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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 59 - 59
1 Jun 2012
Quraishi NA Thambiraj S
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Introduction/Aim

Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. We describe a simple and reliable technique to identify the correct thoracic spine level.

Methods

After induction of general anaesthesia, the patient is placed prone and the pedicle of interest is identified using fluoroscopy. A ‘K’ wire is then inserted percutaneously into this pedicle under image guidance (confirmed in the antero-posterior (AP) and lateral views). The ‘K’ wire is then cut flush and the patient is then positioned laterally and the intended procedure is performed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 19 - 19
1 Jun 2012
Quraishi NA Giannoulis K
Full Access

Introduction

Metastatic involvement of the lumbo-sacral junction/sacrum usually signifies advanced disease. The aim of this study was to report our results on the management of patients with metastases referred to this anatomical region over the last 5 years (July 2006- July 2010).

Methods

Retrospective analysis from a comprehensive spinal oncology database.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 22 - 22
1 Jun 2012
Quraishi NA Edidin A Kurtz S Ong K Lau E
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Introduction/Aims

An increased mortality associated with hip fractures has been recognized, but the impact of vertebral osteoporotic compression fractures (VCF) is still underestimated. The aim of this study was to report on the difference in survival for VCF patients following non-operative and operative [Balloon Kyphoplasty (BKP) or Vertebroplasty (VP)] treatments.

Methods

Operated and non-operated VCF patients were identified from the US Medicare database in 2006 and 2007 and followed for a minimum of 24 months. Patients diagnosed with pathological and traumatic VCFs in the prior year were excluded. Overall survival was estimated by the Kaplan-Meier method, and the differences in mortality rates (operated vs non-operated; balloon kyphoplasty vs vertebroplasty) were assessed by Cox regression, with adjustments for patient demographics, general and specific co-morbidities, that have been previously identified as possible causes of death associated with osteoporotic VCFs.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 492 - 492
1 Sep 2009
Quraishi NA Anraku M Keshavjee S Darling G Johnston M Waddell T Rampersaud YR Lewis SL
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Study Design: A retrospective analysis of prospectively collected data on 18 consecutive patients undergoing en bloc resection of primary bronchogenic tumours that locally invaded the adjacent spinal column with a minimum of 12 months follow-up.

Objectives: To report on operative details, outcome scores, survival and satisfaction in this group of patients.

Summary of Background: Primary thoracic tumours with direct spinal extension have traditionally been regarded as being unresectable and thus, associated with a poor prognosis. However, en bloc surgery is now emerging as being the goal of primary tumor surgery offering the best results for survival.

Methods: We reviewed 18 consecutive patients undergoing concomitant lung and vertebral resection performed by a combined team of an orthopedic surgeon and a thoracic surgeon during 2002–2006. All patients had negative staging for systemic disease (T4 N0 M0).

Results: Mean age of patients was 62.5 +/−11.6 years (33–76 years) with a mean follow-up of 26.1 months (13–60 months). Seven patients had a one-stage procedure and 11 had en bloc resections in two stages. Mean length of operation was 995.8 minutes (280–1965 minutes). Mean estimated blood loss was 5425.8 mls (1430–12830 mls). Mean length of hospital stay was 31 days (range 9–122 days). In total, an average of 3.0 (range 2–4) vertebrae were resected – two patients had a partial vertebrectomy, 10 had a hemivertebrectomy, 2 had a total vertebrectomy and 4 had a combination. Three patients had a ‘palliative’ procedure as a result of local tumour invasion (around the great vessels and dura). The remaining 15 patients were operated with ‘curative’ intent.

The ODI (Oswestry Disability Index) score was 27.4 (+/−13) preoperatively and 42.2 (+/−10.9) post operatively (p=0.004). The scores for SF-36 (Short Form-36) were 34.0 (+/−10.9) preoperatively and 29.7 (+/−6.3) post-operatively (physical component summary; p=0.3); 39.2 (+/−7.9) preoperative and 40.6 (+/− 14.9) postoperative (mental component summary; p=0.85).

There were 6 major complications (1- wound break-down, 3 – required extended respiratory support of which 1 required thoracotomy for lung re-expansion, 1- developed severe distal junctional kyphosis requiring revision, 1 – recurrent laryngeal palsy needing thoraco-plasty) and 3 minor (2- dural tears, 1-chyle leak).

The survival in the ‘curative’ group was 10/15 (67%) with a mean follow-up of 27.3 months; five patients died at a mean of 115 days (86–129 days) due to respiratory complications. All ten surviving patients reported that they were satisfied/very satisfied with surgery. The survival in the ‘palliative’ group was 192 days (48–360).

Conclusions: There is a significant complication rate following en-bloc tumour surgery (> 50%), but curative resections are achievable at the expense of pain and function.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 494 - 494
1 Sep 2009
Quraishi NA Buchanan E Al-Ali S
Full Access

Background: Guidelines for the management of Low Back Pain (LBP) consistently recommend that the initial assessment focuses on the detection of serious spinal pathologies. In 1994 the UK Clinical Standards Advisory Group introduced the concept of “red flags”. One of these red flags is the first presentation of LBP in people over the age of 55 years. The aim of this study was to investigate the incidence of serious spinal pathologies in patients presenting with new onset of LBP over the age of 55 years.

Method/Results: This was a prospective analysis of all patients presenting to a secondary care spinal triage service over a 3 year period (2005–2008). During the study period, in excess of 3000 patients were seen. Of these, a total of 70 patients presented with a first onset of LBP aged over 55 years and had no other red flags. Analysis of this group of patients revealed 2 serious spinal pathologies. Both of which were osteoporotic vertebral compression fractures. Both patients were over age 75. In addition 1 patient had severe central lumbar canal stenosis. Therefore, 2.3% of patients presented with the first onset of LBP > 55 years, of which 2.9% has serious pathology. Patients > 55 years with cancer or infection had other red flags in addition.

Conclusion: In isolation the first onset of LBP over the age > 55 accounts for a small percentage of this secondary care population, of which 2.9% had vertebral compression fractures. Further research into the clinical value of this independent red flag or its added value in combination with other red flags is recommended.