An experience with soft transforaminal lumbar interbody fusion in postoperative discitis not responding to conservative treatment.

OBJECTIVE: To determine the effect of soft Transforaminal Interbody Lumbar Interbody Fusion (sTLIF) in postoperative discitis not responding to conservative treatment. METHODS: This cross-sectional study was conducted in Department of Spine Surgery, CMH Rawalpindi from August 2016 to July 2019. Patients who underwent discectomy were observed and those presenting with postoperative discitis were included in the study. Pain was noted on visual analogue scale before and after the intervention and differences in two readings were noted. Data was collected on predesigned proforma. Statistical analysis was done on SPSS 20.0. RESULTS: Mean age of these patients was 45±12.34 years. The mean pain score on VAS before treatment was 8.33±0.65 and after treatment was 2±0.95. There was statistically significant reduction in pre-treatment and post-treatment pain on VAS (p=0.000). CONCLUSIONS: Postoperative discitis is present among a small number of patients after spine surgery and pain is significantly reduced after the treatment of discitis with TLIF.

Calvarial remodelling surgery: Neurosurgical experience of multidisciplinary craniofacial reconstruction.

OBJECTIVE: To evaluate the safety, cosmetic and functional outcome of craniofacial reconstruction surgery for primary craniosynostosis and clefts. METHODS: This quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi, Pakistan, from June 2011 to December 2014, and comprised paediatric patients undergoing calvarial reconstructive procedures. Fronto-orbital advancement and reconstruction, total calvarial remodelling and box flap reconstruction techniques were used. Parameters recorded were anomaly, procedure, hospital and intensive care unit stay, theatre time, blood transfusion, dural tears, mortality, wound infection, haematoma/seroma, dehiscence, seizures and cosmetic acceptance. Data was analysed using SPSS 17. RESULTS: Of the 45 patients, 24(53.3%) were boys and 21(46.7%) were girls with an overall mean age of 14.1±21.95 months. Besides, 36(80%) patients were operated for craniosynostosis and 9(20%) for tessier clefts. Surgical techniques of Fronto-orbital advancement and reconstruction, total calvarial remodelling and box flap were used on 18(40%), 18(40%) and 9(20%) patients, respectively. The mean theatre time was 315.33±74.67 minutes (range: 240-390minutes). The mean blood transfusion was 313.34±135.84ml (range: 200-600ml). Major wound infection was seen in 1(2.2%) patient and minor wound infection occurred in 6(13.3%) cases. Post-operative seizures were seen in 1(2.2%). Improved appearance and stable head growth were seen in 41(91.1%) patients. Only 1(2.2%) patient did not survive the procedure. CONCLUSIONS: Early detection of craniosynostosis, neurological assessment, radiological evaluation, differentiating between primary and secondary craniosynostosis and multidisciplinary treatment of craniofacial reconstruction led to optimal treatment.

Financial cost to institutions on patients waiting for gall bladder disease surgery.

BACKGROUND: The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. METHODS: This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. RESULTS: A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. CONCLUSION: Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.