Mahadeo M Ghuge

Abstract

Background: Endoscopic spine techniques impart minimum approach related disruption of normal anatomy and provide excellent visualisation and magnification of tissues. The purpose of the study is to evaluate the functional outcome and possible complications of Destandau technique of posterior lumbar discectomy. Materials and Methods: One hundred and five patients were operated for lumbar disc herniation by using Destandau technique of lumbar discectomy from July 2012 to January 2019. Minimum follow-up was 12 months and maximum was 7 years. Results were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores and MacNab’s criteria. Results: Based on MacNab’s criteria, 87 patients (82.85%) had excellent results, 6 patients had good and 12 patients had fair results. Average VAS score for leg pain was improved from 8.3 (range 7-10; SD 1.10) to 0.8(range 0-3; SD 0.86) and average ODI score from 69.65 (range 60-78; SD 5.5) to 4.51 (range 0-12) at one year follow-up. Eighty eight percent patients were able to join sedentary work at 3 weeks, with restrictions to avoid heavy manual work till 6 weeks. The complication rate was 18% which included dural tears (3.8%), recurrent disc (3.8%), discitis (1.9%), transient neuralgia (7.61%) and superficial infection (0.9%). Conclusion: Destandau technique of endoscopic lumbar discectomy is a safe, effective, minimally invasive procedure and reduces the approach related morbidity. It also allows early postoperative rehabilitation and faster return to work. Proper training and experience is vital to overcome the steep learning curve. Keywords: Herniated lumbar disc, Destandau technique, Endoscopic discectomy, Minimally invasive surgery.

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Abstract

Introduction: The purpose of the present study is to evaluate functional outcomes and complications associated with open reduction and internal fixation (ORIF) with plates for displaced midshaft clavicle fractures. Materials and Methods: A retrospective review was performed utilising hospital database for patients treated with ORIF with plate for displaced mid-shaft clavicle fracture from January 2016 to August 2018. The primary outcome measure was union. The secondary outcome measures were functional outcome (DASH), patient satisfaction with treatment and cosmetic appearance, pain, complications and reoperations. All selected patients were requested to attend out-patient department (OPD) for assessment of patient oriented functional outcome measures. Results: Thirty patients were included in the study. Eighty percent were male patients with male female ratio of 4:1, with an average age of 35years. Forty percent fractures were Robinson type 2B1 and 60% were type 2B2. All patients treated with ORIF had fracture union (ie union rate of 100%) at an average time of 7.9 weeks. Patient satisfaction rate was 83%. Mean DASH Score was 14.63 6.27. The complication rate was 33.33%. The common complications were reoperation rate (30%), symptomatic hardware (23.33%), implant failure (6.66%) and superficial infection (3.33%). Conclusion: Open reduction and internal fixation for displaced, midshaft clavicle fracture results in high rates of union and patient satisfaction, and improved functional outcome. Symptomatic hardware removal remains the most common cause of reoperation. Patients with complications reported significantly worst functional outcome scores than patients without complication. Keywords: Clavicle fracture, Mid-shaft, Plate fixation, Functional outcome, Union, Reoperations, Complications.

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