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Musculoskeletal problems and injuries - part 1

Thủ tục này cho phép hình dung đầy đủ và mang lại kết quả thỏa đáng trong số 65% đến 85% patients.11, 58 báo cáo gần đây cho thấy những bệnh nhân trải qua điều trị phẫu thuật đã cải thiện các triệu chứng của họ và phục hồi chức năng lớn hơn bốn năm so với các bệnh nhân được điều trị nonoperatively, 59 tuy nhiên | 18 Walter L. Calmbach is removed the ligamentum flavum is incised and herniated disc material is excised. This procedure allows adequate visualization and yields satisfactory results among 65 to 85 of patients.11 58 Recent reports suggest that patients who undergo surgical therapy have greater improvement of their symptoms and greater functional recovery at four years than patients treated nonoperatively 59 however work status and disability status were similar between these two groups. Previous studies have shown that there is no clear benefit to surgery at ten-year follow-up.11 Microdiscectomy allows smaller incisions little or no bony excision and removal of disc material under magnification. This procedure has fewer complications fewer unsuccessful outcomes and permits faster recovery. However rates of reoperation are significantly higher in patients initially treated with microdiscectomy presumably due to missed disc fragments or operating at the wrong spinal level.58 A recent systematic review concluded that the clinical outcomes for patients after microdiscectomy are comparable to those of standard discectomy.56 Percutaneous discectomy is an outpatient procedure performed under local anesthesia in which the surgeon uses an automated percutaneous cutting and suction probe to aspirate herniated disc material. This procedure results in lower rates of nerve injury postoperative instability infection fibrosis and chronic pain syndromes. However patients undergoing percutaneous discectomy sustain unacceptably high rates of recurrent disc herniation. Only 29 of patients reported satisfactory results after percutaneous discectomy whereas 80 of subjects were satisfied after microdiscectomy.60 A recent systematic review concluded that only 10 to 15 of patients with herniated nucleus pulposus requiring surgery might be suitable candidates for percutaneous discectomy.56 This procedure is not recommended for patients with previous back surgery sequestered disc fragments