RESUMEN
BACKGROUND: The Percutaneous laser disc decompression (PLDD) method was first described by Daniel Choy in Australia in 1987. Therefore, in this study, we examined the clinical signs and symptoms of patients with spinal canal stenosis due to disc protrusion after PLDD surgery. METHODS: In this clinical trial study, 43 patients with spinal canal stenosis due to lumbar disks who referred to Kashani and Zahra Marzieh educational hospitals from 2006 to 2016 were entered the study. The patients were divided into two groups as discogenic canal stenosis (3 females and 9 males) and complex degenerative disorder (canal stenosis due to discogenic and ligamentos) (16 females and 15 males). Patients underwent PLDD surgery and the clinical manifestations such as back and radicular pain, claudication, and complications of the surgery (hematoma, reoperation, and neurological symptoms) in patients were evaluated until one year after the operation. RESULTS: After one year of surgery, the mean of back and radicular pains significantly decreased in both groups (P<0.05). All patients with claudication in the discogenic group improved and 35.5% of patients with complex degenerative disorder were not claudication after one year of surgery. The outcomes of treatment in patients with discogenic canal stenosis were 91.7% excellent, and 8.3% fair and in the complex degenerative disorder group were 64.5% excellent, 19.4% good and 16.1% fair (P=0.16). None of the patients had new neurological symptoms, and 12.9% of the complex degenerative disorder group patients needed reoperation. CONCLUSION: The PLDD method is a better procedure for discogenic canal stenosis than complex degenerative disorder. Therefore, more studies are required in this field for long time.
RESUMEN
BACKGROUND: Intractable pain occurs as a result of extensive damage to soft tissue, bones and muscles after fusion of lumbar spondylolisthesis. Although different drugs and protocols have been suggested for postoperative pain management, the best method of treatment has not been proposed yet. Therefore, this study tried to compare the efficacy of ketamine infusion and routine opioid administration on postoperative pain. METHODS: A double-blind prospective randomized clinical trial was performed on 45 patients candidate for fusion of lumbar spondylolisthesis. Patients were divided into two groups of A (treatment) and B (control). In group A, pain was controlled by intravenous infusion of ketamine. Morphine was also administrated when the patients scored their pain above 4 on a visual analogue scale (VAS). In group B, intravenous infusions of morphine were performed every 6 hours. VAS and whole dosage of morphine were compared between two groups every 6 hours. RESULTS: Morphine and ketamine were both effective on pain control. Mean values of pain intensity at the first to fourth time points were 2.1, 1.8, 1.6, and 1.7 in group A and 3.9, 3.4, 3.5, and 3.5 in group B, respectively (p < 0.01 for all periods). However, ketamine was more efficient in pain reduction during the first 24 hours (p < 0.001). CONCLUSION: Ketamine could be a good alternative analgesic after fusion of lumbar spondylolisthesis. However, the probable side effects should also be considered. Ketamine infusion is more effective than morphine on postoperative pain control. In addition, tolerance to drug application is not a challenging problem at least during 24 hours after operation.
