Ayub Teaching Hospital

Background Degenerative lumbar spine disease (DLSD) is a prevalent condition that significantly impacts quality of life. Surgical interventions, including microdiscectomy and open discectomy, are commonly used to treat symptomatic lumbar disc herniation. However, the comparative effectiveness of these procedures remains a subject of ongoing research. Objective This study aims to compare the clinical outcomes of microdiscectomy and open discectomy in patients with degenerative lumbar spine disease, focusing on pain relief, functional recovery, complications, and patient satisfaction. Methods A total of 600 patients (309 microdiscectomy, 291 open discectomy) were included in this prospective cohort study. Data were collected on demographic characteristics, preoperative and postoperative pain scores, functional recovery (measured by Oswestry Disability Index), and complications. Logistic regression and multiple linear regression models were employed to predict outcomes, and random forest analysis was used to identify key predictors of complications. Results Microdiscectomy was associated with significantly better postoperative outcomes, including reduced pain (213/309 (69%) vs. 146/291 (50%)), faster recovery (mean recovery time 5.2 weeks vs. 7.6 weeks), fewer complications (46/309 (14.9%) vs. 67/291 (23%)), and higher patient satisfaction (101/309 (32.8%) vs. 73/291 (25%)). Additionally, microdiscectomy also resulted in larger overall improvements in functional recovery and mobility scores compared to open discectomy. Conclusion Microdiscectomy provides superior results in pain relief, recovery time, and complication rates compared to open discectomy. This supports recommending microdiscectomy (with proper patient selection) for most patients with lumbar disc herniation.

The rising rates of cesarean sections (CS) globally have increased the number of women with prior cesarean deliveries who may be candidates for vaginal birth after cesarean (VBAC). This study explores the factors influencing the success of VBAC in women with a previous CS and fetomaternal complications associated with VBAC failure.

This cross-sectional study was conducted at the obstetrics unit of Ayub Teaching Hospital, Abbottabad, Pakistan, enrolling 102 eligible women who had previously undergone a CS and were offered the option of attempting a vaginal delivery. Demographic, clinical, and obstetric data were collected on a predesigned proforma. The success of VBAC was defined as a vaginal delivery without the need for an emergency cesarean section. Statistical analysis was done using IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY).

Participants had a mean age of 30.36 ± 2.07 years and a mean body mass index (BMI) of 25.71 ± 0.90 kg/m². The overall VBAC success rate was 79.4% (n=81), with a failure rate of 20.6% (n=21). Maternal complications, including infection and the need for blood transfusion, were significantly higher in the VBAC failure group. Fetal outcomes also showed that VBAC failures were more likely to result in an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score <7 at 10 minutes (P=0.006). Similarly, maternal complications were significantly higher in VBAC failures (5/21, 23.8%) than successes (3/81, 3.7%; P=0.009). On regression analysis, VBAC failure was found to be an independent predictor of both fetal complications (with an odds ratio of 14.610 (95% CI: 1.290-165.421, p = 0.030)) and maternal complications (with an odds ratio of 8.767 (95% CI: 1.762-44.535, p = 0.009)).

VBAC is a safe and effective option for women with a prior CS, with a high success rate; however, VBAC failure was found to be an independent predictor of both fetal and maternal complications. Our findings suggest the importance of a personalized approach to VBAC assessment and counselling to optimize outcomes for women undergoing trial of labor after cesarean (TOLAC).