Outcome of cloward technique in cervical disc prolapse

To determine the association of pre-operative assessment of MRI findings, neurological status and symptoms with postoperative Cloward surgical outcome in cervical disc prolapse. Descriptive study. The Neurosurgery Department of Jinnah Postgraduate Medical Centre [JPMC], Karachi, from May 2008 to May 2009. Patients presenting with neck pain, brachialgia, limb weakness and spasticity were clinically examined for pre-operative neurological status of power, reflexes and sensation. The exclusion criteria were, cervical disc prolapsed patients, planned for smith-Robinson and micro-discectomy, traumatic cervical disc prolapse and cervical spondylosis. Neuroradiological investigations included cervical spine X-rays and MRI. All patients were surgically treated for cervical prolapsed intervertebral disc with anterior cervical discectomy and interbody fusion with Cloward technique. Postoperative neck immobilization was done with cervical collar for 7-8 weeks. Drain was removed on first postoperative day while check plain cervical X-rays were taken on third day. Results were analysed using chi-squre test with significance at p < 0.05. There were 30 patients including, 27 [90%] males and 03 [10%] females with mean age of 44.3 years. The commonest symptom was neck pain. The duration of symptoms ranges from 2 to 6 months. On MRI, prevalent levels of cervical disc prolapse were C 5-6 [43.3%] and C 6-7 [23.3%]; 26 [86.6%] patients had disc herniation causing thecal effacement with cord compression and 04 [13.3%] patients showed ischemia of cord. Single-level Cloward surgery done in 26 [86.3%] patients while two-level Cloward surgery performed in 04 [13.3%] only. About 83.3% patients improved and 13.3% did not while 01 patient was re-operated. No complications and mortality was related to the surgical procedure. Statistically different variables identified, related to outcome were pre-operative neurological status [p=0.001] and spinal cord involvement on MRI [p=0.001]. Cloward technique for cervical disc prolase was simple and safe surgical procedure with favourable results and few complications; 100% fusion occurred after Cloward surgery, even without instrumentation. Outcome was significantly affected by pre-operative neurological status and cord involvement

Management of myelomeningocele

T To find out best possible protocol to provide productive life to children born with Myelomeningocele. Descriptive study. Department of Neurosurgery, Jinnah Postgraduate Medical Centre Karachi from December 2001 to December 2006. The medical record of 415 children with myelomeningocele operated at our center was reviewed retrospectively. The surgical and medical management protocol used for different sites of myelomeningocele was studied.The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All paraplegic patients with dorsolumbar myelomeningocele were treated with either a low-pressure ventriculoperitoneal [VP] shunt only, direct repair or both. Patients with cervical, dorsal and lumbo-sacral myelomeningocele requiring VP shunt were operated either simultaneously for both procedures or with delayed insertions of a VP shunt after treatment of ventriculitis All 16 patients with ruptured myelomeningocele [3.8%] were treated for repair as well as ventriculitis. Complications including CSF leak, wound infection or necrosis after repair of myelomeningocele occurred in 22 cases [5.3%]. The postoperative follow up for all patients was 1- 2 years Surgical intervention with a low-pressure VP shunt in large dorsolumbar myelomeningocele produced good results

Surgical management of tethered spinal cord syndrome: an analysis of 248 cases

To define the presentation, exact mechanism, and surgical treatment of tethered spinal cord syndrome [TSCS] with particular emphasis on timing of surgery and outcome. Department of Neurosurgery, Jinnah Postgraduate Medical Centre [JPMC] from January 2001 to December 2006. A total of 248 patients were included in this study who presented for treatment between 6 days and 32 years of age with a median age of 6.5 months. One hundred patients presented before the age of 6 months. Most common complaint was cosmetic defect/swelling on their back [n 156]. Sixty-six patients had urinary incontinence, 35 patients had deformed or weak leg and 15 had ulcers on their feet. There were 172 female and 76 male patients. The most frequent tethering lesions were lipoma in 156, un-repaired myelomeningocele in 15, post repair myelomeningocele in 18, hypertrichosis in 17, spilt cord malformation in 10, tight filum terminate in 15, dermal sinus or dimple with stalk in 12, sacral agenesis in 3 and appendage with stalk in 2 patients. Out of 100 operated before 6 months of age, only 2 patients returned back with incontinence of urine and required un-tethering again. Improvement of symptoms at 6 months after surgery was noted in 78% patients operated after 6 months of age. Stabilization of symptoms was achieved in 8 patients having adult age at time of surgery. Minimum follow up was two years in 210 and maximum of 4 years in 17 surgically treated patients with stable neurological condition. Best outcome is achieved after complete un-tethering of cord at younger age. To avoid irreversible neurological damage, early diagnosis and repair is recommended. The symptoms most resistant to surgical treatment were orthopedic abnormalities where as bladder dysfunction and motor weaknesses were amendable to surgical therapy