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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_6 | Pages 30 - 30
1 Apr 2014
Durst A Bhagat S Mahendran K Grover H Blake J Lutchman L Rai A Crawford R
Full Access

Aim:

An analysis of significant neuromonitoring changes (NMCs) and evaluation of the efficacy of multimodality neuromonitoring in spinal deformity surgery.

Method:

A retrospective review of prospectively collected data in 320 consecutive paediatric and adult spinal deformity operations. Patients were sub-grouped according to demographics (age, gender), diagnosis, radiographic findings (Cobb angles, MR abnormalities) and operative features (surgical approach, duration, levels of fixation). Post-operative neurological deficit was documented and defined as either spinal cord or nerve root deficit.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXI | Pages 25 - 25
1 Jul 2012
Lau S Bhagat S Baddour E Gul A Ahuja S
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Introduction

The British Scoliosis Society published a document in 2008 which set out the minimum standards for paediatric spinal deformity services to achieve over a period of time. But how do the UK paediatric spinal deformity centres measure up to these benchmarks?

Methods

We performed a telephonic survey, contacting every UK spinal deformity centre. The questionnaire probed how each unit compared to the recommended standards.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXI | Pages 26 - 26
1 Jul 2012
Bhagat S Jenkins N Collins N Broadfoot J Jemmett P James S Ahuja S
Full Access

Purpose

Comparison between Aprotinin and Tranexamic acid on blood conservation in scoliosis surgery.

Null hypothesis

There is no difference in the control of blood loss between 2 drugs.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXI | Pages 15 - 15
1 Jul 2012
Bhagat S Lau S Jones D James S Davies PR
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Purpose

Retrospective review of fusion rates using Grafton DBM/allografts only in AIS.

Methods

Medical records of 30 consecutive patients at an average age of 19(18-24)were reviewed. All patients had segmental fixation with dual rod and pedicle screw construct followed by decortication supplemented with matrix strips/allograft chips. Minimum follow up 1.5 years, average of 2 years (1.5-3). First follow up at 3 months postoperatively and than 6 months subsequently. All patients were evaluated using criteria described by Betz et al for “possible pseudoarthrosis” which included persistent back pain, defects in the fusion mass, loosening of pedicle screws, junctional kyphosis and curve progression of more than 10 degrees from initial standing postoperative PA views.

There were no infections. Average time to clinically and radiographically evident fusion was 12 months (range 10-16). Radiographically visible unfused facet joints were encountered in 3 patients towards the end of the construct. One patient had extension of the construct to treat junctional kyphosis. Other two remained asymptomatic. None had Progression of deformity. One patient developed pars defect at level below construct and was treated with extension of fusion.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXI | Pages 22 - 22
1 Jul 2012
Bhagat S Lau S Singh S James S Jones A Howes J Davies P Ahuja S
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Purpose

Retrospective review of growth sparing spinal instrumentation.

Methods and results

Medical records of 30 children with spinal deformity treated were evaluated. There were 14 male and 16 female patients at an average age of 4.9 years (1-14) at the time of presentation. These included 18 idiopathic, 11 congenital and a 14 year old with delayed growth having GH treatment. All patients underwent dual growing rod construct using hook and pedicle screw instrumentation. Extensions were carried out at approximately 6 monthly intervals. Average follow up was 4.2 years (2-8.5) with an average of 7.3(3-15) extension/exchange procedures per patient. Average immediate postoperative Cobb angle was 29(15-55) from a preoperative Cobb of 68(55-100) and this was maintained to a final mean Cobb angle of 30(15-60). Average gain in T1-S1 length was 5.7(3.5-9.8) cm. Five patients had final fusion at an average age of 15.5 years.

There were no infections following primary operation. Out of 249 procedures including extensions/exchange, there were 9(4.5%) episodes of deep infection in 7 patients requiring debridement. Four patients (13%) had revisions for rod breakage/screw loosening/hook pullout/junctional kyphosis and three(10%) had prominent implants.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXI | Pages 24 - 24
1 Jul 2012
Guha A Khurana A Bhagat S Pugh S Jones A Howes J Davies P Ahuja S
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Purpose

To evaluate efficacy of blood conservation strategies on transfusion requirements in adult scoliosis surgery and establish a protocol for cross matching.

Methods and Results

Retrospective review of 50 consecutive adult scoliosis patients treated using anterior only(14,28%), posterior only(19,38%) or combined(17,34%) approaches. All patients were anaesthetised by the same anaesthetist implementing a standard protocol using cell salvage, controlled hypotension and antifibrinolytics.

Mean age was 24.6 years. BMI was 21.9. On an average 9.5(6-15) levels were fused, with an average duration of surgery of 284.6(130-550) minutes. Antifibrinolytics were used in 31(62%) of the patients which included Aprotinin in 21(42%) and Tranexamic acid in 10(20%). Patients on antifibrinolytics had a significantly (p<0.05) lower blood loss (530ml) as compared to other patients (672ml). Mean volume of the cell saved blood re-transfused was 693.8 ml and mean postoperative HB level dropped to 10.7 g/dl(7.7-15) from a mean preoperative of 13.3 g/dl(10-17).

7(42%) with combined approaches and 3(15.8%) with posterior only approach required blood transfusion, 4/50(8%) of which required intra while 6/50(12%) required intra and postoperative transfusion. None of the patients having anterior surgery alone required blood transfusion.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 61 - 61
1 Jun 2012
Bhagat S Lau S Ahuja S
Full Access

Purpose of Study

To investigate current practice of thromboprophylaxis in major UK spinal centres for both trauma and elective surgery, and to asses compliance with NICE guidelines

Methods

A telephonic survey was carried out which comprised of questions relating to current practice of thromboprophylaxis in major spinal units across the UK. Questions probed practice with regard to trauma versus elective surgery, agents used, timing of prophylaxis, length of treatment and whether practice has changed since the introduction of NICE guidelines.