Objective:  A randomized control trial was conducted to compare the outcome of an endoscopic discectomy with microdiscectomy in lumbar spine disc disease. Material and Methods:  A randomized control trial was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. We included 80 patients of ages between 13 – 65 years, with low backache with radiation towards legs and prolapsed intervertebral disc at L5 – S1 and L4 – L5 levels on MRI were included in the study. Endoscopic/microscopic discectomy was done in a randomized manner under general anesthesia in a prone position with fluoro guidance. Postoperatively, all patients stayed in the recovery room for two hours for monitoring and then shifted to the ward. All patients followed-up-to one year clinically with the help of the Oswestry disability index (ODI). Results:  There were 37 female and 43 male patients in the ages between 13 – 65 years. The mean age of patients was 53.5 years. The 53 patients were having prolapsed disc at L5 S1 levels and 27 patients with disc prolapse at L4 – 5 levels. A good improvement was observed in visual analog scores after surgery in both endoscopic and microscopic discectomy groups. But endoscopic discectomy group required a lesser hospital stay, early mobilization, and lesser postoperative analgesia requirements than the microscopic group. Conclusion:  Endoscopic/microdiscectomy both are equally effective and safer techniques. They both can relief. However, the endoscopic discectomy was found better in terms of early mobilization and lesser postoperative pain.

Background:  Cervical spine stenosis is one of the most common degenerative changes of cervical spondylotic myelopathy (CSM) and results in severe dysfunction of the cervical spinal cord. The conventional treatment of such degenerative cervical spine conditions is anterior cervical discectomy and fusion (ACDF). Strut graft remains the gold standard in ACDF with excellent patient recovery but has many shortcomings. Polyetheretherketone (PEEK) cages have recently become popular as a replacement for strut grafts in patients undergoing ACDF. Objective:  This study was carried out to compare the clinical and radiographic outcomes of autologous bone grafts versus PEEK cages in patients undergoing ACDF surgery. Materials and Methods:  It was a randomized controlled trial conducted at the Neurosurgery Department Punjab Institute of Neurosciences for three years. Patients who consented to be a part of this study and fulfilled our predefined inclusion criteria were recruited and randomized into 2 groups. One group underwent ACDF with auto bone graft whereas the other group underwent ACDF with PEEK cage. Results:  A total of 198 subjects were included in this study. The mean age was calculated as 47.60 ± 9.17 years in the PEEK cage group and 46.74 ± 8.87 years in the Autologous bone graft group. Males accounted for 59.6% of the study population.  The fusion rate was found to be higher in the PEEK cage group with a p-value of 0.002. Conclusion:  PEEK cages are superior to strut grafts as they have lesser morbidity after ACDF surgery in patients with CSM.

Objective:  To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results:  The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion:  Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome.

Objective:  The objective of the current study was to compare the clinical outcomes of a micro-endoscopic discectomy with an open discectomy. Materials & Methods:  This Quasi-experimental study was conducted in the Department of Neurosurgery, Alrazi Healthcare, Lahore, and Ammar Medical Complex, Lahore. The sample consisted of 40 patients with lower back pain with radiation to the lower limbs. A lumbar disc single-segment hernia was diagnosed based on magnetic resonance imaging (MRI) findings. Independent sample t-test was used to explore the difference in outcomes and level of pain between group A and group B. Chi-square test was used to compare the recovery rate of patients in both groups. Results:  A significant difference between the two groups in terms of surgery duration (t = 15.977, P = .000), blood loss during surgery (t = -10.256, P = .000), length of incision (t = -58.355, P = .000), and hospital stay after surgery (t = -4.687, P = .000) was found. The overall recovery rate for the micro-endoscopic Discectomy group was 95% whereas, in the open discectomy group, it was 90%. Conclusion:  Micro-endoscopic discectomy is superior to open discectomy in terms of lesser surgical trauma, lesser blood loss, lesser hospital stay, earlier return to work, and higher pain resolution.