Outcome of Transforaminal Endoscopic Discectomy in Rural India in a Single-Level Lumbar Disc Prolapse Under Local Anesthesia.

Aim The aim of this study was to undertake a clinical study to evaluate the outcomes of transforaminal endoscopic discectomy under local anesthesia and to study the complication rate. Study Design It is a prospective study. Methods We prospectively analyzed outcomes of 60 patients with a single-level lumbar disc prolapse in rural India from December 2018 to April 2020 who underwent endoscopic discectomy under local anesthesia. Follow-up was done using the visual analogue score (VAS) and Oswestry Disability Index (ODI) scoring systems with a minimum follow-up up to 1 year postoperatively. Results In our study of 60 patients, there was 38 cases of L4-L5 disc pathology, 13 L5-S1 discs, and 9 L3-L4 discs. Our study showed a significant clinical reduction in mean VAS score that was 7.07/10 preoperatively and reduced to 3.88/10 at the third month and 3.64/10 at 1 year of follow-up ( p -value < 0.05) showing clinical significance. The ODI scoring done preoperatively was an average mean of 57.37% pointing to how crippled the patients were with lumbar disc prolapse and showed a significant reduction to 29.32% postoperatively at 1 year ( p -value < 0.05) showing clinical significance. This reduction in ODI directly corelates to how almost all patients returned to normal life coping to all activities and were completely pain free at 1 year of follow-up. Conclusion Endoscopic spine surgery in lumbar disc prolapse is highly effective and can deliver a good functional outcome if done with correct preoperative planning and approach.

Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral body compression fractures: clinical and radiological outcomes.

BACKGROUND CONTEXT: Osteoporotic vertebral body compression fracture are the commonest fractures amongst the other osteoporotic fracture sites. These fragility fractures are the result of low energy mechanical forces that that would not ordinarily result in fracture. Percutaneous vertebroplasty and balloon kyphoplasty has been widely used as minimally invasive procedures to treat painful vertebral compression fractures. PURPOSE: Aim of the present study was to evaluate radiological, clinical and functional outcome of patients with osteoporotic vertebral body fractures treated with Balloon Kyphoplasty and Vertebroplasty. STUDY DESIGN: Prospective cohort study PATIENT SAMPLE: 40 patients (Male:15, Female: 25) with average age of 56 +/- 8 years diagnosed with osteoporotic vertebral body compression fracture on clinical and radiological evaluation with no neurological deficit and no other associated fractures were included. OUTCOME MEASURES: Operative time, cost for the procedure, gain in vertebral body height, reduction in pain, ability to perform daily routine activities, risk of cement leakage and any other systemic complications were evaluated and compared in both the study groups. METHODS: All the patients underwent conventional Xray, MRI (to rule out acute from chronic fracture, to check compromise of spinal canal and calculate collapse in vertebral body height), Visual analog scaling for severity of pain and difficulty in daily routine activities by Oswestry disability index preoperatively. Post operative clinal, functional, radiological outcome and complications were compared in patients treated with percutaneous vertebroplasty and balloon kyphoplasty. RESULT: There was significant difference in intraoperative time period and procedure cost for the patients treated with Vertebroplasty(50.75min, 25k) in comparison to balloon kyphoplasty (71.95, 50k) with p value being < .001 There was significant difference between preoperative and postoperative study parameters in both the study groups but there was no significant difference in post operative study parameters amongst both the study groups with p values >.05 for different parameters, 0.381(Gain in vertebral height), 0.108 (pain relief), 0.846(Oswestry disability index) and 0.197(risk of cement leakage) CONCLUSION: Our study suggested that percutaneous vertebroplasty requires less operative time and is more economical than balloon kyphoplasty. Increase in intraoperative time increases the risk of infection. Though the cases of Intraoperative operative cement leakage were more in percutaneous vertebroplasty but is was not significant. However the final radiological, clinical, functional outcome and overall complications were found to be similar in both the groups. Balloon kyphoplasty provided no added benefit over percutaneous vertebroplasty. A study with larger sample size will be needed to warrant one surgical procedure superior to other in the treatment of osteoporotic vertebral body compression fracture.

Transradial, Transscaphoid, Transcapitate, Perilunate Dislocation; A Case Report and Approach to the Patient.

Carpal injuries are uncommon and are mainly seen in the younger age group. The incidence is unclear as many of the cases go undiagnosed. A 22-year-old male patient coming to the hospital after road traffic accidentwith head, face and left wrist injury. After immediate primary management the patient was taken up for a definitive procedure 4 days after the injury. Scaphoid fracture was fixed with the help of Herbert's screw via the dorsal approach. The base of the first metacarpal was fixed with the help of JESS fixator and the distal end radius was fixed with the help of K-wires.  The scapholunate and lunato triquetral ligaments were repaired. The whole construct was stabilized with the help of an external fixator. Postoperative period was uneventful. The external fixator was removed after 4 weeks and patient had a good functional outcome with the patient related wrist evaluation score coming out to be 11 at the end of the third month. This uncommon case of Transradial, Trans scaphoid, transcapitate, and perilunate dislocation was managed successfully with no postoperative complications and a good functional outcome.