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, Llamas F, et al: Peripheral nerve injury by chymopapain injection. J Neurosurg 61: 1–8, 1984 6. Maroon JC , Abla A : Microdiscectomy versus chemonucleolysis. Neurosurgery 16 : 644 – 649 , 1985 Maroon JC, Abla A: Microdiscectomy versus chemonucleolysis. Neurosurgery 16: 644–649, 1985 Neurosurgical Forum: Letters to the Editor Response Robert J. Maciunas , M.D. Burton M. Onofrio , M.D. Mayo Clinic Rochester, Minnesota We appreciate Dr. Sukoff

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Jordan C. Grabel, Raphael Davis and Rosario Zappulla

T he recurrence of radicular pain following lumbar discectomy is not uncommon. 6 Previous reports indicate that between 2% and 8% of patients undergoing microsurgical discectomy of the lumbar spine require a second operation. 4, 7 Recurrent disc herniation and postoperative scarring are the most common findings at reoperation in these cases. A patient is presented who required a second operation following lumbar microdiscectomy and in whom our preoperative radiographic interpretation did not correlate with an unusual intraoperative finding. Case Report

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Microsurgical reoperation following lumbar disc surgery

Timing, surgical findings, and outcome in 92 patients

Uwe Ebeling, H. Kalbarcyk and H. J. Reulen

surgery < 1 month after initial surgery, Group B 1 to 12 months after, and Group C 1 to 20 years after. Time Interval of Reoperation If the final outcome is compared in the three time interval groups, it is evident that Group C patients have an outcome absolutely comparable to a first microdiscectomy with about 90% successful results ( Fig. 3 ). Also, the outcome ratings are similarly distributed. Markedly less successful results are found in Group A, and the worst results with a very low number of excellent and good outcomes and a large number of

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H. August M. van Alphen, Reinder Braakman, P. Dick Bezemer, Gijs Broere and M. Willem Berfelo

-term prospective study of lumbosacral discectomy. J Neurosurg 67 : 49 – 53 , 1987 Lewis PJ, Weir BKA, Broad RW, et al: Long-term prospective study of lumbosacral discectomy. J Neurosurg 67: 49–53, 1987 12. Maroon JC , Abla A : Microdiscectomy versus chemonucleolysis. Neurosurgery 16 : 644 – 648 , 1985 Maroon JC, Abla A: Microdiscectomy versus chemonucleolysis. Neurosurgery 16: 644–648, 1985 13. Martins AN , Ramirez A , Johnston J , et al : Double-blind evaluation of chemonucleolysis

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Joseph C. Maroon, Thomas A. Kopitnik, Larry A. Schulhof, Adnan Abla and James E. Wilberger

( Fig. 2 ). The subcutaneous tissue is dissected free from the underlying fascia and the groove between the multifidus and longissimus muscles is palpated ( Fig. 3 left ). A fascial incision is made at this point and blunt dissection is used to palpate and expose the lateral aspect of the zygapophysial facet joint and the transverse process above and below the disc level to be explored. One or two deep Williams microdiscectomy retractors are used to maintain exposure. It is essential at this point to obtain a radiograph with a probe in position to confirm the

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Foramen Magnum Decompression in Infants with Homozygous Achondroplasia March 1990 72 3 10.3171/jns.1990.72.3.0519 Vascularized Fibular Grafts for Vertebral Body Replacement March 1990 72 3 10.3171/jns.1990.72.3.0519a Cushing's disease: results of transsphenoidal microsurgery with emphasis on surgical failures George T. Tindall Carl J. Herring Richard V. Clark David A. Adams Nelson B. Watts March 1990 72 3 363 369 10.3171/jns.1990.72.3.0363 Posterolateral microdiscectomy for cervical monoradiculopathy caused by

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Francois Aldrich

posterolateral. The policy has evolved to perform an anterior approach for central disc protrusions, a posterolateral microdiscectomy is used exclusively for posterolateral sequestrations, and either an anterior or posterior approach is used for paramedian disc protrusions. The present study deals with 36 patients with acute monoradiculopathy caused by posterolateral soft disc sequestration as classified by CT-myelography and treated by a posterolateral microdiscectomy. Clinical Material and Methods Patient Population Out of a large pool of patients with cervical

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Afrassiab Guity and Paul H. Young

muscle can be trapped between the suture strands and secured with tying. Figures 5 and 6 demonstrate actual patch-graft closure of the dura following transsphenoidal and transclival exposures, respectively. Figure 7 demonstrates direct closure of the dura during lumbar microdiscectomy. Fig. 5. Photographs showing closure of the dura following a transsphenoidal exposure in a cadaver: dural opening (A); patch-graft closure (B). Fig. 6. Photographs showing closure of the dura following a transclival exposure in a cadaver: dural opening (A); patch

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FDA Panel Discussion on Cadaver Dura August 1990 73 2 10.3171/jns.1990.73.2.0310 Microdiscectomy for Posterolateral Soft Cervical Discs August 1990 73 2 10.3171/jns.1990.73.2.0310a Forced Subarachnoid Air for Transsphenoidal Surgery August 1990 73 2 10.3171/jns.1990.73.2.0311 Ontogenesis of Colloid Cysts August 1990 73 2 10.3171/jns.1990.73.2.0312 Surgical treatment of unruptured aneurysms of the posterior circulation Beverly J. Rice Sydney J. Peerless Charles G. Drake August 1990 73 2 165 173 10.3171/jns.1990

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Neurosurgical Forum: Letters to the Editor To The Editor Stephen L. Fedder , M.D. Philadelphia, Pennsylvania 310 311 I read with interest the article by Dr. Aldrich (Aldrich F: Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg 72: 310–377, March, 1990). In the text of the paper, reference is made to a custom-made cervical microdiscectomy retractor. While the model depicted in the article certainly appears adequate for the