The current trend in kyphosis correction is for “every level” instrumentation to achieve intraoperative stability, correction, fusion and implant longevity. We evaluate the medium term follow up of a low implant density (LID) construct. All patients with adolescent kyphosis (idiopathic or Scheurmann's) on our deformity database were identified. Radiographs and records were analysed for neurological complications, correction and revision. The constructs included were all pedicle screw anchors with multiple apical chevron osteotomies and a proximal and distal “box” of 6 to 8 screws. A four rod cantilever reduction manoeuvre with side to side connectors completed the construct. Kyphosis for any other cause was excluded. Follow up less than 12 months was excluded. 23 patients were identified with an average follow up 27 months (72 to 12 months) and a mean implant density of 1.1 (53.5% of “available” pedicles instrumented). There was 1 false positive neurophysiological event without sequelae (4%). There were no proximal junctional failures (0%). There were no pseudarthroses or rod breakages (0%). There was 1 loss of distal rod capture (early set screw failure) (4%). This was revised uneventfully. There were 4 infections requiring debridement (early series). Average initial correction was 44% (77.7 degrees to 43.5 degrees) with a 1% loss of correction at final follow up (43.5 to 44.0 degrees). The fulcrum bending correction index was 107% (based on fulcrum extension radiographs). 85% of curves had a fulcrum flexibility of less than 50%. The average cost saving compared to “every level “instrumentation was £5700 per case. This paper shows that a LID construct for kyphosis has technical outcomes as good as high density constructs. The obvious limitation of the study is the small number of patients in the cohort. The infection rates have improved with changes to perioperative process in the later series of patients. We do not believe these are a consequence of the construct itself.
Shoulder balance after surgery is one main attribute of the cosmetic outcome. It has been difficult to assess on 2D images. The balance results from the interaction of rib cage, shoulder joint and scapular positions, spinal alignment and rotation, muscle size and co-ordination and pain interaction. Attempts have been made to predict shoulder balance from radiograph measurements. There is no consensus on this. To assess whether T1 tilt has any relation to final shoulder balance after surgery.Introduction:
Attempt:
Scheuermann's kyphosis is a fixed round back deformity characterised by wedged vertebrae seen on radiograph. It is known patients presented with a negative sagittal balance before operation. Few studies investigated the outcome after operation, especially the change in the lumbar hyperlordosis. To investigate the change in sagittal profile after correction surgery.Introduction:
Aim:
Spondylodiscitis is a combination of discitis and spondylitis. It is very rare to have an isolated discitis without associated vertebral osteomyelitis. It is relatively uncommon in developed nations. However, this disease can lead to severe disability and even death if left untreated. Antibiotics is the mainstay of treatment but cases with neurological compromise would need prompt surgical decompression and stabilisation. Recovery in serious cases is often a lengthy process, requiring long hospital stay. Our unit conducted a review as it is noted spondylodiscitis is becoming more common in elderly and immunocompromised groups. Retrospective study of spondylodiscitis presented to our unit over the last three years is conducted. Medical records and charts are reviewed, with a focus on disease presentation, risk factors, causative organisms and when surgery becomes necessary.Introduction
Patients and methods
(1) To determine whether any difference exists in AVN risk between surgical reduction [Fish] or pinning-in-situ [PIS] of severe slips. (2) To review the different classifications of SUFE in relation to AVN. 56 children presented with slipped upper femoral epiphysis (SUFE) from 1998 to 2008; 29 males, 27 females; mean age 12.8 years. The Loder & Southwick classifications were used. All slips were treated surgically. The mild and moderate groups were treated with a single pin-in-situ. The severe group had either surgical reduction [Fish femoral neck osteotomy], alternatively a single pin-in-situ, randomised by day of admission. Avascular necrosis of the femoral head (AVN) was the primary outcome measurement.Aim
Materials and Methods
Tarsal Tunnel Syndrome (TTS) was first reported by Keck and Lam separately in 1962. It has been regarded as the lower limb equivalent to Carpal Tunnel Syndrome (CTS). The gold standard of diagnosis proposed over the years is nerve conduction study (NCS). In reality, TTS is much harder to diagnose and treat compared to CTS. Signs and symptoms can be mimicked by other foot and ankle conditions. Our unit had not seen a single positive nerve conduction result of TTS in clinically suspicious cases. We have therefore audited our 10 year experience. This is a retrospective audit. Patient list retrieved from neurophysiology. 42 patients were identified. All were referred with a clinical suspicion of TTS. There was no single positive nerve conduction result showing tarsal tunnel compression. Of these, 27 case notes were retrieved (64%). The demographics are: A) age (23 to 78), B) 12 males, 15 females, and C) 12 involving left side, 4 right side and 11 bilateral. These studies were conducted according to national guidelines. There were 8 abnormal studies: 4 showing spinal radiculopathy, 3 showing higher peripheral neuropathy and 1 showing tibial nerve irritation following previous decompression. 4 cases were operated on. These are: 2 for removal of lumps, 1 for partial plantar fascia release, and 1 for redo-decompression. As for the rest: 16 had no change in the symptoms and were discharged, 6 were referred to other disciplines, 2 resolved spontaneously, 2 lost to follow up and 1 resolved after a total knee replacement.Purpose
Methods and Results
The number of patients in the United Kingdom being admitted with Neck of Femur Fractures (NOF) is increasing each year. Primary first aid for these patients includes adequate analgesia. The commonest forms of analgesia are opioids and in some units regional blockade. However, both have limitations. Regional block is skill dependent while opiates are known to have many side effects. Paracetamol is an analgesia that is safe and has an excellent side-effect profile within standard doses. Intravenous paracetamol has a far higher predictable bio-availibilty than oral, within standard dosage. This study is to assess the suitability of using intravenous Paracetamol as an alternative.
The distribution of shading was categorised as head pain (subdivided into face, vertex and occiput) and arm pain. The incidence of head pain and its distribution was analysed along with its relationship to arm pain. Data collected from patients presenting with thoracolumbar pain over the same period was used as a control. Of 200 patients presenting to the clinic with cervical problems, 58 had head pain. 50 had occipital pain, 28 had vertex pain and 8 had facial pain. None of the thoracolumbar patients had head pain although 12 had upper limb pain. Of the 26 cervical patients who had unilateral arm pain &
head pain, the head and arm pain were always on the same side.
to determine what aspects of people’s lives (domains of impact) where most affected by their spinal problems, to determine the extent to which the SF-36 and ODI represent these domains, to compare the domains of impact resulting from neck and low back pain.
Cervical pathology (n=200 people). 19 domains were identified. Of domains identified as first most important (n=164) 3 domains predominated: work (28%), sleep (24%), walking (24%). Others ranged from 0 – 7.6%. Of all domains identified by all people (n=399), 4 predominated: sleep (62%), work (54%), walking (41%) sitting (36%). Others ranged from 0.6% to 9.8%. Thoraco-Lumbar pathology (n=537 people). 25 domains were identified. Of domains identified as first most important (n=429) 4 domains predominated: walking (49%), working (18%), sitting (12%) and sleeping (11%). Others ranged from 0 – 7.6%. Of all domains identified by all people (n=1096), 4 predominated: sleep (76%), work (50%), walking (47%) sitting (45%). Others ranged from 0.2% to 11.9%.
