Objective: The purpose of this study was to compare the clinical and radiological results of employing local bone graft with a PEEK cage vs bone graft and plate in ACDF. Study Design: Retrospective study Place and Duration: Department of Neurosurgery, Gomal Medical College DI Khan in the period from June, 2022 to November, 2022. Methods: There were 80 cases of both genders were included for anterior cervical discectomy and fusion. Detailed demographic information on enrolled cases was recorded after receiving informed written consent. Patients were divided in two groups. Group I received ACDF by using bone graft and plate in 40 cases while in 40 cases of group II ACDF was performed by using zero size peek cage filled with bone graft and inbuilt screws. Outcomes among both groups were compared. SPSS 22.0 was used to analyze all data. Results: Among 80 cases, there were 46 (57.5%) males and 34 (42.5%) females. Mean age of the patients was 43±18 years. Perioperative mean pain score was 7.5±6.20, mean NDI was 62.4±2.8, mean SF-36 was 29.8±3.15 in group I and in group II mean pain score was 6.9±5.20, NDI was 64.8±3.10 and SF-36 was 30.5±4.13. Significantly reduction in pain score, NDI and increase in SF-36 among both groups were found while in group II outcomes were better than group I. Mean operative time in group I was higher as compared to group II with p value <0.004. There was no any significantly difference in blood loss among both groups. With a p value of 0.003, group II had higher disc space height and segmental interbody angle at the operative segment than group I. Perioperative complication rates in group I was higher with p value <0.05. Conclusion: In this study, we found that patients undergoing ACDF with local bone graft and a PEEK cage had significantly shorter operating times, fewer perioperative problems, and better radiological outcomes than patients undergoing ACDF with bone graft and plate. A PEEK cage-encased local bone graft seems to be a secure substitute for an ACDF's bone transplant. Keywords: Cervical spine, Anterior cervical discectomy and fusion, bone graft, Local bone graft

Objective: The main purpose of this study is to examine whether or not magnesium sulphate improves the Glasgow Coma Scale (GCS) scores of individuals who have suffered severe traumatic brain injury. Study Design: Prospective study Place and Duration: Women medical college Abbottabad and Department of Neurology Hayatabad Medical Complex, during from Jan, 2021 to June, 2021. Methods: This research includes 72 participants of both sexes. Patients were between the ages of 18 and 55 when they were enrolled. All the patients had severe traumatic brain injury and magnesium sulphate treatment was administered to each patient. All of the patients' demographic information was obtained after they signed an informed permission form. In this study, the Glasgow coma score (GCS) was measured on the first and forth days of hospitalization, respectively. The SPSS 20.0 version was used to analyze all of the data. Results:Amon 73 included patients,males were higher in numbers 41 (56.9%) than females 31 (43.1%). Presented patients had mean age 43.6±9.39 years and had mean BMI 25.8±12.83 kg/m2 . Post traumatic mean time of brain injury was 6.16 ±4.41 hours. At first day without magnesium sulfate mean GCS of the patients was 7.3±8.30 but at the 4th day GCS was 11.9±6.42 with p value < 0.04. GCS, on the other hand, showed no significant differences between gender and illness duration. Conclusion: The results of this study led us to the conclusion that the use of magnesium sulphate was an effective method for treating traumatic brain injury in patients. GCS was improved among patients when magnesium sulphate was administered on the seventh day. Keywords: Magnesium Sulfate, traumatic brain injury, Glasgow Coma Score (GCS)

Objective: The study's goal is to find out how often individuals with myelomeningocele and TCS repair have leakage of cerebrospinal fluid. Study Design: Cross-sectional Place and Duration: Women medical college Abbottabad and Children hospital and the institute of child health, Multan, during from the period July, 2021 to Dec, 2021. Methods: There were 55 participants of both sexes in this research. Those being treated ranged in age from 5 to 20 years old. After obtaining written permission, we collected demographic data on each patient, including their age, gender, and BMI measurements. There were patients who had TCS repair as well as those who had undergone myelomeningocele repair procedures. It was determined how often cerebrospinal fluid leaks occurred in patients. SPSS 22.0 was used to analyze all of the data. Results: Among 55 cases, majority were males 32 (58.2%) and 23 (41.8%) were females. Included patients had mean age 9.5±6.14 years. Frequency of CSF leak was found among 18 (32.7%) patients. The mean duration of CSF leaks was 13.11±10.34 days. In 18 patients of CSF leaks, Frequency of MMC repair was 11, TCS release was found in 3 patients and meningocele repair in 4 patients. With the use of tincture benzoyl-enhanced primary wound healing in three patients with CSF leaks during surgery, the HCP postoperative signs were resolved. HCP was found in two further patients after their sutures mended with benzoyl tinctures, and they were placed in the shunt. Conclusion: In this research, we found that CSF leaks are more common in patients having myelomeningocele and TCS repair. Skin-healing tincture benzoyl will help these people. Keywords: Cerebrospinal fluid leak (CSF), Tether cord syndrome (TCS), Myelomeningocele (MMC)

Objective: The aim of this study is to determine the efficacy of endoscopic microdisectomy versus conventional discectomy for lumber disc disease. Study Design: Randomized Control trial Place and Duration: Dow International Medical College and Hospital OJHA Campus, Karachi during the period from December, 2021 to May, 2022. Methods: Total 70 patients of both genders were presented in this study. Patients detailed demographics age, sex and BMI were recorded after taking written consent. Patients were aged between 18-70 years, Patients were divided in to two groups I and II. Group I had 35 patients and underwent for endoscopic microdisectomy and group II received conventional discectomy among 35 patients. The research included patients with low back pain radiating to the legs and prolapsed intervertebral discs at the L5–S1 and L4–L5 levels on MRI. Post-operatively effectiveness was observed between both groups, by using Oswestry disability index (ODI) in follow up of 10 months. Complete data was analyzed by SPSS. Results: Total 34 (48.6%) patients were females and 36 (51.4%) were males. Mean age of the patients were 48.32± 6.44 years with mean BMI 26.14± 3.23 kg/m2. Significantly no difference was observed between age and BMI. Patients who had prolapsed disc at L4-5 levels were 26 (37.14%) and 44 (62.86%) patients had prolapsed disc at L5-S1. Mean post-operative ODI in group I was 21.14± 54 and in group II was 24.16± 3.31. Mean post-operative vas in group I was 3.5 and in group II was 5.7. In group I hospital stay, blood loss and complications were observed less as compared to group II. Conclusion: We concluded in this that both endoscopic microdisectomy and conventional discectomy was effective and safe procedures. But conventional discectomy was found less effective as compared to endoscopic microdisectomy in terms of rapid mobilization and postoperative pain. Keywords: Oswestry Disability Index (ODI), Lumbar Disc Prolapse, Endoscopic Discectomy, Visual Analog Score (VAS)

Objective: The purpose of this study is to examine the relative effectiveness of two different oral dosages of ibuprofen in relieving pain in patients presenting to the emergency department complaining of sudden, severe discomfort. Study Design: Randomized, Double-blind trial Place and Duration: Islamic International Medical College and Trust Islamabad, during from January 2021 to June 2021. Methods: Total 180 patients of both genders with ages 20-75 years had acute pain were presented. After obtaining participants' informed consent, demographic data such as age, sex, BMI, and residence were collected from those who participated. Causes of pain among all cases were also recorded. Single doze 400mg was given to 90 patients in group I and doze of 800mg was given to group II. Visual analogue scale was used for measurement of pain score among both groups. SPSS 22.0 was used to analyze all data. Results: There were majority males 112 (62.2%) and 68 (37.8%) females in this study. Among 180 patients, 80 (44.4%) had age 21-30 years, 60 (33.3%) had age 31-40 years and 50 (27.8%) had age >40 years. Majority was from urban areas 105 (58.3%). Most common cause of acute pain was fallen, RTA, sports and knife abuse among all cases. We found no any significant difference in pain score at 2, 4 and 6 hours among both groups and both doses were effective among all cases in reduction of pain with p value <0.005. Post-treatment side effects were dizziness, nausea and diarrhea among both groups but there was also no any significant difference observed. Conclusion: We concluded in this study the oral ibuprofen (400mg, 800mg) was an effective and useful in reduction of pain score among patients admitted to ED because of injury. No any significant difference was observed between efficacy and as well as in side effects. Keywords: Acute Pain, ED, VAS, Ibuprofen, Side Effects