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Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 14 - 14
1 Feb 2015
Vadhva M Hoggett L Khatri M
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Aim

To assess the safety of Zero Profile Interbody fusion (Zero P) device in Anterior Cervical Decompression and fusion (ACDF) for degenerative cervical stenosis.

Method

89 consecutive patients treated with Zero P interbody device from September 2009 to September 2012 were included in this retrospective study.

Inclusion criterion: degenerative cervical stenosis with myelopathy, persistent radiculopathy after at least 3 months of failed conservative management.

Exclusion criterion: Paediatric population; patients with infection, metastatic disease and trauma.

There were 39 females, 50 males with mean age of 55 (ranging from 24 to 84 years)

56 (64%) had surgery at 1 level, 31 (35%) at 2 levels, 1 (1%) at 3 levels. Total number of levels operated were 121. Common levels operated were C56 (62%) and C67 (47%)

Majority were operated due to radicular symptoms, 56 (64%) had radicular symptoms, 28(31%) had myelopathy and 5 (5%) Myeloradiculopathy


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 8 - 8
1 Feb 2015
Hoggett L Carter S Vadhva M Khatri M
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Aim

To assess the safety of day case lumbar decompressive surgery

Method

Retrospective study of 233 consecutive patients undergoing DCLDS who were identified from a prospective electronic database.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_17 | Pages 21 - 21
1 Apr 2013
Wardlaw D Vadhva M Sabboubeh A
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Purpose of the Study

Assessment of long term results of Chemonucleolysis vs. surgery for soft disc herniation

Material and Methods

From 1982 to 1985, 100 patients with symptomatic disc herniation were randomly allocated to receive either Chemonucleolysis(48) or surgery(52) after a three months trial of conservative treatment. Ten of the chemonucleolysis had surgery. At 10–13 year follow up, Sixty one of the original 100 patients responded, (32 chemonucleolysis; 29 surgery). At 25–27 year Forty four patients responded (24 chemonucleolysis; 20 surgery). Clinical outcome at one year was according to a self-assessment questionnaire: Completely, better improved, the same, or worse, and at the later follow up periods, according to the Macnab criteria. The results of two groups of patients were compared using Chi square and T test for independent samples.

The disc height of the affected disc was measured from the lateral lumbar spine radiograph taken pre-operatively, and at the later two time points, and compared to a normal adjacent disc expressed as a percentage.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 45 - 45
1 Jun 2012
Pulavarti R Vadhva M Wellington K Khatri M
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Aim

Assess efficacy of caudal epidural injection with epidurogram with validated outcome measures.

Introduction

The administration of local steroids and other drugs into caudal epidural space has been well established procedure in the management of low back pain with or without leg symptoms. Various studies have been done to assess the efficacy of the different routes of administration of epidural injections. However, only a few published prospective studies have been done on performing caudal epidural injections under fluoroscopic guidance with validated outcome measures.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 131 - 131
1 Apr 2012
Vadhva M Wardlaw D Sabboubeh A
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Assessment of long term results of Chemonucleolysis vs. surgical enucleation in soft disc herniation

From 1982 to 1985, 100 patients with symptomatic disc herniation were randomly allocated to receive either Chemonucleolysis or disc enucleation after all these patients had a trial of conservative treatment for three months.

The outcome of result was measured using MacNab Criteria with the help of

Questionnaire

Assessing the patients in clinic

44 patients out of original 100 patients were followed up in the clinic 25 years later. 24 were from chemonucleolysis group and 20 from the surgical group.

According to MacNab criteria 62.5% had excellent or good results and 25% poor results in chemonucleolysis group and in surgery group 70% had excellent or good results and 10% poor results. Patients with poor result in Chemonucleolysis group consisted of: a) 1 had poor result post TKR, b) 4 were offered surgical enucleation subsequent to failed Chemonucleolysis though they did not seem to benefit from surgery and 1 out of these 4 also had fibromyalgia. c) 1 had poor result after sustaining fracture neck of femur. Poor results in surgical group were due to persistent back pain.

The results at 25 year follow-up have shown no statistically significant difference between the patients treated by either chemonucleolysis or surgery. The added benefit of using the chymopapain injection is that it is of lower cost. Chemonucleolysis should have a wider role in treatment of intervertebral disc herniation.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 289 - 290
1 Jul 2011
Nandakumar A Bilolikar N Clark N Vadhva M Pawulska A Wardlaw D Smith F
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Purpose: Correlation of clinical outcome of X stop interspinous process decompression in patients with symptomatic lumbar spinal stenosis is made with spinal canal area change on positional MRI.

Method and Results: Clinical outcome was assessed by ZCQ, ODI, SF36 and VAS scores. There is clinically significant improvement if two ZCQ domains improved > threshold or patients were satisfied. Dural sac area was measured standing erect and sitting, neutral, flexion and extension preoperatively and at 2 years. Increased dural sac area was taken as radiological improvement.

Thirty-six patients had MRI at 2 years. Using paired t test we noted statistically significant increase in mean dural sac area in all four positions mentioned above. There was clinical improvement in 26 and some or no improvement in 10 patients. Number with increase in canal cross sectional area was 28 and that with reduced area was 8. Clinical and canal area improvement was seen in 20 (56%) patients and clinical improvement with reduced canal area was seen in 5 (14%). Some or no clinical improvement with canal area improvement occurred in 8 (22%) patients and no significant clinical or canal area improvement in 3 (8%).

Conclusions:

Majority of patients (56%) showed clinical and cross sectional area improvement at 2 years.

One patient with no clinical improvement had subsequent decompression surgery (this patient had dural cross sectional area improvement).

64% patients had similar clinical and dural cross sectional area changes but there is not a clear-cut correlation between clinical outcome and change in canal cross-sectional area.

Interest statement: Commercial/industry support: Medtronics


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 290 - 290
1 Jul 2011
Nandakumar A Bilolikar N Clark N Peehal J Vadhva M Smith F Wardlaw D
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Purpose: Correlation of the clinical outcome of X stop interspinous process decompression (IPD) in patients with symptomatic lumbar spinal stenosis (LSS) is made with their preoperative disc heights.

Method: 45 patients, who had clinical follow-up at 2 years, had pre-operative erect positional MRI scans. Clinical outcome was assessed by Zurich Claudication Questionnaire,ODI,SF36 and VAS scores.ZCQ is the most condition specific for LSS and was used. There is clinically significant improvement if two ZCQ domains improved > threshold (SS> 0.46, PF> 0.42, PS< 2.4) or patients were satisfied. Disc heights were measured in the standing erect posture. Osiris 4.17 software program was used for measurements. Statistics used was Chi-Square test with cross tabulation.

Results: There was clinical improvement in 33 and some or no improvement in 12 patients. Overall preoperative range of disc heights was 1.8 to 10.05 mm, median 5.93. Disc height was less than or equal to 5mm in 21 patients and it was > 5 mm in 24 patients.19 patients who had initial disc height of > 5 mm and 14 patients who had disc height of less than or equal to 5 mm had clinically significant improvement. In the group of patients who had some or no improvement the numbers were 5 and 7 respectively. We found a difference between the groups with bigger and smaller preoperative disc heights and a larger proportion of patients with bigger preoperative disc height had better clinical outcome. This difference was not statistically significant, P = 0.350.

Conclusions: The X stop device remains clinically effective at the end of 2 years in the majority of patients. Overall patients who had bigger preoperative disc heights 79% (i.e. 19/24 who had > 5mm initial disc height) had better clinical outcome compared to those with smaller preoperative disc heights.

Interest statement: Commercial/industry support: Medtronics