Background: Recurrent lumbar disc herniation (RLDH) is one of the major causes for failure of primary surgery. The optimal surgical treatment of RLDH remains controversial. Aim: Retrospectively, we evaluate 135 patients and compare the clinical outcomes between fusion and nonfusion treatment of RLDH. Methods: Records of 75 men and 35 women aged 28–60 years for conventional revision discectomy alone (nonfusion) and 15 men and 10 women aged 30–65 years for revision discectomy with transforaminal lumbar interbody fusion (TLIF) and transpedicular screw fixation (fusion) were reviewed. Demographics, surgical data, and complications were collected and pre- and postoperative assessment were done by the Visual Analogue Scale (VAS) scale and Japanese Orthopaedic Association (JOA) score. The results after surgery were assessed according to the recovery rate as excellent, good, fair, and poor. Results: The mean follow-up period was 28.8 and 24.6 months in Group A (nonfusion) and Group B (fusion group), respectively. The preoperative data between both the groups showed no statistically significant difference. The postoperative mean VAS and JAO scores, recovery rate, and satisfaction rate showed no statistically significant difference except postoperative low back pain and occasional radicular pain and neurological deficit in nonfusion group which was significantly higher than that of fusion group. In comparison to fusion group, nonfusion group required significantly less operative time, less intraoperative blood loss, less postoperative hospital stay, no blood transfusion, and less total cost of the procedure. Satisfaction rate was 80% and 88% in nonfusion and fusion groups, respectively. Conclusions: Both convention revision discectomy (nonfusion) and discectomy with instrumented fusion (TLIF) surgery are effective in patients with RLDH.

Background: Treatment option of postoperative discitis (POD) is either conservative or operative, but till date, there are no established validated protocols of the treatment of postoperative lumbar discitis. Aim: The aim of this study was to assess the outcome of conservative versus operative management of POD following single-level lumbar discectomy. Methods: We prospectively studied a total of 38 cases of POD. The patients were diagnosed clinically, radiologically, and by laboratory investigations and followed up with serial erythrocyte sedimentation rate (ESR), C-reactive protein, X-ray, computed tomography (CT), and magnetic resonance imaging. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and posttreatment complications were collected, and pre- and postoperative assessment was done using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score. Functional outcome of the study was measured by the modified criteria of Kirkaldy–Willis. Results: VAS score for pain was significantly decreased in both groups after treatment. However, posttreatment differences were not statistically significant. In posttreatment mean JOA score, differences were not statistically significant in both groups except the mean difference (−0.47) of restriction of daily activities, which was statistically significant (95% confidence interval: −0.88–−0.07, P = 0.025, unpaired t -test). About 73.7% and 84.2% of the patients had a satisfactory functional outcome in conservative and operative management groups, respectively, at the end of 12-month follow-up. Conclusions: Operative management yielded better outcomes than traditional conservative treatment in terms of functional outcomes, length of hospital stays, and duration of antibiotic treatment as determined by both the pain and daily activity levels.

Background: Recurrent lumbar disc herniation (RLDH) is a common complication following primary microdiscectomy. Notably, revision surgery for recurrent disc herniation typically warrants “aggressive discectomy (AD)” rather than microdiscectomy due to the marked changes in anatomy, including postoperative scar. Here, we prospectively evaluated clinical outcomes of 22 RLDH patients following secondary aggressive discectomy (AD). Methods: Records of 15 males and seven females averaging 41.7 years of age (range 21–60) who developed RLDH following primary microdiscectomy at the L4-5 (n = 12) and L5-S1 (n = 10) levels were studied. All patients underwent secondary AD for recurrent lesions (2014–2019). Multiple clinical parameters were assessed for these 22 patients. Outcomes were evaluated an average of 28.8 months postoperatively and included assessment of visual analog scales (VASs) and Japanese Orthopedic Association (JOA) Scores. Results: The VAS scores for back and radicular pain significantly improved, as did the JOA scores following surgery in all 22 patients after secondary AD. Conclusion: The authors concluded that secondary conventional revision discectomy (e.g., AD) effectively and safely managed RLDH.

<p><strong>Background:</strong> Intradural extramedullary spinal cord tumours (IESCT) accounts for approximately two thirds of all intraspinal neoplasm and are of important clinical consideration and surgery is the essence in cases with neurological deterioration.</p><p><strong>Objective:</strong> To share our experience on the outcome of surgical excision of intradural extramedullary spinal cord tumours. Methods: Results of 60 patients surgically treated intradural extramedullary spinal tumours between Octo­ber 2003 and October 2015 at Bangabandhu Sheikh Mujib Medical University and in our private settings, Dhaka, were analyzed retrospectively. There were 32 males, 28 females with an average age of 52.4 years (13-70 years) and followed up for at least a year. The preoperative symptom with duration, tumours location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade.</p><p><strong>Results:</strong> The tumours were located as, thoracic 32 (53.33%), lumbar 16 (26.67%), cervical 04 (6.67%), and junctional 08 (13.33%), CervicoThoracic-01, Thoracolumbar-07). The histopathological diagnosis included schwannoma 35 (58.33%), meningiomas 14 (23.33%), neurofbroma 4 (6.67%), arachnoid cyst and myxopapillary ependymoma 03 (05.00%) each and paraganglioma 01 (01.67%). The VAS score was reduced in all cases from 8.0 ± 1.2 to 1.2 ± 0.8 (p &lt; 0.003) and the Nurick's grade was improved in all cases from 3.0 ± 1.3 to 1.0 ± 0.0 (p &lt; 0.005). The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Complications included cerebrospinal fluid leakage, parasthesia, dependant bedsore 02 (3.33%) each and recurrence 03 (05.00%). and further neurological deterioration 1 (01.67%) case.</p><p><strong>Conclusion:</strong> lntradural extramedullary tumors detected by MRI are mostly benign and good clinical results can be obtained when treated surgi­cally. Aggressive surgical excision potentially minimizes neurologic morbidity and improved outcome. ­</p>

<p><strong>Background:</strong> Trauma is the leading cause of disability in the first four decades of life and third most common cause of death. Spinal trauma poses considerable threats to survival and quality of life.</p><p><strong>Objective:</strong> Aims of this study is to assess the demographics, mode of trauma, hospital stay, complications, neurological improvement and mortality.</p><p><strong>Methods:</strong> Retrospective Cross sectional analysis of the records of spinal injury patients admitted in the Spine Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital from October 2003 to December 2013 was carried out. The demo­graphics, mode of trauma, involved vertebral level, co-morbid factors; neurological status and its improvement by Ameri­can Spinal Injury Association (ASIA) Score, duration of hospital stay and complications during hospital stay was assessed. Results were analyzed by SPSS.</p><p><strong>Results:</strong> Out of 1288 patients admitted, 192(14.90%) patients(range, 8-72 years) sustained spinal injuries and most (63.02%)of them were young (range, 21-40 years). Male to female ratio was 5:1. Cervical spine was most commonly ( 44.66%) affected followed by lumbar (35 .41 % ), thoracic (13 .54% ), thoraco-lumbar (06.25%) and Cervico-thoracic (03.13%) region. Fracture through intervertebral disc was most common in cervical spine. Among the common causes were road traffic accidents (44.47%), fall from height (29.69%), heavy weight bearing (14.58%) and assault with gunshot (07.29%). Paraparesis was most frequent (51.05%) clinical presentation followed by quadriparesis (45.83%). Significant number of patients (83.33%) required operative treatment (p&lt;0.05) and 09.89% were managed conservatively. Mortality rate (03.64%) was insignificant (p&gt;0.05%) and 03.12% patient refused to take treatment. Of these patients, 77.01 % had shown neurological improvement of at least one grade according to ASIA Score.</p><p><strong>Conclusion:</strong> Wide varieties of patients are encountered and managed varying from conservative to surgery. Carefully selected treatment provides the utmost outcome and reduces mortality.</p>