Pakistan Journal Of Neurological Surgery
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Comparison of the Efficacy of Fusion with Non-Fusion Treatment for Recurrent Lumber Disc Herniation (RLDH)
Get PDFObjective: The study compared the efficacy of fusion with non-fusion treatment for recurrent lumbar disc herniation.
Materials & Methods: 60 patients including 30 – 65 years of either gender, with recurrent disc herniation and radicular pain from at least six months after primary lumbar disc surgery. Epidural scar tissues were separated and partly resected in patients with RLDH (recurrent lumber disc herniation) undergoing standard revision discectomy (Group A). Posterolateral fusion and trans-pedicular screw fixation were used in Group B. Following the implantation of a subcutaneous suction drain, the closure was performed as usual. The effectiveness was evaluated. The Japanese Orthopedic Association's core was used to measure clinical complaints before and after surgery.
Results: Most of the patients (58.33%) were 46 – 65 years old. The mean recurrent time to primary surgery was 11.87 months. 60% of patients reported ? 12 months recurrent time in group B, and 66.6% in group A. Right side was noted in 26.67% of patients of both groups. The mean pre and post-operative JOA scores were 22.34 and 8.54, respectively. The mean recovery rate was 59.32%. This study reported the efficacy of non-fusion treatment versus fusion treatment as 16.67% and 63.33%, respectively.
Conclusion: We concluded that the fusion treatment is better than the non-fusion treatment for recurrent lumbar disc herniation
Relationship between Bilateral Chronic Subdural Hematomas and Postoperative Recurrence
Get PDFObjective: The association between bilateral chronic subdural hematomas and postoperative recurrence remains controversial as conflicting evidence regarding this association exists in the literature. We carried out the present study to assess whether bilateral chronic subdural hematomas are associated with increased postoperative recurrence compared to unilateral chronic subdural hematomas after burrhole drainage.
Materials & Methods: We retrospectively studied the data of all the patients operated on in our department for chronic subdural hematoma evacuation through burrhole drainage and then included the data of sixty-three patients in our study. For the sake of uniformity, only patients without postoperative drainage were included in the study. The patients operated on for unilateral and bilateral chronic subdural hematomas were then compared with each other for their association with postoperative recurrence.
Results: Forty-five patients in our study had been operated on for a unilateral chronic subdural hematoma. Eighteen patients had been operated for bilateral chronic subdural hematomas. Of the forty-five patients who operated for unilateral chronic subdural hematomas, eight (17.8%) had a recurrence. Twelve (66.7%) of the eighteen patients operated for bilateral chronic subdural hematoma had a recurrence. This difference in recurrence between the unilateral and bilateral chronic subdural hematomas was found to be very significant (p = 0.0002).
Conclusion: We conclude that a bilateral chronic subdural hematoma is associated with significantly increased postoperative recurrence compared to a unilateral chronic subdural hematoma following burrhole drainage.
Keywords: Bilateral chronic subdural hematoma, unilateral chronic subdural hematoma, burrhole drainage, recurrence
The Outcome of Prolactinoma in the Postpartum Period: a Study from a Tertiary Care Hospital in Pakistan: a study from a tertiary care hospital in Pakistan
No full textObjective: Prolactin is an essential hormone secreted by the pituitary gland of pregnant women. The pituitary gland undergoes growth, due to lactotroph hyperplasia in response to placental estrogen during pregnancy. Research on the postpartum outcomes of prolactinomas is less. This study evaluates the prevalence of Prolactinoma and the occurrence of spontaneous resolution of Prolactinomas after pregnancy.
Materials and Methods: A cross-section study was conducted at the Punjab Institute of Neurosciences, Lahore. 200 pregnant women were recruited; their blood samples were collected to evaluate serum prolactin levels. Women diagnosed with prolactinomas exhibiting positive symptoms were given dopamine agonists. The administration of dopamine agonist was discontinued at the 24th week of gestation. All participants were monitored till birth, at 40 days after delivery, and throughout breastfeeding. Their prolactin levels were evaluated, and magnetic resonance imaging (MRI) was conducted to verify the resolution of prolactinoma.
Results: The mean age of females in the study was 29.03 ± 7.20 years. Out of 200, 40 (20%) females had prolactinoma. Out of 40, 13 (32.5%) were given Bromocriptine while 27 (67.5%) were given Cabergoline. At presentation, the mean serum prolactin level was 138.91 ± 149.02 ng/ml, which reduced to 21.38 ± 9.80 ng/ml. The mean tumor size at presentation was 7.23 ± 2.07 mm, which reduced to 0.79 ± 0.66 mm after delivery. Out of 40, 30 (75.0%) had spontaneous resolution.
Conclusion: The occurrence of prolactinoma is low in symptomatic patients and can resolve spontaneously after delivery in the majority of cases
Comparison of the Outcomes of Anterior versus Posterior Approaches in Multilevel Cervical Prolapsed Intervertebral Discs
Get PDFObjective: To compare outcomes of the anterior versus posterior approach in multilevel cervical prolapsed intervertebral discs.
Materials and Methods: This is a prospective study conducted on 40 patients, 20 in each group in the Department of Neurosurgery of a tertiary care hospital. Group A patients were operated on by the anterior cervical approach and Group B was operated by the posterior cervical approach. Postoperatively all the patients were followed to assess the outcome, neurological deficit.
Results: Mean age in Group A was 38 years while in Group B, it was 53 years. Group A had 65% male and 35% female patients while Group B had 60% male and 40% female patients. In Group A, 9 (45%) patients had radiculopathy while 11 (55%) patients had myelopathy, while in Group B 7 (35%) developed radiculopathy, and 13 (65%) patients developed myelopathy. We assessed the patients postoperatively and found that in Group A, 18 (90%) patients were improved and 2 (10%) patients had clinically shown worse outcomes. While in Group B, 15 (75%) patients had improvement, and 5 (25%) patients had worse outcomes.
Conclusion: The anterior approach had a short hospital stay and early recovery which makes it a more commonly used procedure by surgeons as compared to the posterior approach the outcome results of our study also showed that the anterior approach was good and had better functional outcomes than the posterior approach, but the difference was not significant statistically
Emerging Challenges in the Management of Initial Traumatic Brain Injury: A Prospective Study from a Developing Country
Get PDFObjective: To identify and highlight the challenges faced in initial traumatic brain injury management in a developing country
Materials and Methods: The study includes 294 TBI-related admissions. We included all admitted Patients with Traumatic brain injury via. A and E (accident & emergency) departments and all patients of either age or gender. We included information related to the area of the initial trauma, whether the patient was referred from another setup after initial management, whether CT brain was performed at an initial health care facility, time since trauma to our hospital/ER presentation, duration of stay in our hospital, whether ICU was provided or not, and whether the patient was managed conservatively or required surgery at our hospital.
Results: Out of the total patients received male to female ratio was 9 to 1 and the age group most involved was 15 to 45 years old.72% of patients were referred from local healthcare setups. 24% of patients underwent surgery. 64% were received from other districts. CT was performed by 41% before presenting. 61% of patients reached the hospital within 3 hours of injury. 51% stayed in the hospital for 1 – 3 days. 17% were shifted to ICU, Ventilator support was only given to 9.5% of patients. In 25% of patients, Steroids were given, and 5 redo surgeries were performed in the same hospital setting.
Conclusion: This Short report provides a snapshot of the difficulties and weaknesses of the health system in the region
Clinical Outcomes of Full Endoscopic Thoracic Discectomy in Acute Disc Herniation: A Case Report from Khyber Pakhtunkhwa
Get PDFObjectives: Thoracic disc herniations are rare relative to lumber and cervical spine herniations and account for 0.25% to 0.75% of cases in the general population. This case report presents a rare case of a 65-year-old male diagnosed with thoracic disc herniation and managed through full endoscopic thoracic discectomy.
Clinical Presentation: A 65-year-old wheelchair-bound male presented to OPD with complaints of paresthesia and sensory symptoms along with motor weakness from the past 2 weeks. No Symptoms of bowel and bladder dysfunction were present.
Diagnosis/Intervention: Sagittal and axial MRI findings revealed disc herniation at the T11 – T12 level. Full endoscopic thoracic discectomy through a transforaminal approach was performed to decompress the spinal cord.
Conclusion: Acute thoracic disc herniations although rare, can present with variable clinical manifestations. Full endoscopic thoracic discectomy through a transforaminal approach is a safe and effective surgical procedure associated with improved patient outcomes, increased satisfaction scores, and decreased chances of complications.
Keywords: Acute thoracic disc herniation, endoscopic discectomy, full endoscopic thoracic discectomy
Intraoperative Computed Tomography Scanner-Guided Junctional Zone Spinal Surgery in Fluoroscopic Limitation Zone-An Early Experience
Get PDFObjective: Confirmation of the level for surgery at the junctional zones of the spine is associated with unique difficulties. C-Arm has its limitations in these areas. The use of intraoperative CT scan with navigation greatly helps in the surgery at junctional zones. These junctional zones include the craniocervical junction, cervico-dorsal junction, and sacroiliac junction. In 2019, we installed an Airo Brain Lab 32-slice MDCT in our facility and researched to evaluate its advantages in junctional zone fluoroscopy-restricted spine operations.
Material and Methods: We performed 20 complex surgeries in all these 3 junctional zones with the use of an intraoperative computed tomography scanner. 3 patients had craniovertebral junction fixation under intra-op CT while 6 had lateral mass fixation. 3 patients had cervicodorsal junction fixation and 4 patients had lumbosacral fixation.
Results: 2 out of 3patients with cervicodorsal fixation had correction of screws trajectory after usage of intra-op CT and 1 patient with lumbosacral fixation. All patients were discharged home with neurology better or the same as compared to pre-op. status while 13 patients had a favorable outcome.
Conclusion: Intraoperative computed tomography scanner is opening new horizons for complex spinal surgeries.
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Incidence of Acute Complications Associated with Spinal Cord Injury (SCI): A Study of the Ayub Teaching Hospital, Abbottabad
Get PDFObjective: To document the occurrence of acute problems as well as post-surgical improvements in individuals suffering from spinal cord injury.
Materials and Methods: This study was conducted retrospectively in the Department of Neurosurgery. All patients of any age and both genders were included who were admitted with spinal injuries. The patients with cervical fractures received the anterior cervical plating plus graft placement in the cervical spine, whereas the patient with thoracolumbar fractures received the transpedicular fixation in thoracolumbar spine fractures. ASIA Impairment Scale for neurological status, GCS at admission, and acute complications developed within two weeks were noted.
Results: 200 patients were included (mean age of 34.6 years). The common cause of SCI was a fall from an elevated position of 62.5%. On admission, 50% of patients’ neurological state was Asia grade A. The most common location involved in patients (70%) was a thoracolumbar junction. 20% of patients presented with neurogenic shock. Postoperatively, the GCS scores in all patients were been improved. The commonest acute complications associated with SCI were pulmonary in 60% of patients. 17% of patients developed an infection, 5% suffered from gastrointestinal issues, and 3% suffered from renal issues. Deep vein thrombosis (DVT) was observed in 9%.
Conclusion: During the early phase of hospitalization, respiratory difficulties were among the most prevalent complications encountered in those suffering from traumatic SCI. These outcomes exacerbate the eventual suffering caused by the spinal cord injury; hence, recognizing the likelihood of occurrence, early detection, exact surgical treatment, and prevention are essential
Association of Hydrocephalus in Children with an Encephalocele
Get PDFObjectives: To describe the association between the occipital encephaloceles with hydrocephalus and how to improve the outcome of patient.
Methodology: Our Prospective study collected records of fifty patients diagnosed with posterior encephaloceles. Data were collected on the gender, location of the encephalocele, presence of neural tissue , dandy walker, microcephaly and hydrocephalus.
Results: Twenty-nine females and twenty-one males were present. Over half of the lesions were supratorcular, while the remaining eight (16%) were torcular and the remaining seventeen (34%) were infratorcular. Primary encephalocele repair were done at an average of 9 days (range 2.5–120 days). In twenty-five of the instances, a diagnosis of hydrocephalus was made. Twenty-four patients had a ventriculo-peritoneal shunt implanted. The average age of implantation of VP shunt was only 1.2 months (range 0.3–9 months). One patient underwent an endoscopic third ventriculostomy with good results. Hydrocephalus was related with Dandy-Walker and ventriculomegaly before encephalocele surgery was performed (p values 0.01 and 0.05, respectively). For hydrocephalus therapy,
Conclusions: Patients born with encephaloceles frequently suffer from hydrocephalus (50%). This is especially true in cases where the patient also has Dandy-Walker syndrome, CMIII malformation, or pre-existing ventriculomegaly. The severity of large encephaloceles is a limiting factor for the development of hydrocephalus when connected with torcular types and microcephaly
The Incidence of Motor Neuron Disease (MND) in Patients Diagnosed with Cervical Spondylotic Myelopathy (CSM)
No full textObjective: Motor neuron disease (MND) can occur in patients with cervical spondylotic myelopathy. The purpose of this study was to determine the prevalence of motor neuron disease in individuals suffering from cervical spondylotic myelopathy (CSM).
Materials & Methods: A prospective study was conducted at the Lady Reading Hospital. The patients(n = 70) included were between ages 55 to 75 with established clinical and radiological diagnoses of CSM. Motor neuron disease was diagnosed clinically by Awaji criteria. The patients were evaluated with NCS/EMG (Nerve Conduction Studies/Electromyography) and followed for 6 months. The motor neuron disease was confirmed by modified El Escorial criteria.
Results: 40 patients had bilateral upper limb weakness (57%), however, the rest of the 30 patients had unilateral upper extremity weakness (42.8%). Hoffman’s sign was positive in 60% of patients. Lhermitte's sign was also positive in 31% of patients. The majority of patients (55.7%) were found with grade 4 for deltoid followed by 51.4% patients for biceps brachii. MRI showed anterior cord compression at the level of C5 and C6 in 27.14% of patients and C6 C7 in 32.8% of patients. 15.7% of patients were suspected of having both CSM and MND.
Conclusion: CSM and MND can occur in the same patients. The incidence of MND is 5.7% in patients with cervical spondylotic myelopathy, hence in CSM patients, workup must be done for MND as it affects the outcome of surgery in these patients