This video aims to describe an endoscopic surgical approach for accessing difficult to reach pathology such as disc herniations after previous surgery. The relatively small size of endoscopic instruments facilitates significant freedom of movement inside the spinal canal. The authors have experience with interlaminar approaches for contralateral pathology such as disc herniations, recurrent disc herniations, spinal stenosis, and facet cysts. The advantages of starting from the opposite side of the canal in a revision situation include the ability to establish a clear plane between the dura and the borders of the canal and visualize the disc from a different angle than the index operation. Contralateral approaches to residual or recurrent herniations can be performed with an “over the top” technique, navigating dorsal to the thecal sac to reach the far side of the canal. In the associated video we demonstrate a novel technique, a contralateral transaxillary endoscopic approach to a recurrent disc herniation at the L5–S1 level in a young male collegiate wrestler. In our experience, we have found this particular approach to be useful in patients with an early take off of the S1 nerve root which creates a large axillary window. In several instances this technique has allowed us to inspect the area of the reherniation from both the axilla and over the top of the thecal sac. This particular patient has a large recurrence 2 years after an open microscopic hemilaminotomy and discectomy. In this instance, an approach was chosen that navigates dorsal to the S1 nerve root and ventral to the thecal sac, starting on the opposite side of the spinal canal from the herniation. This approach is described as a contralateral interlaminar transaxillary discectomy.

This video aims to describe an endoscopic surgical approach for accessing difficult to reach pathology such as disc herniations after previous surgery. The relatively small size of endoscopic instruments facilitates significant freedom of movement inside the spinal canal. The authors have experience with interlaminar approaches for contralateral pathology such as disc herniations, recurrent disc herniations, spinal stenosis, and facet cysts. The advantages of starting from the opposite side of the canal in a revision situation include the ability to establish a clear plane between the dura and the borders of the canal and visualize the disc from a different angle than the index operation. Contralateral approaches to residual or recurrent herniations can be performed with an “over the top” technique, navigating dorsal to the thecal sac to reach the far side of the canal. In the associated video we demonstrate a novel technique, a contralateral transaxillary endoscopic approach to a recurrent disc herniation at the L5–S1 level in a young male collegiate wrestler. In our experience, we have found this particular approach to be useful in patients with an early take off of the S1 nerve root which creates a large axillary window. In several instances this technique has allowed us to inspect the area of the reherniation from both the axilla and over the top of the thecal sac. This particular patient has a large recurrence 2 years after an open microscopic hemilaminotomy and discectomy. In this instance, an approach was chosen that navigates dorsal to the S1 nerve root and ventral to the thecal sac, starting on the opposite side of the spinal canal from the herniation. This approach is described as a contralateral interlaminar transaxillary discectomy.

This video aims to describe an endoscopic surgical approach for accessing difficult to reach pathology such as disc herniations after previous surgery. The relatively small size of endoscopic instruments facilitates significant freedom of movement inside the spinal canal. The authors have experience with interlaminar approaches for contralateral pathology such as disc herniations, recurrent disc herniations, spinal stenosis, and facet cysts. The advantages of starting from the opposite side of the canal in a revision situation include the ability to establish a clear plane between the dura and the borders of the canal and visualize the disc from a different angle than the index operation. Contralateral approaches to residual or recurrent herniations can be performed with an “over the top” technique, navigating dorsal to the thecal sac to reach the far side of the canal. In the associated video we demonstrate a novel technique, a contralateral transaxillary endoscopic approach to a recurrent disc herniation at the L5–S1 level in a young male collegiate wrestler. In our experience, we have found this particular approach to be useful in patients with an early take off of the S1 nerve root which creates a large axillary window. In several instances this technique has allowed us to inspect the area of the reherniation from both the axilla and over the top of the thecal sac. This particular patient has a large recurrence 2 years after an open microscopic hemilaminotomy and discectomy. In this instance, an approach was chosen that navigates dorsal to the S1 nerve root and ventral to the thecal sac, starting on the opposite side of the spinal canal from the herniation. This approach is described as a contralateral interlaminar transaxillary discectomy.

This video aims to describe an endoscopic surgical approach for accessing difficult to reach pathology such as disc herniations after previous surgery. The relatively small size of endoscopic instruments facilitates significant freedom of movement inside the spinal canal. The authors have experience with interlaminar approaches for contralateral pathology such as disc herniations, recurrent disc herniations, spinal stenosis, and facet cysts. The advantages of starting from the opposite side of the canal in a revision situation include the ability to establish a clear plane between the dura and the borders of the canal and visualize the disc from a different angle than the index operation. Contralateral approaches to residual or recurrent herniations can be performed with an “over the top” technique, navigating dorsal to the thecal sac to reach the far side of the canal. In the associated video we demonstrate a novel technique, a contralateral transaxillary endoscopic approach to a recurrent disc herniation at the L5–S1 level in a young male collegiate wrestler. In our experience, we have found this particular approach to be useful in patients with an early take off of the S1 nerve root which creates a large axillary window. In several instances this technique has allowed us to inspect the area of the reherniation from both the axilla and over the top of the thecal sac. This particular patient has a large recurrence 2 years after an open microscopic hemilaminotomy and discectomy. In this instance, an approach was chosen that navigates dorsal to the S1 nerve root and ventral to the thecal sac, starting on the opposite side of the spinal canal from the herniation. This approach is described as a contralateral interlaminar transaxillary discectomy.

This video aims to describe an endoscopic surgical approach for accessing difficult to reach pathology such as disc herniations after previous surgery. The relatively small size of endoscopic instruments facilitates significant freedom of movement inside the spinal canal. The authors have experience with interlaminar approaches for contralateral pathology such as disc herniations, recurrent disc herniations, spinal stenosis, and facet cysts. The advantages of starting from the opposite side of the canal in a revision situation include the ability to establish a clear plane between the dura and the borders of the canal and visualize the disc from a different angle than the index operation. Contralateral approaches to residual or recurrent herniations can be performed with an “over the top” technique, navigating dorsal to the thecal sac to reach the far side of the canal. In the associated video we demonstrate a novel technique, a contralateral transaxillary endoscopic approach to a recurrent disc herniation at the L5–S1 level in a young male collegiate wrestler. In our experience, we have found this particular approach to be useful in patients with an early take off of the S1 nerve root which creates a large axillary window. In several instances this technique has allowed us to inspect the area of the reherniation from both the axilla and over the top of the thecal sac. This particular patient has a large recurrence 2 years after an open microscopic hemilaminotomy and discectomy. In this instance, an approach was chosen that navigates dorsal to the S1 nerve root and ventral to the thecal sac, starting on the opposite side of the spinal canal from the herniation. This approach is described as a contralateral interlaminar transaxillary discectomy.

BACKGROUNDLower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical dislocation. It is important to investigate a suitable management specific to patients with different types of cervical locked facets.

METHODSA total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation.

RESULTSIn this series, there was statistically significant difference (P < 0.05) in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However, unilateral cervical locked facets dislocation can be reduced by posterior open reduction.

CONCLUSIONSUnilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.

Adult ; Aged ; Cervical Vertebrae ; injuries ; Diskectomy ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Spinal Fusion ; Traction

Objective: This study estimated nationally representative medical expenditures of gynecologic cancers, described treatment patterns and assessed key risk factors associated with the economic burden in the United States. Methods: A retrospective repeated measures design was used to estimate the effect of gynecologic cancers on medical expenditures and utilization among women. Data were extracted from the Medical Expenditure Panel Survey (weighted sample of 609,787 US adults) from 2007 to 2014. Using the behavioral model of health services utilization, characteristics of cancer patients were examined and compared among uterine, cervical, and ovarian cancer patients. Multivariable linear regression models were conducted on medical expenditure with a prior logarithmic transformation. Results: The estimated annual medical expenditure attributed to gynecologic cancers was $3.8 billion, with an average cost of $6,293 per patient. The highest annual cost per person was ovarian cancer ($13,566), followed by uterine cancer ($6,852), and cervical cancer ($2,312). The major components of medical costs were hospital inpatient stays (53%, $2.03 billion), followed by office-based visits (15%, $559 million), and outpatient visits (13%, $487 million). Two key prescription expenditures were antineoplastic hormones (10.3%) and analgesics (9.2%). High expenditures were significantly associated with being a married woman (p<0.001), having private health insurance (p<0.001), being from a low- and middleincome family (p<0.001), or living in the Midwest or the South (p<0.001). Conclusion The key risk factors and components were well described for the economic burden of gynecologic cancers. With a growing population of cancer patients, efforts to reduce the burden of gynecologic cancers are warranted.