Revision Lumbar Spine Surgeries: An Early Career Neurosurgery Experience.

BACKGROUND: The aims and ambitions of a surgeon in the early years of his professional career are to make a good reputation by providing excellent patient outcomes and avoiding complex and difficult surgeries. Revision lumbar spine surgeries (RLSSs) pose a significant challenge in terms of surgical management, as the moribund anatomy increases the risk of complications, adding to an unlikely outcome. OBJECTIVE: We conducted this study to determine the clinical indications and outcomes of RLSSs performed by an early career neurosurgeon. MATERIALS AND METHODS: This cross-sectional study was conducted after approval from the hospital's ethical committee, and data was collected in late December of 2022 and early January 2023, from retrospective records for a single early career neurosurgeon. A form was filled with each patient's data, such as age, gender, time since surgery, indication for surgery, operative findings, types of surgery performed, etc. All variables were noted for the patient and were further categorized, based on the clinical records, into many sub-categories. RESULTS: Almost 400 lumbar spine surgeries were performed by the surgeon, and about 45 (11.25%) were revision surgeries, and the full record was available for 42 surgeries. These patients' ages ranged from 22 to 70 years, and the mean age was about 46.74±13.29 SD. The common symptoms leading to revision surgeries were numbness and pain in 17 (40.5%) patients each; common per-operative findings were recurrent disc in eight patients (19%), infection in nine patients (21.4%), and fibrosis/adhesions in 16 (38.1%); most common surgeries performed were diskectomy in 11 (26.2%) and diskectomy plus release of adhesions in 12 (28.6%); complications occurred in 14 (33%), and good to excellent outcomes was recorded in 29 (69%) cases.  Conclusion: RLSSs are difficult compared to first-time lumbar spine surgeries, and the moribund anatomy predisposes to complications, and better shall be dealt with great care and, at the minimum, shall be embarked upon as a team.

Unusual Local Therapies Used for the Treatment of Low Back Pain and Sciatica: Concepts and Approaches.

Background and objective Low back pain (LBP) and sciatica are major healthcare issues globally. Since patients may seek various ways to cure their ailments, these conditions are managed not just by physicians, but many other health-related professionals provide alternative treatment options for it as well. We conducted this study to examine a local subset of patients who used stabbing their back and legs as a treatment option for curing LBP and sciatica. Materials and methods This cross-sectional study was conducted in the outpatient clinic of the Neurosurgery unit of Government Naseer Ullah Babar Memorial Hospital, Peshawar, Pakistan, from July 2019 to March 2020. Patients who presented to the outpatient department (OPD) with complaints of LBP with or without sciatica, with a history of invasive therapy in the form of stabbing the back or leg, or drawing blood from the veins of the lower limbs, were included. All other patients with LBP seeking neurosurgical advice were excluded from the study. The study was approved by the management of the hospital and informed consent was obtained from the patients before interviewing them. Special permission was taken for publishing the photographs. The demographics and clinical information related to patients, such as age, gender, duration of symptoms, time since the local therapy, particulars of the treatment provider, any relief experienced by the patient, duration of relief, the patient beliefs/notions about the therapy and disease, and education level of the patients, were recorded on a predesigned form after taking informed consent. The study was done on purposive sampling. The data was presented in tables and charts and was analyzed using SPSS Statistics version 20 (IBM, Armonk, NY). Results During the study period, more than 8,000 patients visited the neurosurgical OPD, and the majority of them (>70%) sought treatment for LBP and sciatica. Of them, around 130 patients had a history of undergoing some alternative therapy that is not scientifically proven, and it was either in the form of stabbing the back or drawing blood from the veins in the lower limbs. Amongst these patients, almost 80% were males and 20% were females who had undergone this kind of treatment. The age range among the cohort was 25-68 years and the mean age was around 43 years. The duration of symptoms ranged from two months to nine years, and the time since the therapy and patient seeking medical advice ranged from three months to 4.5 years. The treatment had been provided by a local individual who did not hold any medical degree according to the patients in 100% (n=130) of the cases; 67% of patients felt they had experienced some relief from the therapy for a short period, which ranged from three days to one month. About the condition, none of the patients seeking the therapy knew it was nerve-related and were often confused about the term rugg (vessel in the native language) but could not differentiate it from the nerve. Of these patients, 76 required surgery while 54 were managed conservatively for LBP and sciatica. Conclusion A subset of the local population in our part of the world used stabbing the back and leg as a form of therapy for treating the problems of the lower back and sciatica. This has not been previously reported and has no scientific basis. Also, the majority of the patients were uneducated and had very little knowledge of the disease, and the treatment provider was a non-health-related professional.

Duration of In-hospital Stay for Elective Neurosurgical Procedures in a Tertiary Care Hospital.

OBJECTIVE: Public hospitals have fixed days with allotted time slots during which to perform neurosurgical elective cases. If emergency operations or other events preempt these scheduled time slots, the patient remains hospitalized, waiting in queue for a new time slot. We conducted this study to determine the number of days patients remained admitted waiting for elective cases in a tertiary care public hospital, which operates on fixed days. MATERIALS AND METHODS: This cross-sectional study was conducted in the Department of Neurosurgery Unit B, Medical Teaching Institution (MTI) - Lady Reading Hospital (LRH), Peshawar. We reviewed the admission charts and discharge slips of all patients who were admitted and underwent operations between September 2018 and August 2019. A form was made and was completed with each patients' records like age, gender, number of days spent preoperatively and postoperatively and the total duration of stay, indication for surgery (spinal, cranial, peripheral nerve), etc. Patients who had undergone elective neurosurgical procedures were included while those who had undergone emergency surgeries or had expired during the hospital stay, had been discharged or referred to other centers were excluded from the study. All the data were entered into the statistical software SPSS version 22 (IBM Corp., Armonk, NY) and were converted into tables and charts. RESULTS: A total of 1818 patients were admitted/discharged during the study period, and of them, 823 patients were admitted for elective neurosurgical procedures. There were 601 (73.7%) males and 222 (26.3%) females with a male to female ratio of approximately 3:1. The age range was from 09 days to 72 years and was further subdivided into six groups. The procedures were broadly divided into cranial, spinal, related to hydrocephalus (HCP)-related, and miscellaneous. Cranial procedures comprised of surgeries for brain tumors, transsphenoidal operations, vascular procedures for aneurysms, and nerve decompressions, and they comprised about 29.43% (n=244) while spinal procedures accounted for 317 (36.63%) procedures, the rest were related to HCP and miscellaneous. Preoperative and postoperative stay durations were calculated and then added to determine the total stay durations and were further stratified for the specific procedures and categorized into days and weeks. About 58.26% (n=143) of cranial cases, and 156 (49.36%) of spinal cases, 37.57% (n=65) of HCP-related cases, and 36.66% (n=41) of cases in the miscellaneous group had a duration of stay between eight days to more than three weeks.

Early Complications of Ventriculoperitoneal Shunt in Pediatric Patients With Hydrocephalus.

Objective Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for the treatment of hydrocephalus (HDC), especially in children. However, this is prone to many complications, and requires repeated surgeries, which as such increases the morbidity of the patients. It is estimated that majority of the complications occurs in the immediate post-operative period and the rate of complications decreases over the time, with no impunity to these, though. We conducted this study to know about the complications of VPS in the early post-operative period, in pediatric patients with hydrocephalus. Materials and methods This descriptive study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, between June 2019 and January 2020 (seven months). All patients with hydrocephalus below 12 years of age, operated for the first time were included after taking an informed consent, while those with repeated shunt procedures and elderly patients requiring shunt were excluded from the study. Patients' details like age, gender, location, contact number, cause of hydrocephalus, date of shunt placement, type of surgery (elective or emergency) and any follow-up complications like failure, erosion, infections, ileus were noted on a predesigned proforma. After the surgery, patients were followed for a period of one month, and contacted either through the telephone or asked to visit in the outpatients on the specified days, and were evaluated for any shunt-related complications, and any of these complications suspected were further evaluated and noted. The data was analyzed using the statistical program SPSS version 19 (IBM Corp., Armonk, NY). Results are presented in the form of charts, tables and graph. Results During the study period, we evaluated a total of 151 patients; there were 78 (51.65%) males and 73 (48.34%) females with a male to female ratio approaching 1.1:1. The age range was from 22 days to 12 years. The mean age was 38.46 ± 7.53 months. The primary indications for the insertion of VP shunt were: congenital hydrocephalus in 70 (46.4%), post infectious hydrocephalus in 57 (37.7%), hydrocephalus due to tumor in 22 (14.6%), and post traumatic hydrocephalus in two (1.4%) patients. Among the total number of patients, 85 patients (55.6%) were done as elective cases and 66 patients (44.4%) were done as emergency cases. Complications were encountered in 30 patients (19.87%) during the follow-up of 30 days. Complications occurred between day 1 and day 20 of follow-up with a mean of 9.10 ± 1.69 2SD days. Conclusion VP shunt is the most widely used treatment for HDC, but is predisposed to complications and almost every fifth case of VP shunt comes across with complications. Shunt blockage, infections and abdominal wound-related complications are common earlier complications in pediatric patients with hydrocephalus.

Klippel-Feil Syndrome With Auxiliary Anterior Cervical Meningomyelocele and Thoracic Syringomyelia: A Case Report.

STUDY DESIGN: Case report. OBJECTIVE: Since this is the first ever case of a male patient with Klippel-Feil syndrome (KFS) with anterior cervical meningomyelocele and syringomyelia. All four previously reported cases were female patients. This makes this case unique. SUMMARY OF BACKGROUND DATA: KFS with auxiliary anterior cervical meningomyelocele is a rare entity. To the best of our knowledge so far only four cases are reported. METHODS: A 22-year-old male patient was presented to neurology outpatient department with 2-year history of left hand paresthesia and progressive weakness. The diagnostic evaluation showed KFS with auxiliary anterior cervical meningomyelocele and thoracic syringomyelia. RESULTS: Patient was sent to neurosurgery department for intervention. After discussing the possible risks and complications of intervention he opted for conservative therapy and declined the surgery. CONCLUSION: The paucity of data is the key reason for any recommended protocol for management of such patients but the available literature recommends neurosurgical intervention in symptomatic patients. LEVEL OF EVIDENCE: 5.

Bathing and cleaning practices in the camp of Jalozai Pakistan, for internally displaced people, based on Sphere Standards and Indicators.

OBJECTIVES: To evaluate the bathing and cleaning practice, based on Sphere Standards and Indicators, of internally displaced people in the camp of Jalozai, Pakistan. METHODS: This descriptive cross sectional survey was done in displaced population of Jalozai camp Nowshera from February to September 2010. Systematic Random Sampling was done (10% of Phase II Population). Study unit was a single family residing in the camp. A customized structured questionnaire was administered to households and information as recorded by the researchers. Informed consent and confidentiality was maintained while interviewing the household. RESULTS: Although 97% (n=111) families were using soap for bathing but surprisingly none of them were on required Sphere Standards. Similarly 93% (n=107) were using laundry soaps and 49% (n=56) were using washing powder but again were not fulfilling the standards. It was discovered based on our survey that 64% (n=71) displaced people were not using anything for cleaning their children and none were using washable nappies. It was also observed that 99% (n=114) were using toothpastes and other local means for dental hygiene. Less than 10 toothpastes/year were provided to 79% families while 21% (n=24) were not provided at all. CONCLUSION: Our survey population was not on required SPHERE standards for sufficient bathing and laundry soap and they had no access to sufficient amount of toothbrush and toothpaste. Children were not provided with washable nappies or diapers.