Autologous Bone Graft vs PEEK Cage in Patients with Cervical Spondylotic Myelopathy

Background:  Cervical spine stenosis is one of the most common degenerative changes of cervical spondylotic myelopathy (CSM) and results in severe dysfunction of the cervical spinal cord. The conventional treatment of such degenerative cervical spine conditions is anterior cervical discectomy and fusion (ACDF). Strut graft remains the gold standard in ACDF with excellent patient recovery but has many shortcomings. Polyetheretherketone (PEEK) cages have recently become popular as a replacement for strut grafts in patients undergoing ACDF. Objective:  This study was carried out to compare the clinical and radiographic outcomes of autologous bone grafts versus PEEK cages in patients undergoing ACDF surgery. Materials and Methods:  It was a randomized controlled trial conducted at the Neurosurgery Department Punjab Institute of Neurosciences for three years. Patients who consented to be a part of this study and fulfilled our predefined inclusion criteria were recruited and randomized into 2 groups. One group underwent ACDF with auto bone graft whereas the other group underwent ACDF with PEEK cage. Results:  A total of 198 subjects were included in this study. The mean age was calculated as 47.60 ± 9.17 years in the PEEK cage group and 46.74 ± 8.87 years in the Autologous bone graft group. Males accounted for 59.6% of the study population.  The fusion rate was found to be higher in the PEEK cage group with a p-value of 0.002. Conclusion:  PEEK cages are superior to strut grafts as they have lesser morbidity after ACDF surgery in patients with CSM. &nbsp

Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease and Risk of Adjacent Segment Disease

Objective:  To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results:  The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion:  Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome

Outcome of Lateral Mass Fixation and Fusion – A Comprehensive Analytical Study of 205 Lateral Mass Screws in 35 Patients at Punjab Institute of Neurosciences

Objective: To see outcome, accuracy and expected complications in passing lateral mass screws in patients with cervical spine injury, degenerative disease at the cervical spine level and neoplastic lesions.Materials and Methods: In this study, 35 patients were included and 205 screws passed in lateral mass patients’age ranged from 12-70 years (25 males and 10 females) with trauma to the cervical spine, degenerative disease at the cervical spine level and Intradural extramedullary benigntumors and extradural malignant neoplasm.Patients less than 12 years and more than 65 years of age,patients with traumatic ruptured disc causingspinal cord compression anteriorly and operated for cervical spine were excluded from our study.In all patients,we did lateral mass fixation with polyaxial screws and rods under fluoroscopic assistance.For assessment of screws trajectory and position, CT scan cervical spine with 3D reconstruction was performed on a first post op day to confirm screw orientation and direction and for fascet, foraminal, foramen transversarium violations.Results: All screws were passed by using Megrel’s trajectories. Not a single patient had nerve root, cord injury nor vertebral artery injury. One patient had screw pullouts requiring reoperation.12 to 14mm size screws were used under fluoro guidance. On postoperative CT cervical spine with 3D reconstruction shows no breach or violations of any foramen transversarium, nerve root injury or neural foramen penetration by screws. In all patients polyaxial screw/rod construct was used. Conclusion: Cervical spine lateral mass fixation with polyaxial screws is a safe and effective technique in expert hands under fluoroscopic assistance

Language and Visual Deficits after Parietal Lobe Glioma Microsurgery

Objective: To see language and visual field outcome after high grade glioma excision of parietal lobe area.Study Design: It was observational experimental study.Setting: Department of neurosurgery unit 1, Lahore General Hospital, Lahore.Duration: Three years from March 2015 to April 2018.Inclusion Criteria: Both male and female of 13 to 56 yrs of age having intrinsic tumours in left or right parietal lobe area with midline shift, seizure and headache.Exclusion Criteria: Butterfly glioma, gliomatosis cerebri, lymphoma suspected on MRI brain, patient unfit for anaesthesia and surgery. The patients on anticoagulants and with bleeding disorder were also excluded from the surgery. The patients with chronic systemil ailment like renal failure, liver failure and ischemic heart disease were also excluded from the study.Material and Methods: Two hundred and forty one (241) patients were included in the study. All patients were prepared for the surgery and informed consent obtained from all patients. All patients under went microsurgical excision of the tumours and followed for 3 months. But forty patients lost to follow-up in three months.Results: Maximum tumor resection was attempted up to 99 percent. Median age was 47 years (13 – 56 years) and kernofsky performance scale was 75 percent at presentation. Most common presentation was seizure 76 percent, only 3.5 percent presented with parietal lobe syndromes. The most common deficit was language disturbance, which was also noticed in patients with right parietal lobe gliomas. Parietal lobe gliomas produce language and visual deficits in addition to other neurological dysfunction.Recommendations: Result can be improved by preoperative better localization with diffusion tensor tractography and peroperative cortical mapping.Conclusions: Microsurgical resection would increase language and visual deficits in tumors located on supramarginal and angular gyri which are reduced in postoperative period and become fixed in three months