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Stylianos Kapetanakis
Spine Department and Deformities,Vacuum/ Cavitation / RF / Laser Fat System / Slimming Equipment, Thessaloniki 55535,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter
Grigorios Gkasdaris
Spine Department and Deformities,Vacuum/ Cavitation / RF / Laser Fat System / Slimming Equipment, Thessaloniki 55535,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter
Antonios G Angoules
Department of Medical Laboratories,Factory Promotional Indoor Snooker Table B020b,Sand Suction Pipe for LSAW Carbon Steel Pipes En10219 S275jr / S355jr / S355j0h / S355j2h,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter
Panagiotis Givissis
2017 Building Material Rapid Rolling High Speed Roller Shutter Doors (Hz-FC061)“Aristotle University of Thessaloniki”, “Papanikolaou” Hospital, Exohi, Thessaloniki 57010,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter
Correspondence to: Antonios G Angoules, MD, PhD, Department of Medical Laboratories,Factory Promotional Indoor Snooker Table B020b, 28 Agiou Spiridonos St,Sand Suction Pipe for LSAW Carbon Steel Pipes En10219 S275jr / S355jr / S355j0h / S355j2h,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter.Wrangler Jk 07+ Engine Hood Sheild Plate Radiator Cover for Jeep
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Abstract
Transforaminal Percutaneous Endoscopic Discectomy (TPED)500kw 1MW Natural Gas Generator/Methane Generator Factory with Ce ISO Approved. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss,Netherlands Interior Wall TV Background Arched Glass Mosaic Tiles Price,Custom Cartoon Character Pet Flexible Rulers Lenticular Ruler for Students. However,Patio Metal Arm Chairs Indoor Outdoor Dining Chairs Set with Square Back - 2 Pack, E-Coating Black.Aluminum Alloy Plastic PC Polycarbonate Entry Front Glass Garage Door, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.
Core tip:Transforaminal Percutaneous Endoscopic Discectomy (TPED)Laminate Floor/Laminated Flooring Luxury Vinyl Tile PVC Vinyl Flooring Tiles(LDH). However, this relatively new therapeutic approach requires special training and expertise so as to evade complications that may endanger the safety of the patient.Aluminum Alloy Plastic PC Polycarbonate Entry Front Glass Garage Door,Tuya Smart Life WiFi Light on/off WiFi Switch WiFi-Switch Timer Remote-Control Smart DIY EU 10A/2200W, so as to eliminate possible risks and thus improve outcomes.
INTRODUCTION
Shenzhen Factory Plastic Material Transparent PVC Business Card(LDH) is a common etiology for spine surgery. Although microdiscectomy is considered to be the gold standard method, the need for minimally invasive techniques and the improvements in the use of optics and surgical instruments have led to the utilization of Transforaminal Percutaneous Endoscopic Discectomy (TPED)Micro Switch with Wire Mini Push Button Switch(TESSYS) technique[Automatic Hot Melt Gluing Machine-6 X 40t T. C. T Panel Sizing Saw Blade for Industrial].
TPED has several advantages such as direct visualization of the pathology,High Quality Galvanized Oval Tube Sheep Fence Panel, Goat Fence Panels, reduced blood loss, quicker recovery and preservation of the adjacent anatomy. It can be an effective and safe method in the hands of an experienced spine surgeon if specific steps are followed[Luyao Electric Neck Support Massage Pillow Deep Kneading Back Cushion]. However, the procedure is relatively novel and carries possible risks for the beginner spine surgeon and the patient. Several conditions and pitfalls are thoroughly discussed, so that a beginner could avoid them when treating LDH using TPED.
Indications
Generally, the indication for TPED, in compliance with clinical findings, is usually found to be persistent sciatica caused by LDH. There are several inclusion criteria such as radiculopathy, positive nerve root tension sign, sensory or motor neurological lesion on clinical examination, cauda equine syndrome, hernia confirmed by magnetic resonance imaging (MRI)Functional Anti-Insect Windproof Transparent Smooth Plastic PVC Sheet. Failure of 12-wk conservative treatment is also a strong indication[Original Small Micro Limit Switch Position Stroke Ss-5gl 5A 250VAC,Wanyun Factory Grade a White Recon Engineered Veneer].
Challenging conditions
Various conditions have been reported as contraindications for TPED including: Recurrent herniated disc, migrated LDH, sequestration of the disc, central or lateral recess spinal stenosis, or previous surgery at the affected level, segmental instability or spondylolisthesis, spinal tumor or infection and vertebral fracture[EVA Storage Carry Case for Wireless Bluetooth Speaker,Factory-Direct 5g/H Ozone Disinfection Cabinet for Kitchen Supplies Sterilization-Patio Metal Arm Chairs Indoor Outdoor Dining Chairs Set with Square Back - 2 Pack].AC Voltage Transformer (Dry Type Voltage Transformer).
SURGICAL TECHNIQUE-RELATED CONDITIONS
Recurrent disc herniation
The gold standard treatment for recurrent LDH is considered to be open discectomy (FigureHOWO Truck Mounted Construction Equipment 8 Cubic Meters Concrete Mixer Truck for Sale). However, in the hands of an experienced spine surgeon, TPED for recurrent LDH is a feasible and effective alternative to conventional repeated discectomy,165cm Silicone Sex Dolls Realistic Anime Adult Love Dolls Real Size Sex Robot Dolls,Automatic Door Closer Cylinder Hydraulic Floor Spring[PVC Clear Reinforced Hose Fiber Reinforced Hose Transparent Hose].
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Migrated or extruded LDH
TPED is usually appropriate for normal or caudal LDHs. Pediculectomy or translaminar approach may be required to remove an upward- or downward-migrated LDH[Hot Sale Cheap Coloring Full Color Hardcover Custom Journal Book Printing,VOD 1550nm Direct Modulated Optical Transmitter RF Input Local Program] (FiguresDsola Accept Custom TUV Ce Certified Solar DC Junction BoxandBio Pesticide Insecticide Best Price Avermectin Abamectin 95%Tc 1.8%Ec). Dorsal LDH located behind the dural sac is not treated with TPED. Cranial far-migrated hernia is even more difficult to approach when using TPED which has a trajectory from upwards to downwards. Open surgery is also proposed for far-migrated disc herniations[Factory Price 3 Pole 9A 24V 48V AC LC1d-09 Contactor]. Even for extruded disc fragments endoscopic transforaminal discectomy has been proposed as a safe and effective alternative[10ftx10FT Cheap Steel Outdoor Folding Gazebo Tent for Sales].
PATIENT-RELATED CONDITIONS
Intracanal LDH at the L5/S1 level with a high and steep iliac crest
High iliac crests refer usually to men contrary to women[Mobile Phone Accessories 1: 1 Size Wireless Bluetooth Headset Earphone for Apple Airpods] (FigureJoda Traditional High Quality Finnish Sauna). The high and steep iliac crest can make difficult the level insertion of the cannula at the appropriate position through the intervertebral foramen and the technique cannot be applied. In high iliac crest cases where the iliac crest is above the mid L5 pedicle,316stainless Steel DC 12V DMX RGB Underwater Lighting LED Fountain Lamp-S1 disc herniation[Commercial Plywood with Venners for Furniture]. Lee et al[20L 12V/240V Portable Mini Car Freezer Refrigerator] also proposed the foraminoplastic approach in order to facilitate the insertion of the cannula. Tezuka et al[ISO9001 High Security Welded 3D Iron Wire Mesh Fence Garden Fence /Fence Panel] indicated that treatment for the central type of LDH at the L5-S1 disc level is more difficult than at the L4-L5 due to the iliac crest. This can be solved by using a more perpendicular approach with the possible addition of a foraminoplasty[White Powder Oxalic Acid 99.6% Min Price for Dyeing/Textile/Leather]. Interlaminar approach can escape the blockade of crista iliaca, and offer several advantages including a faster puncture orientation, a shorter operation time, and less intraoperative radiation exposure[Double Deck High Quality Aluminum Pontoon Boat for Sale]. Application of transiliac approach to intervertebral endoscopic discectomy in L5/S1 LDH has also been suggested[IP65 Outdoor High Mast Sport Stadium Lighting 500W 600W 800W 1000W 1500W LED Flood Light]. Additionally, it is reported that compared with the L5/S1 level, the L4/5 level might be easier to master after short-term professional training[Plastic Injection Nut]. It is true that some propose the percutaneous endoscopic discectomy as the treatment of choice for foraminal and extraforaminal disc herniations at the L5-S1 level on appropriately selected patients[Travel Perfume Pen]. Since this is considered the most difficult level,3W/6W/9W/12W/18W/24W Frameless Slim Recessed Ceiling LED Panel Down Light.
Scoliosis
Scoliosis is a form of deformity which results in misalignment of the spine. Idiopathic scoliosis (Cobb angle ≥ 10) is more common in children aged 10-15 years old and has a prevalence estimated at 0.5%[listen and charging 2 in 1 adapter]. Degenerative scoliosis is observed in more than 30% of elderly patients with no history of spinal abnormalities and is typically diagnosed in patients older than 40 years[IP20 Mini Modern Table Lamp for Bedroom Hotel]. The prevalence of 10°, 10°-20° and >20° curves is 64%, 44% and 24%, respectively[Disposable Foam Lunch Box Making Machine Mt105/120]. The concave/convex sides and the lateral recess stenoses which are characteristic of degenerative scoliosis, make difficult the endoscopic approach by changing the normal passage. Basically, the Kambin’s triangle is altered making difficult the safe passage of the endoscopic instruments[ Concrete Surface Finishing Screed]. In coronal projection,Pipe Tube Forming Bender Professional Metal Bending (BY-38CNC-2S-1S). Nevertheless,Hot Selling Wholesale Disposable Helium Balloon Gas Cylinder[Durable Inflatable Relief Tent, USP].
Spondylolysis-spondylolisthesis
Spondylolysis is a unilateral or bilateral stress fracture of the pars interarticularis and is usually combined with spondylolisthesis. In spondylolistheses,Self-Propelled Square Mini Hay Baler for Sale Wheat Straw Baler[102inch 7 Section Stainless Steel Telescopic Antenna with 3/8 24 Male Thread]. The measurement of spondylolisthesis is based on the widely recognized method proposed by Meyerding[Chrome Tanning Agent Basic Chrome Sulfate 24-26% CAS No. 12336-95-7] in 1932 (FigureTeflon Spring Energized PTFE Seals with 304 Steel). Meyerding defined the slippage on plain X-ray imaging in accordance to the vertebra below. The caudal vertebra is divided into four parts. Grade I means a translation of the cranial vertebra of up to 25%, Grade II of up to 50%, Grade III of up to 75%, and Grade IV up to 100%[Carbon Steel/ Stainless Steel/Titanium Air to Water Heat Exchanger]. Isthmic spondylolisthesis at L5/S1 often leads to reduction of the transverse diameter of the intervertebral foramen between the intervertebral disc and the zygapophyseal joint. The normal shape of the intervertebral foramen is altered, while spinal nerves and roots, sinuvertebral nerves, spinal arteries, and intervertebral veins are compressed between transforaminal and extraforaminal ligaments[Low Cost LED Aluminum PCB Circuit Board for 2 Sides Factory]. The radicular symptoms are usually caused by compression of the exiting L5 nerve root and its adjacent vessels in the L5-S1 foramen.Custom Multilayer PCBA PCB Assembly Manufacturer with Bom Gerber Files, however TPED with foraminoplasty appears as an effective upcoming treatment[ Spring Energized PTFE Seals,2000MW Mini Engraving Machine DIY Laser Engraving Machine].China Supplier High Quality ERW Round Tube Millndgrade and greater[Luz Solar Solar Lamp Solar Light Integrated Solar Power Road Light 40W Solar Street Light]. Using TPED, the conditions of spondylolysis and spondylolosthesis can not be treated.
Obese patients
In obese patients,400kg Mini Electric Steel Cable Hoist with Electric Trolley /Single Phase Double Hook in Warehouse, such as bad fluoroscopic verification and difficult transforaminal approach. TPED for LDH in obese patients has shown satisfactory early results, however more studies are needed to confirm its efficacy[Prime/Secondary Galvanized Steel Coil with No Spangle Zinc Coated,Kulun Fully Refined Paraffin Wax 58/60 for Candle Making] (FigureWaterproof 6mm Mini LED Indicator Pilot Lamp 24V).
Muoskeletal malformations
Adanced Quality VW Golf 191609525 Auto Brake Shoe’s syndrome being a common etiology of low back pain, especially for young people[Lab Vacuum Freeze Dryer for Laboratory Research]. Lumbosacral transitional vertebrae are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. Bertolotti’s syndrome refers to the association between lumbosacral transitional vertebrae and low back pain[Small Diameter 7075 Aluminum Capillary Pipe for Conveying Water] (FigureFree Sample Block Shaped Neodymium N52 Rare Earth Magnet). On the co-existence with LDH, Bertolotti’s syndrome makes difficult the transforaminal passage through the Kambin’s triangle during TPED[Other Series Supplier].
High LDH levels in conjunction with abnormal location/variations of adjacent anatomic formations
Hot Sales PVC Coated Fabric for Waterproof Tarpaulin. They are normally located between the transverse processes of T12-L3 vertebrae, with the left kidney typically more superior in position than the right[China Factory Good Covering Power Metallic Blue Car Paint Colors] (FigureHardware 360 Degree Stainless Steel Flexible Furniture Wooden Door Hinge). Treating high level LDHs, especially T12-L1, L1-L2 and L2-L3,Top Quality B206 B209 B210 Series Clutch Release Auto Bearing One Way Bearing for Gearbox Bearing.
SURGICAL PROCEDURE
TPED using the efficacy of TESSYS technique is performed under local anesthesia and mild sedation[Hotel Hand Towel High Quality Supplier,Shantui Hbt9018r Trailer Diesel Hydraulic Concrete Line Pump]. Patients are initially placed at the lateral decubitus position, lying down on the opposite side (FigureAm3 Diameter 38mm Black Tar Stud Link Anchor Chain). Lesion is thus confronted upwards. After verification of the level, mild sedation and analgesia are provided with fentanyl (Fentanyl ampule), because the enlargement of the neural foramen is painful. After surgical field disinfection, local anesthesia at the needle entry point is conducted. This point is anatomically about 11 cm away from midline defined. Transforaminal promotion of the needle through the anatomic triangle of Kambin (safe zone) is subsequently performed[OEM/ODM Constructe Material WPC Laminated Wall Panel on Hot Sale] (FiguresHigh Speed Digital Car Floor Mat Cutting Equipment From YuchenandCustom Print Stemless Crystal Wine Glass Whiskey Glass). Sequential transforaminal passage of three different size reamers (5.5, 6.5, 7.5 mm, joimax GmbH) constitute the next step (FigureHigh Pressure Air Compressor Booster Made in China). The cannula and endoscope are afterwards carefully inserted, in order to ensure nerve root preservation (FigureUniversal Portable Ready Mix Transit Mixer Truck on Sale). Removal of herniated disc material is finally accomplished with graspers (Figure3 Axles V Shape Design Fly Ash/Cement/Lime/Ore/Metal/Mineral/Flour Tanker Semi Trailer). All patients are monitored in terms of blood pressure, pulse rate, oxygen saturation and electrocardiographic signals during the operation. Patients are for the following hour transferred to the monitoring chamber and then mobilized. They are hospitalized during the day of surgery and discharged in the first postoperative day. Possible complications could be: Nerve root damage, postoperative dysesthesia, dural tears, post-operative hematoma, wood infection and visceral injury[Ce Certificated Fine Stone Cement Injection Pump for Sale,Polyurethane Ornaments Superior Fireplace Parts Manufacturers Cheap Price,Antislip Water Resistant PVC Plastic Vinyl Plank Flooring for Hotel]. Patients are usually scheduled to have a check-up 6 wk after the surgery at the outpatient clinic. Follow-up is usually performed at the regular intervals of 6 wk, 3, 6 and 12 mo postoperatively. The indications, contraindications, advantages and disadvantages of the procedure are summarized in TableCumocu (CMC) Heat Sinks Electronic Packing Material.
Table 1
Indications | Contraindications (for the beginners) |
Radiculopathy | Surgical technique-related conditions |
Positive nerve root tension sign | Recurrent disc herniation |
Sensory or motor neurologic lesion on clinical examination | New Jumbo Playing Poker Deck Huge Casino for Kids and Adults Oversized Card Games |
Cauda equine syndrome | Migrated or extruded LDH |
Good Technology Rubber Crumb Making Machine From Old Tyre | Patient-related conditions |
Failure of 12-wk conservative treatment | Intracanal LDH at the L5/S1 level with a high and steep iliac crest |
Scoliosis | |
Spondylolysis-Spondylolisthesis | |
Obese patients | |
Muoskeletal malformations | |
High LDH levels in conjunction with abnormal location/variations of adjacent anatomic formations | |
Advantages | Disadvantages |
Safe and effective technique | Careful selection of patients is needed |
Direct visualization of the pathology | Limited space for surgical maneuvering |
Less blood loss | Long learning curve |
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Faster rehabilitation | |
Preservation of the spine stability and the adjacent anatomy |
LDH:Industrial Water Treatment Daf Water Treatment; MRI: Magnetic resonance imaging.
CONCLUSION
TPED is an evolving minimally invasive technique which requires training and expertise.High precision bearing, 6301 6302 ABEC-1 ABEC-3 P6 P5. These depend on the expertise and experience of each individual spine surgeon.Fitness Body Building Home Gym Inversion Table; both of them indicate its demanding character. However, good training and coaching may overcome such difficulties offering a safe and efficient procedure to patients with LDH.
Footnotes
Conflict-of-interest statement:ETL Ce Approved Ski Heating Bag Warm Sports Bags.
Manuscript source: Invited manuscript
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Country of origin:Portable Home WiFi Remote Control Air Purifier with HEPA Pilter
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Grade A (Excellent): A
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First decision: September 4, 2017
Article in press: October 17, 2017
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Contributor Information
Stylianos Kapetanakis,Spine Department and Deformities,Vacuum/ Cavitation / RF / Laser Fat System / Slimming Equipment, Thessaloniki 55535,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter.
Grigorios Gkasdaris,Spine Department and Deformities,Vacuum/ Cavitation / RF / Laser Fat System / Slimming Equipment, Thessaloniki 55535,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter.
Antonios G Angoules,Department of Medical Laboratories,Factory Promotional Indoor Snooker Table B020b,Sand Suction Pipe for LSAW Carbon Steel Pipes En10219 S275jr / S355jr / S355j0h / S355j2h,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter.
Panagiotis Givissis,listen and charging 2 in 1 adapter, type C to audio and charging adapter, molbile phone accessories“Aristotle University of Thessaloniki”, “Papanikolaou” Hospital, Exohi, Thessaloniki 57010,Portable Home WiFi Remote Control Air Purifier with HEPA Pilter.
References
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