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Article
“Conservative treatment for sciatica compare with surgical intervention: a multi-center cohort clinical study” is locked Conservative treatment for sciatica compare with surgical intervention: a multi-center cohort clinical study

Journal: Muthanna Medical Journal مجلة المثنى الطبية ISSN: 2226146x Year: 2016 Volume: 3 Issue: 2 Pages: 133-138
Publisher: Al-Muthanna University جامعة المثنى

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Abstract

The objective of this study is to compare between conservative and surgical intervention in patients with low back ache. A cohort clinical retrospective-prospective study is enrolling 75 patients with low back ache and diagnosed as sciatica in multi-center (Baghdad and Muthanna). The outcome of both procedures depends on the following measures: neurological deficit, Lasègue test, Sciatica Bothersomeness Index, contralateral Lasègue test. Paired t-test applied for efficacy within the group and Chi-square test to compare the efficacy of two groups. After 6 months there was significant difference between operated and non-operated patients related to Sciatica Bothersomeness Index (p = than 0,01), Lasègue test (p=0,001), neurological deficit (p = 0,01) and leg and back pain depending on the activity (p=0,002). There was no difference statistically difference between the groups related to contralateral Lasègue test (p=0,206). In conclusion, we expended formerly accepted operative indications. There were better treatment results in the surgical operated group. A fast reduction of symptoms is the main advantage of the operative treatment strategy. Patients whose pain is treated in process that is acceptable for them may decide to postpone surgery. Patient’s preference for the type of treatment is crucial for an ultimate surgical decision in cases without widespread neurological deficits.


Article
Traumatic dorso lumbar spine fractures and its management

Author: Musaed Hekmat Al Dahhan مساعد حكمت الدهان
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2011 Volume: 7 Issue: 12 Pages: 220-231
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

The dorsolumbar segment is an unstable zone between fixed dorsal and mobile spine. The posterior approach with interpedicular screws and rods for segment stabilization was found appropriate method.Forty eight consecutive patients of dorso-lumbar spine injuries with or without neurological deficit ranged from 18-55 years were included in this study. LI vertebra was fractured in 32 cases, D12 in 12 cases l 1 in 3 cases and D10 in one case.21 patients presented with unstable fractures, 12 of them presented with complete paraplegia while 9 presented with incomplete neurological deficit. 16 patients with stable fractures treated conservatively while 32 patients treated surgically by decompression of the cord (Laminectomy) at the site of injury with stabilization by interpedicular screws and rods. All sixteen patients without neurological deficit and stable fractures treated conservatively and return to the work within 3 weeks of injury, 9 patients presented with partial neurological deficit showed significant improvement after surgery, while those 12 patients who presented with complete paraplegia showed no any significant improvement. The anterior wedge compression angle decreased postoperatively and there is improvement in kyphosis and decrease in severity of the pain. Transpedicular screws fixation with rods is the method of choice in treatment of dorsolumbar spine injury for stabilization and decompression to allow improvement of neurological deficit and early rehabilitation.

تعد إصابات العمود الفقري بمستوى الفقرات الصدرية القطنية من الإصابات الشائعة والخطرة في أن واحد بسبب الانتقال من مستوى الفقرات الصدرية الثابتة إلى مستوى الفقرات القطنية المتحركة والتي بدورها تكون سهلة الانكسار أو الخلع تم دراسة ثمانية وأربعون حالة أدخلت جميعها خلال الأسبوع الأول من الإصابة . كانت أعمار المرضى بين (18-55) سنة وسبب الإصابات أما السقوط من علو أو حوادث السيارات . كان هناك ستة عشرة مريض إصاباتهم مستقرة عولجوا تحفظيا بيما كان هناك اثنان وثلاثون مريضا عولجوا جراحيا بواسطة تثبيت العمود الفقري باستعمال براغي وقضبان من مادة التينانيوم بعد إن أجريت عملية فتح الفقرات وتحرير النخاع ألشوكي من الضغط الحاصل بسبب انكسار جسم الفقرة ورجوعه إلى الخلف وضغطة على النخاع ألشوكي . تحسنت حالة المرضى الذين كانوا يعانون من ضرر عصبي جزئي بينما لم نلاحظ أي تحسن على المرضى الذين يعانون من شلل الإطراف السفلى الكامل .تحسن حالة تقوس العمود الفقري ما بعد العملية بالإضافة إلى تراجع حدة الألم المصاحبة للكسر


Article
Penetrating Carotid Artery Injuries

Author: Abdul Salam Y Taha
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 1 Pages: 96-103
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Penetrating carotid artery injuries (PCAI) in civil time are infrequent, yet they present significant diagnostic and therapeutic challenges and can be associated with significant morbidity and mortality. Proper resuscitation and urgent exploration is necessary for actively bleeding patients.OBJECTIVE:The aim of this paper is to present our humble experience in management of such injuries with literature review. PATIENTS AND METHODS: Herein, we present 5 cases of penetrating carotid artery injuries managed in Sulaimania and Basrah from January 1996 to 30th of November 2009.RESULTS: All patients were young males. Three injuries were located in zone III and 2 in zone II. Four patients presented hours to days after the injury while the fifth presented after few months. Angiography was done in 2 patients with a false aneurysm of internal carotid artery (ICA). All 3 patients with ICA injuries were managed by ligation due to profuse bleeding and poor access. The 2 patients with common carotid artery (CCA) injuries in zone II had an end to end repair. All 5 patients have survived without significant neurological deficits.CONCLUSION: Penetrating carotid artery injuries in zone II usually do not require preoperative angiography unlike those in zone I and III. Repair is always desired. It is a straightforward operation for zone II injuries but really challenging for zone III due to poor access. Certain zone III injuries may be just observed or treated by endovascular stenting when facilities permit. Ligation of ICA carries a high risk of stroke; however, young people with well developed circle of Willis may tolerate it well

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