ADVAntAgES of ArthroSCoPiC AnD EnDoSCoPiC DiSC Surg Ery

The availability of small-caliber, rigid-rod endoscopes three-dimensional cameras and developing image modification technology has provided operating surgeons with a superior means of visualization and tissue differentiation than the naked eye and microscope. The aquarium effect of the technology provides clearer and larger images of anatomical structures. Although the microscope permits visualization of the dorsolateral aspect of the contents of the spinal canal, spinal endoscopy via a...

History Of Surgical Management Of Sciatica

Goldthwait Procedure

In the early twentieth century, laminectomy was being performed for the treatment of a variety of spinal disorders. In 1911, Goldthwait (16) described the management of a 39-yr-old male who underwent spinal manipulation, and then he developed paralysis in Fig. 5. Potrait of Domenico Cotugno. Fig. 5. Potrait of Domenico Cotugno. the lower extremities. His conservative management included plaster immobilization and rest. The patient failed to show improvement, and 6 wk later he underwent...

Management Of Back And Leg Pain In Ancient Medicine

Islamic Miracles And Modern Science

Low back and sciatic pain has been one of the most common and disabling spinal disorders recorded in medical history. The role of the spinal canal's contents in extremity function is well demonstrated in the Dying Lioness (Fig. 1), a ca. 650 bc. Assyrian artwork. In the writings of Hippocrates (460-370 bc) one can find references to the anatomy of the brain, brachial plexus, and sciatic nerve. In animal dissections it appears that he had difficulty in differentiating tendons from peripheral...

Recognition Of Sciatica And Its Associated Symptomatology

Domenico Cotugno (Fig. 5), an eighteenth century Italian physician (7), introduced the term sciatica into the medical vocabulary. Without having knowledge of the common etiology of this disabling spinal disorder, he described some of the signs and symptoms commonly seen in association with sciatic pain. Subsequently, Cotugno's disease as an entity gained acceptance in European medicine. Associated clinical findings of sciatica Fig. 4. Cauterization points for spine and other disorders....

Annulus fibrosus

Posterior Annular Tear Noted

In elderly patients, the nucleus becomes dehydrated and collagenized and begins to migrate posteriorly through the torn fibers of the annulus Fig. 16 . From a clinician's point of view, the dorsolateral migration of the nuclear tissue will present three distinct Fig. 16. Fresh cadaveric specimen of a degenerated disc following injection of methylene blue. Note the disorganization of the nuclear tissue, annular tear, and migration of the nucleus into the periphery. Fig. 16. Fresh cadaveric...

DiAgnoSiS of luMbAr DiSC hErni AtionS inClu Sion AnD ExClu Sion Crit EriA

Traversing Nerve Root Compression

The satisfactory outcome of arthroscopically and endoscopically assisted management of herniated lumbar discs hinges on accurate diagnosis of the symptom-producing site. Although the mean age of onset of symptoms of disc herniation is around 35 yr, disc herniations are occasionally observed in populations older than 60 or younger than 20 yr of age. In younger children, combined slippage of the intervertebral disc and the vertebral plates may be responsible for the presenting symptomatology. A...

References

Hippocrates in Garrison's History of neurology Charles C Thomas, Springfield, IL, 1969, 7-8. 2. Aristotle In medicine an illustrated history, Harry N. Abrams, New York, 1978, p. 219. 3. Erasistratos Medicine an illustrated history, Harry N. Abrams, New York, 1978, pp. 310-312. 4. Avicenna in Medicine an illustrated history, Harry N. Abrams New York, 1978, p. 313. 5. Avicenna in The illustrated history of surgery, A B Nordbok, Gothenburg, Sweden, 1988, p. 73. 6. Avicenna in Medicine an...

Intracanalicular ligaments

In a virgin spine, fine and mobile vascular and ligamentous structures on the floor of the spinal canal may be seen under endoscopic magnification Fig. 12A,B . Hoffman's ligament, which extends from the ventral and lateral dura to the posterior longitudinal ligament, and the dural ligament, which extends from the dura and traversing root to the posterior longitudinal ligament and periosteum, may be identified following adequate hemostasis. Fig. 13. A Gross anatomy of annulus fibrosus and NP in...