Results of arthrospine assisted percutaneous technique for lumbar discectomy.

BACKGROUND: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive "Arthrospine assisted percutaneous technique for lumbar discectomy" is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments. MATERIALS AND METHODS: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years). The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3), L2-L3 (n = 2), L3-L4 (n = 8), L4-L5 (n = 90), and L5-S1 (n = 47). Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments. RESULTS: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90%) patients had excellent to good, 12 (8%) had fair, and 2 patients (1.3%) had poor results. The complications observed were discitis in 3 patients (2%), dural tear in 4 patients (2.6%), and nerve root injury in 2 patients (1.3%). About 90% patients were able to return to light and sedentary work with an average delay of 2 weeks and normal physical activities after 2 months. CONCLUSION: Arthrospine system is compatible with 30° arthroscope and conventional micro-discectomy instruments. Technique minimizes approach related morbidity and provides minimal access corridor for lumbar discectomy.

Posterior endoscopic discectomy: Results in 300 patients.

BACKGROUND: Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system. MATERIALS AND METHODS: A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab's criteria after a minimum followup of 12 months and maximum up to 24 months. RESULTS: Based on modified Macnab's criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months. CONCLUSION: Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.

Water resource management for sustainable agriculture in Punjab, India.

The state of Punjab comprising 1.5% area of the country has been contributing 40-50% rice and 60-65% wheat to the central pool since last three decades. During last 35 years The area under foodgrains has increased from 39,200 sq km ha to 63,400 sq km and the production of rice and wheat has increased from 0.18 to 0.32 kg/m2 and 0.22 to 0.43 kg/m2 respectively. This change in cropping pattern has increased irrigation water requirement tremendously and the irrigated area has increased from 71 to 95% in the state. Also the number of tube wells has increased from 0.192 to 1.165 million in the last 35 years. The excessive indiscriminate exploitation of ground water has created a declining water table situation in the state. The problem is most critical in central Punjab. The average rate of decline over the last few years has been 55 cm per year. The worst affected districts are Moga, Sangrur, Nawanshahar, Ludhiana and Jalandhar. This has resulted in extra power consumption, affects the socio-economic conditions of the small farmers, destroy the ecological balance and adversely affect the sustainable agricultural production and economy of the state. Therefore, in this paper attempt has been made to analyse the problem of declining water table, possible factors responsible for this and suggest suitable strategies for arresting declining water table for sustainable agriculture in Punjab. The strategies include shift of cropping pattern, delay in paddy transplantation, precision irrigation and rainwater harvesting for artificial groundwater recharge.

MANAGEMENT OF UNSTABLE TIBIAL DIAPHYSEAL FRACTURES BY EXTERNAL FIXATION.

A group of 30 patients of unstable tibial diaphyseal fractures were managed using unilateral tubular external fixator. The fixator assembly comprised a double stainless steel hollow rod with universal joints and schanz screws as principal implant. Reduction and controlled distraction or compression were achieved by means of distracter/compressor device. Early dynamization was resorted to. The union rate was 100% with average healing time between 20 weeks for closed unstable fractures and 27 weeks for open Gustilo grade-II fractures. Minor pin tract infections accounted for majority of the complications. The unilateral fixator assembly permits early ambulation in unstable tibial diaphyseal fractures without sacrificing a sound anatomical result.