European Stars And Stripes (Newspaper) - February 7, 1989, Darmstadt, Hesse                                By Mike King Cox news service the unrelenting pain that reached from his lower Back Down his leg left Little doubt i Robert h. Morrisson s mind what was inshore. I was hurting All the Way Down to my ankle said Morrisson who was injured in a head on collision two years ago. I knew the Only thing left was a big operation and i was t looking Forward to being Laid up for  like Many others who suffer Back pain severe enough to warrant surgery Morrisson dreaded the ordeal. The operation requires four to seven Days in a Hospital six weeks of Home recovery and restricted activity for up to six months. Slipped or herniated disks Are one of the most common problems affecting the 8 million americans a year who suffer Low Back pain and surgical disk repair is one of the most common major operations in the United states. More than 200,000 of them Are done each year. Morrisson however is one of a growing number of patients to try an alternative known As percutaneous Diske Tomy. Done on an outpatient basis the operation takes Only 20 to 30 minutes and costs roughly half As much As traditional surgery. I Haven t Felt a pain in the Back or leg since said Morrisson principal at the Walden Middle school in Atlanta ga., who underwent the procedure last april. I was up and around the next  Many patients leave with a band Aid sized scar and return to work within a week. Some experts believe the new procedure May someday be As important to Lumbar disk surgery As arthroscopic surgery which is now widely used to repair injured Knees. Before the development of arthroscopic surgery most knee operations required a Large incision and removal of Calcium deposits or repair of injured ligaments by hand. Patients had to stay off their feet for weeks. But arthroscopic surgery enables doctors to use a tiny camera on the end of a scope to operate on the knee with instruments that can be manipulated through the scope. Because the operation requires Only a Small incision patients can return to Normal activities within a week. In percutaneous Diske Tomies similarly simplified surgery is possible on some patients with ruptured disks. Using a fluoroscopy image a kind of video a Ray to guide a Long Needle like device to the site of the herniated disk doctors use a Small probe to remove fluid from the disk. The operation performed with local anaesthesia requires Only a 3-millimeter incision in the patient s Side. After several years of experiments with the probe called a nuclei Tome the . Food and drug administration in 1987 approved the device for widespread use. Morrisson s surgeon or. David p. Rouben of Atlanta has performed the surgery on 22 patients. He says 18 have recovered without a recurrence of serious pain a rate in line with a recent National Survey of 2,000 cases that showed the procedure to be effective % 75 percent to 80 percent of the time. We have found the new procedure to be profoundly Safe and highly effective in most patients said Rouben. When it does t work it does not harm the patient or expose them to the risks of traditional surgery. A panel of experts in medical technology of the american medical association recently concluded that the procedure is a promising treatment for herniated disk repair but said it is too Early to Tell whether it will achieve a permanent place in orthopaedic surgery. Longer term follow up of patients is needed to make that determination the panel said. At one time or another Low Back pain occurs in 80 percent of All people in the United states Between the Ages of 25 and 69. The american Academy of orthopaedic surgeons estimates the annual medical Cost for Back pain and injury excluding disability and indirect costs at $8 billion. Herniated disc the herniated disc Chicago Tribune cushioning each of Back s vertebrae Are discs composed of a fibrous cartilage network and a gelatinous Core called the nucleus Pul Posus. Discs Are More than 80% water which makes them highly elastic and enables them to absorb jolts to the Back. With age the discs dry out. The fibres holding the Core become torn allowing the Core to leak out and to form a bulge. If this bulge presses on any of the roots of the nerves radiating from the spinal Cord pain weakness and numbness will occur. Page 16 the stars and stripes slipped disks Are caused by the rupture of cushioning material Between vertebrae in the lower Back. As the thick Sticky nucleus of the disk swells it increases pressure on the spinal nerve and causes acute Low Back and leg pain a condition called sciatica. A slipped disk can usually be detected through sophisticated imaging devices such As computerized tomography or magnetic resonance. American doctors have debated for years How to treat the problem. Some recommend Complete bed rest so the swelling will decrease and the disk can return to Normal. Others believe that bed rest does not help that much but patients should simply avoid strenuous activity. If that fails doctors often resort to steroid injections protecting skin in Winter new York times moisturizers soothe dry skin and protect it from Low temperatures and High winds. With Winter Here in Earnest the question is which products work Best the selection ranges from Light gels to thick ointments with separate items for face eyes lips body neck hands and feet. Or. Diana Dihova a dermatologist at new York University medical Center in new York City says thick oily products prevent moisture loss Best. Those with exotic ingredients she says Are no better than Standard Oil in water mixtures. A Good All purpose Moisturizer can be used All Over the body and one of the most effective is also one of the simplest and cheapest Petroleum Jelly. The trick to using such a heavy emollient is to use Only a Small amount while the skin is warm and Damp after washing and to rub it in Well. Or. Sidney Hurwitz a paediatric dermatologist at Yale University advises acne prone patients to avoid products with isopropyl Myr state Myris Tyl Myr state sodium Laurel sulfite Iso Staryl reopen Tanate red dyes used in cosmetics butyl Ste Arate stearic acid isopropyl Palmitate acetyl Palmitate decal Oleate lanolin Laureth-4 and head Ethyl alcohol. Experts say children do not need special products. The average Moisturizer has a shelf life of two to three years. Keep cosmetics in Cool dry places. Tuesday february 7,1989 around the site of the disk to reduce the swelling. A decade ago Many researchers believed surgery could be avoided altogether by the use of an enzyme chem Papain to break Down proteins inside the nucleus of the herniated disk. The procedure has lost favor because the injections were sometimes complicated by infections life threatening respiratory reactions and paralysis. Many patients also suffered a recurrence of the same herniated disk within two to three years. Conventional surgery is still the treatment of Choice for most cases of herniated disks even though it involves some risk. According to medical literature 90 percent to 95 percent of the operations Are successful. But in 2 percent to 3 percent of the cases infections deep in the Back can totally disable the patient. And in a few cases less than 1 percent the surgery itself causes permanent neural damage leaving the patient partially paralysed. And about 5 percent of those who have disks removed suffer lasting pain from the scar tissue that forms around the site of the surgery. Conventional surgery usually involves a general anaesthesia for the patient and up to a week in the Hospital with doctor and Hospital fees often exceeding $6,500. The percutaneous Diske Tomy however usually costs Between $3,500 and $4,500. But the new approach in t for everyone. Because elderly patients Are More prone to deterioration of the spine the operation is usually limited to people under 55 years of age. Patients who have undergone previous Back surgery for herniated disks Are also excluded since scar tissue around the site of the original surgery makes it difficult to place the probe properly. Patients with severely herniated disks in which part of the disk Breaks away also require conventional surgery. To avoid the person s abdominal organs the procedure is rarely performed on patients with problems involving the upper two Lumbar disks of the spinal column. But most problems with herniated disks involve the three lower Lumbar disks which Are easily reached. Because the fluoroscopy provides an imprecise picture of the probe s location the patient who is Given Only a local aesthetic must help the doctor position it properly. If he feels pain the probe May be pinching the spinal nerve and must be readjusted. When the probe is properly placed inside the disk the patient feels no pain. I was nervous. I frankly expected some bad pain during the operation. But it was nothing. It was virtually painless said Teresa Adinaro director of the outpatient radiology Center at Georgia Baptist medical Center who underwent the surgery last March. One major problem with the procedure is that doctors have no Way of knowing whether they have removed enough of the ruptured disk to make a difference. Using Only a fluoroscopy and crude measurements of the material expelled by suction the surgeon must guess whether enough disk matter has been removed to relieve the pain. In conventional surgery the doctor can see the exposed disk. And because the technique was Only performed at about a dozen centers in the United states until a year ago Little is known about whether patients Are susceptible to a recurrence of the hernia. The medical association panel worried that even though the procedure is relatively new patients May already be expecting too much from it. Some patients who have gone through the procedure agree. Robert Marcus 30, a Bank vice president who underwent the surgery last May has recovered More slowly than most of Reuben s patients. As a Marathon runner and avid golfer before he was diagnosed with a herniated disk in 1987, Marcus had hoped to be Able to resume Normal activities a few weeks after his surgery. I m seeing gradual improvement. I m walking and jogging now but there is still a Little bit of Back pain Marcus said. I have been Able to get Back to what most people would consider a Normal  because it is so new Rouben and other specialists who use the procedure still Aren t sure How widespread percutaneous Diske Tomies will be in the future. I m not sure Well Ever rely on it the Way we use arthroscopic surgery but it will be a very useful alternative for Many patients he said