Objective:  To study the Efficacy of Balloon Kyphoplasty in compression fractures of the thoracolumbar spine. Material and Methods:  This study was conducted on 95 patients with thoracolumbar wedge fractures from 2017 to 2022. Complete neurological examination and CT and MRI scans of the spine of all patients were done. All patients have been treated with a balloon kyphoplasty procedure. Data was collected on VAS score, SF-36 score, kyphotic angle and percentage of vertebral body destruction both preoperatively and post-operatively. Statistical analysis was done by using paired sample t-test. Results:  The mean age was 57 years. Males were 58.9% and females 41.0%. Osteoporosis was the cause of fracture in 90.5% and trauma in 9.4% of patients. VAS improved from 7.42 ± 1.24 to post-procedure 3.24 ± 1.51, P < 0.0001. SF-36 improved from 35.31 ± 17.4 to post-procedure 49.23 ± 19.2, P < 0.0001. Kyphosis angle restoration from 18.42 ± 7.41 to post-procedure 10.61 ± 6.32, P value < 0.0001. Percentage loss of vertebral height from 32.91% to postoperatively 17.64% (SD-17.2 and P < 0.0001). 10.5% of patients developed cement leakage and there is no leakage in 89.4%. The adjacent level fracture occurred in 4 patients. Conclusion:  Balloon Kyphoplasty is an effective procedure for thoracolumbar wedge fractures. It improves pain, activities of daily living, kyphosis angle improvement, and restoration of vertebral height.

Objective: To assess the relationship between hypovitaminosis D and chronic low back pain in South Punjab. Materials and Methods: Retrospective research was done from January 2021 to June 2022. 173 chronic nonspecific low back pain patients presenting in outpatient clinics were included in our study. Two groups were made of all patients, one was vitamin-D level deficient, and the other was a vitamin-D normal group. The blood level of 30 ng/ml of vitamin D was taken as normal. Chronic Low back pain status was analyzed by VAS score. All the demographic data of patients were recorded. The relationship between vitamin D and VAS score was assessed by the spearman coefficient and p <0.05 was taken as significant. Results: The majority of patients had a mean age of 36.45 ± 21 years, were female preponderance, married, and vegetarians with a mean sun exposure time of about 2 hours. In group 1, the vitamin D level was 13.41 ± 3.8 and in group 2 vitamin D was 38.71 ± 5.8 with p value< 0.0001. Spearman rho coefficient was used to assess the relationship between vitamin D and pain score. The result was a negative correlation between these 2 variables (r=-0.572) and p <0.0001. Conclusion This research work showed the significant probability of association between vitamin D level and patients having nonspecific chronic low back pain. There was a negative association between vitamin D level and VAS score of patients having chronic low back pain.

Objective:  This study aimed to determine the relation of severity of lumbar spinal stenosis and pain improvement after caudal epidural injection. Material and Methods:  70 patients of neurogenic claudication were included from July 2019 to June 2020. MRI lumbosacral spine was done of all patients to categorize the degree of spinal stenosis on T2-W axial. All patients were given caudal epidural steroid injection as a day case procedure. Follow-up was done at 3 & 8 weeks and pain improvement was assessed by using Ronald satisfaction score. Results:  Mean age was 37.9 ± 7.8 years. 48.6% patients were male and 51.6% were female. The improvement was observed in 28 patients (40%) at 3 weeks and in 46 patients (65.7%) at 8 weeks. There  was no  statistically significant  relationship between  lumbar spinal stenosis and pain improvements at 3 weeks (p value 0.30) and 8 weeks (p value 0.32). Conclusion:  The grade of lumbar spinal stenosis has no significant effect on pain improvement after caudal epidural steroid injection. Keywords:  LSS (Lumbar spinal stenosis), caudal epidural steroid injection (ESI), neurogenic claudication, MRI (Magnetic resonance imaging), T2W (T2 weighted) images.

Objective: To compare the clinical, radiological and functional outcomes of patients between open TLIF and minimally invasive TLIF techniques. Study Design: Prospective cohort study Place and duration: Study was conducted at department of neurosurgery Bakhtawar Amin Hospital, Multan from August 2021 to July 2022 in duration of one year. Methodology: A total of 94 patients planned for transforaminal lumbar interbody fusion (TLIF) were enrolled in study. Main variables of study were intra operative blood loss, duration of surgery, VAS score, ODI index and functional score. SPSS version 24 was used for data analysis, t-test and chi square test were applied to see association among variables. P value less than or equal 0.05 was considered as significant. Results: Oswestry disability index readings were 35.16±2.18 and 5.12±0.61 in O-TLIF and MIS-TLIF groups respectively at 3 weeks after surgery. The differences were statistically insignificant, (p>0.050). Physical component summary of both the groups at different time intervals as shown better outcomes in MIS-TLIF group, no difference was found to be statistically significant except at 6 week. Mental component summary in both the groups was almost equal, (p>0.050). Implications: There was no local study on comparison of open and minimally invasive technique for TLIF, our study will fulfill the local reference gap and help the surgeons for choice of better management technique in future. Conclusion: Minimally invasive surgery TLIF technique is better in immediate benefits as soft tissue injury and iatrogenic injury which is associated with better post operative pain functional recovery time. So, minimal invasive interbody fusion is a safe and reliable option for short term (blood loss, post operative pain) and long term outcomes like functional recovery. Keywords: Interbody fusion, VAS score, SF-36, ODI index, TLIF Technique

Objective:  To study the efficacy of the posterior and posterolateral approach in thoracolumbar tuberculosis. Material and Methods:  60 patients with thoracolumbar TB spine were enrolled in the study from 2015 to 2021. These patients had single-level disease with low back pain and neurological compromise in lower limbs. The diagnosis was made on an MRI of the spine and elevated ESR levels. All patients were started with antituberculous treatment. The pain was measured on the VAS score, and neurological status was assessed on the ASIA score. Kyphosis angle was calculated on a lateral x-ray of the spine. All patients were operated on by posterior and posterolateral approaches with decompression and fusion. At follow-up, fusion was assessed on every visit by x-ray along with neurological status and pain score. Results:  The mean age of patients was 45.8 years (25 to 66 years). 59.5% patients achieved radiological fusion on follow-up x-rays. There was a significant improvement in VAS score preoperatively mean and SD6.38 ± 1.24to postoperatively 4.45 ± 1.09. The mean and SD of kyphosis in patients preoperatively was 22.3 ± 3.06 to post-operative 22.3 ± 3.06 with a p-value < 0.05 which shows significant improvement. Conclusion:  Posterior and posterolateral decompression and fusion of thoracolumbar tuberculosis is a good surgical approach in respect of neurological outcome, correction of kyphosis, and pain improvement.