ABSTRACT
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. This activity reviews the evaluation and management of lumbar disc herniation and discusses the role of the healthcare team in evaluating and improving care for patients with this condition. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines. Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 777 studies; 7 were eligible for inclusion in the analysis. Further understanding of spinal disc herniation and treatment protocols may help improve evaluation and management in the future. Our research covered a range of management options. Disc herniation is a frequent problem for internists, emergency department doctors, nurse practitioners, and primary care physicians. To manage efficiently, an interprofessional team is needed. The first course of treatment is conservative, with paracetamol and anti-inflammatories being frequently used to relieve pain. A chemist must supervise the use of opioid analgesics in certain situations. Although surgery is sometimes the final option, patients frequently have neurological damage and lingering discomfort. In circumstances where physical treatment is not working, MRI interpretation becomes necessary. Primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues. Results can be enhanced by regular exercise and preserving a healthy body weight.
ABSTRACT
OBJECTIVES: The purpose of this prospective study was to identify selection criteria for immediate single-stage reconstruction in patients with severe complex craniofacial trauma to improve their functional outcome and reduce complications. PATIENTS AND METHODS: In this series, 24 new patients (16 men and 8 women) were added to our previous group (26 patients) with an age range from 10 to 55 years with mean of 26 years and Glasgow Coma Scale scores of 5-13; all patients had a combined single-stage repair of their complex craniofacial injuries within 6 h of their admission. We added some modifications to our standard technique using three-dimensional computed tomography, intracranial pressure monitoring, and support of dural repair/graft using dural patch and glue. The esthetic facial outcome was evaluated by an independent plastic assessor based on objective scale criteria. This series was carried out in Prince Salman Military Hospital between November 2010 and September 2013. RESULTS: Early neurosurgical outcome was considered good in 22/24 patients (92%), moderate in one patient (4%), and poor in the last one (4%). At late evaluation, 20 cases (83%) regained their consciousness without any cognitive deficit. One patient (4%) remained in neurovegetative status. Early esthetic outcome was considered to be excellent in 18/24 patients (75%), good in 3 patients (12.5%), deemed fair in 2 patients (8%), and labeled poor in only 1 patient (4%). At late evaluation, the patient labeled fair had improved to good with topical scar management and the patient deemed poor had improved to fair with two successive plastic procedures. Complications included a cerebrospinal fluid leak in 2 patients (8%), one was managed conservatively and the second was treated surgically with intra- and extradural grafting. CONCLUSION: In complex frontofaciobasal injuries, successful facial repair depends on immediate and definitive reconstruction. However, improved neurological outcomes in these patients depend on judicious selection of the appropriate candidates from severely head-injured patients.