Surgery versus conservative management for lumbar disc herniation with radiculopathy: A systematic review and meta-analysis

Introduction: Lumbar Disk Herniation with Radiculopathy (LDHR) appears to be a large and costly problem. The paradigm regarding the best treatment for LDHR has being between surgery and conservative management. The aim of this study was to compare and summarize evidence regarding the effectiveness of surgery and conservative treatment for individuals with sciatica due to lumbar disc herniation. Methods: This study reviewed all literatures published on individuals with LDHR, who were managed either via surgery or conservative method. Pain and functional disability were the main outcome measures analyzed. A comprehensive search of PubMed, TRIP, PEDro and CINAHL was conducted from October, 2011 to June 2017. Two independent researchers selected the studies, and extracted the data. Methodological quality was assessed using the PEDro scale. Meta-analysis was carried out where suitable. Results: Eight studies involving (n=1,507) were included in the review. Meta-analysis was conducted for only 4 studies (n=784). The meta-analysis showed significant benefit for early surgery than conservative care -8.01(95% CI, -9.27 to -6.72) in the short-term effect -0.49 (95% CI, -0.7 to -0.28). However, the result for long-term effect did not show any significant difference between surgery and conservative care 1.60 (95% CI, -6.85 to 10.05). Conclusion: This current evidence suggest that early surgery for individuals with lumbar disc herniation with radiculopathy is better than conservative care in the short-term without any long-term difference. The results of this review should be interpreted with caution as the populations of the included studies were largely heterogeneous

Extadigits: an unusual presentation

Extra digit is a common congenital anomaly in our environment which usually affect the hands and occasionally the feet but very rarely both. A five months old male infant presented with accessory digits of the both hands and feet, with two extra digits on the left hand and one on the right hand, right foot and left foot. The extra digits were well developed, with normal range of motion, good capillary refill and intact sensation. General examination revealed an otherwise healthy child with no associated congenital malformations. The treatment modality used was surgical removal of the extra digits and reconstruction of any associated anomalies in the remaining ray such as longitudinal epiphyseal bracket. After the surgery the patients is no longer experience difficulty with fitting gloves and shoes as well as discrimination among peer groups in his future life

MANAGEMENT OF SEVERE KNEE FLEXION CONTRACTURES IN A CHILD WITH ARTHROGRYPOSIS MULTIPLEX CONGENITA

Arthrogryposis multiplex congenita is a syndrome characterized by the presence of congenital contractures involving multiple joints usually with flexion deformities, with or without pterygia or webbing at the joints. The aim of this case report was to highlight the challenges of management of severe knee contractures in AMC and possible solutions in a resource limited setting like ours. We presented a one-year-old child with bilateral severe knee contractures secondary to arthrogryposes. The involvement of knee is present in about 70% of cases with arthrogryposis, with flexion deformity more common than extension deformity. Knee flexion contractures, as seen in our patient, is one of the most disabling deformities. The surgical option adopted in the case presentedwere met with various challenges including abnormal muscles insertions, shortening and fibosis of the muscles, abnormal position and shortening of the neurovascular structures in the popliteal fossa

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population