The Outcome of Minimally Invasive Discectomy in Single Level Lumbar Disc Prolapse

Abstract Lumbar disc surgery in carefully selected patients who have failed conservative treatments can significantly improve quality of life. Minimally invasive treatment of lumbar disc herniation has been popularized in recent years. The aim of the study was to assess the outcome of minimal invasive (loupe) discectomy among lumbar disc prolapse patients in Sulaimani. A prospective study carried out in Shar and Sulaimani Teaching hospitals in Sulaimani city for period from 1 st of February, 2013 to end of June, 2014 on sample of 30 patients with single level lumbar disc prolapse admitted to orthopedic units. The data were collected by the researcher through direct interview and filling a prepared questionnaire. The outcome of surgery was evaluated by comparing the symptoms (back pain, leg pain, and leg parathesia) and the muscle power grading (EHL & FHL) of the patients pre-and post-operatively. Mean age of studied patients was 39.1 ± 9.3 years. Males were more than females. Disc prolapse level was L4-L5 among 17 and L5-S1 among 13 patients. Studying the symptoms pre-and post-operatively, revealed significant decrease in leg pain, leg parathesia and back pain post-operatively (p < 0.001). Studying EHL & FHL power grading preand post-operatively, revealed significant increase in muscle power grades 4 and grade 5 postoperatively (p < 0.001). We concluded that minimal invasive discectomy is good and safe treatment option for lumbar disc prolapse

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries