Paravertebral anaesthesia is a particularly effective, safe and reliable option in scoliosis patients undergoing anterior release in whom percutaneous epidural placement may be difficult to perform. A recent systematic review and meta-analysis of randomized trials has demonstrated that whilst paravertebral block and thoracic epidural insertion provide comparable pain relief after thoracic surgery, paravertebral block placement is associated with a better side effect profile, including a reduction in pulmonary complications, hypotension, nausea and vomiting and urinary retention. We describe a case of a 16 year old female patient who underwent staged correction of her thoracolumbar scoliosis. A paravertebral catheter was inserted under direct vision for continuous infusion post operative analgesia following the anterior release. 48 hours after surgery a swelling was noted in the groin, which was confirmed with ultrasonography as a fluid collection. The swelling resolved upon removing the paravertebral catheter. This suggests that it was caused by the local anaesthetic fluid tracking along the psoas muscle. Retroperitoneal infections, venous thrombosis, femoral hernia, femoral artery aneurysm and inguinal lymphadenopathy are other differentials. Ultrasonography was a fast and sensitive investigation to rule out these differentials and determined that fluid communicating with the abdominal cavity was the cause for this swelling. The infused local anaesthetic had tracked down into the femoral triangle and the swelling resolved upon cessation of the infusion.
Average age was 6.5 years(2–12). Average follow-up was 24 months (6m-36m).
Five specimens were implanted for each group 1) with pedicle screw (into L3 and L5) and tested with/without Synex (expandable) cage anteriorly, 2) implanted with a Synex cage and Double screw+rod Ventrofix system, 3) Synex cage and Double screw+ Single rod Ventrofix construct and 4) Synex cage and Single screw+ Single rod Ventrofix system.
The double screw/ single rod system is less effective than the Ventrofix System but is comparable to the pedicle screw construct. The single screw/ single rod construct leads to unacceptable movement about the axis of the inferior screw particularly in extension with a ROM much greater than the intact spine (p<
0.001)
Pre and post procedure pain and physical function scores were noted using the standard SF 36 questionnaire, as well as whether subsequent surgery was required. Mean follow up time was seven months (range 2–13 months).
We have examined the outcome in 19 professional rugby union players who underwent anterior cervical discectomy and fusion between 1998 and 2003. Through a retrospective review of the medical records and telephone interviews of all 19 players, we have attempted to determine the likelihood of improvement, return to professional sport and the long-term consequences. We have also attempted to relate the probability of symptoms in the neck and radicular pain in the arm to the position of play. Neck and radicular pain were improved in 17 patients, with 13 returning to rugby, the majority by six months after operation. Of these, 13 returned to their pre-operative standard of play, one to a lower level and five have not played rugby again. Two of those who returned to the game have subsequently suffered further symptoms in the neck, one of whom was obliged to retire. The majority of the players with problems in the neck were front row forwards. A return to playing rugby union after surgery and fusion of the anterior cervical spine is both likely and safe and need not end a career in the game.
Patients admitted to trauma wards are routinely screened for MRSA pre-operatively. The majority of them have implant surgery before the screening results were available. The aim of our study was to identify the incidence of MRSA wound infection in these patients and their outcome following it. We randomly reviewed 40 patients who were colonised with MRSA pre-operatively and have had implant surgeries. The case notes, drug charts and the microbiology were reviewed to identify the incidence of MRSA wound infection and its outcome in these patients. The place of residence, site of colonisation and the treatment given were also considered. 70% of the patients were admitted from home and 20% had previous admission within one year. The commonest site colonised is the nose (50%) followed by the perineum in 20%. Multiple sites were colonised in 10% of the patients. Only 50% of them with positive nasal MRSA were given nasal bactroban and chlohexidine wash was given in only 70% of them with MRSA colonisation in other areas. 22.5% (9/40) of the patients developed MRSA infection post operatively and they were treated with vancomycin or teicoplanin. Wound debridement and washout were done in 67.5%. 75% of the MRSA infected wound healed well with no MRSA in the wound site after treatment. 25% of the MRSA infected wounds had persistent MRSA in the wound. As per our study the incidence of MRSA wound infection in patients colonised pre-operatively is about 22.5%. Most cases seem to heal well without much complication with appropriate antibiotics and wound care.
We studied the correction achieved and the maintenance of the correction at a minimum 15 months follow up using the Paediatric USS.
To assess the results of this technique for stabilisation of severe spondylolisthesis, 12 patients with symptomatic severe spondylolisthesis underwent this procedure. The slipped L5 vertebra was stabilized using a hollow medullary screw through the posterior part of the body of S1 into the slipped L5 body, supplemented with pedicle screws into L5 and S1 with posterolateral fusion. At one year follow-up, all but one patient had improved in leg pain. 2 patients were aware of the prominent pedicle screws. 360° fusion was achieved without any progression of spondylolisthesis. Thus 360° fusion for severe L5-S1 spondylo-listhesis can be achieved effectively using this technique.
The purpose of this prospective study is to evaluate the benefits of intra discal electrothermal treatment (IDET) for discogenic back pain. 40 patients with chronic discogenic back pain underwent this therapy. All the patients had a failed trial of conservative treatment. Patients with a positive provocative discogram were selected for IDET. The outcome is assessed using a SF36 questionnaire pre-procedure and then at 3,6,12,18 and 24 months post-operatively. The mean age group of the patients was 37 years (range 15–58 years). All the patients had a minimum follow up of 18 months. Out of the 40 patients 5(12.5%) had no improvement and had to undergo an interbody fusion within 6 months following IDET and hence were excluded from the study. No patient developed any neurological complications. Of the rest of the 35 patients at a minimum of 18 months follow-up 56 % (p=0.042) patients had improvement in physical function scores and 52% (p=0.034) had improvement in pain scores as per the SF36. Conclusion: IDET appears to be an effective alternative to control pain in patients who might otherwise be candidates for spinal fusion.
Controversy exists as to whether the biomechanical properties of a 360 lumbar fusion are influenced by the order in which the anterior and posterior components of the procedure are performed. The fusion technique used Magerl screws to effect the posterior fusion and a Syncage implant (Stratec) to effect the anterior component of the fusion. Isolated motion segments from calf spines were tested in each of two groups of five. In the first group the posterior fusion was performed first and in the second group the anterior fusion was performed first. Loads were applied as a dead weight of 2Nm in each range of movement of the spine (flexion/extension, lateral flexion and rotation). The range of movement was measured using the Qualisys motion analysis software linked to a set of five cameras, using external marker clusters attached to the vertebral bodies. Each motion segment was tested prior to instrumentation, post anterior or posterior instrumentation and with both anterior and posterior instrumentation. Ranges of movement following 360 instrumentation were increased in all planes tested when posterior fixation was performed first; flexion/extension 26% v 55% (p=0.020), lateral flexion 18% v 34% (p=0.382), and rotation 18% v 73% (p=0.034). It was concluded that posterior fixation should not be performed prior to anterior fixation as this results in a significant loss of stability in both flexion/extension and rotation