Lateral access minimally invasive spine surgery in adult spinal deformity.

Background: Oblique lumbar interbody fusion (OLIF) and percutaneous posterior approach for screw fixation (PPS) is the latest minimal invasive treatment for spinal deformity in adult patients (ASD). This study aims to design and highlight key points for ASD correction. Materials and methods: We retrospectively analyzed 54 patients who had undergone OLIF with PPS for ASD from October 2019 to January 2022 (average 71.5 ± 6.2 years-old, male 4, female 50) with a mean follow-up period of 29.2 months. Clinical outcomes are expressed by values including the Oswestry disability index (ODI) and visual analogue scale (VAS) for back pain. The imagistic assessment was also performed preoperatively and at 12, and 24 months postoperatively. For OLIF51, CT- MRI fusion images were obtained before surgery. Results: Postoperative ODI and VAS were 30.5 ± 18.9% and 31.2 ± 6.9 mm, respectively. The average operating time and blood loss during the surgical exposure was 490.9 ± 85.4 min and 1195.2 ± 653.8 ml. Preoperative SVA, PI-LL, and PT were 96.5 ± 55.9 mm, 39.3 ± 22.1°, 34.5 ± 11.0°, respectively. Postoperatively, SVA and PT became normal (24.1 ± 39.0 mm, 17.1 ± 10.3°) and PI-LL was ideal (2.4 ± 12.6°). Postoperative ODI and VAS were 30.5 ± 18.9% and 31.2 ± 6.9 mm. For OLIF51, the results revealed gain in L5-S1 lordosis and intervertebral disc height 9.4° and 4.2 mm respectively. The complications consisted of PJK in 21 cases (38.9%), rod breakage in 5 cases (9.3%), deep or superficial wound infection in 2 cases (3.7%). Conclusion: Clinical and imagistic results of OLIF and PPS for ASD were excellent. The radiographic measurements revealed that OLIF51 created good L5-S1 lordosis and significant L5-S1 disc height. CT-MRI fusion images were very useful for evaluating vascular anatomy for OLIF51.

OUTCOME OF OPEN CARPAL TUNNEL RELEASE SURGERY.

BACKGROUND: Carpel tunnel syndrome is a common compression neuropathy of the median nerve causing pain, numbness and functional dysfunction of the hand. Among the available treatments, surgical release of the nerve is the most effective and acceptable treatment option. The aim of this study was to see the outcomes of surgical release of carpel tunnel using open technique. METHODS: This descriptive case series was conducted at the Department of neurosurgery, Ayub Teaching Hospital Abbottabad from April 2013 to March 2014. One hundred consecutive patients with carpel tunnel syndrome were included who underwent open carpel tunnel release surgery. They were followed up at 1, 3 and 6 months. Residual pain, numbness and functional improvement of the hand were the main outcome measures. RESULTS: Out of 100 patients, 19 were males. The age ranged from 32 to 50 years with a mean of 39.29±3.99 years. The duration of symptoms was from 5 to 24 months. In the entire series patient functional outcome and satisfaction was 82% at 1 month, 94% at 3 months and 97% at 6 months. 18% patient had residual pain at 1 month post-operative follow-up, 6% at 3 months and 3% at 6 month follow-up. CONCLUSION: Open carpel tunnel release surgery is an effective procedure for compression neuropathy of the median nerve. It should be offered to all patients with moderate to severe pain and functional disability related to carpel tunnel syndrome.

Nanosomal Amphotericin B is an efficacious alternative to Ambisome for fungal therapy.

Amphotericin B was formulated in lipids (Nanosomal Amphotericin B) without using any detergent or toxic organic solvents during the preparation. Electron microscopy and particle size determination of Nanosomal Amphotericin B showed a homogeneous population of nanosized particles below 100 nm. Hemolysis assay indicated that Nanosomal Amphotericin B causes significantly less lysis of red blood cells than Amphotericin B deoxycholate and was comparable to Ambisome. A maximum daily dose of Nanosomal Amphotericin B at 5 mg/kg in rabbits and 10 mg/kg in mice for 28 days showed no symptoms of toxicity, mortality or significant body weight reduction. Hematological and gross pathological analysis of tissues revealed no abnormalities attributable to the drug treatment. Nanosomal Amphotericin B and Ambisome were injected (iv) at 2 mg/kg consecutively for 5 days into mice infected with Aspergillus fumigatus. The treatment resulted in 90% survival with Nanosomal Amphotericin B and only 30% survival with Ambisome after 10 days of fungal infection. However, all of the 10 control mice which were not treated with Amphotericin B died within 5 days of fungal infection. Nanosomal Amphotericin B is safe, cost effective and provides an alternative option for treatment of fungal disease.