Pakistan Journal Of Neurological Surgery

History and Evaluation of Women in Neurosurgery (WINS) Chapter, Pakistan Society of Neurosurgeons (PSN)

Fahmida Arab Mallah — 2026-03-17

Encouraging and Empowering Women in Neurosurgery From Pakistan

Fahmida Arab Mallah — 2026-03-17

Efficiency of Horizontal Skin Incision at 1-Level And 2-Level Anterior Cervical Discectomy and Fusion: A Prospective Observational Study

Sohrab khan — 2026-03-17

Objective: Horizontal skin incision is an optimal treatment approach in Anterior Cervical Discectomy and Fusion (ACDF). However, evidence comparing the efficiency of these incisions in 1-level and 2-level ACDF remained uncertain. The study aimed to assess and compare efficiency, clinical and cosmetic outcomes, along with patient and clinician satisfaction, and complications associated with horizontal skin incision in 1-level and 2-level ACDF procedures.

Methods: A prospective observational study recruiting 453 participants who underwent ACDF via horizontal skin incision was conducted between February 2023 to January 2024. Participants were divided into 1-level (n=256) and 2-level (n=188) ACDF groups. Operative parameters, cosmetic outcomes (POSAS, VSS), and postoperative complications were assessed. A follow-up at 3, 6, and 12 months was held. SPSS software v.26 was employed for data analysis, and a p-value of <0.05 was considered significant.

Results: The 2-level ACDF group showed significantly longer incision length, surgical duration, and hospitalization (p<0.001). The 1-level ACDF exhibited superior results regarding scar visibility, symmetry, and patient satisfaction at each follow-up (p<0.05). Mean PSOAS and VSS scores were also significantly lower (better) in the 1-level group, indicating better cosmetic outcomes. Complications, including dysphagia and dysphonia, were significantly more prevalent in the 2-level ACDF group (p<0.05), while wound-related complications were comparable across both groups (p>0.05).

Conclusion: The horizontal (transverse) skin incision provided favorable outcomes across both groups. However, 1-level ACDF was associated with greater efficiency, minimal complications, and a higher satisfaction level among patients. Additionally, multiple-level ACDF has an increased risk of postoperative complications and blood loss.

Biomechanical Outcome of Short Segment Trans-pedicular Fixation at Thoraco-Lumbar Junction Fractures with Incorporation of Screws at Fractured Level

Muhammad Farooq — 2026-03-17

Objective: Despite consensus on the surgical management of thoracolumbar fractures, considerable controversy exists regarding the correction of kyphotic deformity. This study is to evaluate the extent of correction of kyphotic deformity in 6S short-segment TP Fixation (6S-SSF) with incorporation of Screws into fractured vertebrae in Thoracolumbar Junction Fractures (TLJ).

Material and Methods: This retrospective cohort study analyzed 34 patients with unstable thoracolumbar fractures (T10-L3) treated with six-screw short-segment transpedicular fixation between March 2019 and February 2021. Primary outcomes included correction of kyphotic deformity and maintenance of reduction at 12-month follow-up. Secondary outcomes encompassed vertebral height restoration and functional scores.

Results: The cohort comprised 25 males (73.5%) and 9 females (26.5%) with a mean age of 37.2 ± 9.8 years. L1 fractures predominated (41.2%), followed by T12 fractures (29.4%). Mean preoperative kyphotic angle measured 16.3° ± 4.2°, improving to 7.6° ± 3.1° postoperatively. At 12-month follow-up, the kyphotic angle measured 8.1° ± 3.4°, representing minimal correction loss of 0.5° ± 1.2°.

Conclusion: The Six-screw short-segment transpedicular fixation in thoracolumbar fractures, including the fractured vertebra, demonstrates superior biomechanical stability with effective kyphotic correction and minimal loss of reduction as compared to traditional four-screw constructs.

Ethical Challenges for healthcare providers in End-of-Life Decision-Making for Severe Head Injury patients

Iqbal Ahmad — 2026-03-17

Objectives: This study aims to determine the ethical challenges healthcare providers encounter while making end-of-life decisions for patients with severe head injuries in a tertiary care hospital.

Materials & Methods: A cross-sectional, questionnaire-based survey was conducted from Feb – May 2025, targeting neurosurgeons, ICU physicians, and nurses with a minimum of one year of experience. The structured tool examined frequency, types, and sources of ethical dilemmas, decision-making approaches, and institutional support. Statistical analysis was performed using SPSS version 26.

Results: Of the 100 healthcare professionals surveyed, 78% frequently encountered ethical dilemmas, with resource limitations, familial pressure, and lack of institutional policy cited as the primary issues. A significant association was found between professional role and perceived institutional support (p<0.05), and a positive correlation between experience and confidence in decision-making (r=0.32).

Conclusion: The findings highlight a lack of ethical preparedness and insufficient institutional support for end-of-life decision-making. Improving this area requires structured ethics training, the implementation of formal policies, and multidisciplinary collaboration that reflects the local sociocultural context.

Keywords: End-of-life care, ethical challenges, severe head injury, healthcare providers, Pakistan.

Short-Term Clinical Efficacy of Lacosamide in Orthopedic Spine Patients with Acute Sciatica: A Prospective Observational Study at Akhtar Saeed Trust Teaching Hospital, Lahore

Syed Ahmad Bilal Bukhari — 2026-03-17

Objective: To evaluate the short-term clinical efficacy and tolerability of intravenous lacosamide in orthopedic spine patients presenting with acute sciatica.

Materials and Methods: This prospective observational study was conducted at the Department of Orthopedic Surgery, Akhtar Saeed Trust Teaching Hospital, Lahore, from January 2023 to January 2024. One hundred adult patients (20–65 years) with acute lumbosacral radiculopathy were included. All patients received intravenous lacosamide 200 mg diluted in 100 mL normal saline, administered twice daily for three consecutive days. Clinical outcomes were assessed at baseline and on day 4 using the Numerical Rating Scale (NRS) for pain, Oswestry Disability Index (ODI), Straight Leg Raise (SLR) test, and Claudication Distance (CD). Statistical analysis was performed using paired t-tests.

Results: After 4 days of treatment, significant improvements were observed across all outcome measures. Mean NRS decreased from 8.2 ± 1.1 to 3.1 ± 1.4 (p < 0.001), and mean ODI reduced from 58.7 ± 11.3% to 29.6 ± 10.8% (p<0.001). Mean SLR angle increased from 42.6 ± 10.5° to 68.3 ± 11.9° (p<0.001), while mean claudication distance improved from 145.2 ± 48.3 m to 266.4 ± 59.8 m (p < 0.001). Adverse effects were mild and included dizziness (8%), nausea (5%), and somnolence (4%), with no serious events.

Conclusion: Short-term intravenous lacosamide significantly improved pain, functional disability, and objective neurological parameters in patients with acute sciatica and was well tolerated, supporting its role as an adjunct in acute radicular pain management.

Outcomes of Neuronavigation-Guided Ventriculoperitoneal Shunt Placement in Idiopathic Intracranial Hypertension: A Retrospective Study

Muhammad Mehboob Alam — 2026-03-17

Objectives: Idiopathic Intracranial Hypertension (IIH) is the buildup of pressure inside the skull that presents mostly as a headache. Ventriculoperitoneal (VP) shunts are the treatment of choice. Given the challenge of canulating slit ventricles, this study evaluates the outcomes of neuronavigation-guided VP shunt placement.

Materials & Methods: Patients undergoing neuronavigation-guided VP shunt placement were included from January 2021 to June 2024. Patient demographics, clinical signs and symptoms, Body Mass Index (BMI), operative details, and outcomes were recorded. Primary outcomes assessed were predisposing factors, symptom improvement, complication rates, and revision surgery. SPSS v.27 was used for data analysis.

Results: A total of 21 patients were included in this study who reported a statistically significant improvement in symptoms following VP shunt placement (p<0.05). Headache relief and visual improvement were the most notable outcomes, with 94% of patients experiencing substantial benefit. One patient had suboptimal placement, and one patient developed a superficial SSI. Both patients were discharged without any complications after treatment. None of the patients included in the study developed low-pressure headaches.

Conclusion: This study reports improved outcomes with Neuronavigation-guided VP shunt placement, resulting in improved surgeon confidence and reduced risk of shunt malposition. Further multicenter, large sample size studies are needed to validate these outcomes.

Frequency of Raised Serum C-Reactive Protein (CRP) Levels Among Stroke Patients at A Tertiary Care Hospital

Umair Zafar — 2026-03-17

Objective: To determine the frequency of raised serum C-reactive protein levels among stroke patients at a tertiary care hospital.

Materials and Methods: This was a descriptive cross-sectional study designed to estimate the frequency of raised serum C-reactive protein (CRP) levels among stroke patients. The study was not intended to establish causal relationships. A descriptive cross-sectional case series study was conducted at the Department of Neurology, Nishtar Medical University Hospital, Multan, from 26-10-2018 to 26-04-19. A total of 85 stroke patients were enrolled. Once registered in the study, a 3 ml venous blood sample was drawn in a sterilized syringe under aseptic conditions and sent to the Central Laboratory of the hospital for serum CRP levels. Data was entered and analyzed by the computer program SPSS version 26.

Results: Out of 85 patients, 54 (63.5%) were male, and 55 (62.4%) were above 55 years. Serum CRP levels were raised in 46 (54.1) patients. CRP has a significant association with age >55 years (p=0.007), rural residence (p=0.048), hypertension (p=0.001), and diabetes (p=0.001. Whereas other variables showed no statistically significant correlation.

Conclusion: A very high frequency of raised serum C-reactive protein (CRP) was observed among stroke patients in our study. Raised CRP was significantly associated with hypertension, diabetes, age, and residential status. All clinicians who care for this type of patient should regularly monitor serum C-reactive protein levels, since this monitoring contributes to a better clinical evolution, favoring the prognosis and functional stability of the patient.

Extent of Resection and Complications in Transsphenoidal Surgery for Pituitary Adenoma and Its Outcome

Muhammad Ali Noman — 2026-03-17

Objective: The aim of the research is to determine the level of resection and postoperative complications during transsphenoidal surgery in pituitary adenoma.

Materials & Methods: Seventy patients with radiologically confirmed pituitary adenomas who met the inclusion criteria were included in the final analysis. An expert neurosurgeon carried out all the procedures. The degree of tumor resection was evaluated based on comparing preoperative to the postoperative magnetic resonance imaging (MRI) scans at three months postop and ranged from gross total, near total, and subtotal resection. The postop complications were also evaluated, including CSF leak, hematoma, diabetes insipidus, and hyponatremia.

Results: The average age of the participants in the study was 48.01, and the standard deviation was 11.13, with most of the patients being males (65.7 percent). Gross total resection was attained in 57.1%, and near-total and subtotal resection were attained in 15.7% and 27.1% cases, respectively. In relation to the complications,
CSF leak had a case of 10.0 percent, diabetes insipidus cases were 5.7 percent, and 8.6 percent cases had hyponatremia.

Conclusion: Transsphenoidal surgery for pituitary adenoma demonstrated grand total resection in 57.1% of cases, near total resection in 15.7%, and subtotal resection in 27.1% of cases. CSF leak was the most frequent post-op complication.

Role of Intraoperative Neuromonitoring for Meningomyelocele Repair

Tabraiz Wali Shah — 2026-03-17

Objectives: To determine the impact of multimodal intraoperative neuromonitoring on post-meningomyelocele repair-neurological outcome in patients receiving meningomyelocele repair.

Material and Methods: This retrospective comparative study included 50 patients who underwent primary meningomyelocele repair. The patients were separated into the IONM group (n= 42) and the non-IONM group (n= 8). In a limited number of cases, multimodal neuromonitoring was used and consisted of the following measurements: somatosensory evoked potentials, motor evoked potentials, electromyography, and the bulbocavernosus reflex measurement. The major resultant effect was the occurrence of new postoperative neurological deficits. The statistical analysis was conducted in SPSS, and p < 0.05 was assumed to be significant.

Results: The proportion of neurological impairments postoperatively was significantly less in the IONM than the non-IONM group (7.1% vs. 37.5, p < 0.01). Intraoperative alerts were witnessed in 21.4 percent of observed cases, and a timely surgical change was made. The lack of IONM had been linked with increased chances of neurological worsening (RR = 5.3). There were no differences in the length of operation and blood loss.

Conclusion: This retrospective cohort of multimodal intraoperative neuromonitoring was linked to a reduced incidence of postoperative neurological loss and can potentially become an effective addition during meningomyelocele repair.

Dysautonomia as a Surgical Complication of Transdiaphragmatic Approach to Thoracolumbar Fractures

Muzamil Dilber — 2026-03-17

Objective: A Quasi-experimental study was conducted to observe the effects of sympathetic chain resection or mobilization in patients with dorsolumbar fractures undergoing anterior decompression and stabilization.

Materials and Methods: Patients with thoracolumbar traumatic fractures who underwent anterior decompression and fixation were included. Autonomic sympathetic effects were studied by checking cutaneous temperature at the dorsum of the feet, plantar ninhydrin sweat test, and sympathetic skin response on the dorsum of the foot by electrical stimulation.

Results: 33 patients were operated on for thoracolumbar fractures. Sympathetic changes were more prominent at combined L1 and L2 fractures (18%) as compared to D11, D12 (90%) in the early postoperative period. Affected limb temperature increased in (57.5%), with positive ninhydrin test in 54.5% and Negative in 57.5%. Average difference in cutaneous temperature on the right side = 96.01°F and on the left side = 96.7°F. The average mean difference on both sides was 1.66°F. Sympathetic skin response was positive in 57.5% and Negative in 54.5% of cases. Nerve conduction studies revealed reduced amplitude and prolonged latencies, asymmetrical, L>R, of bilateral. Permanent sympathetic damage was observed in 9% and, temporary damage in 72%, and 18% were fail to follow up after six months.

Conclusion: Unilateral thoracolumbar sympathetic chain mobilization or resection (ramisectomy or ganglionectomy) leads to cutaneous temperature elevation, decreased sweating, decreased SPO2, and trophic changes on the operative side. Thus, the sympathetic chain should be handled with care to avoid sympathetic dysautonomia in the lower limbs.

Comparative Analysis of Mini-Transverse and Mid Palmar Longitudinal Incision in The Management of Carpal Tunnel Syndrome: A Retrospective Study

Kamran Ullah — 2026-03-17

Objective: This study aims to compare these two techniques in terms of postoperative pain, recovery time, complication rate, and patient satisfaction.

Material and Methods: This comparative study included 95 patients diagnosed with CTS on the basis of clinical examination supported by electrodiagnostic findings. Participants underwent either a mini transverse or a mid-palmar longitudinal incision for CTS decompression. Patient-reported outcome measures were collected in terms of postoperative pain, time to recovery, number of complications, and overall satisfaction. Statistical analysis was done by SPSS software, with a significance level set at p< 0.05.

Results: Out of 95 surgical procedures, 48 (50.5%) were performed using mini-transverse and 47 (49.5%) were mid-palmar longitudinal incisions. Patients in the mini-transverse incision experienced significantly lower intraoperative blood loss (mean 28 mL vs. 52 mL, p = 0.02) and reduced complication rates (e.g., infections: 3% vs. 5%, p = 0.12). Mini-transverse incision showed better neurological recovery at discharge (83% vs. 76%, p = 0.04) and at 6 months after surgery (88% vs. 82%, p = 0.05).

Conclusion: Mini transverse incision offers a less invasive alternative to the mid palmar longitudinal incision, resulting in less blood loss, fewer complications, faster recovery time, and higher patient satisfaction. These results support the growing inclination toward minimally invasive methods in the surgical management of CTS.

Safety and CSF Leak Outcomes After Endoscopic Endonasal Resection of Giant Pituitary Adenomas Without Nasoseptal Flap

Khawar Anwar — 2026-03-17

Objective: The study aimed to assess the risk of CSF leakage without the use of Nasoseptal flap elevations (NSFE) as compared to the standard practices of endoscopic endonasal approach (EEA) and multilayer graft reconstruction.

Materials & Methods: A retrospective review of EEA surgeries performed with multilayer graft repair in patients with per op CSF Leak but not with the NSFE, between June 2018 and February 2023, with a follow-up at one and three months. A proforma mentioning perioperative, preoperative, pre-operative, and follow-up data regarding CSF leak, intervention, and investigation was used. Descriptive statistical analysis was done.

Results: We collected data for 175 patients (70 male and 105 female). Mean age was 40 yrs. Mean tumor size in diameter was 45mm.CSF leakage in NSFE ranged from one to five percent in the literature, owing to the size. Similarly, due to large tumor sizes, there were 54/175 (30.86%) patients with CSF leak postoperatively. These 54 cases underwent multilayer graft reconstruction during the same surgery. Total CSF leaks were 8/175(4.57%) on follow-ups. Five patients out of these eight improved with conservative management (lumbar drain and puncture). Two patients had to go for surgery immediately postoperatively, and one had a follow-up. Redosurgery accounted for 3/175(1.71%). There were no invasive nasal complications as in NSFE.

Conclusion: Even with giant macro adenomas, EEA with multilayer graft reconstruction gave equally effective results as compared to the landmark considered treatment option, controlling CSF leak, and the NSFE.

Revision Surgery For Degenerative Spine Disease in Resource-Limited Neurosurgical Settings of A Low – Income Country: A Growing Challenge

Muhammad Abbas Khan — 2026-03-17

Purpose: To determine the functional outcome and perioperative complications of degenerative spine disease revision surgery in a resource-constrained neurosurgical environment.

Materials & Methods: One hundred adults (>= 18 years) who had undergone degenerative cervical/ thoracic/ lumbar spine surgery before and were undergoing revision surgery were recruited. The demographic data, comorbidities, surgical history, hospitalisation, and perioperative complications (30 days) were captured. The Oswestry Disability Index (ODI) and the visual analogue scale (VAS) were used as a functional outcome measure during preoperative and 6 months postoperative. The response to be classified as a favorable outcome was a 30 percent or greater reduction in ODI and a 2-point or greater reduction in VAS with no new permanent neurological impairment.

Results: Mean ODI changed to an improved value of 37.10 ± 9.42 (as compared to 56.49 ± 9.42), and mean VAS to a worse value of 4.79 ± 1.33 (as compared to 7.50 ± 0.94). A positive result was attained in 58 percent of patients. The adverse effects included but were not limited to dural tear (7%), wound infection (6%), new neurological deficit (4%), implant-related problems (5%), and major medical events (3%). There was no significant baseline or surgical factor that had any association with outcome.

Conclusion: Degenerative spine disease after surgery may be effectively revised to generate significant functional outcomes with satisfactory complication rates in a resource-restricted environment.

Keywords: Spinal Diseases/surgery, Reoperation, Developing Countries, Neurosurgical Procedures, Treatment Outcome.

Traumatic Brain Injury during Pregnancy: Maternal-Fetal Outcomes and Management

Shirin Gul Suhail — 2026-03-17

Objective: To provide local evidence for the development of a maternal-fetal unit of management to control adverse outcomes in pregnant patients with traumatic brain injury (TBI).

Material and Methods: This study was executed at the Punjab Institute of Neurosciences (PINS) and the Department of Obstetrics and Gynecology, General Hospital, Lahore (LGH). The study recruited a sample of 30 patients who reported with TBI. In the first phase of the study, initial assessment and treatment for the patients were provided; later, maternal-fetal outcomes of these patients were observed. After the description of data, the Chi-square test of association and Analysis of variance were used to draw inferences.

Results: The average maternal age was 30 ± 4.7 years, and most of the patients got this injury during the second and third trimester. Road accidents were the leading cause of TBI in these patients, and a significant number underwent neurosurgical interventions, with three mortalities. More than half of the patients needed critical care in the intensive care unit. A substantial proportion of fetal distress, neonatal deaths, cesarean deliveries, preterm births, and maternal mortality had been recorded in patients who had severe TBI as per the Glasgow Coma Scale.

Conclusion: This study concludes that both maternal and fetal status are at risk in this study group; however, a well-defined maternal-fetal management unit, which is a combination of obstetricians, neurosurgeons, and critical care professionals, can reduce the potential negative outcomes.

Ethical Challenges for Healthcare Providers in End-of-LIFE Decision-Making for Severe Head Injury Patients

Iqbal Ahmad — 2026-03-17

Materials & Methods: A cross-sectional, questionnaire-based survey was conducted targeting neurosurgeons, ICU physicians, and nurses with a minimum of one year of experience. The structured tool examined frequency, types, and sources of ethical dilemmas, decision-making approaches, and institutional support. Statistical analysis was performed using SPSS version 26.

Perioperative Use Of Tranexamic Acid In Brain Tumor Resection: Effects On Intraoperative Blood Loss And Thrombosis Risk.

Naeem ul haq — 2026-03-17

Objective: To determine if there is a reduction in the amount of blood lost during surgery for patients with a brain tumor if tranexamic acid (TXA) is given before surgery.

Study Design: Prospective cohort study.

Setting and Duration: The Department of Neurosurgery, Mardan Medical Complex, Pakistan, from January 2020 to December 2024.

Methodology: 100 patients (n = 100) due to undergo a planned brain tumor resection volunteered. From the TXA group (n = 50), intravenous TXA 10 mg/kg was administered 30 minutes before induction; from the control group (n = 50), nothing was administered. The amount of blood loss during surgery, the number of transfusions required, the time taken to perform the surgery, and postoperative blood clotting events were noted. p=0.05 was used as the threshold for statistical significance.

Results: TXA reduced blood loss during surgery (480 +/- 130 vs 740 +/- 210; p < .001) and the need for blood transfusions (12% vs 28%) during these surgeries, confirming the first outcome. TXA and control group thromboembolism event rates of 4% and 6%, respectively; p = 0.64 (95% CI 0.23 – 2.15) indicates comparability in thromboembolic event rates and absence of new brain bleeding after surgery.

Conclusion: Preoperative TXA reduces blood loss and the need for blood transfusions, and does not increase the risk of thromboembolic complications after surgery. For selected patients undergoing neurosurgery, TXA can be deemed safe and effective.

Incidence and Outcomes of High-Grade Gliomas in Young Adults: An Emerging Challenge

Adeel Ur Rehman — 2026-03-17

Objective: High-grade gliomas are typically associated with older age, whereas low-grade gliomas are more common in young people. However, in recent years, there has been a surge in high-grade gliomas among the young population in our area, which prompted us to examine this phenomenon more closely and its implications for treatment. To measure the incidence of high-grade gliomas in the young population and to examine trends. In addition, we examined the molecular characteristics of these gliomas and the postoperative outcomes following resection.

Materials & Methods: A retrospective study was conducted in our department, in which we reviewed patient records from January 2022 to July 2025. We included 85 patients in our final cohort aged 18 to 39 years with a confirmed diagnosis of high-grade glioma (WHO Grades III and IV). Our exclusion criteria were individuals with low-grade gliomas, non-glial tumors, or incomplete records. From available patient records, we extracted demographic data, tumor incidence, molecular markers (IDH, MGMT, ATRX), and clinical outcomes. Statistical analysis was done on SPSS version 26.

Results: Results showed a statistically significant increase in the incidence of high-grade gliomas in young adults (p < 0.01). Molecular analysis revealed that IDH-wildtype tumors accounted for 74% (37 of 50 cases). Of these, 43.2% exhibited MGMT promoter methylation (16 of 37). Among the IDH-mutant cases (26%, 13 of 50), ATRX loss was present in 84.6% (11 of 13 cases). The median overall survival was 16.5 months.

CT-Measured Contusion Volume as a Predictor of Outcome in Surgically Treated Traumatic Brain Injury

Mewat Shah — 2026-03-17

Objective: To determine the association between hemorrhagic contusion volume measured on computed tomography and neurological recovery in surgically managed traumatic brain injury patients.

Lost Time, Lost Function: The Impact of Delayed Referral and Surgical Timing on Outcomes in Caries Spine in a Developing Country

Usman Ahmad — 2026-03-17

Objective: In Pakistan, delayed referrals are frequent in spinal TB, leading to late presentations with established neurological deficits and vertebral destruction. We investigated the effects of referral delays and surgical timing on neurological outcomes in surgically treated spinal TB patients.

Materials and Methods: This prospective study was carried out at the Punjab Institute of Neurosciences, Lahore, from January to December 2025. Fifty-six surgical spinal TB patients were grouped as early (less than four weeks from first medical contact to surgery) or delayed (more than four weeks). Neurological status was assessed using Frankel Grade. Hospital stays and complications were also recorded. Chi-square test, independent t-test, and multivariate regression were used for analysis.

Results: Mean age was 38.4 years; 64.3% were male. Delayed presentation occurred in 60.7% of patients, commonly due to misdiagnosis as mechanical backache (57.1%) and financial constraints (50.0%). The thoracolumbar junction was the commonest site (50.0%). The early surgery group showed better neurological improvement (86.4% vs. 67.6%, p=0.024), more complete recoveries (54.5% vs. 29.4%, p=0.048), and shorter hospital stay (12.4 vs. 18.6 days, p=0.001). Delayed referral independently predicted poor outcome (aOR 2.6, p=0.034).

Conclusion: Surgery within four weeks of first medical contact leads to better neurological recovery in spinal TB. Training primary care physicians to recognize spinal TB early and refer promptly can improve patient outcomes.

Frequency and Prognostic Evaluation of Sciatic Nerve Injury following Posterior Wall Acetabular Fixation

Aimal Sattar — 2026-03-17

Objective: To evaluate the frequency of sciatic nerve injury after surgical fixation of posterior wall acetabular fractures and to assess its impact on neurological recovery and functional outcome.

Materials & Methods: A prospective observational study was conducted at the Department of Orthopedics Lady Reading Hospital Peshawar from April 2024 to May 2025 A total of 110 patients who underwent posterior wall acetabular fixation were included Sciatic nerve function was assessed before and after surgery using clinical and electrophysiological methods Follow-up evaluations were done at one three and six months Functional outcomes were measured using the Medical Research Council scale and the Lower Extremity Functional Scale.

Results: Sciatic nerve injury occurred in 16 patients, which is 14.5 percent. The peroneal division was affected more than the tibial division. Most injuries were neuropraxia, with 81.3 percent of these cases showing favorable recovery within six months. Poor outcomes were linked to surgery delayed beyond seven days, intraoperative traction lasting more than thirty minutes, and complex fracture patterns.

Conclusion: Sciatic nerve injury is a significant complication following posterior wall acetabular fixation. However, most cases recover without major intervention. Early surgery, minimal traction, and careful handling of fracture fragments can reduce injury risk and improve functional recovery.