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Object. Cervical radiculopathy caused by either soft herniated disc material or foraminal stenosis is a common problem. Anterior and posterior surgical approaches are commonly used to decompress the nerve root. The authors undertook a study to establish the feasibility of performing a microendoscopic posterior approach for cervical foraminotomy in the clinical setting. Methods. The authors performed an endoscopic posterior foraminotomy technique in which they used a rigid endoscope, in both a cadaver model and in three clinical cases, including one in which a multiple-level procedure was undertaken. Postoperatively, all patients returned to functional work status within 4 weeks. The mean length of hospitalization was 1.3 days. Conclusions. The advantages to this technique include improved intraoperative visualization, a smaller incision, and significantly less postoperative discomfort compared with a traditional keyhole approach.

Thoracic disc herniation has always carried with it the potential for serious adverse neurological consequences if not treated appropriately. The authors review the historical evolution of treatment for thoracic disc herniation from the early surgical series using dorsal approaches (which were known to involve a significant risk of paraplegia) to later surgical series in which lateral and then ventral approaches to the disc were increasingly emphasized, with significant improvement in patient outcome. The evolution of minimally invasive thoracoscopic techniques is discussed, together with the results of several surgical series demonstrating significant reductions in morbidity compared with more traditional methods. The technique of thoracoscopic discectomy is presented in detail.

Cervical radiculopathy that is caused by either soft herniated disc material or foraminal stenosis is a common problem. Anterior and posterior surgical approaches are commonly performed to decompress the nerve root. The authors describe an endoscopic posterior foraminotomy procedure in which they use a rigid endoscope, in both a cadaveric model and in three clinical cases, including a multiple level case. Postoperatively, all patients returned to functional work status within 4 weeks. The mean length of hospitalization was 1.3 days. The advantages of this technique include improved visualization, a smaller incision, and significantly less postoperative discomfort when compared with a matched group of patients in whom open nonendoscopic foraminotomy has been performed.

Objective: To provide the reader with an update on the disposition of nitroprusside in the body and the current therapy in managing cyanide and thiocyanate toxicity. Data Sources: Currently available literature reports were used to provide readers with a comprehensive framework that will enable them to monitor for, prevent, and if needed, treat patients with cyanide and/or thiocyanate toxicity. Additional sources were used to provide risk factors, which enable practitioners to identify patients predisposed to such toxicities while receiving nitroprusside. Conclusions: The continuously changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease have increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective and at the same time result in minimal adverse reactions. Members of the healthcare professions must be able to identify situations that warrant close therapeutic monitoring to prevent extended hospital stays caused by iatrogenic diseases. Nitroprusside is a frequently used agent that can result in extended hospital stays, increased resource use, and even death caused by cyanide and/or thiocyanate toxicity. The identification of patients at risk, methods to monitor therapy, and treatments for toxicity will help reduce such reactions and provide maximal therapeutic response with minimal toxic consequences when using nitroprusside.