Neurological improvement after cervical traction in patients with cervical spine injury

To estimate frequency of neurological improvement after cervical traction in patients with cervical spine injury. This observational study was conducted at Department of Neurosurgery, Lady Reading Hospital, Peshawar - Pakistan from December 2010 to November 2011. The medical record of all cases, in which cervical traction was applied for cervical spine injury, was checked from record room. Documentation was done according to proforma designed, indicating age, sex, neurological status before and after cervical traction and investigations with findings on X-rays, CT and MRI. The data was analyzed from different angles in SPSS software. A total of 30 patients were included in this study. There were 20 males and 10 females. The age of the patients ranged from 13 to 80 years [mean= 31.07 +/- 15.45]. Majority of the patients [83.3%] were young, in the age range of 13- 40 years. Neurological improvement was noted in 14 [46.7%] patients. It was more in age group of 13-20 years [66.7%] and in those who presented with weakness of Frankle grade "B" and "C" [66.7% each]. The improvement was more in patients in whom anatomical alignment of spine was achieved. Skeletal cervical traction is safe and effective means of early decompression of spinal cord with neurological improvement. It is more effective in young individuals and those presenting with Frankle grade B and C weakness

Unilateral approach for bilateral decompression of lumbar spinal stenosis: a minimal invasive surgery

To assess the feasibility and efficacy of a novel, minimally invasive spinal surgery technique for the correction of lumbar spinal stenosis involving unilateral approach for bilateral decompression. Cross-sectional observational study. Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from January to December 2010. A total of 60 patients with lumbar stenosis were randomly assigned to undergo either a conventional laminectomy [30 patients, Group A], or a unilateral approach [30 patients, Group B]. Clinical outcomes was measured using the scale of Finneson and Cooper. All the data was collected by using a proforma and different parameters were assessed for a minimum follow-up period of three months. Data was analyzed by descriptive statistics using SPSS software version 17. Adequate decompression was achieved in all patients. Compared with patients in the conventional laminectomy group, patients who received the novel procedure [unilateral approach] had a reduced mean duration of hospital stay, a faster recovery rate and majority of the patients [88.33%] had an excellent to fair operative result according to the Finneson and Cooper scale. Five major complications occurred in all patient groups, 2 patients had unintended dural rent and 2 wound dehiscence each and fifth patient had worsening of symptoms. There was no mortality in the series. The ultimate goal of the unilateral approach to treat lumbar spinal stenosis is to achieve adequate decompression of the neural elements. An additional benefit of a minimally invasive approach is adequate preservation of vertebral stability, as it requires only minimal muscle trauma, preservation of supraspinous/intraspinous ligament complex and spinous process, therefore, allows early mobilization. This also shortens the hospital stay, reduces postoperative back pain, and leads to satisfactory outcome.

Frequency of causes of ventriculo-peritoneal shunt failure in hydrocephalus patients

To analyze ventriculo-peritoneal shunt [VP shunt] failure cases in hydrocephalic patients, in a tertiary care hospital. This descriptive study was carried out in the Department of Neurosurgery Lady Reading Hospital Peshawar, from June 2009 to May 2010 [one year].The medical record of all cases operated in last one year was checked from record room. Documentation was done according to proforma designed indicating age, sex, clinical features, investigations with findings on X-rays, CT and MRI and per operative findings. Complications related to upper end, lower end and shunt track were noted. Data was analyzed to assess the causes for shunt failure in hydrocephalus patients. A total of 56 patients were included in this study. There were 43 children and 13 adults. Among children, 26 were males and 17 were females while in adults, 5 were males and 8 were females. Out of these, 28 patients were having blocked shunt, 20 cases with infected shunt, 6 patients had eroded and 2 patients displaced shunt. Although shunt surgery is a common procedure performed for hydrocephalus, different complications were associated in our study where shunt failure was mainly due to shunt dysfunction, infection or breakage of shunt system. Complications were more with upper end. Infection was common in pediatric age group