Background: Cervical spondylotic myelopathy (CSM) is a common spinal cord disorder that develops in elderly people. Anterior cervical decompression and fusion (ACDF) is an effective and reliable procedure for the treatment of CSM. Objective: To find out the results of ACDF by cervical cage with bone graft for the treatment of single level cervical spondylotic myelopathy. Methods: This prospective observational study was conducted in the Department of Orthopedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, over a period of two years from March 2015 to August 2017. Forty patients with cervical spondylotic myelopathy were diagnosed on the basis of presenting complains, clinical examination and investigations and were enrolled in this study. The history of the patients was collected, clinical examination was done and relevant investigations were done for each patient. In this study, Nurick grading and VAS scale were used for evaluation of the result. Result: Male gender was predominant in this study; male-female ratio was 2.63:1. Mean age of the patients was 45.9 ± 9.1 years within the range of 30-65 years. Both sides were affected in 14 (35.0%) cases, only right side was affected in 15 (37.5%) cases and only left side was affected in 11 (27.5%) cases. Involved disc spaces were C3/4 (10.0%), C4/5 (22.5%), C5/6 (42.5%) and C6/7 (25.0%). Transientdysphagia was observed in 2 (5.0%), transient para paresis in 1 (2.5.0%), wound infection in 1(2.5.0%) case and damage to the dura was observed in 1 (2.5.0%) case. Signs of fusion were observed in 10 (25.0%) cases after 3 months, 30 (75.0%) cases after 6 months and in all patients after 12months. The result was found to be excellent in 35 (87.5%) and good in 5 (12.5%) cases. Conclusion: Anterior cervical discectomy and fusion by cervical cage with bone graft is an effective procedure for management of CSM.
Backgroud: Calcaneum is the most commonly fractured tarsal bone. Approximately 75% are intra-articular fractures. Controversy continues regarding the management of calcaneal fractures. Earlier conservative management was preferred and surgical management considered inappropriate for these fractures. This trend is gradually changing with better understanding of disabling nature of injuries in combination with improved implant and routine use of intra-operative imaging. Closed treatment with cast invariably leads to long-term complications. However, still clinical evidence supporting operative treatment is limited and complications are frequently documented. Objectives: To evaluate the functional outcome of intraarticular fractures of calcaneum in terms of American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale (VAS) score. Methods: This study was a retrospective analytic study. The study was conducted in the Department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Nepal. Data collection and analysis of patients operated from July 2017 to June 2019 was done. Twenty six cases that fulfilled inclusion criteria were analysed. Results: Average age of the patients was 32 years. Sanders type 2B was the most common fracture pattern. There was significant improvement in Bohler angle (25.1°), calcaneal height (4.3cm) and width (3.9cm). Average AOFAS score and VAS score at final follow up were 81.4 and 7.9 respectively. Conclusion: Open reduction and internal fixation with plate is associated with good clinical and functional outcome in Sander type II and III fractures. With good surgical techniques, improved implant and proper use of fluoroscopy, proper restoration of Bohler angle, calcaneal height and width can be achieved.
<p>The aim of this study is to evaluate balloon kyphoplasty as a surgical option for osteoporotic thoracolumbar compression fracture. The study was conducted on 30 patients from January 2014 to December 2017. The anterior vertebral height, kyphotic angle and functional evaluation by Oswestry disability index (ODI) and visual analogue scale (VAS) score were recorded preoperatively, immediate post-operatively at 3, 6, 12 months and yearly then on. All patients showed improvement in mean kyphotic angle from 16.4 ± 3.5 to 5.6 ± 1.7 post-operatively and 8.4 ± 1.6 at final follow-up. There was significant increase in mean anterior vertebral height from 51 ± 7.3% before surgery to 75.5 ± 7.4% at one day after surgery and 71.2 ± 3.2% at the last follow-up. There was significant improvement in mean VAS score from 8.1 ± 0.9 before surgery to 2.2 ± 0.4 at one day, and 2.4 ± 0.3 at final follow-up. The improvement in patients’ ODI score after surgery from 71.4 ± 3.4 to 26.0 ± 4.8 at one day and 21.2 ± 5.5 at final follow-up was noted. The mean operating time was 45.5 ± 15.5 min for each vertebra. Within first day of surgery improvement in pain relief and mobility was experienced by all patients. The orthopedic balloon ruptured in one patient and it was replaced then procedure was continued with no complications. There were no neurological complications in all cases and there was no infections and any occurrence of symptomatic pulmonary embolism. In conclusion, balloon kyphoplasty is a good minimally invasive procedure where along with reduction of pain and disability there is also restoration of sagittal alignment post-operatively.</p>
<p class="Abstract">This study was performed in 21 patients with sacral chordoma from July 2008 to June 2017 and posterior surgical approach was used for resection. Out of 21 patients, 12 had done subtotal sacrectomy and the remaining 9 had done partial sacrectomy. Their follow-up periods were at least five years. Operative time ranged between two to four hours. All patients recovered well from operation and two to five units of blood transfusion were needed for each. After operation, majority of the patients developed some bowel and bladder dysfunction and five patients developed wound infection. During the follow-up, two patients had tumor recurrence and one patient expired two years after operation. The remaining 18 patients were tumor-free at the 5-years follow-up. Wide surgical resection via the posterior midline approach could be a good management plan for the sacral chordoma. However, complete removal with surgical margin varies according to the location of the tumor.</p>
<p class="Abstract">The aim of our study is to evaluate the clinical and functional outcome following lumbar laminoplasty with posterior element reconstruction with mini-plate and screws for multilevel lumbar canal stenosis. This study was done on 40 patients (18 males and 22 females) of degenerative multilevel lumber canal stenosis patients underwent open double door lumbar laminoplasty with posterior element reconstruction with mini-plate and screws from January 2015 to June 2018. Thirty four patients underwent surgery for 2 level involvement and 6 underwent for 3 level involvement of lumbar canal stenosis. The mean post-operative hospital stay was 5.2 ± 1.1 days. Per-operative complication was dural tear in 2 cases. Pre-operative mean VAS score of back pain and leg pain were 7.0 ± 0.7 and 7.2 ± 1.1 which were significantly reduced to 1.0 ± 0.2 and 1.0 ± 0.8 respectively at final follow-up. All patients were followed-up for minimum 1 year. Pre-operative mean Japanese Orthopedic Association score was 8.6 ± 2.2 which was significantly increased to 14.8 ± 0.4 after 12 months of surgery. Pre-operative mean Oswestry Disability Index was 34.4 ± 3.0 which was significantly reduced to 8.5 ± 2.2 after 12 months of surgery. The outcome of lumbar laminoplasty with posterior element reconstruction with mini-plate and screws for multilevel lumbar canal stenosis show good result and can be one of the good option for the treatment for multilevel lumbar canal stenosis.</p>
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