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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_10 | Pages 52 - 52
1 Oct 2019
Angus M Tomlinson Z Carrasco R Horner D Siddique I
Full Access

Purpose

To establish if the subjective features of both bilateral leg pain and sexual dysfunction are presenting features in cauda equina syndrome (CES).

Background

There appears to be conflicting expert opinion ‘red flag’ symptoms in the context of CES with many experts basing clinical decisions on the objective clinical findings only.

Bilateral radiculopathy has been suggested as a possible sign of suspected CES, although a consensus statement by BASS and SBNS makes no reference to either this or sexual dysfunction. However, bilateral leg pain is included in the NICE clinical knowledge summary and sexual dysfunction is highlighted within CES guidance by the American Association of Neurological Surgeons.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_10 | Pages 44 - 44
1 Oct 2019
Watt T Abbott C Oxborrow N Siddique I Verma R Angus M
Full Access

Purpose

A Virtual Spinal Clinic (VSC) was set-up at a regional spinal referral centre to see if patient care could be improved through early advice to provide timely management, early onward referral, improve patient satisfaction and minimise chronicity. The clinic was based on the successful virtual model used throughout the country within orthopaedic fracture clinics. VSC is a Consultant led multi-disciplinary (MDT) clinic run by Advanced Practitioners (AP).

Methods

A 3-month trial of the VSC was completed bi-weekly. Patients diagnosed with conservatively managed spinal fractures were referred from the on-call service. A management plan was devised by a Consultant Spinal Surgeon and communicated to patients by the AP via a telephone-call consultation where clinical advice and management could be discussed.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 4 - 4
1 May 2017
Angus M Verma R Mohammad S Siddique I Dickens V Rawlinson G
Full Access

Background

Low back pain (LBP) with or without leg pain, is one of the most common causes of pain and disability and a frequent cause of attendance to emergency departments (ED). Increasing numbers of patients create a difficult challenge for clinicians to effectively and appropriately manage patients with LBP in an urgent care setting.

Purpose

To improve the management of atraumatic spinal pain patients admitted onto the emergency assessment unit (EAU) thus improving quality of care, reducing bed stay and facilitating appropriate discharge and follow-up within an interdisciplinary model.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 16 - 16
1 Feb 2016
Aljawadi A Imo E Sethi G Arnall F Choudhry M George K Tambe A Verma R Yasin M Mohammed S Siddique I
Full Access

Back ground:

The aim of this study is to evaluate the long-term outcome after posterior spinal stabilization surgery for the management of de novo non-tuberculous bacterial spinal infection.

Method and Result:

Patients presenting to a single tertiary referral spinal centre between August 2011 and June 2014 were included in the study. 21 patients with nontuberculous bacterial infection were identified and included in the study. All patients were managed surgically with posterior stabilisation, with or without neural decompression, without debridement of the infected tissue. Neurological state was assessed using the frankel grading system before and after urgery. Long-term follow-up data was collected using SpineTango COMI questionnaires and Euro Qol EQ-5D system with a mean follow-up duration of 20 months postoperatively.

The mean improvement in neurological deficits was 0.92 Frankel grade (range 0–4). At final followup, at a mean of 20 months, mean COMI score was 4.59, average VAS for back pain was 4.28. These symptoms were having no effect or only minor effect on the work or usual activities in 52%. 38% of patients reported a good quality of life. The average EQ-5D value was 0.569. There were no problems with mobility in 44% of patients. In 72% there were no problems with self-care.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 22 - 22
1 Feb 2016
Sethi G Choudhry M Fisher B Divecha H Leach J Arnall F Verma R Yasin N Mohammed S Siddique I
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Back ground:

Previous studies have stated that presence of concomitant back pain has a negative effect on the outcome of lumbar decompression/microdiscectomy but none have actually defined what level of back pain should be considered as significant. This is a study of consecutive patients who underwent a primary single level lumbar micro decompression /microdiscectomy performed by thirty nine surgeons at a single tertiary spinal centre between August 2011 and December 2014. The aim was to determine the differential effect of the intensity of back pain and leg pain as a predictor of outcome.

Method and Result:

Data was prospectively collected using SpineTango COMI questionnaires pre-operatively and at 3 months postoperatively. 995 patients who had a complete dataset were included in the analysis. Multivariate regression analysis and ROC curves were used to evaluate factors associated with poor outcome. At 3 months follow up 72.16% of patients were satisfied with the outcome of surgery. The VAS for low back pain was a significant predictor of poor outcome. Of patients with a VAS of 6 or more 34% had a poor outcome following surgery while of patients with a VAS of less than 6, 17% had a poor outcome at three months.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 103 - 103
1 Apr 2012
Choudhury M Siddique I Gardner A Spilsbury J Marks D
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Spinal Deformity Service, Royal Orthopaedic Hospital, Birmingham, UK

To describe the technique of nonfusion annulotomy and nuclectomy with posterior growing rod instrumentation for the treatment of non-congenital early onset scoliosis

To present our results of the application of this technique in a consecutive series of nine patients with mean follow up of 76 months (range 16 to 123 months)

We undertook retrospective observational casenote and radiograph study of patients with noncongenital early onset scoliosis having annulotomy and nuclectomy at the apex of their respective curves with standard posterior growing rod instrumentation between 1998 and 2009.

10 patients were identified with one excluded due to short follow up period. Of the nine patients included mean follow up was 76 months. Mean age at primary surgery was 71.7 months (range 29- 97 months)

We measured pre and post operative Cobb angle, T1-S1 height change and change in height over the apical segments.

Mean pre op cobb angle was 74° (range 62- 81°). Mean post op cobb angle was 38°. Three patients have completed their treatment programme with a mean number of 9 lengthenings achieved. Six patients are still undergoing lengthenings. CT demonstrates that the annulotmized segment does not fuse at a mean 3.5 years postoperatively. All patients demonstrated growth over total spinal height and also over apical segments which had undergone annultomy/ nuclectomy. We also report complications.

We have demonstrated that anterior annulotomy and nuclectomy with posterior growing rod construct does allow for spinal growth over released segments without autofusion.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 29 - 29
1 Jan 2011
Siddique I Hakimi M Javed S Wellington K Smith R Khatri M
Full Access

Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the outcome of the DYNESYS system (Zimmer, Inc.) in a consecutive series of 34 patients undergoing this procedure between 2001 and 2006.

Prospectively collected outcome measure data obtained pre-operatively and at 1 year post-operatively was analysed using the Wilcoxon Signed Rank Test. Kaplan Meier survival analysis was performed using revision surgery as the end point. Cox Regression was utilised to identify variables that were related to implant survival.

Pain rating on the visual analogue scale improved from a mean of 7 pre-op to 4 at 1 year (p=0.009), Roland Morris Disability Questionnaire scores from 13 to 9 (p=0.02), Modified Somatic Perception Questionnaire from 13 to 9 (p=0.03). When reporting subjective outcome, 54% of patients reported “better” or “much better” outcomes at last followup (12–69 months post op). Eight patients (25%) required removal of the implant and conversion to fusion, one of whom had deep infection. Kaplan Meier survival analysis revealed a survival of 78% at 5 years (95% CI, 60 – 96%). Previous spinal surgery was significantly related to the time of survival of the implant (p=0.008).

Our study has demonstrated a high revision rate for this implant and 54% patient satisfaction. We recommend that patients be counseled regarding these risks and further use of this implant should be subject to the outcome of larger studies and randomised controlled trials.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 381 - 381
1 Jul 2010
Siddique I Khatri M Norris H Ross R
Full Access

Aim: To analyse the impact of implant position in the outcome of Charite III Disc Replacement implants.

Methodology: 160 Charite III Lumbar Disc Replacements that were implanted between 1990 and 2000. The average age was 46 years with 62 Males and 98 Female subjects. An independent observer (HN) administered Pain score (VAS 1–10) for Low Back Pain (LBP) and Oswestry Disability Index (ODI). These clinical outcome parameters were compared with coronal and sagittal position of the implants from the latest available radiographs. Those with operation at L3L4 (small numbers = 20) and inadequate radiographs were excluded.

Results: 48 implants were optimally placed and 70 implants were placed sub optimally. Both the groups were in similar age groups (45.02 years, SD 7.61 and 48.31 years, SD 8.04). Clinical: No statistical or clinically significant difference was observed in LBP on VAS (4.92 V/S 4.41), ODI (42.8 V/S 38.0) and in Patient Satisfaction at an average follow up of 70 months. Movements: Average movement at optimally placed discs at L4L5 was 4.4o(95% CI 2.3–6.7) and at L5S1 was 5.9o(95% CI4.2–7.5) and at sub optimally placed disc at L4L5 was 3.8o(95% CI 2.4–5.1) and at L5S1 was 3.8o(95%CI 2.3–5.3).

Conclusions: Clinical and radiological results after Charite III Disc Replacement is NOT dependent on positioning of implants.

Ethics approval: None

Interest Statement: None


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 382 - 383
1 Jul 2010
Siddique I Hakimi M Javed Z Smith R Khatri M
Full Access

Introduction: Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the results of this system in thirty four patients who underwent this procedure between 2002 and 2006.

Methods & Results: Validated outcome measures including Visual Analog Score (VAS), Roland Morris Disability Questionnaire (RMDQ), Modified Zung Score and Modified Somatic Perception Questionnaire (MSPQ) were evaluated preoperatively and at 1 year post operatively. Subjective patient outcome (much better, better, same, worse) was assessed at final followup Kaplan-Meier Survival analysis was performed using need for revision surgery as endpoint. The indications for surgery in thirty patients was radicular pain and back pain, these patients underwent discectomy (12 patients) or decompression (18 patients) in addition to Dynesys. Two patients who had only back pain underwent Dynesys alone. There were statistically significant improvements in VAS, RMDQ, Modified Zung and MSPQ scores at 1 year. However at final followup 46% of patients had a unsatisfactory subjective patient outcome (worse or the same). 25% of patients required revision surgery (posterolateral fusion) for ongoing pain (seven patients) or infection (one patient).

Conclusion: We recommend that all patients undergoing this procedure are counselled regarding the high rate of revision surgery and patient dissatisfaction. Routine use of this implant should be subject to the findings of larger studies and randomised controlled trials.

Ethics approval: None

Interest Statement: None


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 427 - 427
1 Jul 2010
Siddique I Sacho R Oxborrow N Wraith J Williamson J
Full Access

Aim: This study presents analysis of the largest case series to date in the published literature of patients with Hurler Syndrome, to identify the severity of thoraco-lumbar kyphosis, risk factors for progression and results of intervention.

Methods and Results: Forty two patients with MPS-I had treatment with Bone-marrow transplantation and/ or enzyme replacement therapy between June 1995 and October 2007. These patients had regular systematic clinical review and were seen at least annually. Standing lateral radiographs of the thoracolumbar spine were retrieved and analysed.

At initial examination (average age 1y 1m) the thoracolumbar kyphosis measured a mean of 39.6 degrees (SD 12 degrees). Analysis of non-operatively treated patients revealed that patients with an initial kyphosis angle (average age 1y 2m) of less than 40 degrees were significantly less likely to develop progressive kyphosis over the average follow-up period of 3.5 years (mean initial angle 30 degrees and at final follow-up 34 degrees) than those with an angle greater than 40 degrees (mean angle initially 46 degrees and at final follow-up 61 degrees), p=0.005 (repeated measures ANOVA). Seven patients underwent surgical intervention at mean age of 3 years for progressive deformity with favourable results.

Conclusion: Thoracolumbar kyphosis is of variable severity in Hurler’s syndrome and patient’s who present with a kyphosis angle of greater than forty degrees on initial radiographic examination are significantly more likely to develop progressive kyphosis.

Ethics approval: None

Interest Statement: None


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 231 - 231
1 Mar 2010
Siddique I Hakimi M Javed S Smith R Khatri M
Full Access

Introduction: Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the results of this system in thirty four patients who underwent this procedure between 2002 and 2006.

Methods & Results: Validated outcome measures including Visual Analog Score (VAS), Roland Morris Disability Questionnaire (RMDQ), Modified Zung Score and Modified Somatic Perception Questionnaire (MSPQ) were evaluated preoperatively and at 1 year post operatively. Subjective patient outcome (much better, better, same, worse) was assessed at final followup Kaplan-Meier Survival analysis was performed using need for revision surgery as endpoint. The indications for surgery in thirty patients was radicular pain and back pain, these patients underwent discectomy (12 patients) or decompression (18 patients) in addition to Dynesys. Two patients who had only back pain underwent Dynesys alone. There were statistically significant improvements in VAS, RMDQ, Modified Zung and MSPQ scores at 1 year. However at final followup 46% of patients had a unsatisfactory subjective patient outcome (worse or the same). 25% of patients required revision surgery (posterolateral fusion) for ongoing pain (seven patients) or infection (one patient).

Conclusion: We recommend that all patients undergoing this procedure are counselled regarding the high rate of revision surgery and patient dissatisfaction. Routine use of this implant should be subject to the findings of larger studies and randomised controlled trials.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 271 - 272
1 May 2006
Choudry Q Siddique I Eastwood G Mohan R
Full Access

Introduction: Blood conservation has rapidly moved into political and medical agendas. The ongoing shortage of blood in blood banks and the discovery of vCJD pose a threat to UK blood supply with ever rising costs. The use of blood conservation techniques is increasingly being used in surgery to help reduce the need for homologous blood.

We studied the use of Autologous blood transfusion drains (Bellovac ABT) in lower limb arthroplasty compared with standard closed suction drains. We studied 123 lower limb arthroplasty (61 TKR & 62 THR) to see if there was a significant reduction in the need for homologous blood transfusion when using re-transfusion drains and its cost effectiveness.

Methods: Retrospective analysis of 123 patients undergone lower limb arthroplasty from March 2002 to Dec 2004 under one surgeon using the same technique for TKR and THR. 61 TKR (30 ABT drains v 31 standard drain) and 62 THR (30 ABT drains v 32 standard drain). Data was collected on sex, age, pre & post op Hb, volumes drained, volumes re-transfused and the number of homologous blood transfusions.

Results: 30 THR with ABT drains: 14 male, 16 female, mean age 68.7, mean pre op Hb 13.67, mean post op Hb 10.55,mean volume re-transfused 324ml, mean volume drained 466ml. 7 patients(23%) required additional homologous blood transfusion.

32 THR with standard drains: 14 male, 18 female, mean age 68.4, mean pre op Hb 12.96, mean post op Hb 9.36, mean volume drained 579.5ml. 24 patients (75%) required homologous blood transfusion.

30 TKR with ABT drains: 14 male, 16 female, mean age 69.8, mean pre-op Hb13.4, mean post-op Hb 11.03, mean volume re-transfused 415ml, mean volume drained 580ml. 4 patients (13%) required additional homologous blood transfusion.

31 TKR with Standard drains: 13 male, 18 female. Mean age72.1, mean pre-op Hb13.33, mean post-op Hb10.4, mean volume drained 711.5ml. 14 patients (45%) required homologous blood transfusion.

No re-transfusion complications occurred in the ABT group. 2 patients requiring homologous blood had increasing pyrexia and transfusion hence stopped.

Discussion: 11 out of 60 patients (18%) using ABT drains required additional homologous blood compared with 38 out of 63 patients (60%) requiring homologous blood using standard drains. Pvalue< 0.001. We show a stastically significant reduction in the need for homologous blood transfusion using an autologous blood re-transfusion drain. One unit of blood costs approximately £120 the ABT drain less than half of this amount, there is a significant cost saving in using autologous blood re-transfusion drains. We conclude that using Autologous blood Re-transfusion drains is safe, cost effective and reduces the need for homologous blood transfusion. If drains are to be used then Re-transfusion drains should be used.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 22 - 22
1 Mar 2006
Ng B Soong V Sankar B Siddique I Maguire M Mohil R Henderson A
Full Access

Purpose: To evaluate the objective outcomes in patients who had undergone hardware removal after ORIF of calcaneus fractures.

Materials and Methods: Between 1994 and 2002, 31 cases of hardware removal was performed in 30 patients (25 male, 5 female) with an average age at operation of 47 years (31 to 65 years) were reviewed. Patients’ demographic details were recorded including smoking habit. Fracture patterns were graded according to the Sanders’ classification with preoperative CT scans. The clinical result was assessed using Bristol hind foot scoring system. Serial radiographs assessments were also recorded.

Results: Average follow-up was 4.5 years. Average delay from time of injury to surgery was 12.4 days (range 5 to 24 days). 7 (23%)fractures were Sanders’ type 2A, 8 (26%)fractures were type 2B, 6 (19%)fractures were type 2C, 2 (6%) fractures were type 3AB and 8 (26%) fractures were type 3AC. Average time from surgery to hardware removal was 27 months (range 11 to 45 months). There were 16 smokers and 14 non-smokers. There were 5 deep infections and 3 superficial wound infections after ORIF of calcaneus fractures. 84% of the patients shown objective improvement following hardware removal at the latest follow-up. 2 patients had unsuccessful hardware removal due to dense scarring. No wound infections were recorded. Smoking habit had no significant bearing on the objective outcome improvement following hardware removal (p= 0.891), time from surgery to hardware removal (p=0.53) and wound morbidity (p= 0.4882). Objective improvement showed a statistically significant improvement in the Sanders’ type 2 compared with Sanders’ type 3 (p=0.015).

Conclusion: Removal of hardware is justified in symptomatic patients following ORIF calcaneus fractures. It results in an improved objective outcome and has a low complication rate. Hardware removal may be considered in cases of Sanders’ type 2 calcaneus fractures which are refractory to improvement.