Transpedicular Decompression And Spinal Fixation In Thoracolumbar Burst Fractures

Objective: To evaluate the results of transpedicular decompression and single stage pedicle screw fixation in burst fractures of thoracolumbar spine. Materials & Methods: This study was carried out at PNS Shifa from Dec 2010 to Jan 2013. All consecutive traumatic burst fractures that underwent surgery were included in the study. Twenty three consecutive patients aged 17 to 57 (mean, 41) years who had burst fractures in the thoracolumbar (n=13) and lumbar (n=10) regions and were surgically treated were included in this study. There were 18 males and 5 females. Fractures were classified according to the AO classification. The extent of spinal canal compromise was assessed by computed tomography, and the neurological status by the modified Frankel grading for traumatic paraplegia. All patients underwent posterior transpedicular decompression and same stage pedicle screw fixation. Outcome was assessed on Frankel grading scale. Results: The extent and level of neurological injury varied. It did not correlate with extent of canal compromise, age and sex of the patient. Neurological injury was greater with T11 and T12 injuries than Lumbar fractures. No worsening of neurological grade was observed after surgery; rather 20 of 23 patients (86.9%) improved to the next higher grade. Screw malposition to the extent warranting readjustment was noted in 2 cases. Hardware failure occurred in 1 case after 6 months, bed sores in 3 cases and deep vein thrombosis in 1 case. Conclusion: Single stage Transpedicular decompression and spinal fixation from a posterior approach gives good results in burst fractures of thoracolumbar spin

Micro-endoscopic Disectomy: Early Experience and Results

Objective: This prospective study was conducted to assess results and experience with microscopic endoscopic disectomy (MED).Study Design: This is a prospective study carried out at PNS Shifa, which is a tertiary care hospital, from July 2011 to June 2012.Methods: Thirty eight patients underwent surgery in which the MED system was used; all procedures were performed under general anesthesia. All patients were followed prospectively. MED system used in this study consisted of tubular retractors and an endoscope with xenon light source and HD image system by Karl Storz co. Germany. Outcomes were measured using Macnab criteria.Results: Thirty eight patients (27 males, 11females) underwent MED for prolapsed lumbar intervertebral disc. Mean operating time was 80 minutes. Follow up ranged from 3 to 12 months with a mean follow up 7.8 months. Thirty two patients had an excellent outcome while three had a good outcome. Three patients had a poor outcome. One patient with a big dural tear required conversion to a standard microdiscectomy and was excluded from outcome assessment. Three complications were noted and were all related to dural tears.Conclusions: Minimally invasive surgery using MED is clinically effective and reliable. Patient satisfaction is high and complications rates are comparable with those associated with traditional microdiscectomy procedures.Abbreviations: MED: Microendoscopic discectomy, HD: High Definition

Clinical parameters and treatment outcome in patients of acromegaly: A retrospective analysis of 51 patients

The aim of the study was to analyze the pattern of clinical presentation and management outcome in patients of acromegaly. It is a cross-sectional study based on the clinical records of 51 patients of Acromegaly. All the recorded clinical data was analyzed to see the pattern of clinical presentation and management outcome. IBM SPSS statistics version 22 was used for statistical analysis. The median age was 32 years. Twenty seven patients underwent surgery and 6 (22.2%) achieved remission. With pharmacological management, 35.8% patients achieved control of the disease with Octreotide LAR and 7.1% with cabergoline. Eighteen patients were treated with External Beam Radiation (EBR) and Stereotactic Radiosurgery (SRS). Remission rate has been 88.9% with SRS and 33.3% with EBR. The study shows higher prevalence of Growth Hormone (GH) secreting tumour in younger people and men. Remission rate was highest in patients treated with radiotherapy after partial response to TSS. Keywords: Acromegaly, trans-sphenoidal surgery, radiotherapy, Octreotide. Continuous..