레이블이 discectomy인 게시물을 표시합니다. 모든 게시물 표시
레이블이 discectomy인 게시물을 표시합니다. 모든 게시물 표시

2014년 10월 1일 수요일

우리들병원 안용 병원장 spine논문 게재 Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study

우리들 병원 안용 원장님의 SPINE저널에 게재된 논문 입니다.
내시경 수술을 시행하는 의사와 스텝들에게 방사선 피폭은 매우 민감한 사항 입니다. 논문에서는 경피적 내시경 요추 절제술을 시행하는 동안의 방사선 피폭량을 분석하고 일년에 허용 가능한 수술 건수를 산정했습니다.
자세한 내용은 아래 서지사항의 링크 따라가시면 있습니다^^

*Authors: Ahn Y, Kim CH, Lee JH, Lee SH, Kim JS
*Bibliography: Spine (Phila Pa 1976). 2013 Apr 1;38(7):617-25.


STUDY DESIGN
A prospective study.


OBJECTIVE
-To determine the radiation dose to which the surgeons are exposed during percutaneous endoscopic lumbar discectomy (PELD)
-To calculate the allowable number of cases per year.


SUMMARY OF BACKGROUND DATA
-Minimal invasiveness can be achieved through the use of fluoroscopy and endoscopy.
-The radiation dose to the surgeon during PELD is unknown.


METHODS
-The occupational radiation dose absorbed by 3 spinal surgeons performing 30 consecutive PELDs (33 levels) during a 3-month period was evaluated.
-Transforaminal PELDs were performed according to the standard technique.
-Part of measured the radiation exposure: neck, chest, arm, and both hands of the surgeons
-Occupational exposure guidelines of National Council on Radiation Protection & Measurements were used to calculate the allowable number of procedures per year.


RESULTS
-mean operation time: 49.8 minutes / mean fluoroscopy time was 2.5 minutes.
(No significant correlations)

Calculated radiation doses per operated level
-neck: 0.0785 mSv /chest: 0.1718 mSv /right upper arm: 0.0461 mSv/ left ring finger: 0.7318 mSv/ right ring finger: 0.6694 mSv.

allowable number of cases per year
-using a lead apron: 5379 operations can be performed per year
-without using a lead apron: 291 operations can be performed


CONCLUSION
-Without radiation shielding, a surgeon performing 291 PELDs annually would be exposed to the maximum allowable radiation dose.
-Given the measurable lifetime radiation hazards to the surgeon, the use of adequate protective equipment is essential to reducing exposure during PELD.

2013년 11월 17일 일요일

The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Brief review


*Title: The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry.

*Author: Zoher Ghogawala, Christopher I. Shaffrey, Anthony L. Asher, Robert F. Heary, Tanya Logvinenko, Neil R. Malhotra, Stephen J. Dante, R. John Hurlbert, Andrea F. Douglas, Subu N. Magge, Praveen V. Mumm aneni, Joseph S. Cheng, Justin S. Smith, Michael G. Kaiser, Khalid M. Abbed, Daniel M. Sciubba, Daniel K. Resnick




Object
Purpose:
-To establish a multicenter cooperative research group.
-To demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures.


Methods
Study type: Observational prospective cohort study (13 US academic, community sites)

Subject: Total 160 patients (lumbar disc herniation 125 + spondylolisthesis 35)
-Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis.

Follow-up time: 1, 3, 6, 12 months after surgery

Evaluation method: SF-36, Oswestry Disability Index (ODI), and visual analog scale (VAS)
-pre&post


Results
-There were 198 enrolled over 1 year.
Median age: 45 yrs (49% female) for lumbar discectomy (n = 148)/
58 yrs (58% female) for lumbar spondylolisthesis (n = 50)

Complications: 12 patients (6.1%)  -At 30 days
(10 patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis)

Follow-up rate: 88.3% (over 1 yr)

Clinical outcomes(VAS, ODI, SF-36 scores): Both lumbar discectomy and single-level fusion procedures were significant improvements(p ≤ 0.0002).

Return to work: 80% of patients (for 1 yr).


-Flow diagram of the NeuroPoint-SD study showing enrollment and follow-up compliance rates.


Conclusions

-It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice.