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The Bone & Joint Journal
Vol. 103-B, Issue 8 | Pages 1400 - 1404
1 Aug 2021
Sim FCJ Birley E Khan AL Loughenbury PR Millner P

Aims

The aim of this study was to determine whether there is an increased prevalence of scoliosis in patients who have suffered from a haematopoietic malignancy in childhood.

Methods

Patients with a history of lymphoma or leukaemia with a current age between 12 and 25 years were identified from the regional paediatric oncology database. The medical records and radiological findings were reviewed, and any spinal deformity identified. The treatment of the malignancy and the spinal deformity, if any, was noted.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 67 - 67
1 Jun 2012
Khan AL Oliver WM Fender D Gibson MJ
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Aim

To identify patterns in referral and the management pathway of patients with primary bone tumours of the spine referred to the Orthopaedic Spine Unit in order to recommend ways to improve the service.

Methods and Results

A retrospective notes and imaging review to evaluate the referral pathway undertaken by patients ending up in the orthopaedic spine unit over a 5 year period according to the recommendations for primary bone tumours. Significant events leading to potential improvement in outcomes were assessed. Recommendations for improvements are suggested. None of the 38 patients evaluated were referred within two weeks of presentation, and only 6 were referred directly to the bone tumour service. Almost half (15/32) of the patients who had an indirect referral pathway had a prior intervention. Five of these had non-surgical, while 10 had surgical interventions outside the tumour centre before their referral. Of these, seven had malignant tumours.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 426 - 426
1 Jul 2010
Irwin AA Khan AL Fender D Sanderson PL Gibson MJ
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Background: Selective lumbar nerve root blocks (SLNRB) are widely used as a diagnostic tool. The usefulness of this technique depends on the ability to accurately infiltrate the desired nerve root without blocking the traversing nerve root to the next level. The aim of this retrospective study was to ascertain the accuracy of SLNRB’s in adult deformity.

Method: 30 SLNRB’s were performed by one surgeon on patients with adult deformity.Pre-operative AP + lateral lumbar films were used to quantify the degree of deformity using the Schwab grading system. An AP fluoroscopic film was taken and analysed to determine the flow of injectate in relation to pedicle anatomy. The results were analysed to determine the accuracy of SLN-RB’s in adult deformity.

Results: Of the 30 patients with deformity 17 needle tips were positioned lateral to the middle third of the pedicle and 13 under the middle third of the pedicle. Of the 17 needle tips placed laterally 8 (47%) had flow into the nerve root sheath, 6 (35%) into the nerve root sheath + canal and 3 (17%) into the canal alone. Overall accuracy with no epidural spread was 40% compared the published standard of 61%.

Conclusions: The accuracy of SLNRB in adult deformity was significantly less than the published standard in patients without deformity. In addition the accuracy of SLNRB with needle tip position lateral to the pedicle was only 47% compared to 96% in previous studies. The suggestion of this author is that contrast is used in all SLNRB’s in patients with deformity in order to allow accurate clinical interpretation of results.