Outcome of single stage vertebral column resection in treatment of kyphotic deformity.

OBJECTIVE: To find the frequency of deformity correction, functional outcome and complications of single-stage vertebral column resection in patients with kyphotic deformity. METHODS: The prospective case series was conducted at Hayatabad Medical Complex, Peshawar, and Aman Hospital, Peshawar, from January 2012 to December 2013, and comprised all patients who underwent single-stage posterior vertebral column resection. Only patients with severe rigid sharp deformity of different aetiology that required more than 40 degree correction and who had at least 3-month follow-up were included. Data was processed using SPSS 16. RESULTS: Of the total 18 patients, 11(61.1%) were male and 7(38.9%) were female, with an overall mean age of 28.7±13.6 years (range: 12-60 years). Among them, 8(44.4%) patients had congenital kyphosis, 5(27.8%) had posttraumatic origin, 4(22.2%) had post-tuberculous deformity, while 1(5.6%) had iatrogenic kyphosis. The apex of the deformity was in thoracic spine in 12(66.7%) patients, while in 6(33.3%) patients it was in the lumbar spine. The average pre- and post-operative Cobb's angle was 66.2±18.9 degrees and 18.8±12.8 degrees respectively. Mean correction of deformities was 47.3±13.3 degrees. The mean correction achieved in percentage terms was 73.5±8.6 per cent (range: 56-87%). There were no patients with post-operative deterioration of neurological status. Two (11%) patients underwent re-exploration of the wounds with wash and cultures due to wound discharge. CONCLUSIONS: Posterior vertebral column resection was found to be a very effective method of correction of severe kyphotic deformities in expert hands with acceptable morbidity.

Early outcome of surgical intervention in subaxial cervical spine injuries.

OBJECTIVE: To determine the surgical outcome of patients with axial cervical spine fractures. METHODS: The study was conducted at the Spine Unit of Hayatabad Medical Complex, Peshawar, and Aman Hospital, Peshawar, from January 2012 to March 2013. Patients with sub-axial cervical spine fractures were treated surgically. The outcome was measured using Visual Analogue Score, Neck Disability Index, by neurology and on the basis of complications. SPSS 16 was used for statistical analysis. RESULTS: Of the 50 patients in the study, 7(14%) were females, while 43(86%) were male. Overall mean age was 30.3±7.9 years (range: 18-60 years). Major cause of injury was road traffic accidents in 29(58%). A total of 29(58%) patients had dislocation of the spine which was successfully reduced in 22(75.9%). Mean postoperative visual analogue score was 2.9±1.5 (range: 1-7) at last follow-up. Mean neck disability index score was 10.9±5.2 (range: 4-26). Dysphagia was the most common complication in 12(24%). CONCLUSIONS: Majority of the sub-axial fractures can be treated effectively with good outcome through anterior approach. Gradual axial skull traction is an easy and safe method for reduction of cervical fracture dislocations.

The use of locally harvested bone chips as a graft in spine fusion surgery.

OBJECTIVE: To evaluate the outcome of local corticocancellous bone chips used for fusion in various kinds of spine surgeries. METHODS: The observational prospective study was conducted at the Hayatabad Medical Complex, Peshawar, and Aman Hospital, Peshawar, from April 2011 to April 2013, and comprised cases in which locally harvested bone chips removed during decompression were used as bone graft for arthodesis. All cases were successfully followed up for at least one year. SPSS 16 was used for statistical analysis. RESULTS: Of the80 patients in the study, 44(55%) were female and 36(45%) were male. The overall mean age was 39.5±12.7 years (range: 13-75 years). Besides, 34(42.5%) were operated for spine surgery, 22(27.5%) for spondylolisthesis, 12(15.0%) for disc degeneration and 12 (15%) for spinal stenosis. In 54(67.5%) patients posterio-lateral fusion with decompression was done, while in 26(32.5%) transforaminal lumbar interbody fusion was done. Oswestry Disability Index scoreat last follow-up ranged from 4 to 56 with a mean of 17.7±10.7. CONCLUSIONS: Locally harvested bone chips are reasonable alternative to iliac crest bone graft, having comparable results while avoiding donor site morbidity associated with iliac crest bone grafts.

Liquid-crystal phase-shifting lateral shearing interferometer with improved fringe contrast for 3D surface profilometry.

We report the development of a common-path and nonmechanical scanning phase-shifting lateral shearing interferometer based on a homogeneous gap and wedge-shaped gap liquid-crystal (LC) cell. The modified cell consists of semi-reflecting and fully reflecting glass plates with LC material sandwiched between them so that the amount of reflected light from both the surfaces is nearly equal, thus generating high contrast interference fringes. The thickness of the LC cell was maintained at ~3 µm uniformly for a homogeneous gap and a varying wedge gap was also introduced between two glass plates. Phase-shifting linear fringe patterns of high contrast were generated. The phase-shifted interferograms were projected onto an object and the distorted interferograms were recorded by a CCD camera. The phase-shifting fringe analysis technique was used to reconstruct the 3D shape of the object. The present system is compact and low cost.

Fighting lung cancer in the developed world--a model of care in a UK hospital.

OBJECTIVES: To highlight the initial management approach for Lung Cancer in a UK Hospital with the aim of translating the principles of such methodology to a developing country, such as Pakistan. METHODS: A descriptive observational study was carried out at Stobhill Hospital, Glasgow, UK. The investigator (IMB) observed the Lung Cancer Service, attending the weekly 'New patients Clinic', 'Results Clinic', and 'Multidisciplinary team (MDT) meetings'. The process observations and the factual data describing the details of the service were recorded on a pre-designed pro-forma. Observations relating to two aspects of this service (Results Clinic and MDT) are included in this report. RESULTS: The methodology of communicating results of lung cancer investigations to patients in a pre-planned and staged manner at a dedicated 'Results Clinic' was identified as a useful approach. A format of communication was consistently followed. CONCLUSION: The MDT consisted of a Respiratory Physician, Clinical Oncologist, Thoracic Surgeon, Radiologist, Pathologist and Palliative Care Specialist. Each patient's case was discussed on an individual basis and the team developed a consensus regarding diagnosis, staging of the disease, further need for diagnostic procedures and treatment options, bearing in mind the patient's performance status, co-morbidity and their wishes. This approach has improved the initial part of the lung cancer patient journey and components of this approach could easily be transferred to a developing country.