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Fritz L. Jenkner, Eldon L. Foltz and Arthur A. Ward Jr.

monkey have been demonstrated on several occasions by X-ray. However, the conventional posterolateral approach to the human disc places the annulus defect within the spinal canal beneath the nerve root, where extrusion of BCP would be undesirable. For that reason the use of BCP in the human is not contemplated unless the anterolateral, retroperitoneal approach suggested by Lindblom 6 is utilized. SUMMARY 1. Simple disc removal in the monkey resulted in histological evidence of fibrous intervertebral union but caused no limitation of motion as

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Dwight Parkinson and Christopher Shields

approach, 8, 13 placing a 6 in. No. 18 lumbar puncture needle with the assistance of an image intensifier. A common mistake is to start the needle insertion too far medially. It should be started at least 4 in. lateral to the spinous process in its posterolateral approach to the disc center in order to readily clear the lamina and nerve roots. In aiming at a 5th space, the needle must also clear the posterior portion of the iliac crests and hence should be started through the skin at about the same level as for a 4th disc. Before injecting we verify the needle

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Russel H. Patterson Jr. and Ehud Arbit

usually necessary to ligate an intercostal artery. The posterolateral approach described by Jefferson 13 combines a laminectomy with the partial removal of the transverse process, the pedicle, and the vertebral body through a T-shaped incision. 13 We believe that the operation need not be as extensive as this, and that removal of the pedicle and part of the articular process through a midline linear incision provides sufficient room to remove the protruding disc safely. If laminectomy seems appropriate, it is easy enough to complete after removing the disc. As for the

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David G. Kline, Joseph Kott, George Barnes and Lester Bryant

H istorically , the posterior approach to the brachial plexus is based on the evolution of the posterolateral approach for removal of the first thoracic rib for thoracic outlet syndrome. The technique of posterolateral first-rib resection had its origin during the pre-antibiotic era of treatment of tuberculosis and empyema. Simon in 1869 and Estlander in 1879 employed a trapezius-splitting incision for thoracoplasty in the treatment of chronic empyema. 8 De Cerenville in 1885 and Quincke and Sprengler in 1888 formalized and named the procedure. 8 In the

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Shalom D. Michowiz, Harry Z. Rappaport, Itzchak Shaked, Allon Yellin and Abraham Sahar

defect compatible with disc herniation at the T11–12 interspace. Cerebral arteriography was normal, with no evidence of a venous drainage abnormality. Fig. 2. Anteroposterior myelogram showing a filling defect opposite the T11–12 intervertebral space (arrow) . Operation Using a posterolateral approach, we performed a costotransversectomy with removal of the T11–12 disc. Following surgery there was significant improvement of muscle strength in the lower extremities. The spasticity resolved and the gait improved within a number of days. Significant

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Mark N. Hadley, Robert F. Spetzler, Roberto Masferrer, Neil A. Martin and L. Philip Carter

stump. Discussion George and Laurian 8 described a posterolateral approach to the distal vertebral artery which they had effectively employed in eight cases of extracranial vertebral artery pathology. Others have advocated an anterior or anterolateral approach to extracranial distal vertebral artery disease, allowing dissection of the external carotid artery or one of its proximal branches for use in anastomosis to the diseased vertebral artery. 3, 13 None of these approaches would have been practical in our case. We employed a posterior midline

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Lawrence S. Chin, Keith L. Black and Julian T. Hoff

were worse. Arseni and Nash 4 also found that 60% of their patients had fair or unchanged results following laminectomy. Hulme 8 used an extended costotransversectomy to approach the herniated disc and reported encouraging results in four of six patients. A transthoracic lateral approach has also been described. 18, 19 In 1978, Patterson and Arbit 17 described an extrapleural posterolateral approach that included laminectomy and removal of a pedicle, a modification of an approach originally proposed by Carson, et al. 6 The recent literature documents the

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have chemonucleolysis, and if that failed, he would go to Dr. Fager for surgery. If we had the same problem, we would first have a percutaneous discectomy, and if that failed, we would be on the next flight to Boston! References 1. Fager CA : Pituitary ablation — current surgical techniques. Lahey Clin Found Bull 18 : 155 – 163 , 1969 Fager CA: Pituitary ablation — current surgical techniques. Lahey Clin Found Bull 18: 155–163, 1969 2. Fager CA : Posterolateral approach to ruptured median and paramedian

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Brian Shaw, Frederick L. Mansfield and Lawrence Borges

, and further posterior stabilization. The one-stage posterolateral approach is less invasive, requires no special surgical techniques, and may be associated with less morbidity and shorter hospitalization. Blood loss seems to be less for the posterolateral approach: blood replacement in Harrington's series 10 averaged 1200 cc versus 640 cc in our series. Although our study is small, it supports the concept that significant anterior decompression can be achieved via a posterolateral approach. The only other similar studies published thus far are those of Lesoin

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Francois Aldrich

types of cervical discs has tended to obscure the progressive development of the posterolateral approach to these lesions. In most instances either the anterior or posterior approach can be used with satisfactory results; the choice is determined by the preference of the surgeon. In some situations, however, the lesion might dictate a specific approach. Soft cervical disc sequestrations, causing severe monoradiculopathy, may be classified according to the computerized tomography (CT)-myelography findings into three major groups: namely, central, paracentral, and