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In lumbar spine surgery, complications due to damage of the vascular and nervous system may occur. The Authors describe all the possible events in posterior and anterior accesses and examine the precautions to avoid them and, if they arise, how to treat them. [ABSTRACT FROM AUTHOR]

In the history of surgery lumbar herniectomy has a relatively recent appearance; moreover at the beginning of the 20th century neurosurgeons and orthopedic surgeons performed posterior laminectomy in the presence of severe neurological damage, finding tissues that have been mostly labeled as tumors. Only at the middle of the century the prolapse of the nucleus pulposus was recognized as the most frequent cause of roots compression. Techniques for removing the compression after a large laminectomy have been progressively improved so as radiological methods of locating precisely the exact position of the hernia (MIR). In accordance with these developments also the surgical procedure of removing the cause of the root compression did improve as the microdiscectomy. As all surgical procedures herniectomy may have complications and it is very important to prevent them adopting radiological control on the operating table to prevent space mistake, and checking the absence of abdominal compression to avoid excessive intraoperative bleeding. In spite of approximately more than 90% of satisfactory results, the possibility of a high percentage of spontaneous relief of symptoms in the first six months means that the surgical treatment must be adopted in very selected cases during this period. [ABSTRACT FROM AUTHOR]

Background: Bone marrow stimulation techniques in cartilage repair such as drilling are limited by the formation of fibrous to hyaline-like repair tissue. It has been suggested such techniques can be enhanced by covering the defect with scaffolds. We present an innovative approach using a polyglycolic acid (PGA)-hyaluronan scaffold with platelet-rich-plasma (PRP) in drilling.Questions/purposes: We asked whether (1) PRP immersed in a cell-free PGA-hyaluronan scaffold improves patient-reported 1-year outcomes for the Knee injury and Osteoarthritis Score (KOOS), and (2) implantation of the scaffold in combination with bone marrow stimulation leads to the formation of hyaline-like cartilage repair tissue.Patients and Methods: We reviewed 52 patients who had arthroscopic implantation of the PGA-hyaluronan scaffold immersed with PRP in articular cartilage defects of the knee pretreated with Pridie drilling. Patients were assessed by KOOS. At 9 months followup, histologic staining was performed in specimens obtained from five patients to assess the repair tissue quality.Results: The KOOS subscores improved for pain (55 to 91), symptoms (57 to 88), activities of daily living (69 to 86), sports and recreation (36 to 70), and quality of life (38 to 73). The histologic evaluation showed a homogeneous hyaline-like cartilage repair tissue.Conclusions: The cell-free PGA-hyaluronan scaffold combined with PRP leads to cartilage repair and improved patient-reported outcomes (KOOS) during 12 months of followup. Histologic sections showed morphologic features of hyaline-like repair tissue. Long-term followup is needed to determine if the cartilage repair tissue is durable.Level Of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Musculoskeletal tumours are rare, with a wide variety of presentations. Three 'up to date' topics are focused, two in imaging, one in management. Contrast Enhanced UltraSound is promising also as a guidance for tru-cut biopsy and magnetic resonance with functional imaging studies (DCE, DWI, MRI-spectroscopy) could help in diagnosis and treatment. Piedmont and Valle d'Aosta Oncological Network could be an organizational model for musculoskeletal tumours in an interdisciplinary organization. [ABSTRACT FROM AUTHOR]

Operative intervention is indicated for lesions involving the periacetabular area and is reserved to patients who fail to respond adequately to non operative treatment. Though merely palliative in most of the cases, in few selected patients, Capanna class I, surgery may achieve a curative role just as in primary tumours of the bone. Staging procedures and different surgical techniques are described [ABSTRACT FROM AUTHOR]

Previous studies have shown that low-power laser biostimulation (lasertherapy) promotes posttraumatic nerve regeneration. The objective of the present study was to investigate the effects of postoperative lasertherapy on nerve regeneration after end-to-side neurorrhaphy, an innovative technique for peripheral nerve repair. After complete transection, the left median nerve was repaired by end-to-side neurorrhaphy on the ulnar "donor" nerve. The animals were then divided into four groups: one placebo group, and three laser-treated groups that received lasertherapy three times a week for 3 weeks starting from postoperative day 1. Three different types of laser emission were used: continuous (808 nm), pulsed (905 nm), and a combination of the two. Functional testing was carried out every 2 weeks after surgery by means of the grasping test. At the time of withdrawal 16 weeks postoperatively, muscle mass recovery was assessed by weighing the muscles innervated by the median nerve. Finally, the repaired nerves were withdrawn, embedded in resin and analyzed by light and electron microscopy. Results showed that laser biostimulation induces: (1) a statistically significant faster recovery of the lesioned function; (2) a statistically significant faster recovery of muscle mass; (3) a statistically significant faster myelination of the regenerated nerve fibers. From comparison of the three different types of laser emissions, it turned out that the best functional outcome was obtained by means of pulsed-continuous-combined laser biostimulation. Taken together, the results of the present study confirm previous experimental data on the effectiveness of lasertherapy for the promotion of peripheral nerve regeneration and suggest that early postoperative lasertherapy should be considered as a very promising physiotherapeutic tool for rehabilitation after end-to-side neurorrhaphy. [ABSTRACT FROM AUTHOR]

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