Pakistan Journal Of Neurological Surgery
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The Outcome of Laminectomy versus Laminoforaminotomy in Terms of Claudication Distance in Lumbar Spinal Stenosis
Get PDFObjectives: The study aimed to compare the surgical outcome of two different procedures for lumbar spinal stenosis. It helped us in the decision-making to go for less invasive procedures, as compared to conventional laminectomy in lumbar spinal stenosis patient patients.
Materials and Methods: An interventional randomized controlled trial was conducted in the department of neurosurgery, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS Islamabad. A total of 158 adult patients aged between 35 to 55 years with an established diagnosis of lumbar stenosis and claudication distance of fewer than 100 meters were enrolled. Patients were randomly included into two equal groups via the computerized method. In Group A laminectomy was done and in Group Blaminoforaminotomy was adopted. The outcome was measured in terms of claudication distance at 4 weeks after the procedure, and compared in both groups.
Results: The mean age of the patients was 44.92 ± 6.28 years. Poor outcome was significantly lower in the Laminoforaminotomy group as compared to the Laminectomy group, at 4 weeks after the procedure. The frequency of claudication distance > 500m (good) at 4 weeks was found to be 62 (78.5%) in the Laminectomy group and it was found in 74 (93.7%) patients in the Laminoforaminotomy group (p = 0.022).
Conclusions: The study concluded that the laminoforaminotomy is superior to laminectomy, in terms of claudication distance at four weeks after the procedure
The Lower-Back Painkiller Challenge: Efficacy of Tramadol Versus Tapentadol
Get PDFIntroduction: To reduce pain levels in people with lower back pain, the study looked at the comparative efficacy and tolerability of Tramadol and Tapentadol taken by oral route.
Materials & Methods: This comparative study consisted of a total of 126 patients divided into 2 groups, the Tapentadol and Tramadol groups for managing low back pain. Participants aged 18-60 with moderate or higher pain intensity were included. Data on pain intensity, adverse events, and patient-reported outcomes were collected at baseline, day 7, and day 14. Participants were randomly assigned to Tapentadol or Tramadol groups, receiving respective medications for 14 days. Data analysis involved t t-test to compare groups. Means and SD were also calculated.
Results: The mean age of the patients in the Tramadol group was 33.1 ± 19.1 and in the Tapentadol group was 37.6 ± 19.9, respectively. Sixty of the total participants were men and sixty-five were women. Participants were split equally between groups A and B, with 30 men and 33 women in group A and 30 men and 32 women in group B. The findings demonstrated that both medications considerably lessened moderate to severe chronic lower back pain (CLBP) patients' pain levels. At 28 days after the baseline, the mean VAS scores for groups A and B were 34.57 and 37.55, respectively.
Conclusion: According to the study's findings, these two medications effectively reduce pain in those with chronic lower back pain. Tapentadol is observed to be tolerated well and more effective than Tramadol.
 
The Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country
No full textBackground: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction.
Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25.
Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%).
Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes
Management of intrasellar arachnoidocele
Get PDFArachnoidocele in its sellar location is not common. The variability of its clinical signs and the lack of standard treatment make the management complex. The authors report a clinical case through which therapeutic modalities will be discussed. We report a case of a 42-year-old patient who complained of intermittent headaches of progressively increasing intensity over the past 2 years. The persistence of the headaches despite analgesic treatment had motivated the performance of a brain CT scan and then an MRI which had objectified the presence of an intrastellararachnoidocele. The endocrine laboratory function was normal. Short-term treatment with morphine and corticosteroids had achieved a rapid and long-lasting course after a 2-year follow-up. Endoscopic surgery is a treatment option for sellar arachnoidocele. The indication must take into account the clinical and radiological elements because some sellar arachnoidocele evolve favorably under drug treatment
Text Neck Syndrome among Undergraduate Students in Lahore, Pakistan
Get PDFObjective: To evaluate the frequency, severity, and prevalence of Text Neck Syndrome among undergraduate students using mobiles, tablets, or laptops.
Material and Methods: The descriptive study was conducted in two private colleges in Lahore after approval from the institutional review board of Sharif Medical and Dental College, Lahore, Pakistan. Students with ages greater than 16 years who used mobile phones daily for more than 1 hour were enrolled. Baseline demographic information was collected and questions regarding the duration of phone usage and neck pain were asked. Calculated a sample size of 266 with the help of the WINPEPI statistical program with a confidence of 95% and acceptance difference of 0.06 with an assumed proportion of 0.46.
Results: The age range was 18 – 23 years. Out of 266 undergraduate students, 122 (46%) were male and 144 (54%) were female. 157 (59%) students reported having neck pain: Mild in 88 (56.1%), Moderate in 55 (35%), and Severe in 14 (8.9%) students according to self-perception. 97 (61.8%) students were intermittent, 35 (22.3%) had continuous, and 25 (15.9%) had debilitating neck pain.
Conclusion: According to this study, Text Neck Syndrome was common in undergraduate students using smartphones, tablets, or laptops
Depressed Skull Fracture Surgical Management and Outcome among Head Injury Patients: Experience at Tertiary Care Hospital
Get PDFObjective: To evaluate outcomes in patients with managed depressed skull fractures operatively having head injuries.
Methods: This study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro. We analyzed 76 patients who underwent operative management for skull fractures. Patient selection included both children and adults with skull fractures evident on CT brain scans using bone windows.
Results: Our study included 76 patients, with 48 males and 28 females, and a mean age of 28.68 ± 10.33 years. Among them, 45 (59.21%) were under 30 years old, and the highest incidence of depressed skull fractures occurred in the 21 – 30 age group. Road traffic accidents were the leading cause, accounting for 42 (55.25%) cases, while falls from heights contributed to 24 (31.57%) cases, and 7 (9.21%) resulted from objects falling on the patients.
Conclusion: Patients with head injuries can be fatal if not managed promptly. Neglecting the management of a depressed fracture can also impact the outcome in these cases and lead to a series of complications.
 
THE Recurrence Rate After Using Subdural Drain in Patients with Chronic Subdural Hematoma
No full textObjective: One of the most often carried out procedures in the neurosurgical field is the drainage of chronic subdural hematomas (CSDHs). According to Scotti, subdural hematoma was identified radiologically as a subdural collection that was hypodense to parenchyma and manifested 21 days following trauma. This definition was based on the CT scan. In this study, we want to find the effectiveness of subdural drain in managing chronic subdural hematoma from the perspective of recurrence in our setup.
Materials and Methods: After the procedure, the patients were admitted to the ward for 48 hours and the drain was removed after 48 hours. Then the patients were discharged and follow-up was taken one month for diagnosis of recurrence. Recurrence was labeled positive if postoperative symptomatic recurrence of hematoma that needs re-operation of any type within one month of primary surgery.
Results: Among 85 patients mean age was 51 years with a standard deviation ± 7.55. 60(71%) patients were male and 25(29%) patients were female. Moreover s10 (12%) patients had recurrence while 75(88%) patients didn’t have recurrence.
Conclusion: According to our research, patients with Chronic Subdural Hematoma (CSDH) had a 12% recurrence incidence following the placement of a subdural drain
Pattern and Outcome of TBI in Children: An Observational Study at the Children Hospital Lahore
Get PDFObjective: TBI is one of the leading causes of mortality. To prevent these deaths and injuries epidemiological evidence is required in individual areas. The study aims to understand the common causes of TBI in children in a localized area of Pakistan.
Material and Methods: This is a descriptive study that enrolled 720 children with head injuries aged 0 to 14 years from September 2021 to June 2022 at UCHS/CHL. Demographic variables like age and gender were noted. Moreover, presenting features of the wound/injury, the cause behind the injury, the severity of the wound, as well as operative procedures that were undertaken, were all recorded.
Results: Mean age of the children was 5 years. Most of them were boys (69.25%). Many of the head injuries were caused due to falls (78.94%) followed by RTA (20.7%). 62.32% of the patients arrived via ambulance. The mortality rate among severe head injury was 65.09%, moderate head injury was 26.31% and mild head injury was 8.52%. It was observed favorable outcomes were noted in patients who presented to the hospital within four hours of injury. (The p-value is .0026).
Conclusion: Head injuries among children in Pakistan are primarily due to falls and road accidents. There is a need for betterment in the architecture of housing and road traffic management to prevent TBI-related mortalities. Awareness and logistics need to be provided for the quick transfer of patients with trauma to neurosurgical emergencies
Analysis of Bilateral Stereotactic Pallidotomy in Patients Presenting with Generalized Dystonia
Get PDFObjective: To find the improvement with stereotactic pallidotomy. The main aim of the study was to assess the outcome based on mean change in Burke-Marsden-Fahn Dystonia Scale (BMFDS) score after stereotactic pallidotomy in patients presenting with generalized dystonia.
Material & Methods: Quasi-experimental study was conducted over five years at Unit II, Department of Neurosurgery, Lahore General Hospital, Lahore. A total of 16 patients 9 were males and 6 were female meeting inclusion criteria of age 20-70years of either gender presenting with generalized dystonia for at least 6 months. Patients underwent stereotactic pallidotomy. Furthermore, Patients with coagulopathies (PT, apt > 4 sec deranged), Patients with a history of trauma, Patients with CVA (on history), and patients having intracranial pathology (trauma/hematoma) were excluded. BMFDS score was noted at baseline and after 3 months of surgery, and change in BMFDS was noted. The questionnaire was used to collect information. SPSS Version 21 was used to examine the data that had been gathered.
Results: The patients' average age was 47.35 and 14.40 years. There were 19 (31.67%) males and 41 (68.33%) females. The mean duration of dystonia was 15.43 ± 6.13 months. At baseline, the mean BMFDS was 49.67 ± 5.69 which was reduced to 18.03 ± 3.35. The mean change in BMFDS was 31.63 ± 6.38. There was a significant change in BMFDS (p < 0.05).
Conclusion: Hence, in patients with generalized dystonia, stereotactic pallidotomy is beneficial in lowering the BMFDS score by more than 50%
Significance of Relationship Between Lumbar Disc Degeneration and Modic Changes in Acute Disc Herniation
Get PDFObjective: To determine the significance of the relationship between lumbar disc degeneration and Modic changes in acute disc herniation.
Materials and Methods: This study included 323 patients 25 to 42 years of age having acute symptoms of acute single-level lumbar disc herniation. A simple random sampling technique was used to enroll these patients. MRI lumbosacral spine 1.5 tesla was done on all patients. The patients and MRIs were evaluated by a consultant neurosurgeon and anesthetist both having more than five years of clinical experience. The disc herniations, their types, disc degeneration by Pfirrmann grading, Modic changes in end plates, their types, and location were assessed.
Results: The mean age was 34.2±3 years. Males were 185 and females were 138. A total of 1615 discs from L1 to S1 of 323 patients were evaluated. 785 (48.6%) discs had degeneration, 356(22.0%) discs had herniation, 339(20.9%) discs had Modic changes. Out of the 356 herniated discs, 347(97.4%) discs had disc degeneration while 9(2.5%) discs did not have degeneration with a p-value <0.001. Out of the 356 herniated discs, 66(18.5%) discs had Modic changes while 290(81.4%) discs did not have Modic changes with a p-value <0.001.
Conclusion: We conclude that disc degeneration and Modic changes had a significant association with acute disc herniation