Iatrogenic Damage Research Articles

A Transvenous Endovascular Approach in Straight Sinus has Minor Impacts on Chordae Willisii.

The transvenous endovascular approach has become an optimal method for the treatment of cerebrovascular diseases. This procedure might cause iatrogenic damage to the chordae willisii (CW) in the straight sinus. However, little literature has been found to support this hypothesis. To investigate the possible damage of CW in the straight sinus during a transvenous endovascular procedure. The features of the CW from 38 cadaveric heads were observed via an endoscope mimicking a mechanical thrombectomy procedure in the straight sinus. Endoscopic observation and light microscopy examination were used to assess the damage of the CW throughout the procedure. Valve-like lamellae and longitudinal lamellae were found predominantly in the posterior portion of the straight sinus. Trabeculae were present in both the anterior and posterior portions of the straight sinus. Samples treated with a stent had a significantly higher rate of Grade 1 damage during the eight procedures compared with samples treated with a balloon (P = 0.02). The incidence of damage to the CW surface was higher in the stent group than in the balloon group (P = 0.00). The use of stent or balloon did not increase the rate of CW damage during repeated experiments. The stent or balloon navigation through the straight sinus can cause minor damage to the CW. Frequent uses of retrograde navigation through the straight sinus do not seem to increase the possibility of damage to CW.

New ways of treatment of fractures of the humeral shaft: does the combination of intramedullary nail osteosynthesis and cerclage improve the healing process?

IntroductionThe humeral shaft fracture is a rare fracture of the long bones with various treatment options. Dreaded complications such as lesions of the radial nerve or non-unions make the decision for what kind of therapy option more difficult. Biomechanically the upper arm is mostly exposed to rotational forces, which affect intramedullary nail osteosynthesis. Additive cerclage may compensate for these in spiral fractures. The aim of this study is to investigate what effect a combination of intramedullary nail osteosynthesis and limited invasive cerclage has on the rate of healing. In addition, this study addresses the question if complications arise as a result of cerclage.MethodsIn this retrospective study, 109 patients were evaluated, who, during a period of 6 years, underwent operative treatment of a humerus shaft fracture with a combination of intramedullary nail osteosynthesis and additive cerclage. The primary end point was to establish the rate of healing. A secondary end point was to evaluate complications such as infections and damage to the nerve. This was followed by an examination of patient files and X-ray images and a statistical analysis with SPSS.Results and conclusionThe healing process shows a non-union rate of 2.6%, and complications such as secondary radial nerve lesions of 4.6%. The antegrade intramedullary nail osteosynthesis with limited invasive, additive cerclage reduces the risk of non-union and does not lead to an increased risk of iatrogenic damage to the radial nerve. Wound healing was not impaired and there were no infections through the cerclage in our patient cohort.

Case report on the Management of Thrombosis in Popliteal Artery, Arterial Embolization and Thrombosis of Left Limb

Introduction: Arterial vascular occlusion can be caused by an embolus or acute thrombosis. Acute arterial occlusion can be induced by iatrogenic damage, such as that produced by the insertion of invasive catheters used for arteriography. It can occur as a result of PTA or stent implantation, the use of an intraaortic balloon pump, or IV drug addiction. Other causes include fractures, crush injuries, and penetrating wounds that change the intima of the artery. Reliable identification of an arterial blockage as embolic or thrombotic in origin is necessary to begin appropriate therapy.
 Clinical Findings: On examination vitals was heart rate is 80 beats/min respiration 22beats/min blood pressures 120/80 mmHg temperature 97oF the chest was clear, patient is oriented on local examination gangrene over left lower limb, RTPCR test was done and patient was put in isolation ward and on day 3 the RTPCR report is negative.
 Diagnostic Evaluation: Coagulation profile APTT-31.5, PT-16.5, INR-1.28, UREA-16, SODIUM-128, POTASSIUM-4.3, RTPCR-NEGATIVE, HBSAG-NON-REACTIVE, HCV-NONREACTIVE.
 Therapeutic Intervention: The patient was taken to the catheterization lab and local anesthesia is given and balloonplasty was done using ARMADA 4MM X 120cm with that Inj. Urokinase 1.5 Lac IU is given stat by infusion the
 Conclusion: My patient aged 24 years male was admitted to Cardiac unit in AVBRH hospital Sawangi (M) Wardha on date 25/03/2021 for visit in hospital OPD with complaints of leg pain with redness and swelling over the leg.

Comment on renal autotransplantation: A final option to preserve the kidney after an iatrogenic ureteral injury.

To the Editor, Autologous Renal Transplantation (ART) since firstly described in 1963 by Hardy, has been used in various cases. There are various reasons for the transplantation such as iatrogenic ureteral damage, chronic kidney pain, unresectable renal tumors or renovascular diseases. Indications concerning the suitable patients for this kind of procedure are gradually increasing. Nevertheless, each case is unique, and the treatment must be personalized [...].

Which Fibers of the Medial Collateral Ligament (MCL) Should Be Released in the Pie Crust Technique Applied During Knee Arthroscopy: Superficial MCL or Deep MCL?

BackgroundKnee arthroscopy is the most common surgery performed to treat meniscal injuries. The pie crust (PC) technique is applied during knee arthroscopy to increase joint vision of the medial femorotibial compartment and reduce the risk of iatrogenic damage. Medial collateral ligament (MCL) release is applied in the PC technique. Currently, there are no studies directly comparing the release of the superficial MCL (sMCL) or deep MCL (dMCL) when applied during the PC technique. In this study, we compared the clinical and functional results of the release of the deep and proximal tibial attachment of the superficial fibers of the MCL.MethodologyWe evaluated the results of 67 (27 women and 40 men) patients who underwent the PC technique during knee arthroscopy due to a medial meniscal tear. The patients who underwent the PC technique were divided into two groups according to the release of the deep and superficial fibers of the MCL. All patients were evaluated for pain, functional capacity, and laxity using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee scores. All patients were evaluated with radiographic examinations such as valgus laxity angle and medial tibiofemoral compartment opening height.ResultsThe KOOS and Oxford Knee Scores in both groups showed a statistically significant increase at 12 months postoperatively compared with the preoperative values (p = 0.005, 0.002, 0.002, and 0.01, respectively). No statistically significant difference was found between the groups (p > 0.05). When the valgus laxity angle before the PC technique was compared with the 12-month result after the procedure, no statistically significant difference was noted (p > 0.05). There was no evidence of complications such as chondral injury and saphenous nerve or vein injury among patients in either group.ConclusionsIn this study, we did not observe laxity in the long-term follow-up of the groups in which the superficial or deep fibers of the MCL were released. In our view, the PC technique has similar effects on surgical outcomes regardless of sMCL and dMCL release techniques.

Who cares about oligozoospermia when we have ICSI

The value of assessing subfertile males with oligozoospermia is controversial due to prevailing notions that therapies are limited and ICSI may provide the couple with a baby without the need to explain the nature or cause of underlying male infertility. This article highlights that indiscriminately offering ICSI to oligozoospermic men is not free of potential adverse effects and does not grant subfertile men the best fertility pathway. Recent data support associations between oligozoospermia and poor male reproductive health, DNA and epigenetic damage in spermatozoa, and possible adverse health consequences to offspring. Many conditions affecting the testicles are capable of causing oligozoospermia (varicocele, genital infections, congenital and genetic defects testicular torsion/trauma, chronic diseases, inadequate lifestyle, occupational/environmental exposure to toxicants, drugs, cancer and related treatments, acute febrile illness, endocrine disorders, and iatrogenic damage to the genitourinary system). If oligozoospermia is detected, therapeutic interventions can improve sperm quantity/quality and the overall male health, ultimately resulting in better pregnancy outcomes even when ICSI is used. Fertility clinics are urged to engage male infertility specialists in diagnosing and treating oligozoospermia as a matter of best clinical practice. A well-conducted male infertility evaluation represents a unique opportunity to identify relevant medical and infertility conditions, many of which may be treated or alleviated. The andrological assessment may also help guide the optimal application of ICSI. The final goals are to positively impact the overall patient health, the couple's pregnancy prospects, and the offspring's well-being.

Effectiveness of different fiber post removal techniques and their influence on dentinal microcrack formation

ObjectivesThe aim of this study was to evaluate the effectiveness of different fiber post removal techniques and to correlate dentinal loss with microcrack formation.Materials and methodsForty-five extracted single-rooted teeth were root canal treated and fiber posts were adhesively luted. Specimens were divided into three groups (n = 15) according to the removal technique: long-shaft round bur (EndoTracer #08, Komet, Lemgo, Germany), SonicFlex Endo (KaVo, Biberach, Germany), DT Post Removal Kit (VDW, Munich, Germany). Roots were scanned before post cementation and after post removal using micro-computed tomography. Dentin loss, residual luting material, working time, and the induction of microcracks were assessed. Statistical analysis was performed by using multiple contrast tests (max-t tests, α = 0.05). Correlations between parameters dentin loss/new microcracks and dentin loss/residual material were calculated using Kendall’s tau.ResultsPost removal with SonicFlex Endo resulted in the highest amount of removed dentin with significant differences to the round bur and the DT Post Removal Kit. No technique was found to completely remove the post and luting material. All techniques induced microcracks with the DT Post Removal Kit presenting the highest number of new defects. No correlation between dentin loss and new microcracks was observed. Deviations from the original root canal occurred in all groups, but no perforation was observed.ConclusionsAll techniques resulted in dentin loss, residual luting material, and the formation of microcracks. However, no correlation between dentin loss and the induction of microcracks was observed.Clinical relevanceAs all techniques resulted in microcrack formation and dentin loss, this study emphasizes the risk of iatrogenic damage due to post removal procedures.

Using Lyve1-Cre+ Mice to Visualize Lymphatics for Laser Capture Microdissection

Background: 
 Lymphedema is characterized by limb swelling secondary to lymphatic dysfunction. Lymphedema most frequently develops following breast cancer treatment due to iatrogenic damage of the lymphatics from surgery and radiation. Lymphedema affects 20-40% of breast cancer survivors. There is no cure for this disease. For determination of successful delivery of gene-based therapies, target cells are often isolated and analyzed via real-time PCR. One method to isolate a region of cells within a tissue section is laser capture microdissection (LCM). This process involves outlining the desired regions, which are cut on membrane slides and captured using a laser. Using LCM requires visualization and identification of the target tissue. In the case of lymphedema therapies, the target tissue is lymphatic vasculature. 
 
 Rationale of Project: 
 While lymphatics can be visualized using immunohistochemistry antibodies specific to lymphatic markers, the process is time consuming and can interfere with RNA levels in the tissue. Another option to visualize lymphatics is to use Lyve1-Cre+ mice. These mice express enhanced green fluorescent protein on lymphatic cells. The purpose of this project is to assess the utility of Lyve1-Cre+ and develop the methodology to capture the lymphatics in the murine tail to enable utilization of this methodology in murine tail model of lymphedema. 
 
 Methodology Development: 
 Samples of Lyve1-Cre+ mouse tails were harvested. Sections (10µm) were captured on LCM slides and dehydrated. The slides were visualized on the LCM microscope system, lymphatics vessels fluoresced green. They were captured via laser dissection. The captured samples were analyzed for the lymphatic specific genes (Prox1 and Lyve1) via quantitative real-time PCR to determine the purity of capture.

Therapeutic properties of glass-ionomer cements: Their application to orthodontic treatment.

Fluoride has been shown to be an effective agent in the prevention of caries during orthodontic treatment. Resin-modified glass-ionomer cements possess therapeutic anticariogenic properties acting as a fluoride reservoir and releasing fluoride into the environment, particularly at low pH where there is a threat of enamel demineralisation and white spot lesions (WSL's). Patient compliance to instructions in standard oral hygiene measures limits the success of caries prevention and the routine use of glass-ionomer cements can mitigate the lack of compliance, although RMGIC's are not a panacea against WSL's. The adhesion of GIC's to the enamel surface is a physicochemical bond rather than a mechanical bond which reduces the risk of iatrogenic damage to the enamel when bonding and debonding attachments. RMGIC's can be recommended as a bonding adhesive for all attachments but one needs to be selective when bonding molar attachments to avoid occlusal interferences as masticatory forces can be high in these areas.

Enhanced surgical technique for sutureless intrascleral fixation of intraocular lenses.

A simplified intrascleral fixation technique involving implantation of the Carlevale intraocular lens (IOL) in the posterior chamber is described, which lodges the T-shaped IOL haptics in the scleral wall, not requiring scleral flaps. This surgical modification reduces operative time, limits iatrogenic damage to the sclera, and avoids friction between haptics and the conjunctiva, which may cause conjunctival erosion and infection in the long term. 13 patients with crystalline lens or IOL dislocation/subluxation had surgery to implant the Carlevale IOL in the posterior chamber. Mean corrected distance visual acuity preoperatively was 0.75 ± 0.5 logMAR (range, 0.2 to 1.5 logMAR) and improved to 0.28 ± 0.3 logMAR (range, 0 to 1.0 logMAR) postoperatively. Complications rarely occurred and were not sight-threatening. The sutureless scleral fixation of the Carlevale IOL using the modified surgical technique may represent a safe and effective procedure to restore visual function in patients with damaged zonular-capsular support.

Rhinological tactics in the complex treatment of patients with severe combined cranio-facial trauma who are on mechanical ventilation

Introduction. In recent years, injuries ranked fourth among the main causes of death of the population after diseases of the cardiovascular system, malignant neoplasms and infectious diseases. The clinical course of associated injuries, as a rule, is characterized by a high number of complications, much more than in isolated injuries.Objective. Explore approaches to improving otorynolaryngological tactics from the standpoint of normalizing the functional state of the nasal mucosa, as well as increasing the effectiveness of treatment of patients with severe concomitant trauma on prolonged mechanical ventilation.Materials and methods. In the process of studying the problem of impaired mucociliary clearance of the nasal mucosa, the functional state of the mucous membrane in patients with severe concomitant head trauma undergoing prolonged artificial lung ventilation was analyzed. We studied the state of one of the most important mechanisms of sanitation and local protection of the respiratory tract - mucociliary clearance, which provides the necessary potential for barrier, cleansing and immune functions. A study was made of the thermal effect of the nasal cavity, pH + of the mucous membrane, the study of the frequency of beating of the cilia of the ciliated epithelium and the rate of mucociliary transportResults and discussion. The results of the study showed that the problem of post-traumatic and nosocomial sinusitis in patients with severe concomitant head trauma must be resolved as soon as possible, with the involvement of modern diagnostic and treatment methods, including the proposed method of artificial ventilation of the nose. The severity of the patient's condition, the severity of the injuries received excludes the use of advanced methods of surgical, otorhinolaryngological treatment.Conclusion. 12:30 PMThe use of minimally invasive methods of treatment, precision technical execution, including under endovideo control, polysinusotomy made it possible not to burden the condition of the victims and exclude iatrogenic damage that could entail irreversible changes in the body and condition of the victim.

Reducing retraction forces with tactile feedback during robotic total mesorectal excision in a porcine model.

Excessive tissue-instrument interaction forces during robotic surgery have the potential for causing iatrogenic tissue damages. The current in vivo study seeks to assess whether tactile feedback could reduce intraoperative tissue-instrument interaction forces during robotic-assisted total mesorectal excision. Five subjects, including three experts and two novices, used the da Vinci robot to perform total mesorectum excision in four pigs. The grip force in the left arm, used for retraction, and the pushing force in the right arm, used for blunt pelvic dissection around the rectum, were recorded. Tissue-instrument interaction forces were compared between trials done with and without tactile feedback. The mean force exerted on the tissue was consistently higher in the retracting arm than the dissecting arm (3.72 ± 1.19 vs 0.32 ± 0.36N, p < 0.01). Tactile feedback brought about significant reductions in average retraction forces (3.69 ± 1.08N vs 4.16 ± 1.12N, p = 0.02), but dissection forces appeared unaffected (0.43 ± 0.42 vs 0.37 ± 0.28N, p = 0.71). No significant differences were found between retraction and dissection forces exerted by novice and expert robotic surgeons. This in vivo animal study demonstrated the efficacy of tactile feedback in reducing retraction forces during total mesorectal excision. Further research is required to quantify the clinical impact of such force reduction.

Facial nerve lesion as a complication of cryodestruction for facial basal cell carcinoma

Background. Skin cancer is the most common malignant neoplasm which represents an important problem for modern health care. Published data show that the incidence is increasing over the past 50 years; by 310% annually. The prevalence of skin cancer depends on a number of factors: genetic, environmental influences, age, profession. Treatment options for basal cell skin cancer include surgery, radiation therapy, photodynamic therapy, local chemotherapy and immunotherapy, radio wave therapy, cryosurgery, laser therapy, and targeted therapy. Among them, cryosurgery is an effective, technically simple and inexpensive method of treatment available on an outpatient basis for a number of benign, precancerous and malignant skin tumors. However, the use of cryosurgery is accompanied by various complications.&#x0D; Aim. To present a case of iatrogenic damage to facial nerve during cryosurgery for facial basal cell carcinoma.&#x0D; Materials and methods. A 69-year-old patient who, in April 2019, was diagnosed with skin cancer of the left parotid region, stage I cT1N0M0, nodal variant at the regional oncological dispensary. Cytology showed basal cell carcinoma. The tumor, 1.62 cm in size, was located at the level of the earlobe. Cryodestruction was carried out by double freezing for 30 s, the thawing time was 60 s. During treatment and 7 days after treatment, the patient noted a sharp pain in the area of intervention, so he took analgesics. On the 8th day, the asymmetry of the face on the left, the drooping mouth and the inability to cover the eyes. The patient consulted a neurologist, he was diagnosed with facial nerve lesion on the left. For this disorder, the patient received conservative inpatient and outpatient treatment for a long time (several months), as a result of which some improvement was observed.&#x0D; Results. Complete functional recovery did not occur. The wound healed under a scab, with oozing, for 8 weeks. A follow-up examination in April 2021 revealed a local recurrence in the area of the scar, and a cytological examination revealed a basal cell carcinoma.&#x0D; Conclusion. This case indicates a possible risk of damage to the facial nerve at the site of its exit on the face during cryosurgical treatment for skin cancer in this area. When choosing a method of treatment, attention should be paid to the localization of the tumor, given critical anatomical zones.

Robotic Milling of Electrode Lead Channels During Cochlear Implantation in an ex-vivo Model.

Objective: Robotic cochlear implantation is an emerging surgical technique for patients with sensorineural hearing loss. Access to the middle and inner ear is provided through a small-diameter hole created by a robotic drilling process without a mastoidectomy. Using the same image-guided robotic system, we propose an electrode lead management technique using robotic milling that replaces the standard process of stowing excess electrode lead in the mastoidectomy cavity. Before accessing the middle ear, an electrode channel is milled robotically based on intraoperative planning. The goal is to further standardize cochlear implantation, minimize the risk of iatrogenic intracochlear damage, and to create optimal conditions for a long implant life through protection from external trauma and immobilization in a slight press fit to prevent mechanical fatigue and electrode migrations.Methods: The proposed workflow was executed on 12 ex-vivo temporal bones and evaluated for safety and efficacy. For safety, the difference between planned and resulting channels were measured postoperatively in micro-computed tomography, and the length outside the planned safety margin of 1.0 mm was determined. For efficacy, the channel width and depth were measured to assess the press fit immobilization and the protection from external trauma, respectively.Results: All 12 cases were completed with successful electrode fixations after cochlear insertions. The milled channels stayed within the planned safety margins and the probability of their violation was lower than one in 10,000 patients. Maximal deviations in lateral and depth directions of 0.35 and 0.29 mm were measured, respectively. The channels could be milled with a width that immobilized the electrode leads. The average channel depth was 2.20 mm, while the planned channel depth was 2.30 mm. The shallowest channel depth was 1.82 mm, still deep enough to contain the full 1.30 mm diameter of the electrode used for the experiments.Conclusion: This study proposes a robotic electrode lead management and fixation technique and verified its safety and efficacy in an ex-vivo study. The method of image-guided robotic bone removal presented here with average errors of 0.2 mm and maximal errors below 0.5 mm could be used for a variety of other otologic surgical procedures.

Suprafascial plane endoscopy versus open carpal tunnel release for idiopathic carpal tunnel syndrome: Use of the Accordion Severity Grading System

This study aimed to assess the safety and effectiveness of modified endoscopic technique with a single portal from an external carpal tunnel approach for surgical operations in a suprafascial plane superficial to the transverse carpal ligament. Reversible nerve injury risk is threefold greater with a conventional endoscopic method than with open carpal tunnel release (OCTR), and this suprafascial plane endoscopic release (SPER) should circumvent the problem of hardware in the carpal tunnel encountered with the conventional endoscopic method and liable to cause iatrogenic damage to the median nerve. However, the surgical consequences of the new technique have not been studied. To fill this gap, a retrospective therapeutic study was conducted to compare negative outcomes versus open surgery. The Accordion Severity Grading System was used to grade complications from 0 to 3 according to necessity of treatment. Sequela and failure rates were also compared between the SPER and OCTR groups. Eighty-eight cases in 72 patients with idiopathic carpal tunnel syndrome (ICTS) met the inclusion criteria. SPER was performed in 28 hands in 27 patients, and OCTR in 60 hands in 49 patients. The results showed no significant difference in complication, sequela, or failure rates between groups (p > 0.05). Suprafascial plane endoscopic release, has certain advantages over the open method and was validated as a safe and effective method of treating ICTS.

Use of 3D Planning and Patient-specific Guides for Proximal Humerus Corrective Osteotomy Associated With Shoulder Prosthesis Implantation in Proximal Humeral Varus Malunion.

Humeral stem prosthesis implantation in case of proximal humerus varus malunion (type 1D fracture sequelae) is often complicated by greater tuberosity fracture and by posterosuperior rotator cuff iatrogenic damage. Moreover, the varus malunited humeral head could lead to scapular impingement and reduce the range of motion. To address this problem, we introduced a new surgical procedure consisting in a proximal humerus osteotomy, planned with three-dimensional (3D) preoperative virtual surgery, and performed with patient-specific surgical guides, to correct humerus deformity before the implantation of the prosthetic humeral stem. A 3D evaluation of the deformity, based on the comparison to the healthy contralateral side or to anatomical standard values, is firstly performed. The metaphyseal osteotomy is then planned and virtually performed. To faithfully reproduce the planned correction, 3D printed surgical guides are prepared. Before the surgery, it is advisable to perform a simulation of the planned osteotomies to verify their real feasibility and to find any critical issues. Preliminary outcomes of this surgical technique are encouraging, but formal studies are warranted to validate its clinical utility and longevity of results.

Origin, branching pattern, foraminal and intraspinal distribution of the human lumbar sinuvertebral nerves

BACKGROUND CONTEXTThe lumbar sinuvertebral nerve (SVN) innervates the outer posterior intervertebral disc (IVD); it is thought to mediate discogenic low-back pain (LBP). Controversy, however, exists on its origins at higher (L1–L2) versus lower (L3–L5) lumbar levels. Additionally, lack of knowledge regarding its foraminal and intraspinal branching patterns and extensions may lead to iatrogenic damage. PURPOSETo systematically describe the origins of the L2 and L5 SVNs, their morphological variation in the intervertebral foramen (IVF) and intraspinal distribution. STUDY DESIGNDissection-based study of 20 SVNs with histological confirmation in five embalmed human cadavers. METHODSThe origin, branching pattern and distribution of the L2 and L5 SVNs was investigated bilaterally in five human cadavers using dorsal and anterolateral dissection approaches. Parameters studied included somatic and/or autonomic SVN root contributions, foraminal SVN morphology and course, diameter, branching point, intraspinal distribution and IVD innervation pattern. Nerve tissue was confirmed by immunostaining for neurofilament and S100 proteins. RESULTSThe SVN and its origins was identified in all except one IVF at L2 and in all foramina at L5. At L2, the SVN arose in nearly 90% of sides from both somatic and autonomic roots and at L5 in 40% of sides. The remaining SVNs were formed by purely autonomic roots. The SVN arose from significantly more roots at L2 than L5 (3.1 ± 0.3 vs. 1.9 ± 0.3, respectively; p=.022). Four different SVN morphologies could be discerned in the L2 IVF: single filament (22%), multiple (parallel or diverging) filament (33%), immediate splitting (22%) and plexiform (22%) types, whereas the L5 SVN consisted of single (90%) and multiple (10%) filament types. SVN filaments were significantly thicker at L2 than L5 (0.48 ± 0.06 mm vs. 0.33 ± 0.02 mm, respectively; p=.043). Ascending SVN filaments coursed roughly parallel to the exiting spinal nerve root trajectory at L2 and L5. Branching of the SVN into ascending and descending branches occurred mostly intraspinal both at L2 and L5. Spinal canal distribution was also similar for L2 and L5 SVNs. Lumbar posterior IVDs were innervated by the descending branch of the parent SVN and ascending branch of the subjacent SVN. CONCLUSIONSThe SVN at L2 originates from both somatic and autonomic roots in 90% of cases and at L5 in 40% of cases. The remaining SVNs are purely autonomic. In the IVF, the L2 SVN is morphologically heterogeneous, but generally consists of numerous filaments, whereas at L5 90% contains a single SVN filament. The L2 SVN is formed by more roots and is thicker than the L5 SVN. Intraspinal SVN distribution is confined to its level of origin; lumbar posterior IVDs are innervated by corresponding and subjacent SVNs (ie, two spinal levels). CLINICAL SIGNIFICANCEOur findings indicate that L5 discogenic LBP may be mediated both segmentally and nonsegmentally in 40% of cases and nonsegmentally in 60% of cases. Failure of lower lumbar discogenic pain treatment may be the result of only interrupting the nonsegmental pathway, but not the segmental one as well. Relating SVN anatomy to microsurgical spinal approaches may prevent iatrogenic damage to the SVN and the formation of postsurgical back pain.

Gross, computed tomographic, and endoscopic anatomy of the equine carpal extensor tendon sheaths.

(1) To describe the computed tomography (CT) and gross anatomy of the equine extensor carpi radialis sheath (ECRS) and common digital extensor sheath (CDETS); (2) to describe a single-portal endoscopic examination of the ECRS and CDETS. Ex vivo experimental. Thirty clinically normal cadaver thoracic equine limbs severed at the humeral diaphysis. Ten limbs underwent plain and intrathecal contrast CT examinations and gross dissection of the ECRS and CDETS. Single-portal endoscopic examination of ECRS and CDETS was attempted in 4 limbs and endoscopic examination was performed on 16 limbs. Endoscopic video recordings were reviewed by 3 observers for quality of visualization before dissection and examination for iatrogenic damage. Interobserver agreement for ECRS and CDETS visualization was determined with Fleiss' κ agreement. Extensor carpi radialis sheath and CDETS anatomy was consistent between gross dissection and CT examinations. The ECRS endoscopic portal was medial at the level of the intersection between the extensor carpi obliquus and extensor carpi radialis tendon. The CDETS endoscopic portal was lateral, 5cm proximal to the lateral styloid process of the ulna. The ECRS and CDETS were well visualized and interobserver agreement was substantial (κ=.73; P < .0001) and moderate (κ = .53; P < .0001), respectively. Computed tomography examinations provided useful anatomical information, consistent with gross dissection of the ECRS and CDETS. The described single-portal endoscopic techniques allowed consistent tenoscopic examination of the majority of the ECRS and CDETS. Awareness of the intrathecal anatomy of the ECRS and CDETS should facilitate the treatment of these tendon sheaths. The proposed portals provide good to excellent single-site endoscopic visualization of the majority of the ECRS and CDETS.

Evaluation of the effectiveness of the use of low-traumatic surgical access in the reverse shoulder arthroplasty

BACKGROUND: The number of reversible shoulder joint endoprostheses installed in the world at the present stage is several times greater than the number of hemiarthroplasty performed. Nevertheless shoulder arthroplasty is considered a traumatic operation and can be accompanied by a number of complications, both from the side of implants and due to the traumatic nature of the surgical technique. During surgical interventions on the shoulder joint with a wide dissection of the skin and subcutaneous tissue, iatrogenic damage to structures such as the axillary nerve, posterior and anterior arteries and veins surrounding the humerus can often be detected, which triggers a whole cascade of pathophysiological and regulatory processes in which Interventions immediately release inflammatory mediators. Therefore, orthopedic traumatologists strive to reduce the risk of intra- and postoperative complications, and it is necessary to improve the surgical technique of surgical interventions towards their less traumatic performance.&#x0D; AIM: Development and evaluation of the effectiveness of the use of low-traumatic surgical access when performing reverse shoulder arthroplasty.&#x0D; MATERIALS AND METHODS: In the period 20172020, 169 patients with various diseases, injuries of the shoulder joint and their consequences were operated on in the Department of Adult Orthopedics of the N.N. Priorov National Research Medical Center of the Russian Federation, who underwent reverse shoulder arthroplasty according to generally accepted indications. In the main group (84 patients), surgical treatment was performed using a low-traumatic surgical approach, while the control group (85 patients) underwent standard procedures. Functional, clinical and radiological results of surgical treatment of patients of the main and control groups were evaluated and compared after 3, 6 and 12 months.&#x0D; RESULTS: In the main group, excellent results (25 points on DASH) were observed in 73 patients, good results (2650 points) in 10 patients. In 1 patient, the results were assessed as satisfactory (5175 points). In the control group of observation, the clinical result was worse (68 excellent, 16 good and 1 satisfactory result).&#x0D; CONCLUSION: On the basis of the performed study, taking into account the better results in the main group of patients, the technique of low-traumatic surgical access for reverse shoulder arthroplasty can be recommended for wide use in clinical practice.

Features of TLIF/PLIF in lumbar spine nerve root anomalies. The literature review and own experience

Introduction. Anomalies of the roots of the lumbar spine are often not diagnosed at the preoperative stage and may cause technical difficulties during performing decompression‑stabilization surgeries of spine.Purpose of the study. To study the clinical features of patients with anomalies of the lumbar roots on the background of de‑ generative diseases of the spine, to develop techniques to protect abnormal nerve roots from damage during TLIF/PLIF.Materials and methods. Performed retrospective analysis of the results of treatment of 9 patients whom were done TLIF/PLIF for degenerative‑dystrophic diseases of the lumbar spine in the period from 2018–2019 was. The distribution of changes detected in the spine was carried out according to the classification of Schizas, Meyerding and Neidre &amp; Macnab.Results. The study group of patients was 0.63 % of all operated patients using the TLIF/PLIF technique (n = 1432). Developmental anomalies of the nerve roots were not identified during routine MRI in all patients. In six patients (66.7 %), radicular pain manifested in two dermatomes; intraoperatively, these patients had conjoint roots (Ia). Three pa‑ tients (33.3 %) had radicular pain in several (&gt;2) dermatomes. The root tension sign (Lasegue sign) was negative in eight (88.9 %) patients. The intensity of the preoperative pain syndrome in the leg averaged 6.44 (VAS), in the back 6.11, and in the postoperative period it decreased to 0.7 and 2.1, respectively.Conclusion. Clinical preoperative markers for the presence of root anomalies can be two‑dermatomal radicular mani‑ festations in the presence of a single‑level process, as well as the absence of a Lasegue sign in severe radiculopathy. Intraoperative detection of anomalies requires a balanced approach to the choice of the method of surgical intervention from the surgeon. To prevent iatrogenic damage of anomaly roots at the stage of surgical treatment, it is necessary to change the preoperative planning strategy in favor of choosing the contralateral side for interbody fusion. In addition, root traction and interbody distraction should be minimal.