ObjectiveThe aim of this study was to evaluate the results of different methods of decompression in lumbar canal stenosis (LCS) with regard to the effectiveness of different techniques in relieving symptoms, duration of surgery, intraoperative blood loss, and decreasing of postoperative complications.BackgroundLCS is defined as a narrowing of any part of the lumbar spinal canal. Several surgical techniques for lumbar spine decompression have been described over the last few decades. The aim of surgery for symptomatic LCS is to relieve the symptoms by adequate neural decompression while preserving the anatomy and the biomechanical function of the lumbar spine as much as possible.Patients and methodsThis prospective study was conducted from September 2015 to August 2017 including three groups: group A treated with conventional laminectomy (CL), group B treated with CL with posterolateral fusion, and group C treated with unilateral laminectomy with bilateral decompression. We used Oswestry disability index to assess preoperative and postoperative disabilities and pain.ResultsIn this study, statistical results revealed that there was statistical significance in the improvement of claudicating sciatica between the three groups as regards the Oswestry disability index (P < 0.001). There was statistical significance between three groups with regard to blood loss (P < 0.001), length of surgical procedure (P = 0.009), postoperative hospital stays (P < 0.001), and postoperative complication.ConclusionOn the basis of short-term follow-up, a minimally invasive technique like unilateral laminectomy with bilateral decompression allowed decompression, preserving spine stability with a natural range of motion, with less blood loss, less hospital stay, and decreased intraoperative and postoperative complication rather than CL with or without posterolateral fusion.
Background: Posterior fossa arteriovenous malformations (AVMs) are complex neurovascular lesions, relatively infrequent and difficultly is encountered not uncommonly during their treatment. Although they represent less than 15% of all AVMs, studies showed that they have more aggressive natural history. The authors present their initial experience with multimodality management of 20 posterior fossa AVMs, with an emphasis on endovascular treatment in Egypt. Method(s): From January 2012 to august 2015; twenty patients with posterior fossa AVMs treated with endovascular techniques, radiosurgery and/or surgery were analyzed. Result(s): Out of the twenty cases; 15 cases were treated with onyx embolisation through 27 sessions, one case with glue NBCA. Out of these cases 3 were embolised over 90%, the rest of cases were partially embolised and referred for complementary treatment with surgery or gama knife. The most frequent difficulties encountered during endovascular treatment were catheter navigation in the tortuousity of SCA (2 territories), AICA (2 territories), PICA (1 territory). Identification of onyx flow to the vein in the working angle (3 cases), extravasation of onyx (2 cases). The average occlusion rate of the AVM embolised after an average 1.8 (range 1-7) procedure per case was 52.66%. The average size of AVM embolised was 2.6 cm in maximum diameter. 4 cases (20%) complicated by cerebellar tremors and ataxia 2 of them were transitory and 2 were permanent, one case died from pulmonary embolism. Pod2 and two cases with hemihypothesia, one was permanent. Conclusion(s): Considering our early experience, onyx embolisation to posterior fossa AVMs is feasible and can lead considerable obliteration rate when the AVM has single feeder, although the consideration of deep supply to the cerebellar nuclei and brain stem perforators is of utmost importance to diminish the possible untowarded consequences.
Chiari malformation type 1 (CM) is known as the downward migration of the cerebellar tonsils and the medial part of the caudal cerebellar lobules through foramen magnum (FM) into the upper cervical canal leading to obstruction and disturbance of cerebral spinal fluid (CSF) circulation at the level of FM, which result in syringomyelia (SM). Many authors advocate that only FM decompression is sufficient, while others insist that duraplasty or additional methods as different types of shunts are mandatory. A retrospective study of 28 patients who had undergone operations from 2014 to 2018, of posterior fossa and foramen magnum decompression alone or with duraplasty, and their records and radiographic data of MRI and CT were analyzed and compared. Decompression alone was done in 14 patients, and decompression with duraplasty was done also in 14 patients. The clinical improvement was significantly higher in duraplasty group (71.4%) when compared to the decompression group (42.8%, p<0.05). FM and posterior fossa decompression with duraplasty is superior to decompression only in CM associated with or without syringomyelia, however a higher complication rate when duraplasty is done.
Background Options of surgical treatment of a symptomatic recurrent lumbar disc include simple lumbar discectomy or discetomy with instrumented fusion .Controversy still exits on which is the better treatment option . The aim of this study is to determine clinical outcomes of patients with recurrent lumbar disc herniation after re-do lumbar microdiscectomy versus discectomy and fusion in an attempt to determine if fusion is necessary. Methods Data of 47 patients who underwent surgery for a recurrent lumbar disc herniation from July 2013 to January 2018 were retrospectively reviewed. Patients were divided in to 2 groups depending on the surgical treatment modality, whether redo lumbar discectomy or discectomy and intrumented fusion with interbody transforaminal interbody (TLIF) cage. The patients demographics, clinical data, radiographic data and clinical outcomes were evaluated. There were 25 patients (53.2%) who underwent redo-lumbar discectomy and 22 patients (46.8%) who underwent discectomy and fusion . There were 5 (20%) patients treated by redo discectomy who required a repeat surgery in the form of fusion. Comparison of the preoperative data between both groups showed no statistical significant difference in the following parameters: age, sex, mean time for disc recurrence; symptom duration; disc levels operated; herniated disc characteristic; association of modic changes; preoperative VAS and JAO scores. Satisfaction was rated as excellent in 96% of simple discectomy group patients versus 77.2% of discectomy and fusion group. recovery and return to work. Lumbar fusion does offer symptoms relief with a clinical outcome comparable to simple discectomy . Fusion can be advantageous over simple discectomy in selected cases.
