Objectives: We determined the Outcome of subaxial cervical injury management in adults through anterior approach open reduction and fixation injury < 72 hours. Material and Methods: A total of 71 patients declared to have a recent chronicle of traumatic cervical spine injury with a conventional diagnosis of subaxial injury by Magnetic Resonance Imaging (MRI) and X-Ray anteroposterior and lateral views. ASIA Impairment Scale was used for assessment and was done at the time of admission and after six months. Results: Mean age of the patients in our study was 38.54 ± 5.47 years. According to American Spinal Injury Association (ASIA) scale, improvement by two grades was seen in 18 cases and improvement by one – grade was observed in 48 cases. Mortality was seen in 5 cases, where 2 deaths were related to associated injury, one related to a complication of surgery and other 2 died due to aspiration complications. Out of 66 cases, the outcome was good in 49 (74.29%) and fair in 17 (25.76%). Conclusion: The study results revealed that Anterior Cervical Discectomy and Fusion (ACDF) is considered to be a better treatment choice for better anatomical stabilization of the spine with early reduction. Keywords: Subaxial cervical injury, anterior approach, ASIA (American Spinal Injury Association) scoring.
Objective: To determine the outcome of Transpedicular Fixation via Posterior Approach for Dorsal and Lumbar Spine Tuberculosis. Material/Methods: This study was cross-sectional and conducted from 01/02/2015 to 30/7/2020 in the department of neurosurgery. A total of 36 patients with dorsal and lumbar spine tuberculosis were operated on for transpedicular fixation. Assessment scores were used pre-operative and post-operative and patients were kept on follow-up till six months after the surgical procedure. Variables like age, gender, spinal level, preoperative, and follow-up clinical status were calculated. Results: There were 19 (53%) male and 17 (47%) female patients with a mean age of 27 ± 8. Thoracolumbar was the commonest segment involved in 17 (47%) patients, followed by lower thoracic in 8 (22%) and lumbar in 7 (19%). There were 7 (19%) patients on the preoperative American Spinal Injury Association (ASIA) impairment scale in grade B, 12 (33%) in grade C, 15 (42%) in grade D, and 2 (5%) in grade E. The follow-up assessment at 6 months showed that ASIA grade B was seen in 3 (8%), grade C in 4 (11%), grade D in 16 (44%), and Grade E in 13 (36%) patients. Preoperative and follow-up scores on the ASIA impairment scale, COBS ANGLE, and ESR showed a significant difference (p-value < 0.05). Conclusion: We concluded that transpedicular fixation can restore the stability of the spine in thoracic and lumbar tuberculosis. The procedure is important for the improvement of clinical symptoms, correction of kyphosis, and stabilization of the spinal column.
Objective: To assess the clinical outcome of fenestration as minimally invasive surgery among patients with lumbar disc herniation undergoing microdiscectomy. Methods: This retrospective observational study was conducted at the Neurosurgery Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi from June 2015 to December 2019. Patients with single-level unilateral side lumbar disc herniation underwent microdiscectomy, age more than 18 years of either gender were consecutively included. The patients were observed for pre and post-surgical pain improvement using a rd visual analogue scale (VAS). The follow-up was conducted at 3 months of treatment. Results: A total of 247 cases were enrolled. The mean age was 47.57 ±8.22 years. There were 152 (61.5%) males and 95 (38.5%) females. Back pain and radiating leg pain, i.e. 182 (73.7%) and 139 (56.3%) respectively were the most common complaints. Complications were reported in 19 (7.69%) cases. Of these 19 cases, 8 (42.10%) had discitis, 6 (31.57%) had superficial infection, and 5 (26.31%) had dual tear. The VAS score was markedly improved when compared among pre and post-operative cases (7.56 ±1.01 vs. 2.46 ±0.84,. Conclusion:Our study shows that a microdiscectomy is an effective approach with removal for the unilateral disc with a small incision, early mobilization, low rate to morbidity and success rate based on VAS scoring system was 86.6% ranged from good to excellent.
OBJECTIVE: To determine frequency of hydrocephalus in brain tumor perioperative and and need of perment VP shunt . METHOD & MATERIAL: This was descriptive study, the ethical approval was taken from the hospital, study duration from 24-June-2014 to 30-september-2020 at JPMC, Karachi. Inclusion criteria were patient with brain tumor associated with hydrocephalus or postoperatively developed hydrocephalus within 3months of surgery and exclusion criteria were they had shunted previously due to some other reason, history of operation of brain tumor previously, history of trauma. RESULTS: We operated 156 cases of brain tumor concomitant with hydrocephalus, these included pre-operative and post-surgery development of hydrocephalus, out of that 65 (41.6%) were adult and 91 (58.33%) were children, who had hydrocephalus due to brain tumor. 90 (57.6%) were male and 66(42.3%) were female. The mean age for an adult was 34.2±8years and 8.1±4years was for a pediatric population of the patient. Patients who had preoperative hydrocephalus were 34 (21.7%) adults and 55(35.25%) pediatric and post-operative development of hydrocephalus was 28 (17.9%) in adults and 41 (26.28%) pediatric patients, CONCLUSION: The common brain tumor associate with hydrocephalus in children was craniopharyngioma and in adults it was CP angle tumor. Among 6026 cases of brain surgeries 2.6% required vp shunt dependency. Considering common cause of hydrocephalus in brain tumors, perioperative decision-making plays a pivotal role in the management of tumour-associated hydrocephalus.
Objective: The aim of study to assess the prevalence of divergent modes of injuries in traumatic posterior fossa extradural hematomas (PFEDH) along with the description of surgical and clinical management. Material and Methods: A descriptive study was performed at the Jinnah Postgraduate Medical Centre (JPMC), Karachi from May 2014 to October 2020. Total 37 patients who presented with posterior hematoma of any age and gender were included. CT scan Brain plain with the bone window was performed for a basic diagnosis to assess the volume, and any associated fracture, or any injury in the posterior fossa. The outcome was calculated from the scores of the Glasgow Coma Scale (GCS). Results: 70% were male and around 30% were female patients. The mean calculated age was 32 ± 5.33 years. A road traffic trauma was the major cause of brain injury in 25 (67.56%) cases. The majority (56.75%) of patients reported headache, nausea and vomiting. 35% of patients were conservatively managed, with an average hematoma size of 3 cm on CT scan and GCS > 12 while 64.86% patients were operated, with the average size of hematoma > 3 cm and GCS < 10 while 61% of the patient had an occipital fracture. The majority of patients (8.1%) reported complications such as brain contusions and post-traumatic hydrocephalus. Conclusion: Post fossa EDH should be managed aggressively, especially those with low GCS (< 8), and volume > 3 cm. Patients who are to be managed conservatively also require close observation.
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