RESUMEN
OBJECTIVE: This prospective-controlled observational study looked at well-matched patients with spinal pain and radicular symptoms, caused by lumbar intervertebral disc herniation to compare the short-term clinical outcome of transforaminal and interlaminar epidural steroid injection (ESI) in a resource challenged tertiary institution in Nigeria. MATERIALS AND METHODS: 49 patients with radicular symptoms who were matched for age, symptom duration, magnetic resonance imaging findings, and pre-injection revised Oswentry Disability Index (ODI) score and Visual Analogue Scale (VAS) were assigned into ESI technique. The ODI and VAS score were analyzed immediately after an injection and upon follow-up (average 178.5 days), also with the need for repeated injections and surgical interventions over a 1-year follow-up interval. RESULT: In the transforaminal group (25 patients), there was a statistically significant improvement in the ODI scores from before the injection (ODI mean 62.4) to immediately after the injection (ODI mean 24.4, P < 0.01), and upon follow-up (ODI mean 20.8, P < 0.01). 9 patients (18.4%) required 1 or 2 repeated injections, 3 (6.1%) patients underwent surgery and 2 (4%) patients lost to follow-up. In the interlaminar group (24 patients), there was a statistically significant improvement in the ODI scores from before the injection (ODI mean 60.7) to immediately after the injection (ODI mean 30.1, P < 0.01), but not upon follow-up (ODI mean 43.2, P = 0.09). 11 (22.4%) patients required 1 or 2 repeated injection, 4 (8%) patients underwent surgery and 3 (6.1%) patients were lost to follow-up. There is an average of 2 fold improvement of transforaminal ESI over interlaminar ESI in a 40 point scale of ODI score on follow-up, which was statistically significant (P < 0.01). The VAS showed similar pattern with the ODI scores in the study. CONCLUSION: Transforaminal ESI to treat symptomatic lumbar disc herniation resulted in better short-term pain improvement and fewer long-term surgical interventions compared to interlaminar ESI.
RESUMEN
OBJECTIVE: To report the clinical presentation and peculiarity of management of Klippel-Feil syndrome (KFS) at the University of Abuja Teaching Hospital, Gwagwalada. BACKGROUND: KFS is a rare pathology that has not been previously reported on in Nigeria. METHODS: Case review was employed to report this pathology. RESULT: This case is a 10 year old boy with KFS presenting with cosmetic blemish and scoliosis. Surgical treatment of the cosmesis was offered but patient defaulted because of fund due to their low income. CONCLUSION: KFS is an uncommon pathology in the male. The management is essentially conservative but surgery is an option if there was cervical spine instability, scoliosis and cosmetic blemish.