ABSTRACT
Background Cranioplasty (CP) is a common cranial reconstructive procedure. It is performed after craniectomy due to various causes such as relieving increased intracranial pressure, infection, and tumor infiltration. Although CP is an easy procedure, it is associated with a high rate of complications. We aimed to retrospectively investigate the outcomes of CP at the King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah (KAMC-J). Methods This is a retrospective observational study that included all patients who had CP (first time or redo) at KAMC-J from 1st January 2010 to 31st December 2020. Patients with congenital cranial malformation were excluded. Result A total of 68 patients underwent CP. Of those, 23 (34%) had complications. The most common complication was infection (10.3%). Twelve of the 23 patients had major complications that necessitated reoperation. Of those 12, six underwent redo CP; three out of these six patients had further complications which were also managed surgically. On bivariate analysis, cranial defects over 50 cm² were associated with a higher rate of both infection and hydrocephalus (p=0.018) while the frontal site was associated with a higher rate of infection (p=0.014). Moreover, traumatic brain injury as an etiology was exclusively associated with post-cranioplasty hydrocephalus (p=0.03). Conclusion Patients undergoing CP after craniectomy are prone to a considerably high rate of adverse outcomes. The overall rate of complications in this study was 34%, with an infection rate of 10.3% and a 1.5% mortality rate. Consistent with other studies, larger cranial defects as well as frontal sites have a higher rate of infection.
ABSTRACT
Introduction Magnetic reasoning imaging (MRI) is the imaging modality of choice for detecting spinal pathologies. The study of the appropriateness of MRI utilization in Saudi Arabia is lacking. As a result, this research aims to assess the use and misuse of lumbar MRI in lower back pain (LBP) at the National Guard Hospital (NGH) in Jeddah city. Methods This is a retrospective cohort study that included all adult patients who had lumbar MRI for LBP at NGH in 2019. A total of 1,225 patients were included. Patients with extreme ages, trauma, recent lumbar spine surgery, spine or spinal canal tumors, and infection were excluded, leaving a number of 805 patients. Specific MRI findings were obtained and assessed in association with history and physical examination. Results LBP with radiculopathy was the most common complaint (82.9%) followed by LBP without radiculopathy (12.8%), with the lowest being limb pain alone (2.6%). Overall, 72% of patients had negative MRI findings, which did not explain their symptoms, and 28% had positive MRI findings that were not associated with their symptoms (p < 0.001). A complete physical examination was performed on 27.5% of patients, of which only 12% had positive findings. MRI was ordered for 72.5% of patients without a complete physical examination. Finally, 88.2% of patients who had MRI were managed conservatively, while only 6.7% were managed with surgery (p < 0.04). Conclusion The number of patients who had proper assessment prior to the ordering of MRI was significantly low. The decision to request MRI was not based on any scientific basis. This study has demonstrated that without proper and strict guidelines, MRIs will continue to be overutilized, which, in turn, will have negative consequences on the waiting time for an MRI and the cost of all the unnecessary MRIs. Furthermore, a good number of patients nowadays who do not have any indications for an MRI keep asking their physicians for it, and if the physician refuses, they transfer to another physician who will order the MRI.
