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Objective The spinal column is one of the most prevalent regions for metastasis, with an increasing frequency of spinal metastases. Spinal cord metastatic tumor damages the vertebral body, weakens the spinal support, and exerts mass effect on the spinal cord. Overzealous surgical intervention does not provide any additional benefit in most of the spinal metastasis due to shorter life expectancy. The principal goal of this study is to analyze the outcome of various surgical treatments offered to patients with metastatic spinal cord compression (MSCC). Methods Retrospective cohort study including all patients that underwent surgical intervention for MSCC from March 2013 to March 2020. Results A total of 198 patients were included, 113 males and 85 females; the mean age was 62 years. The most common primary cancer was prostate (21.71%) followed by hematological (20.07%) and lung (16.66%). At 6-month postsurgery, 68.68% of patients were Frankel grade D or E (vs. 23.23% preoperatively), 16.6% were grade C (vs 57% preoperatively), and 14.64% were grade A or B (vs. 19.69% preoperatively). Pain on numeric rating scale was decreased from 6.38 ± 3.08 to 3.39 ± 0.73 at 24 hours postsurgery and 1.94 ± 0.67 at 6 months. Conclusion This study found that the majority of patients, undergoing minimally invasive spinal stabilization and decompression for metastatic spinal tumors, have better quality of life, analgesia, and mobility. In conclusion, treatment for spinal metastases should be individualized and a multidisciplinary approach is needed.
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OBJECTIVES: This study discusses the experience at our centre with treating traumatic thoracolumbar fractures using percutaneous pedicle screw fixation. METHODS: We reviewed the case notes and imaging retrospectively between January 2013 and June 2019. RESULTS: A total of 257 patients were included, 123 males and 134 females aged between 17 and 70; the mean age was 47.6 years. The majority of injuries were from fall from significant height. The fractures involved the thoracic and lumbar vertebra in 98 and 151 of the cases respectively. Percutaneous pedicle screw fixation was performed either one or two levels above and below the fracture depending on the level of injury. Forty two cases were treated with additional short pedicle screws at the level of fracture. More than 15% (39) of the patients presented with a neurological deficit; more than 80% (32) of those showed post-operative improvement in their neurology as per Frankel Grading system. The mean operative time was 117 min ± 45 min; mean length of hospital stay was 7.2 days ± 3.8 days, with significant improvement in pain. CONCLUSIONS: Percutaneous pedicle screw fixation is a safe surgical option with comparable outcomes to open surgery and a potential reduction in perioperative morbidity.
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Background Severe traumatic brain injury (TBI) is one of the leading public health problems across the world. TBI is associated with high economic costs to the healthcare system specially in developing countries. Decompressive craniectomy is a procedure in which an area of the skull is removed to increase the volume of intracranial compartment. There are various techniques of decompressive craniectomy used that include subtemporal and circular decompression, and unilateral or bilateral frontotemporoparietal decompression. Objective The aim of this study was to compare the outcome of decompressive craniectomy for the management of severe TBI versus conservative management alone at the Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan. Methods The study (randomized controlled trial) was conducted from February 1, 2014, till June 30, 2017. Results A total of 136 patients were included after following the inclusion criteria. They were randomly assigned to two groups, making it 68 patients in each study group. There were 89 males and 47 females. All the patients received standard care recommended by the Brain Trauma Foundation. The mortality rate observed at 6 months in decompressive craniectomy was 22.05%, while among conservative management group, it was 45.58%. Difference in mortality of both groups at 6 months was significant. Total 61.76% (42) of patients from decompressive craniectomy group had a favorable outcome (Glasgow outcome scale: 4-5) at 6 months. While among conservative management group, total 35.29% (24) had a favorable outcome (Glasgow outcome scale: 4-5). Difference in Glasgow outcome scale at 6 months of both groups was significant. Conclusion In conclusion, decompressive craniectomy is simple, safe, and better than conservative management alone.
