Association between pre-operative high sensitive C-reactive protein and immediate post-operative radicular pain following prolapsed lumbar intervertebral disc surgery

Background: Nerve root compression is often inadequately understanding radicular pain due to prolapsed lumbar intervertebral disc, a common neurosurgical presentation. Inflammation is proved as an important etio-pathological component of radiculopathy, even after surgery. Methods: This cross-sectional intervention study conducted from March 2022 to September 2023. Data collected from 45 patients with prolapsed lumber intervertebral Disc, who underwent surgical intervention in Department of Neurosurgery, BSMMU. Results: The mean±SD age of the patients was 38.4±11.6 years, most of them 37 (82.2%) aged within 29 to 60 years. Majority 30 (66.7%) of them were male. Patients presented with pain, numbness and weakness was 45 (100%), 33 (73.3%) and 8 (17.8%) respectively. Among the participants most 36 (80%) had right sided and 9 (20%) had left sided radiation. The mean±SD level of pre-operative high sensitive C-reactive protein was 2.1±1.7. Pre-operative high sensitive C-reactive protein was significantly associated pre-operative, post-operative and mean change in visual analogue score (p<0.001, p<0.001, p= 0.006 respectively). Correlation of high sensitive C-reactive protein and VAS score (both pre and post-operative) were also statistically significant with p =0.017 and p <0.001 respectively. Conclusions: In our study, there is an association between pre-operative serum high sensitive C- reactive protein and post-operative radicular pain following surgical intervention in patients with prolapsed lumbar intervertebral disc.

Synchronous Carotid Body and Glomus Jugulare Tumors : A Case Report and Review of Literature

Paragangliomas are rare neuroendocrine tumors that are usually benign in nature. They may be either familial or sporadic in their occurrence. Numerous neuroendocrine tumors are collectively included under the umbrella of paragangliomas. Among them, carotid body tumors and glomus jugulare tumors are extremely rare. Thus, we present a rare case of 29-year-old male who was admitted with hearing difficulties and tinnitus in the left ear, with swelling on the left side of the neck. Based on clinical and radiological findings, a diagnosis of left-sided glomus jugulare with carotid body tumor was made. The patient underwent a twostage surgery with an interval of approximately 2 months. Histopathology revealed a paraganglioma. Herein, we present the clinical features, imaging findings, management, and a brief review of literature on the classification, evaluation, and management of carotid body and glomus jugulare tumors. Paraganglioma is a slow-growing tumor. The synchronous occurrence of carotid body and glomus jugulare tumors is infrequent. Microsurgical resection remains the primary treatment modality. Therefore, our patient underwent two-stage surgery. The rarity of occurrence and the proximity and adherence to vital neurovascular structures have resulted in the treatment of paragangliomas remaining a challenge.