Pakistan Journal Of Neurological Surgery

Frequency of Functional Outcome Among Patients with Spinal Tumor Visiting Tertiary Care Hospital

2025-02-20T13:58:50+00:00

Objective: To determine the frequency of functional outcomes among patients with spinal tumors.

Materials and Methods: This study was conducted at the neurological surgery department, Liaquat University of Medical and Health Sciences, Jamshoro and it was a descriptive study. A total of 145 patients presenting with spinal cord tumors were admitted through the outpatient department (OPD) and subsequently underwent surgical procedures. The diagnosis was primarily based on MRI findings, and the Frankel scale was used to assess neurological progress.

Results: The current study included 145 patients in total, with 65.5% of them being male. The majority (75.2%) were older than 60, whereas the mean age was 65.65±6.43 years. In contrast to the 15.9% of tumors in the cervical spine, 73.8% in the thoracic spine, and 10.3% in the lumbar spine, there were 13.8% intramedullary and 86.2% extramedullary tumors. Eight percent of patients required dorsal stabilization, 9.7% had surgical issues, 11.7% had medical difficulties, 66.2% required perioperative corticosteroid administration, and 11% required neuromonitoring. Upon admission, 11.7% had radiating pain, 34.5% had back discomfort, 82.1% had sensory deficiency, and 71% had bowel/bladder dysfunction. The mean McCormick score was 3.17±0.67 and 2.56±0.92 on admission and discharge, respectively whereas the mean KPS was 49.42±11.78 and 49.42±11.78 receptively. There were 40% of patients with unfavorable and 60% with favorable outcomes.

Conclusion: Early diagnosis with minimal symptoms leads to better outcomes, whereas delayed presentation and significant neurological deficits are associated with poorer prognosis.

Clinical Outcomes of Transforaminal Injection in the Management of Lumber Radiculopathy

2025-01-10T10:03:27+00:00

Objective: The objective of this study was to evaluate the clinical outcomes of transforaminal dexamethasone injection in patients with lumber radiculopathy.

Material and Methods: This one-year cross-sectional study was carried out at Afridi Medical Complex from February 2022 to January 2023. The included patients of lumber radiculopathy underwent a single dose of transforaminal dexamethasone injection under the guidance of a fluoroscope. The outcome measures including pain, disability, and mobility were assessed through VAS, RMDQ, and FTFD before, one month, and two months post-intervention.

Results: The study included 487 patients undergoing the intervention, the mean age of participants was 52.3. Following the injection, the mean leg pain score improved from a baseline of 8.2 ± 1.1 to 3.0 ± 0.8 (p < 0.001). One-month post-injection, it further decreased to 2.5 ± 0.7 (p < 0.001) and at two months to 2.0 ± 0.6
(p < 0.001). When measured at baseline the mobility score of FTFD was 18.6 ± 4.5 cm which then improved to 11.2 ± 3.7 cm after one month and then to a further 7.8 ± 2.9 cm at two months (p < 0.001).

Conclusion: For those patients unresponsive to conservative treatment options including medication and physical therapy, transforaminal dexamethasone injection is a safe and effective intervention in terms of improvement in different outcome measures including pain, disability, mobility, and return to work.

Surgical Outcomes of Lumbar Spine Procedures; A Prospective Cohort Study in A Tertiary Care Hospital

2024-05-21T05:37:00+00:00

Objective: To know about the surgical results of lumbar spine procedures performed at MTI Hayatabad Medical Complex and Naseer Teaching Hospital Peshawar.

Material and Methods: This prospective cohort study was carried out in the Neurosurgery department at Nasser Teaching Hospital and MTI Hayatabad Medical Complex, from 1^st January 2020 to 25^th January 2024. We included 267 patients, consisting of both genders, that is, male and female, with the ages ranging from 17 years to 72 years. The Lumbar spine procedures included in our study were; Laminectomy, Partial laminectomy, Discectomy, Right and Left Fenestration, all the rest of the lumbar spine procedures were excluded. The surgical outcome was assessed using a VAS score for grading pain before the procedure and 6 months after the procedure.

Results: The study revealed that the average age of the patients was 41.87 years, with a standard deviation of 12.827 years. The youngest patient was 17 years old, and the oldest was 72 years. In terms of gender distribution, males accounted for 46.1% (123 out of 267), while females made up 53.9% (144 out of 267). The most commonly affected site was the L4-L5 level, observed in 133 patients (49.8%), followed by the L5-S1 level, which affected 105 patients (39.3%).

Conclusion: The results indicate that such surgeries can significantly improve patient outcomes in terms of pain relief.

Determining the Occurrence, Predictors and Contributing Factors of Ischemic Versus Hemorrhagic Stroke Among Patients with Post Stroke Epilepsy; A Comparative Study

2025-01-17T12:05:39+00:00

Objective: To assess the occurrence, and contributing factors of post-stroke epilepsy in stroke patients and to compare the frequency of ischemic versus hemorrhagic stroke in patients presenting at Nishtar Hospital, Multan.

Materials & Methods: The patients with stroke, fulfilling inclusion criteria admitted to the neurology department of Nishtar Hospital, Multan were recruited in the study. A detailed history of the current illness as well as a history especially related to seizures was questioned. CT scan brain of all the patients was done and type of type i.e., ischemic or hemorrhagic was determined. Patients were followed for 3-month intervals for the occurrence of epilepsy.

Results: out of a total of 136 patients with stroke, ischemic stroke was found in 107 (78.7%) patients and hemorrhagic stroke in 29 (21.3%). Most patients were males 80 (58.8%) while 56 (41.2%) were females. The mean age of the patients was 55.55±10.17 years and the mean BMI was 25.26±5.54 kg/m2. The frequency of obesity, hypertension, diabetes, and smoking was 21.3%, 48.5%, 44.9%, and 44.1% respectively. Seizure was observed in 35(25.7%) patients with stroke, commonly in hemorrhagic stroke (12/17, 70.58%).

Conclusion: Old age, hypertension, and smoking significantly increase stroke risk. Epilepsy can complicate stroke with a higher incidence of hemorrhagic stroke.

Micro-bleedings of Cerebrum and Leukoaraiosis: Magnetic Resonance Imaging-Based Correlation Analysis by Micro-Bleed Anatomical Rating and Fazekas

2024-10-23T19:31:19+00:00

Objectives: Using Fazekas and Micro-bleed Anatomical Rating Scales (MARS) to assess the inter-relationship of MB(C) and leukoaraiosis based on magnetic resonance imaging (MRI).

Materials and Methods: Cross-sectional observational research was carried out at the radiology department of RYK Hospital Rahim Yar Khan, Pakistan. The study involved 70 participants who had MRI brain scans and were discovered to have micro-bleeds. The Micro-bleed Anatomical Rating scale (MARS) was used to grade micro-bleeds and Fazeka’s scale was implied for grading leukoaraiosis. The relationship between MARS and Fazeka’s scale was ascertained by Spearman's correlation.

Results: The patient's mean age was 65 years and 2 months, with male to female gender ratio of 1.8:1. A significant correlation (p<0.001) was observed between micro-bleeds grading of MARS and Fazekas grades, with a significant correlation coefficient of 1. Cerebral micro-bleeds also correlated with coexisting diseases, notably hypertension (84.28%), diabetes (60.00%), and smoking (55.71%). MRI analysis showed micro-bleeds were most frequently in variable locations (44.6%), followed by lobar regions (27.7%), deeper areas (18.5%), and basal nuclei (9.2%).

Conclusion: Leukoaraiosis (LA) and MB(C) have a strong correlation that suggests micro-blood vessel ischemia and hemorrhage as ultimate outcomes.