Surgical outcome of reduction and instrumented fusion in lumbar degenerative spondylolisthesis

Background: Lumbar degenerative spondylolisthesis [LDS] is a degenerative slippage of the lumbar vertebrae. We aimed to evaluate the surgical outcome of degenerative spondylolisthesis with neural decompression, pedicular screw fixation, reduction, and posterolateral fusion

Methods: This before-after study was carried out on 45 patients [37 female and 8 male] with LDS operated from August 2008 to January 2011. The patients' pain and disability were assessed by visual analogue scale [VAS] and Oswestry disability index [ODI] questionnaire. In surgery, we applied distraction force to facilitate slip reduction. All the intra- and postoperative complications were recorded. The paired t-test and Pearson correlation coefficient were used for statistical analysis

Results: The mean age of patients and mean follow-up period were 58.3 +/- 3.5 years and 31.2 +/- 4.8 months, respectively. The mean slip correction rate was 52.2% with a mean correction loss of 4.8%. Preoperative VAS and ODI improved from 8.8 and 71.6 to postoperative 2.1 and 28.7, respectively. Clinical improvement was more prominent in more reduced patients, but Pearson coefficient could not find a significant correlation

Conclusion: Although spinal decompression with fusion and posterior instrumentation in surgical treatment of the patients with LDS result in satisfactory outcome, vertebral reduction cannot significantly enhance the clinical improvement

Posterior hip fracture -dislocation associated with ipsilateral intertrochantric fracture; a rare case report

Hip dislocation occurs when the femur does not break and the force is transmitted towards the hip joint leading to a posterior dislocation of the femoral head with or without posterior acetabular fracture. We present the case of a 26 year old patient involved in motor vehicle accident. Clinical and imaging [radiography, CT] examination revealed an intertrochanteric fracture associated with ipsilateral posterior hip dislocation and posterior acetabular wall fracture simultaneously with epsilateraal tibial and fibular fractures. Such associations is very rare and can be explained by an extremely powerful force generated the three lesions simultaneously. This case is important not only because of its extreme rarity but also because of treatment method

Atrial fibrillation after off-pump versus on-pump coronary artery bypass graft surgery

Atrial fibrillation [AF] is the most common postoperative arrhythmic complication after coronary artery bypass graft surgery [CABG]. The aim of the present study was to compare AF prevalence after off-pump versus on-pump CABG. In this prospective study, performed between September 2008 and September 2009, 128 consecutive patients in our local cardiovascular surgery ward were allocated into two groups of off-pump [95 patients] and on-pump CABG [33 cases]. We compared preoperative risk factors such as left ventricular ejection fraction [LVEF]<%40, hypertension [HTN], and Cr>2mg/dl, site of grafting such as the left coronary descending artery [LAD], right coronary artery [RCA], and left circumflex artery [LCX] in the two groups of surgery techniques [on-pump versus off-pump CABG] with/without postoperative AF after 24 hours of surgery in the Intensive Care Unit, Statistical power of the study was 80%, and a P-value less than 0.05 was considered significant. The prevalence of AF was 15 [15.8%] in the off-pump group versus 7 [21.2%] in the on-pump group [p=0.67] 24 hours after CABG. In the on-pump group, there was no difference between age categories [p=0.11]. In the on-pump group, as opposed to the off-pump CABG group, there was no relationship between the surgery techniques with or without AF, LVEF <%40, and HTN. There was a significant relation with Cr more than 2 mg/dl in the on-pump CABG group [p=0.001] versus the off-pump CABG group [p=0.057]. There was no statistical relation between the type of vascular graft [LAD, RCA, and LCX] between the on-pump and off-pump CABG patients attributed to with or without AF. There was no reduction in the AF rate in the off and on-pump CABG versus off-pump CABG. It seems that there was another predictive factor for AF in the off and on-pump CABG groups, so further prospective trials with larger sample sizes are recommended