effectiveness of short course pre-operative anti-tuberculosis therapy without the risk of generalization of the disease after radical surgery.The method of surgical treatment of tuberculous spondylitis used in patients and utilizing telescopic titanium cages against the background of short course pre-operative anti-tuberculosis therapy, taking into account the drug resistance of Mycobacterium tuberculosis and therapy continuation after surgery, significantly improved the frequency of excellent treatment results (up to 54.0% versus 32%). At the same time, the period of preparation for radical surgery was significantly reduced, the frequency of complications went down to 13.3% versus 33.3%, the period of in-patient treatment decreased to 96 ± 12 bed-days versus 190 ± 21 (p &lt; 0.01), and the chances of social rehabilitation of operated patients improved.

Application of ultrasonic osteotome in the posterior lumbar interbody fusion surgery by unilateral fenestration and bilateral decompression in the treatment of degenerative lumbar spinal stenosis

To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis. The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups ( P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients' lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients' lumbar and back function improvement before operation and at 6 months after operation. The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B ( P<0.05). There was no nerve root injury, dural tear, cerebrospinal fluid leakage, and hematoma formation during and after operation in the two groups. All patients were followed up after operation, the follow-up time in group A was 6-18 months (mean, 10.5 months) and in group B was 6-20 months (mean, 9.3 months). There was no complication such as internal fixation fracture, loosening and nail pulling occurred during the follow-up period of the two groups. There was no significant difference in VAS scores between the two groups at 3 days after operation ( t=1.448, P=0.154); the VAS score of group A was significantly lower than that of group B at 3 and 6 months after operation ( P<0.05). The ODI scores of the two groups were significantly improved at 6 months after operation ( P<0.05), and there was no significant difference in ODI scores between the two groups before operation and at 6 months after operation ( P>0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups ( Z=-0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference ( χ 2=0.001, P=0.979 ). The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.

Thoracic Epidural Abscesses: A Systematic Review.

Study Design:Systematic review.Objectives:Past research has demonstrated increased speed and severity of progression for spinal epidural abscesses (SEAs) of the thoracic level, specifically, when compared with SEAs of other spinal cord levels. Untreated, this infection can result in permanent neurological sequelae with eventual progression to death if inadequately managed. Despite the seriousness of this disease, no articles have focused on the presentation, diagnosis, and treatment of SEAs of the thoracic level. For this reason, specific focus on SEAs of the thoracic level occurred when researchers designed and implemented the following systematic review.Methods:A query of Ovid-Medline and EMBASE, Cochrane Central, and additional review sources was conducted. Search criteria focused on articles specific to thoracic epidural abscesses.Results:Twenty-five articles met inclusion criteria. The most commonly reported symptoms present on admission included back pain, paraparesis/paraplegia, fever, and loss of bowel/bladder control. Significant risk factors included diabetes, intravenous drug use, and advanced age (P = .001). Patients were most often treated surgically with either laminectomy, hemilaminectomy, or radical decompression with debridement. Patients who presented with neurological deficits and had delayed surgical intervention following a failed antibiotic course tended to do worse compared with their immediate surgical management counterparts (P < .005).Conclusions:For the first time researchers have focused specifically on SEAs of the thoracic level, as opposed to previously published general analysis of SEAs as a whole. Based on the results, investigators recommend early magnetic resonance imaging of the spine, laboratory workup (sedimentation rate/C-reactive protein, complete blood count), abscess culture followed by empiric antibiotics, and immediate surgical decompression when neurological deficits are present.

Analysis of C5 palsy in cervical myelopathy with massive anterior compression following laminoplasty

BackgroundLittle data is available about comparison of the incidence and clinical characteristics of the C5 palsy between patients of cervical myelopathy with occupying ratio greater than 50% and those with occupying ratio less than 50% following laminoplasty.MethodsOne-hundred eighteen patients with cervical myelopathy who underwent open door laminoplasty were reviewed in this study. The patients were divided into two groups: group A comprising 55 patients with an anterior occupying ratio greater than 50% and group B comprising 63 patients with an anterior occupying less than 50%. Clinical and radiological outcomes were assessed between two groups.ResultsNo statistically difference was found in preoperative Japanese Orthopedic Association (JOA) score of both groups (10.7 ± 1.7 in group A vs 10.9 ± 1.1 in group B, P > 0.05). Improvements in postoperative JOA score were achieved, and there was a statistical difference (14.0 ± 1.4 in group A vs 14.8 ± 0.9 in group B, P < 0.05). Group A had a lower rate of recovery than group B (P < 0.05). Totally, 12 of 118 (10.2%) patients developed the C5 palsy postoperatively. C5 palsy occurred in 3 of 63 patients in the group B compared with 9 of 55 in the group A. Statistically significant difference was found in the incidence of C5 palsy between the two groups (P < 0.05). Furthermore, patients in group A required significantly longer recovery periods than group B. Both preoperative and postoperative MRI presented more levels of T2 high-signal lesion in group A than group B. The degree of posterior shift of the cord after posterior decompression in group A was less than group B (P < 0.05).ConclusionsPatients with a high degree of anterior compression have higher risk of C5 palsy than those with a relative low degree of anterior compression.

CRANIECTOMIE DECOMPRESSIVE CHEZ LE TRAUMATISE CRANIEN GRAVE

The authors report a prospective study of 40 patients admitted for a serious head injury with GCS between 4 and 6 between May’ 93 and January’ 96, and who benefited from a radical decompression. The first group of 27 cases benefited from precocious surgery in the first 24 hours, taking into account the seriousness of neurologic and scannographic picture. The second group of 13 cases benefited from late surgery beyond 24th hours. In none of these cases the CT scan detected a focal neurosurgical lesions. In this group, 11 patients were operated before the 4th day after injury, and 2 patients beyond the 6th day. Out of the 40 patients, 10 deaths occurred in the six first postoperatory days and seven cases after a long stay in intensive care, 5 had a good recovery, 5 kept a moderate handicap, 6 had a severe disability and 7 presented a vegetative state. Although from the literature data show that the officiency of decompressive hemicraniotomy would be controversial in the absence of controlled tests, we deem that this technique could be a saving gesture allowing survival without side-effects in some cases.

Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies.

At the present time, an update to the classical microsurgical transoral decompression is strongly provided by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present our experience on the endoscope-assisted microsurgical transoral approach to anterior craniovertebral junction (CVJ) compressive pathology. We analysed seven patients (3 paediatrics and 4 adults ranging from 6 to 78 years) operated on for CVJ decompressive procedures using an open access, microsurgical technique, neuronavigation and endoscopy. All techniques mentioned were simultaneously employed. Among the endoscopic routes described in the literature, we have preferred the transoral using 30° endoscopes. In all the cases endoscopy allowed a radical decompression compared to the microsurgical technique alone, as confirmed intraoperatively with contrast medium fluoroscopy. In conclusion, endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Moreover, intraoperative fluoroscopy helps to recognize residual compression. Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches. In our opinion, the endoscope deserves a role as "support" to the standard transoral microsurgical approach since 30° angulated endoscopy significantly increases the surgical area exposed at the level of the anterior CVJ.

Anterior radical decompression for severe ossification of the posterior longitudinal ligament in the cervical spine

To report the outcome of anterior radical decompression for the treatment of severe ossification of the posterior longitudinal ligament (OPLL) with an average occupying ratio exceeding 50% in the cervical spine. From July 2002 to February 2006, 26 patients with cervical OPLL occupying ratio of the spinal cord exceeding 50% underwent anterior decompression and fusion. There were 18 males and 8 females. The average age was 59 years (ranged from 43 to 73 years) and the mean occupying ratio was (65 +/- 20)%; Before operation, the JOA score was 8.7 +/- 2.8, and the sagittal diameter of spinal cord was (25 +/- 7)%. The ossified ligament was classified into two groups, the base-open group and the base-closed group. The occupying ratio was measured on 3-D CT scans, and the sagittal diameter of the deformed spinal cord was measured at the narrowest level on sagittal T2-weighted MRI. All patients received anterior decompression with the ossified ligament removed completely. Among them, 10 cases underwent one level corpectomy combined with one level diskectomy, 3 cases underwent 2 level corpectomy, and the other 13 patients underwent one level corpectomy. The decompressed segments were reconstructed either with a iliac crest strut or a titanium cage, and an anterior locking plate was implanted to prevent graft extrusion in every patient. All patients were monitored with ECP during decompression. The occupying ratio decreased to (10 +/- 5)%, the sagittal diameter of spinal cord increased to (75 +/- 15)%, and the average diameter of spinal cord at the narrowest site increased 3 times after operation. The JOA score was 14.2 +/- 2.5, with an average improvement ratio of (61 +/- 24)%. Three patients accompanied with diabetes presented with temporarily neurological deterioration. There were two cases complicated with cerebrospinal fluid leaks but cured within 2 weeks after surgery. One case accompanied with diabetes underwent a second emergency reexploration for hematoma in the spinal canal which caused a dyspnea. Anterior radical decompression is an optimal method for the management of severe OPLL in the cervical spine. Higher rate of neuro-function recovery can be anticipated.

Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression

A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches. In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data. From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained. We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained.

Intraventricular Glioneuronal Hamartoma: Histopathological Correlation with Magnetic Resonance Spectroscopy

Intraventricular hamartomas are extremely uncommon lesions outside of a setting of tuberous sclerosis. The second case of its kind in medical literature is presented and its possible aetiopathogenesis, imaging characteristics, pathognomonic magnetic resonance spectroscopy (MRS) and histopathology are discussed. An 11-year-old male presented with a seizure disorder for one year, with headache and vomiting for 15 days. Computerized tomography (CT) revealed a non-enhancing, heterogeneous, left-sided, trigonal lesion with areas of calcification trapping the left frontal horn. Magnetic resonance imaging (MRI) indicated that the lesion was iso to hypointense on T1 weighted images (T1WI) and iso to hyperintense on T2 weighted images (T2WI). A pathognomonic neurochemical signature was elicited on (1)H MRS showing low N-acetylaspartate resonance and normal creatine:choline ratios. Radical decompression of the tumor resulted in an excellent outcome. The diagnosis was established by positive immunohistochemical reactivity for synaptophysin, glial fibrillary acidic protein (GFAP) and myelin basic protein. This is the first case report in existing medical literature in which a histopathological correlation is available for a hamartoma with an unequivocal MRS signal. The authors advocate the use of MRS in patients with tuberous sclerosis or neurofibromatosis with suspected hamartomas to distinguish these benign lesions from gliomas prior to a surgical exploration.

巨大滑液嚢腫を伴った股関節結核の一例

This case involves an 81-year-old woman. The patient's medical history indicates radiation therapy for uterine cervical cancer 15 years ago. Subsequent metastasis to the lungs occurred ten years ago, and lobectomy was performed. Pyrexia in the right coxalgia was found about a half year ago during check up. She had been given antibiotics for the treatment of osteomyelitis at a previous hospital, but the condition in the right coxalgia lingered in greater and lesser degrees alternately. In the initial diagnosis, we observed that range-of-motion was restricted in the right hip joint, and X-ray examination showed Otto innominate bone deformation. Combined computed tomography and MRI examinations indicated giant cystic lesions extending to the lesser trochanter from the iliacus muscle of the iliac fossa. Bone scintigram examination showrd aberrant accumulation in the right acetabular roof, right femoral head, and trochanter. Tuberculin reaction was negative in two tests. There were no unusual findings in conventional chest X-ray examination. Articulatio simplex type rheumatoid arthritis, coxotuberculosis, osteomyelitis, and metastatic bone tumor were considered from the above observations. We performed puncture on the fourth day of hospitalization and diagnosed coxotuberculosis in a polymerase chain reaction. Treatment of the hip in which the joint space had been destroyed consisted of radical decompression, drainage of abscess, and removal of avascular tissues. This was followed by antituberculosis chemotherapy with multiple drugs until there was clinical and hematological evidence.

Stereotactic aspiration of intracerebral haematoma: significance of surgical timing and haematoma volume reduction.

We reviewed 63 patients with primary intracerebral haemorrhage (PICH) in basal ganglia treated by computed tomography (CT)-guided stereotactic aspiration to evaluate the impact of surgical timing and degree of haematoma volume reduction on neurological outcome evaluated with Glasgow Outcome Score (GOS). In 19 patients operation was performed within 24h from the symptom onset with more than 60% of haematoma volume reduction. At 3 weeks 11 patients (58%) achieved a favorable outcome (GOS 4 or 5). In the other 44 patients only 10 (23%) recovered to GOS 4 or 5. These differences were statistically significant. At 6 months a still larger proportion of patients with early radical decompression showed favorable outcome, however, the difference was not statistically significant. The results demonstrate that early and radical stereotactic aspiration provided a better neurological outcome at the early recovery phase, though the beneficial effect on the final outcome was not significant statistically.

Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis

Lumbar spinal stenosis can be effectively treated by performing an extensive ipsilateral spinal decompression, including a partial pediculotomy, and contralateral posterior bone fusion. Infrequently, complications can arise following radical decompression to alleviate symptoms of stenosis, and one such complication is a pedicle fracture. Three reports of pedicle fractures following extensive spinal decompression and contralateral posterior fusion are detailed. This complication is emphasized, and interventions are discussed. Three patients presented with symptoms attributable to lumbar stenosis; they were initially treated with an ipsilateral decompression, achieved in part, through a partial pediculotomy followed by contralateral autologous bone fusion. Initially, all three patients improved postoperatively; however, they later developed neurological symptoms ipsilateral to the side of spinal decompression. Computerized tomography scanning demonstrated pedicle fractures on the decompressed side. This complication has not yet been reported in association with decompression and fusion for lumbar stenosis. Two of the patients developed leg pain necessitating reoperation whereas the third experienced only mild transient symptoms. The fractured pedicle was removed in one patient; laminar and spinous process fusion was performed again. Another patient underwent a total laminectomy, removal of the fractured pedicle, and bilateral transverse process fusion. Reoperation yielded satisfactory outcomes. The third patient's symptoms resolved without intervention. Pedicle fractures are a potential complication of extensive lumbar decompression and contralateral posterior fusion. Loading forces from the facets or transverse processes are possibly the cause of such fractures. Removal of the fractured pedicle, additional decompression, and enhanced bone fusion are recommended when the symptoms warrant surgical intervention.

Anaplastic ganglioglioma: case report and review of the literature

A 10-year-old girl underwent radical decompression of a right temporal tumour extending to the insular cortex which proved to be a differentiated ganglioglioma. One year later, she presented with a bleeding right frontal tumour extending to the insula, the histology of which showed it to be the anaplastic variant of ganglioglioma. She underwent postoperative radiotherapy butdied 6monthsafter the second operation.Anaplastic ganglioglioma is a rare variantofganglioglioma and progression of the latter to anaplastic ganglioglioma is an extremely rare occurrence. The literature regarding ganglioglioma is reviewed.

Pott's Paraplegia

Sixty-seven patients were treated for Pott's paraplegia: 58 were adults and 9 were children. Sixty-four patients had active disease, and 3 had healed disease. All patients had triple chemotherapy with or without decompression surgery. Thirteen patients, including 9 children, were treated conservatively, whereas 54 patients who met the selection criteria for surgery were treated surgically. Fifty-two patients had anterior radical decompression surgery, and for 14 of them, anterior surgery was preceded by posterior instrumental stabilization surgery. Two patients with healed disease had posterior decompressive corpectomy. There was functional recovery in 60 (89.6%) patients, including 13 who had active disease that was treated conservatively. In 47 of the 54 surgically treated patients there was neurologic recovery, and 2 of these recovered incompletely with some residual spasticity. In the remaining 7 patients, there was no recovery. It took 2 to 6 months for recovery for the patients with conservative treatment, whereas it took <2 months for the patients with anterior decompression. The patients who had the combined 2-stage procedure could be mobilized earlier after neurologic recovery than could the patients having the anterior radical surgery and the conservatively treated patients. It was proven that paraplegia of active disease can be treated successfully by conservative or surgical means and that paraplegia caused by healing of fibrosis in the severely deformed spine was difficult to treat successfully, even with radical surgery.

Scanning electron microscopic study of inner ear barotrauma: in the guinea pig under hypobaric pressure

In order to investigate the mechanism of inner ear barotrauma, guinea pigs, with bilateral eustachian tube occlusion, were subjected to decompression and compression between 760 and 460 mmHg in a hypobaric pressure chamber. We divided the guinea pigs into two groups, A and B. Group A showed normal eustachian tubes, and group B showed bilaterally occluded eustachian tubes. Group B animals were divided into three types according to the rates of compression and decompression. After pressure loading, morphological changes in the hair cells of the organ of Corti were studied by means of scanning electron microscopy. There was no damage to hair cells in the setting of normal eustachian tube function, as in group A. On the other hand, mild to severe hair cell damage was observed with rapid decompression in group B. This observation suggests that relative positive pressure in the middle ear cavity is an important factor in inner ear barotrauma. The mechanism of hair cell damage due to inner ear barotrauma is presumed to be distortion of the organ of Corti caused by a difference in pressure between perilymph and endolymph resulting in injury to the stereocilica.

Radical orbital decompression for severe dysthyroid exophthalmos.

A surgical technique is described for radical decompression of the orbit for dysthyroid exophthalmopathy. The operation should be considered in a patient with proptosis greater than 30 mm bilaterally or one with unilateral proptosis of 10 mm or more greater than the opposite eye. Such exophthalmos is frequently associated wih corneal exposure and ulceration, extreme cosmetic disfigurement, and optic neuropathy. The surgical procedure is performed through a 35-mm lateral skin incision and a lateral canthotomy with subconjunctival dissection. All four walls of the orbit are partially removed. This panorbital decompression procedure has been performed on five patients, with reduction of preoperative proptosis by as much as 17 mm. Complications were minimal. A review of the effectiveness of other orbital decompressive procedures is presented. It appears that the four-wall decompressive procedure offers the maximum degree of orbital reduction.