Management for failed back surgery syndrome: three-in-one procedure versus percutaneous spinal fixation alone

Objectives: To evaluate the short-term outcome of a 3-in-1 procedure including percutaneous facet radiofrequency, percutaneous spinal fixation and steroid with hyaluronidase enzyme injection versus percutaneous spinal fixation alone for cases with failed back surgery syndrome (FBSS).Patients and methods: The study included 50 patients who had had previous spinal surgery since a mean duration of 39.7 ± 8.5 months and developed recurrent back pain since a mean duration of 10 ± 2.1 months. Patients were randomly allocated into two groups; group A underwent percutaneous spinal fixation only and group B underwent the 3-in-1 procedure. Outcome was evaluated at the end of six months postoperatively (PO) using a pain numeric rating scale (NRS), the Oswestry Disability Index (ODI) and Odom’s criteria for evaluation of surgical outcome with evaluation of patients’ satisfaction by outcome.Results: All patients showed progressive decrease of NRS pain and ODI scores compared with preoperative scores. However, patients in group B showed significantly lower postoperative NRS pain scores and ODI with significantly higher frequency of patients having had > 50% reduction of both scores compared with patients in group A. PO analgesic consumption rate in both groups was significantly lower than the preoperative rate with a significant reduction of mean total scoring compared with preoperative scoring. The frequency of patients who found the provided therapeutic procedure satisfactory and its outcome good-to excellent was significantly higher among patients in group B compared with group A.Conclusion: Short-term outcomes of the applied 3-in-1 procedure are promising for improvement of symptoms secondary to FBSS and may ultimately prove to be recommended as the therapeutic modality for such a challenging clinical problem.Keywords: failed spinal surgery, percutaneous facet radiofrequency, percutaneous spinal fixatio

Les Effets d’implémentation des ERP sur l’évolution des pratiques du Contrôle de Gestion : Etat de l’art et perspectives

Depuis le début des années 1990, nombreuses entreprises ont adopté des systèmes ERP pour assurer une gestion intégrale de leurs activités. Ces systèmes impliquent des transformations organisationnelles et technologiques conséquentes qui doivent être prises en considération.Force est de constaté que le thème des ERP est encore peu étudié dans le contexte marocain, les recherches concernant leur impact organisationnel sont encore en nombre très limité ; très rares sont les études qui s’intéressent à l’impact des ERP sur la fonction contrôle de gestion.Partant de ce constant, il nous semble intéressant de présenter dans cet article un état des lieux de la littérature afin de combler le vide à la fois théorique et « informationnel » sur l’influence des ERP sur la fonction contrôle de gestion. Le but étant d’en fournir des balises de repérage en déterminant les courants de recherche et en tirant des enseignements pour des travaux futurs

Performance of Zaraibi and Damascus lactating does fed high and low energy rations

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Immediate post-discectomy percutaneous facet nerve continuous and nerve root pulsed radiofrequency and intraluminal injection of steroid with hyaluronidase improved outcome of surgery for lumbar disk herniation

Objectives: Evaluation of effects of postoperative (PO) facet nerve continuous thermal radiofrequency neurotomy (CTRFN), nerve root pulsed RF (PRF) and triamcinolone with hyaluronidase injection on outcome of patients undergoing open lumber discectomy. Patients & methods: Seventy patients were allocated into the following groups: Group S underwent open discectomy alone and Group M underwent open discectomy followed by the three adjuvant procedures. Low back pain (LBP) severity was assessed using numeric rating scale (NRS) and disability was assessed using the Oswestry Disability Index (ODI). Primary outcome measure was at least 50% improvement of NRS and ODI. Secondary outcome involved scoring of pain medication requirements, Odom's criteria for improvement of preoperative abnormal findings and patients' satisfaction. Results: Throughout 12-m follow-up, mean NRS and ODI scores of all patients were significantly lower than preoperative scores with significantly lower scores in group M than in group S. Frequency of patients had ⩾50% improvement which was significantly higher in group M than in group S. Patients of both groups showed significant reduction of scoring of consumed analgesics with significantly less consumption of PO analgesics in group M than in group S. Odom's scoring, resumption of activity and overall satisfaction scoring were significantly higher in group M than in group S. Conclusion: Open discectomy provided significant improvement of LBP and disability secondary to LDH. Discectomy with adjuvant therapy including PRF, CTRFN and triamcinolone and hyaluronidase intraluminar injection significantly improved outcome compared to discectomy alone