Role of anterior decompression with internal fixation in dorsal spine tuberculosis

To assess efficacy of anterior decompression and internal fixation using mesh cage and rod with screws in patients with dorsal spine tuberculosis This observational study was conducted in the Department of Neurosurgery Lady Reading Hospital Peshawar from July 2010 to June 2012 [2 years]. There were 38 patients with dorsal spine tuberculosis who underwent anterior decompression and fusion using anterior spinal instrumentation and allograft replacement. We included those patients in our study, who undergone anterior decompression with internal fixation for dorsal spine tuberculosis, of both genders irrespective of their age. We excluded those patients who were unfit for surgery, treated conservatively, involved spine other than dorsal spine or undergone procedure other than anterior approach for Carrie's spine. Clinical outcome of the patients was assessed using the frankle grade. The patients were observed for post-operative complications, neurological improvement and bony fusion. We had total of 38 patients who undergone the procedure in whom23 [60.5%] were males and 15 [39.5%] females with male / female ratio of 1.5: 1. Their age ranged from 4-70 years [mean 37years]. The most common level involved were between D5-D12 for which thoracotomy was needed. Preoperative neurodeficit was observed in 76.3% patients of whom 89.7% showed improvement after surgery. Our patients had 7.9% complications after surgery. We had wound infection in 5.3% and dyspnea in 2.6% cases. There were no graft related complications and bony fusion was observed in all the patients. It is concluded from our study that anterior decompression with internal fixation using cage and rod with screws is an effective procedure in dorsal spine tuberculosis. It has few complications and yields good results

Early complications of simple anterior cervical discectomy

To analyze early complications after simple anterior cervical discectomy. This descriptive study was conducted at the department of Neurosurgery, Post-graduate medical institute, Lady Reading Hospital Peshawar from January 2009 to December, 2010. Ninety five [95] consecutive patients who underwent single level anterior cervical discectomy without bone grafting for degenerative cervical disc herniation were included in the study irrespective of their age and gender. The patients were observed for post-operative complications for a period of 8weeks after surgery. The patients were observed for complications during hospital stay, 1[st] follow up at 2 weeks and 2[nd] follow up after 8 weeks of surgery. Out of 95 cases, 67.4% [n=64] were males and 32.6% [31] females. Majority [n=29, 30.5%] patients were in the age range of 41-50years, 24.2% [n=23] in the age group of 31-40 years and 20% [n=19] in the age range of 21-30 years. Almost 70.5% [n=67] of the patients presented within 6 months of onset of their symptoms. The commonest complication after surgery was transient hoarseness in 3.2% [n=3] cases. We had post-op dysphagia and discitis each in 2.1% [n=2] patients. The overall morbidity was 8.5% [n=8]. One patient died because of anesthesia complication and not because of surgery complications

spectrum of intradural spinal tumors

To assess the spectrum of clinical, radiological and histological features of patients with intradural spinal tumors. This descriptive study was carried out in Department of Neurosurgery Lady Reading Hospital Peshawar, from April 2003 to March 2009. Medical records of patients with spinal tumors were reviewed and patients operated for intradural spinal tumors were identified. A total of 312 patients, out of 525 cases of spinal tumors, with different intradural spinal tumors were considered in this study. Their clinical features, radiological reports, peroperative findings and histological reports were analyzed in different aspects. There were total of 312 patients with age range from 2 years to 74 years, with median age of 38 years. Out of these 187 were males and 125 were female, overall male to female ratio of 1.5: 1. Backache, leg weakness, parasthesia and poor sphincters were the main clinical features. MRI spine [274 cases] was the main diagnostic tool along with plain X-rays and X-ray myelography in limited cases [35 cases]. CT myelogram was done only in 3 cases. The common site of involvement was dorsal spine followed by lumber and cervical spines respectively in 185, 80 and 47 cases. Histological report was suggestive of Neurofibroma in 166 Meningioma in 96, Ependymoma in 20, Dermoid in 12, Astrocytoma in 7, Hemangioblastom and Tuberculoma in 3 cases each and Hydatid cyst in one case. Neurofibroma and meningioma constituted majority of cases belonging to intradural extramedulary group, while ependymoma and astrocytoma were common intramedullary tumors. Third and 5[th] decade of life was the common age group for both Intramedulary and extramedulary tumors. Intramedulary lesions were common in 3[rd] decade of life

Experience with 349 cases of intradural spinal tumors at Lady Reading Hospital Peshawar

To analyze the variables of patients operated for intradural spinal tumors at Lady Reading Hospital Peshawar. An analytical descriptive study Place and duration of study: Department of Neurosurgery Lady Reading Hospital Peshawar, from April 2003 to March 2010 [7 years]. Medical record of patients with spinal tumors were revised and patients suffering from intradural spinal tumors were searched. There were total 572 cases of spinal tumors, of which 349 had different intradural lesions. Their clinical features, radiological reports, peroperative findings and histological reports were analyzed in different aspects. Of the total 349 patients with intradural spinal tumors 201 were males and 148 female, with male to female ratio of almost 1.4:1. Age of the patients ranged between 2 years to 77 years, with median of 39.2 years. The common clinical features were backache, leg weakness, parasthesia and poor sphincters. Magnetic Resonance Imaging of the spine was the main [309 cases] diagnostic tool along with plain x-ray and myelography in limited cases [35 cases]. CT myelogram was done only in 5 cases. Dorsal spine was involved in 62.5% cases, lumber and cervical spine in 25.5% and 12% patients respectively. Neurofibroma was the commonest [51%] intradural spinal tumor, we also had meningioma in 30.66%. Other intraspinal lesions were dermoid, lipoma, ependymoma, astrocytoma, tuberculoma, arachnoid and hydatid cysts. Of all the spinal tumors intradural are more common [61%] than extradural. Neurofibroma and meningioma constituted majority of cases belonging to extramedullary intradural group, while ependymoma and dermoid were common intramedullary tumor. 3rd and 5th decade of life were the common age group for both intramedulary and extramedullary tumors. Intramedullary tumors were common in 3rd decade of life

Inguinal herniorraphy with vicryl darn: experience with 1150 cases

To know the outcome of posterior wall strengthening with Vicryl darn in patients with inguinal hernias. This study was conducted at Lady Reading Hospital Peshawar during the period of 14 years from March 1991 to February 2005. All patients underwent posterior wall repair with Vicryl darn. Data was retrieved from computer software, maintained in personal computer over the years. Patients were admitted from OPD, preoperative assessment was done in the ward. Postoperative morbidity and mortality was recorded. Follow up period was from one to ten years. A total number of 1150 inguinal hernias in 1090 patients [60 had bilateral hernias] were operated by the principle author during the time period. Common age was 30-59 years. Males predominated with a male to female ratio of 40:1. All patients were operated by a single surgeon. Indirect inguinal hernias were more common with indirect and direct ratio of 5:1. Post-operative wound infection occurred in 52 cases [4.5%]. Scrotal haematoma in 9 cases [0.8%]. Recurrence has been recorded at rate of 1.5% in patients who had completed 10 years follow-up. Out of 1090 patients, so for 202 [18.5%, have been lost to follow tip. Three patient died post-operatively due to co-morbid factors not directly related to surgery. In our set up posterior wall strengthening with Vicryl darn [repair] in patients with inguinal hernias still has excellent results. These results are comparable with mesh hernioplasty