7 research outputs found
The relationship between the grading of lumbar spinal stenosis and pain improvement after caudal epidural steroid injection.
No full textObjective: This study aimed to determine the relation of severity of lumbar spinal stenosis and pain improvement after caudal epidural injection.
Material and Methods: 70 patients of neurogenic claudication were included from July 2019 to June 2020. MRI lumbosacral spine was done of all patients to categorize the degree of spinal stenosis on T2-W axial. All patients were given caudal epidural steroid injection as a day case procedure. Follow-up was done at 3 & 8 weeks and pain improvement was assessed by using Ronald satisfaction score.
Results: Mean age was 37.9 ± 7.8 years. 48.6% patients were male and 51.6% were female. The improvement was observed in 28 patients (40%) at 3 weeks and in 46 patients (65.7%) at 8 weeks. There was no statistically significant relationship between lumbar
spinal stenosis and pain improvements at 3 weeks (p value 0.30) and 8 weeks (p value 0.32).
Conclusion: The grade of lumbar spinal stenosis has no significant effect on pain improvement after caudal epidural steroid injection.
Keywords: LSS (Lumbar spinal stenosis), caudal epidural steroid injection (ESI), neurogenic claudication, MRI (Magnetic resonance imaging), T2W (T2 weighted) images
Efficacy of Balloon Kyphoplasty in Compression Fractures of the Thoracolumbar Spine
No full textObjective: To study the Efficacy of Balloon Kyphoplasty in compression fractures of the thoracolumbar spine.
Material and Methods: This study was conducted on 95 patients with thoracolumbar wedge fractures from 2017 to 2022. Complete neurological examination and CT and MRI scans of the spine of all patients were done. All patients have been treated with a balloon kyphoplasty procedure. Data was collected on VAS score, SF-36 score, kyphotic angle and percentage of vertebral body destruction both preoperatively and post-operatively. Statistical analysis was done by using paired sample t-test.
Results: The mean age was 57 years. Males were 58.9% and females 41.0%. Osteoporosis was the cause of fracture in 90.5% and trauma in 9.4% of patients. VAS improved from 7.42 ± 1.24 to post-procedure 3.24 ± 1.51, P < 0.0001. SF-36 improved from 35.31 ± 17.4 to post-procedure 49.23 ± 19.2, P < 0.0001. Kyphosis angle restoration from 18.42 ± 7.41 to post-procedure 10.61 ± 6.32, P value < 0.0001. Percentage loss of vertebral height from 32.91% to postoperatively 17.64% (SD-17.2 and P < 0.0001). 10.5% of patients developed cement leakage and there is no leakage in 89.4%. The adjacent level fracture occurred in 4 patients.
Conclusion: Balloon Kyphoplasty is an effective procedure for thoracolumbar wedge fractures. It improves pain, activities of daily living, kyphosis angle improvement, and restoration of vertebral height
Significance of Correlation Between Spinopelvic Parameters in Patients of Chronic Low Back Pain
No full textObjective: To determine the significance of the correlation between spinopelvic parameters in patients with chronic low back pain.
Materials and Methods: 129 patients with chronic low back pain of a minimum of 03 months duration were included in our study from September 2020 to February 2023. Sagittal standing spinopelvic radiographs were done on all patients. Various spinopelvic measurements were done including PI, PT, LLA, SLA L1 – L3, SLA L3 – S1, LSA, SHA, and SIA. Pearson correlation was used to determine the correlation coefficient.
Results: The mean age was 36.45 ± 9.54 years. Males were 59 and females 70. Mean and SD of spine pelvic measures were LLA = 57.32 ± 12.45, SLA L1-L3 = 15.31 ± 3.75, SLA L3 – S1 = 42.46 ± 8.34, LSA = 8.94 ± 4.72, SHA = 38.10 ± 7.94, SIA = 52.42 ± 6.84, PT = 11.21 ± 5.83, PI = 48.72 ± 8.90. PI has a significant positive correlation with LLA ( r= 0.492 and p-value < 0.001).
Conclusion: PI and LLA are important spinopelvic parameters and have significant correlation with other spinopelvic parameters and derangement of one of them can affect the overall spine sagittal balance resulting in chronic low back pain
Postoperative Neurological Outcome in Spinal Tuberculosis Patients Presenting with Severe Neurological Deficits
No full textObjective: To determine the postoperative neurological outcome in spinal tuberculosis patients presenting with severe neurological deficits.
Materials and Methods: 57 patients of 22 to 65 years of spinal tuberculosis were included in this study from January 2018 to March 2023. Data was collected from the hospital records of the patients who were admitted and operated on for tuberculosis of the spine. All regions of the spine were taken for study. ASIA scoring was done and patients were labeled from ASIA scores A to E. All patients were operated and postoperative ASIA scoring was also done on follow-up visits. An Independent sample t-test was used to assess the difference in the mean of these variables.
Results: The mean age was 44.45 ± 8.54 years. Males were 39 and females 18. Preoperatively 27 patients had ASIA B, 28 patients had ASIA C and 02 patients had ASIA D score. All these patients improved postoperatively. The mean preoperative ASIA Score was 2.03 ± 2.4 and the mean postoperative ASIA score was 4.1 ± 1.3 withp-value of 0.02. Patients having old age, who present late and with poor grades in neurology had worse outcomes postoperatively.
Conclusion: Patients with spinal tuberculosis presenting even with severe neurological deficits had significant improvement in neurology postoperatively.
Keywords: Spinal tuberculosis (TB), American Spinal Injury Impairment Score (ASIA), Mycobacterium Tuberculosis, Potts disease, Trans-pedicular decompression and fusion, Laminectomy, Magnetic resonance imaging (MRI)
Efficacy of Posterior and Posterolateral Approach for Decompression and Fusion for Thoracolumbar Tuberculosis
No full textObjective: To study the efficacy of the posterior and posterolateral approach in thoracolumbar tuberculosis.
Material and Methods: 60 patients with thoracolumbar TB spine were enrolled in the study from 2015 to 2021. These patients had single-level disease with low back pain and neurological compromise in lower limbs. The diagnosis was made on an MRI of the spine and elevated ESR levels. All patients were started with antituberculous treatment. The pain was measured on the VAS score, and neurological status was assessed on the ASIA score. Kyphosis angle was calculated on a lateral x-ray of the spine. All patients were operated on by posterior and posterolateral approaches with decompression and fusion. At follow-up, fusion was assessed on every visit by x-ray along with neurological status and pain score.
Results: The mean age of patients was 45.8 years (25 to 66 years). 59.5% patients achieved radiological fusion on follow-up x-rays. There was a significant improvement in VAS score preoperatively mean and SD6.38 ± 1.24to postoperatively 4.45 ± 1.09. The mean and SD of kyphosis in patients preoperatively was 22.3 ± 3.06 to post-operative 22.3 ± 3.06 with a p-value < 0.05 which shows significant improvement.
Conclusion: Posterior and posterolateral decompression and fusion of thoracolumbar tuberculosis is a good surgical approach in respect of neurological outcome, correction of kyphosis, and pain improvement
Assessment of the Association between Hypovitaminosis D and Chronic Low Back Pain in South Punjab
No full textObjective: To assess the relationship between hypovitaminosis D and chronic low back pain in South Punjab.
Materials and Methods: Retrospective research was done from January 2021 to June 2022. 173 chronic nonspecific low back pain patients presenting in outpatient clinics were included in our study. Two groups were made of all patients, one was vitamin-D level deficient, and the other was a vitamin-D normal group. The blood level of 30 ng/ml of vitamin D was taken as normal. Chronic Low back pain status was analyzed by VAS score. All the demographic data of patients were recorded. The relationship between vitamin D and VAS score was assessed by the spearman coefficient and p <0.05 was taken as significant.
Results: The majority of patients had a mean age of 36.45 ± 21 years, were female preponderance, married, and vegetarians with a mean sun exposure time of about 2 hours. In group 1, the vitamin D level was 13.41 ± 3.8 and in group 2 vitamin D was 38.71 ± 5.8 with p value< 0.0001. Spearman rho coefficient was used to assess the relationship between vitamin D and pain score. The result was a negative correlation between these 2 variables (r=-0.572) and p <0.0001.
Conclusion This research work showed the significant probability of association between vitamin D level and patients having nonspecific chronic low back pain. There was a negative association between vitamin D level and VAS score of patients having chronic low back pain.
Computerized Tomographic Based Study of Thoracic Spine Morphology in Relevance to Pedicle Screw Fixation in Pakistani Population
No full textObjective: To study the thoracic spine anatomy for accurate placement of pedicle screws using computerized tomography.
Material and Methods: CT scans of 200 patients were included in our study. T1 to T12 vertebrae morphology was studied for each patient. Following measurements were taken, 1: Transverse pedicle width, 2 = Depth of anterior cortex along pedicle axis, 3 = Transverse pedicle angle, 4 = canal dimensions, 5 = vertebral body height anterior and posterior, 6 = mid vertebral body width.
Results: Transverse pedicle width decreased from T1 (4.06 ± 0.50 mm) to T4 (3.72 ± 0.17 mm) and then gradually increases to T12 (6.08 ± 0.60 mm). Depth of the anterior vertebral cortex remained constant from T1 to T4 and gradually increases up to T12. Transverse pedicle angle remained constant from T1 to T4 with a maximum at T4 (23.39 ± 3.15 mm) and then gradually decreased to T12 (3.99 ± 2.16 mm). Anteroposterior (AP) canal dimensions were minimum at T7 (17.03 ± 1.01 mm) and maximum at T2 (21.2 ± 1.07 mm). Interpedicular (IPD) canal dimensions were minimum at T6 (19.18 ± 1.6 mm) and maximum at T3 (23.18 ± 1.2 mm). Anterior vertebral body height was minimum at T1 (16.9 ± 1.34 mm) and maximum at T12 (27.14 ± 1.34mm). Posterior vertebral body height was minimum at T1 (18.8 ± 1.13 mm) and maximum at T12 (29.76 ± 1.43 mm).
Conclusion: A detailed anatomy of the thoracic spine is essential for surgical planning to decrease postoperative complications
