The Variants of Frontal Recess and Its Effect in the Development and Prevalence of Frontal Sinusitis in Patients in a Tertiary Care Hospital: A Retrospective Observational Study.

According to medical literature, the frontal recess' intricate physical structure resembles an inverted funnel. The anatomical structure is not distant from the frontal ostium. Surgery requires a good understanding of the frontal recess architecture because of the intricate anatomy of this relatively small area. The pathophysiological characteristics of frontal sinusitis and the process of sinus ventilation through the sinus ostium have been linked, according to medical literature. Medical studies show that one of the most important factors affecting the amount of drainage in the frontal sinuses is the size of the frontal sinus ostium. Inflammation brought on by frontal recess cells can frequently affect the airflow in the frontal sinuses. The drainage channel of the frontal sinus is stated as narrowing in the current investigation as an observed phenomenon. The aim of this study was to examine the frontal recess changes and how they might affect the emergence of frontal sinusitis. The classification of frontal recesses according to their various categories was the study's principal finding. The investigation of the causal elements that resulted in the development of frontal sinusitis was the study's secondary goal. In a hospital setting, a cohort of 200 patients with sinonasal disorders underwent a retrospective observational research. Over the course of a year, from July 2021 to June 2022, the study participants had evaluations at a tertiary care center. 200 CT PNS images of individuals who fit certain inclusion and exclusion criteria were examined in this study. Using the chi-square test, the study looked into the relationships between several risk factors, including age, gender, and the type of frontal recess. The presence of frontal sinusitis served as the main outcome indicator. This study included a total of 200 participants with a mean age was 43.38 years (± 10.69). There was 146 (73%) male and 54 (27%) female were in the study. Type I frontal recess in 50 (25%), type II in 82 (41%), type III in 24 (12%) and type IV in 18 (9%) patients. The association of age (P = 0.141) and gender (P = 0.345) with frontal sinusitis was not significant. The statistical association between type of frontal recess and frontal sinusitis was statistically not significant. The association between age and the type of frontal recess was found to be statistically significant by Fischer's exact test with P value of 0.012 (< 0.05), whereas gender was not associated with the type of frontal recess by the same test. It is difficult to overstate the significance of the terms frontal recess, frontal sinusitis, and sinus ostium in this particular medical context. This article was a retrospective observational study that investigates the connection between frontal sinusitis and changes in the frontal recess in patients receiving care at tertiary medical facilities.

Correction: An Observational Study of Hearing Loss Among Menopausal Women.

[This corrects the article DOI: 10.1007/s12070-023-04121-5.].

Ent Manifestations in Sculptors of South Chennai, India: A Cross Sectional Observational Study.

Despite the National Occupational Safety and Legislation Act 2020's implementation, reports of workplace accidents are rising in India. Various ear, nose, and throat conditions have been linked to a wide range of physico-chemical variables. Due to a lack of training, inadequate knowledge, a lack of awareness of occupational health and safety risks, or a lack of accessibility to or use of personal protective equipment (PPE), sculptors are frequently exposed to a variety of physical, compound and unplanned risks, chemical, and accidental hazards. The study aimed to assess the various ear, nose and throat manifestations like noise induced hearing loss, occupational rhinitis and non-infectious pharyngitis among the sculptors working in the southern part of Chennai. This observational study was performed in a total of 110 sculptors. Demographic data like age, education, duration of occupation, use of PPE like face mask, ear plug during work hours, whether sculpting is a family occupation or first generation sculptor. A detailed history and thorough ENT examination was performed with pure tone audiometry (PTA), diagnostic nasal endoscopy (DNE) and videolaryngoscopy (VLS). If any problem is detected they will be treated accordingly. Most of them (70%) were in the age group of 21-40 years but 71% of them are sculptors for more than 15 years which infers introduction to the occupation at an early age. The reason for this could be more than 80% of them possessed the heritage of sculpting as their family occupation. Duration of occupation was significantly associated with chronic rhinitis (P value was 0.002) and NIHL (P value was 0.002) whereas education and use of PPE like face mask or ear plugs were not associated with ENT manifestations. This study focuses on the sculptors' working habits, their ignorance of safety precautions, and an assessment of the numerous ENT ailments. These manifestations showed a strong correlation to exposure time. To prevent the issues from becoming more severe, regular medical monitoring is required for early detection and intervention.

An Observational Study of Hearing Loss Among Menopausal Women.

Senile deafness and hearing loss in adults over 50 are major public health issues as a result of the population's ageing demographic. Menopausal women tend to develop hearing loss, while no clear link has been found between the two. The purpose of this study was to determine how menopause and diabetes mellitus affects hearing loss. We assessed 158 menopausal women in total. Pure Tone Audiometry and HbA1c levels was measured, along with appropriate clinical history and examination. The association between those levels and hearing was researched by chi-square test. There were 158 study participants. Mean age of the study population was 50.5 (± 2.49) years. Onset and duration of hard of hearing was assessed in 41 patients (25.9%). 33% (N = 53) of the patients had history of Diabetes mellitus, of which 52.8% offered history of the disease for more than or equal to five years. On audiological assessment, 74.1% had no hearing loss (N = 117), 4.4% had unilateral sensorineural hearing loss (N = 7) and 21.5% had bilateral sensorineural hearing loss (N = 34). Statistics show that hearing loss is statistically connected with ageing and poor glycemic management. With chi square values of 9.629 and P value 0.002 found a significant correlation between ageing and hearing loss. Poor glycemic control is significantly associated with hearing loss with a chi-square value of 4.304 and P value 0.038. Poor glycemic control and menopause is found to be strongly associated with sensorineural hearing loss. Further prospective, hormonal studies including larger population is recommended.

Audiological Profile in Allergic Rhinitis, a Hospital Based Study.

A type-I hypersensitivity reaction of the nasal mucosa, allergic rhinitis (AR) is distinguished by nasal obstruction, watery rhinorrhea, sneezing, and throat, mouth, and nose irritation. It is assumed that allergies can affect the inner, middle, or outer ear. Many writers have studied the relationship between allergic rhinitis and otitis media. Most of them concur that bacterial infection and Eustachian tube obstruction are significant risk factors for the development of otitis media with effusion in addition to allergies. One hundred study participants had a full clinical evaluation that included an ENT history and examination. In the ENT OPD, the audiological examination was conducted using Pure Tone Audiometry (PTA) and Impedance Audiometry (IA). At frequencies of 250 and 8000 Hz, respectively, the bone and air conduction thresholds were studied. The commercially available "AT235 INTERACOUSTICS" tympanometer was used for the tympanometry procedure. With pressure variations between + 200 and - 300daPa, tympanometry was carried out employing a 226 Hz probe tone. Mean age of study population was 52.16 and 24% each in age group 51 to 60 and 61 to 70 years respectively. 73 (73%) were male and 27 (27%) were female. 46% of allergic rhinitis study population was found to have normal hearing and 43% had mild conductive hearing loss. Most common type of impedance curve was A type (47%). Patients having acute phase of allergy with symptoms less than 3 months had more ear block and secretory otitis media. Patients with duration more than 3 months had resolved secretory otitis media hence the hearing was normal in 33 cases and 11 had mild conductive hearing loss. This study was concluded that there is correlation between the severity of the hearing loss and duration of allergic rhinitis.

Does Prophylactic Pinning Affect the Proximal Femur Morphology in Slipped Capital Femoral Epiphysis?

Background: The role of prophylactic pinning of the contralateral hip in unilateral SCFE is well established in patients with risk factors for developing contralateral slip. The effect of prophylactic pinning on the growth and morphology of the hip is not well documented in the literature. We aimed to study the effect of prophylactic pinning on the residual growth and morphology of the proximal femur. Materials & Methods: The institutional database was searched for all unilateral SCFE cases for the period 2011 to 2020. A total of 171 unilateral SCFE cases were identified. All the radiographs were scanned and those patients who had follow-up X-rays till skeletal maturity were included in the study. Prophylactic pinning was performed using 6.5 mm fully threaded cancellous screws in supine position on a radiolucent table. The following radiological parameters were measured on the post-operative X-rays and at skeletal maturity: (i) neck length (NL), (ii) neck-shaft angle (NSA), (iii) femoral offset (FO), (iv) articulo-trochanteric distance (ATD) and (iv) tip-apex distance (TAD) by two different observers. Results: The mean age of the cohort was 13.7 years. ATD decreased from the mean value of 25.67 mm in post-operative radiographs to 20.84 mm in final follow-up radiographs. The NL, FO, and TAD were found to be increasing with age with mean final follow-up values of 55.35 mm, 41.41 mm, and 6.19 mm respectively compared to post-operative mean values of 50.95 mm, 37.4 mm, and 4.69 mm. There was no significant change in the neck-shaft angle. The mean post-operative NSA was 132.9° and it was 131.8° at final follow-up radiographs. Conclusion: Prophylactic pinning in unilateral SCFE does not stop the growth of the proximal femur completely. The ATD decreases in all the patients with prophylactic screw fixation probably due to the discrepancy in growth between the trochanteric apophysis and proximal femoral physis. The clinical effects of this subtle change in the morphology of the proximal femur need further investigation. Level of Evidence: Level IV Case series.

Congenital Stenosis of the Spine-A Cross-Sectional Study of 1019 Whole-Spine Computed Tomography Scans to Determine Prevalence and Association Among Multilevel, Tandem, and Triple Region Stenosis.

BACKGOUND: Patients with congenital stenosis of the spine (CSS) present with clinical symptoms at an early age and fewer degenerative hypertrophic changes than the more common degenerative cohort. Literature is lacking in the true prevalence of CSS affecting the 3 segments of the spine in isolation, as well as in tandem in the Indian subcontinent. METHODS: Anteroposterior spinal canal diameter in axial plane computed tomography at the midvertebral level was measured in asymptomatic patients with whole-spine computed tomography. Spinal canal stenosis was defined as a diameter of <12 mm for the cervical region, <12 mm for the thoracic region, and <13 mm for the lumbar region. Single-level and multilevel stenosis, as well as tandem and triple-region stenosis, were evaluated. RESULTS: The results show the prevalence of CSS as 16.6%, 11.5%, and 20.1% involving the cervical, thoracic, and lumbar spine, respectively. Single-level stenosis affected 90.6%, 94%, and 79.8% of the patients with cervical, thoracic, and lumbar CSS, respectively. Tandem stenosis affected 10.4% of the population (n = 104), with cervicolumbar stenosis being the most prevalent (n = 51, 5%). The presence of CSS in any one segment of the spine was significantly associated with the presence of stenosis at one of the other segments (P < 0.05). Triple-region stenosis was seen in 0.3% (n = 3) patients. CONCLUSIONS: The prevalence of cervical, thoracic, lumbar and tandem stenosis from our study is established at 16.6%, 11.5%, 20.1%, and 10.4%. Additionally, our study demonstrates the association between stenosis of the different regions of the spine.

A 2-Year Outcomes and Complications of Various Techniques of Lumbar Discectomy: A Multicentric Prospective Study.

STUDY DESIGN: Prospective Study. OBJECTIVES: There are numerous techniques for performing lumbar discectomy, each with its own rationale and stated benefits. The authors set out to evaluate and compare the perioperative variables, results, and complications of each treatment in a group of patients provided by ten hospitals and operated on by experienced surgeons. METHODS: This prospective study comprised of 591 patients operated between February-2017 to February-2019. The procedures included open discectomy, microdiscectomy, tubular microdiscectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy and Destandau techniques with a follow-up of minimum 2 years. VAS (Visual Analogue Score) for back and leg pain, ODI (Oswestry Disability Index), duration of surgery, hospital stay, length of scar, operative blood loss and peri-operative complications were recorded in each group. RESULTS: Post-operatively, there was a significant improvement in the VAS score for back pain as well as leg pain, and ODI scores spanning all groups, with no significant distinction amongst them. When compared to open procedures (open discectomy and microdiscectomy), minimally invasive surgeries (tubular discectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy, and Destandau techniques) reported shorter operative time, duration of hospital stays, better cosmesis, and lower blood loss. Overall, the complication rate was reported to be 8.62%. Complication rates differed slightly across approaches. CONCLUSION: Minimally invasive surgeries have citable advantages over open approaches in terms of perioperative variables. However, all approaches are successful and provide comparable pain relief with similar functional outcomes at long term follow up.

Case Series - Pediatric Tracheostomy for Upper Airway Obstruction.

Certain congenital craniofacial malformations can cause upper airway obstruction. Due to neurological involvement, these craniofacial deformities with upper airway blockage frequently require tracheostomy. Children who need weeks or months of continuous ventilator assistance require tracheostomies, which improve pulmonary toilet and decrease laryngotracheal lesions such subglottic stenosis and tracheomalacia. In this case report we will be discussing about two patients who underwent Pediatric tracheostomy for Pierre Robin sequence and supraglottic stenosis in our institute. This paper emphasizes on some of the rare causes of pediatric upper airway obstruction - Pierre Robin sequence and supraglottic stenosis. Also the importance of tracheostomy procedure, which is the gold standard for management of upper airway obstruction in patients who are not responding to conservative management is emphasized. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03892-1.

Evaluating the Outcomes of Closed Reduction of Different Types of Nasal Bone Fractures.

This study was conducted to evaluate the outcomes of closed reduction of different types of nasal bone fractures depending on time between onset of injury and reduction and comparing the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). A hospital based Prospective cohort type of study was conducted among cases of nasal bone fracture attending the outpatient department of Otorhinolaryngology at Chettinad Hospital and Research Institute, Chennai during the months of August 2021 to January 2022. A total of 54 participants were included in the study. Primary outcome was to assess the effectiveness of closed reduction of different types of nasal bone fractures postoperatively. The second objective was to compare the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). Using chi square test, the association of factors such as age, sex, mode of injury, external framework deformity, type of fracture and treatment was analyzed with outcome measures such as post op degree of deviation, arch irregularity, malalignment, bony irregularity, bony displacement, olfactory disturbances and result. We analyzed the sample data statistically and measured the outcomes which showed that post operatively after undergoing closed reduction, some degree of deviation was present in 17(31.48./.), arch irregularity present in 12(22.2./.), malalignment in 11(20.37./.), bony irregularity in 24(44.44./.), bony displacement in 19(35.19./.), olfactory disturbances in 2(3.70./.). Comparing the outcome factors between early and late reduction, we found that the outcome was better in early closed reduction when compared with late closed reduction. Among the 54 patients studied, the results of closed reduction were found to be excellent in 27(50./.), Fair in 16(29.63./.), Good in 10(18.52./.) and poor in 1(1.85./.) We could thus conclude from this study that early closed reduction of nasal bone fracture gave better results than a late closed reduction in terms of post operative deformity, arch irregularity, malalignment, bony irregularity, bony displacement and olfactory disturbances.

Epithelioid Hemangioma of Tongue a Case Report.

Epithelioid hemangioma is an uncommon benign vascular lesion which most commonly appears as a nodular lesion in the head and neck area. Here, we present a rare case of nodular swelling in the dorsal aspect of the tongue in a 30 year old male for the past 3 months. Excision of growth was done and histopathological examination revealed epithelioid hemangioma of the tongue. Patient is on regular follow up and there is no evidence of recurrence. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03969-x.

Caffey's Disease of the Scapula: A Case Report.

Infantile cortical hyperostosis also named as Caffey's disease is a rare self-limiting inflammatory disease that usually affects children during infancy. It is characterized by subperiosteal new bone formation usually involving the diaphysis of long bone as well as the ribs, mandible, scapula, and ribs. It is crucial to diagnose the disease at an earlier stage to avoid superfluous surgery. We report a rare case of infantile cortical hyperostosis of the scapula, its clinical and radiological features.

"Satellite pedicle screws" - A novel technique of pedicle screw insertion in obese patients undergoing lumbar fusion.

The presence of thick sub-cutaneous fat and bulky paraspinal musculature mandates extensive surgical dissection in obese patients undergoing open Transforaminal lumbar interbody fusion surgery. Securing a 'converging' pedicle screw trajectory becomes difficult by the counterforces of the erector spinae muscles and thick sub-cutaneous fat in obese patients, especially at the L5-S1 level. We describe the use of a limited standard posterior midline exposure and a separate, far lateral 'satellite' incision to insert pedicle screws in an optimal trajectory in obese patients. Through proper pre-operative planning of the axial and sagittal MRI, the appropriate entry site is determined which is executed intra-operatively to insert pedicle screws freehand. Through a single 1.5 cm incision, both L5-S1 screws were inserted. Fourteen obese patients (mean BMI was 30.5 ± 1.1) received 56 satellite pedicle screws for TLIF at L5-S1 level. The mean age was 48.3 ± 9.7 years. The mean blood loss was 244.8 ± 114 ml and the mean operative time was 126.7 ± 82.8 min. In all patients, the screws were inserted as per pre-operative planning without any difficulties. All wounds healed well without wound complications. There were no screw related complications, and in the antero-posterior and lateral radiographs, there were no screw breaches. Satellite free-hand pedicle screws are safe and easily reproducible. They enable limited dissection of the main surgical wound and well-medialised converging pedicle screws in obese patients.

Improved indirect instantaneous torque control based torque sharing function approach of SRM drives in EVs using hybrid technique.

This manuscript proposes an improved indirect instantaneous torque control (IITC) based torque sharing function (TSF) method of switched reluctance motor (SRM) drives in electric vehicles (EVs) using a hybrid system. The proposed hybrid techniques are joint performance of both Reptile Search Algorithm (RSA) and Honey Badger Algorithm (HBA), hence it is named as Enhanced RSA (ERSA) method. Here, an IITC method of SRMs for EVs is utilized. It achieves the requirements of the vehicle, like minimum torque ripple, improved speed range, high effectiveness, and maximal torque per ampere (MTPA). To precisely specify the switched reluctance motor and its magnetic features are measured by the proposed method. The modified Torque sharing function compensates the torque error along with incoming phase, which contains the minimal rate of change of flux linkage. Finally, the ERSA method is implemented to define the best control parameters. Then, the proposed ERSA system is performed on the MATLAB platform and the performance is compared to different existing systems. The MSE for case 1 and case 2 using proposed system attains 0.01093 and 0.01095. The voltage deviation for case 1 and case 2 using proposed system reaches 5 and 5. The power factor for case 1 and case 2 reaches a value of 50 and 40 using the proposed system.

Pediatric spinal injuries- current concepts.

Spinal injuries in children contribute to the highest mortality and morbidity among all pediatric injuries. Fortunately, these injuries are a rare clinical entity but pose a difficulty in diagnosis due to challenges in neurological evaluation of a child and varied radiological presentation. Anatomical and biomechanical aspects of developing musculoskeletal system, relative plasticity of the pediatric spine make children vulnerable to spine injuries. Though motor vehicle collisions are common, children also suffer non-accidental trauma, falls and sports injuries. More chances of cervical spine involvement, higher susceptibility of spinal cord to tensile forces and associated multisystem injuries result in devastating consequences in children compared to adults. Injuries like SCIWORA, vertebral apophyseal injuries, birth-related spinal cord injuries are more specific injuries in pediatric age group. A vigilant clinical, neurological and radiological evaluation is mandatory in all children with suspected spinal injuries. Normal radiological features like ossification centers, pseudosubluxation and physiological vertebral wedging should be carefully noted as they could be misinterpreted as injuries. While CT scans help in better understanding of the fracture pattern, Magnetic Resonance Imaging in children is beneficial especially in detecting SCIWORA and other soft tissue injuries. Management principles of these pediatric spinal injuries are similar to adults. Literature evidences support conservative management in injuries like SCIWORA, unless there is an ongoing spinal cord compression. As in adults, the role of high dose methylprednisolone is still controversial in pediatric spinal cord injuries. Stable spinal injuries can be managed conservatively using orthosis or halo. Instrumentation by both anterior and posterior techniques has been described, but it is challenging due to smaller anatomy and poor implant purchase. In addition to pedicle screw instrumentation, wiring techniques are very beneficial especially in younger children.

ISSLS PRIZE in basic science 2023: Lactate in lumbar discs-metabolic waste or energy biofuel? Insights from in vivo MRS and T2r analysis following exercise and nimodipine in healthy volunteers.

PURPOSE: To quantitatively assess the dynamic changes of Lactate in lumbar discs under different physiological conditions using MRS and T2r. METHODS: In step1, MRS and T2r sequences were standardized in 10 volunteers. Step2, analysed effects of high cellular demand. 66 discs of 20 volunteers with no back pain were evaluated pre-exercise (EX-0), immediately after targeted short-time low back exercises (EX-1) and 60 min after (EX-2). In Step 3, to study effects of high glucose and oxygen concentration, 50 lumbar discs in 10 volunteers were analysed before (D0) and after 10 days intake of the calcium channel blocker, nimodipine (D1). RESULTS: Lactate showed a distinctly different response to exercise in that Grade 1 discs with a significant decrease in EX-1 and a trend for normalization in Ex-2. In contrast, Pfirrmann grade 2 and 3 and discs above 40 years showed a higher lactate relative to proteoglycan in EX-0, an increase in lactate EX-1 and mild dip in Ex-2. Similarly, following nimodipine, grade 1 discs showed an increase in lactate which was absent in grade 2 and 3 discs. In contrast, exercise and Nimodipine had no significant change in T2r values and MRS spectrum of proteoglycan, N-acetyl aspartate, carbohydrate, choline, creatine, and glutathione across age groups and Pfirrmann grades. CONCLUSION: MRS documented changes in lactate response to cellular demand which suggested a 'Lactate Symbiotic metabolic Pathway'. The differences in lactate response preceded changes in Proteoglycan/hydration and thus could be a dynamic radiological biomarker of early degeneration.

Thoracic Myelopathy in Ossified Ligamentum Flavum: Surgical Management and Long-Term Outcome Following 2 Different Techniques of Surgical Decompression.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Thoracic ossified ligamentum flavum (TOLF) has been reported to present with varying degrees of neuro-deficit and multiple factors have been purported to affect its outcome. Purpose of study was to analyze factors affecting outcome and impact of ultrasonic osteotome (UO). METHODS: We retrospectively reviewed patients treated for thoracic myelopathy secondary to OLF between 2010 and 2017. 77 patients with complete clinico-radiological records and 2 years follow-up were included. Initial 45 patients, conventional high-speed burr (HSB-group A) was used for decompression. In others, UO was used in combination with HSB (group B). Myelopathy was graded using modified Japanese orthopaedic association grading pre-operatively and each postoperative visit. At final follow-up, recovery rate was calculated. Radiological details including location, morphology, dural ossification, signal change and spinal ossifications were recorded. RESULTS: Mean mJOA at presentation and final follow-up were 4.3±1.8 and 7.6±1.9 respectively (p = 0.001). HRR was 49.9±23 at final follow-up. A significant reduction in dural tear (12.5%; 29%) and surgical time (125.8±49.5; 189.4±52.5) were observed in group B (p = 0.00). However, there was no statistically significant difference (p = 0.18) in recovery rates between groups A (44.8±26.1) and B (52.8±24.3). Symptom duration (p = 0.00), severity of myelopathy (p = 0.04) and cord signal changes on MRI (p = 0.02) were important predictors of outcome. CONCLUSION: Use of UO significantly reduced operative time and dural tears, although resulted in similar recovery rate as compared with HSB. Pre-operative severity of myelopathy, symptom duration and presence of cord signal change were the most significant predictors of outcome.

Do all Isler's type sacral fractures necessarily require surgical fixation?

INTRODUCTION: A unilateral vertical sacral fracture that exits medial or through the L5-S1 facet joint is considered to affect the lumbo-sacral integrity, and it is denoted as an indication for surgical fixation. However, no studies have analysed the outcomes after non-operative treatment of such injuries. METHODS: A retrospective review of all sacral fractures treated over a five-year period was performed to identify patients with Isler's fractures. Demographic and surgical data, all pre-operative and follow-up images (AP radiographs, CT images), functional outcomes based on VAS, SF-12 and return to work were documented for all patients. RESULTS: The incidence of Isler's fractures was 18% (34/181). The mean age was 42.12 ± 16.3 years. As per Isler's subtypes, fractures passed through L5-S1 joint in 13 (Type 2a) and medial to it in 15 (Type 2b), fractures of L5 or S1 facets in 3 (Type 1), Type 3 injuries were not detected. All patients had concomitant pelvic ring injuries. Sixteen fractures (neurologically intact, < 1 cm displacement, anterior ring stable, no facetal dislocation) were treated non-operatively while 18 patients underwent surgery. At a mean of 15.2 months, the fractures had united in all patients radiographically. The mean VAS score for low back pain (1.4 ± 1.01 vs 1.5 ± 0.79), ability to squat and sit cross-legged (56.3% vs 55.6%) and return to work (68.8% vs 66.7%), and Majeed score (77.2 ± 3.9 vs 79.6 ± 4.1) were similar in non-surgical and surgical groups, respectively, at the final follow-up. CONCLUSION: Our study indicates that 47% of Isler's fractures were mechanically stable and could be effectively treated non-operatively with good radiological and functional outcomes.

Perioperative analgesic efficacy and safety of erector spinae plane block in posterior cervical spine surgery-a double blinded, randomized controlled study.

BACKGROUND CONTENT: Posterior cervical spine surgery (PCSS) are typically open surgeries and entail significant postoperative pain. Current perioperative pain management in PCSS is reliant on multimodal analgesia. While perioperative epidural anesthetic infusion can be used in lumbar surgeries, this is not an option in the cervical spine. Pre-emptive regional analgesia through erector spinae plane block (ESPB) has shown significant perioperative analgesic benefits in lumbar spine surgeries. There are no such clinical studies in PCSS. PURPOSE: To assess the safety and efficacy of ultrasound-guided ESPB for perioperative analgesia in PCSS. STUDY DESIGN: Prospective, randomized controlled, double-blinded study. PATIENT SAMPLE: Eighty-six patients requiring sub-axial PCSS with or without instrumentation were randomized into two groups, those who underwent ESPB with multimodal analgesia (case) and those with only multimodal analgesia (control). OUTCOME MEASURES: Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization and complications were recorded. METHODS: After anesthesia and prone position, case patients received ultrasound-guided ESPB at the T1 level using 15 ml of 0.25% bupivacaine and 8 mg Dexamethasone bilaterally while the control patients received only standard postoperative multimodal analgesia. RESULTS: There were 43 patients in each group; the two groups were identical in demographic and surgical profile. The intraoperative opioid consumption (119.53±40.35 vs. 308.6±189.78; p<.001) in mcg), muscle relaxant usage (50.00±0.00 mg vs. 59.53±3.75 mg, p<.001), surgical duration (124.77±26.63/ 156.74±37.01 min; p<.01) and intraoperative blood loss (310.47±130.73 ml vs. 429.77±148.50 ml; p<.05) were significantly less in the ESPB group. In the postoperative period, the control group's pain score was significantly higher (p<.001). The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores also showed significant differences between the case and control groups (p<.001). The mean time required to ambulate (sitting/walking) was statistically less in cases (15.81±6.15/20.72±4.02 h) when compared to controls (16.86±6.18/ 23.05±8.88 h; p<.001). CONCLUSION: In patients undergoing PCSS, ESPB is a safe and effective technique with better outcomes than standard multimodal analgesia alone, in terms of reduced intraoperative opioid requirements and blood loss, better postoperative analgesia and early mobilization.