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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
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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.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 8 | Pages 1054 - 1060
1 Aug 2010
Quraishi NA Gokaslan ZL Boriani S

Metastatic epidural compression of the spinal cord is a significant source of morbidity in patients with systemic cancer. With improved oncological treatment, survival in these patients is improving and metastatic cord compression is encountered increasingly often. The treatment is mostly palliative. Surgical management involves early circumferential decompression of the cord with concomitant stabilisation of the spine. Patients with radiosensitive tumours without cord compression benefit from radiotherapy. Spinal stereotactic radiosurgery and minimally invasive techniques, such as vertebroplasty and kyphoplasty, with or without radiofrequency ablation, are promising options for treatment and are beginning to be used in selected patients with spinal metastases.

In this paper we review the surgical management of patients with metastatic epidural spinal cord compression.


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
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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.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 9 | Pages 1197 - 1200
1 Sep 2007
Quraishi NA Johnston P Bayer J Crowe M Chakrabarti AJ

This study prospectively evaluated the outcome of manipulation under anaesthesia and hydrodilatation as treatments for adhesive capsulitis. A total of 36 patients (38 shoulders) were randomised to receive either method, with all patients being treated in stage II of the disease process.

The mean age of the patients was 55.2 years (44 to 70) and the mean duration of symptoms was 33.7 weeks (12 to 76). Eighteen shoulders (17 patients) underwent manipulation under anaesthesia and 20 (19 patients) had hydrodilatation. There were three insulin-dependent diabetics in each group. The mean visual analogue score in the manipulation under anaesthesia group was 5.7 (3 to 8.5; n = 18) before treatment, 4.7 (0 to 8.5; n = 16) at two months (paired t-test p = 0.02), and 2.7 (0 to 9; n = 16) at six months (paired t-test, p = 0.0006). The mean score in the hydrodilatation group was 6.1 (4 to 10; n = 20) before treatment, 2.4 (0 to 8; n = 18) at two months (paired t-test, p = 0.001), and 1.7 (0 to 7; n = 18) at six months (paired t-test, p = 0.0006). The visual analogue scores in the hydrodilatation group were significantly better than in the manipulation under anaesthesia group over the six-month follow-up period (p < 0.0001).

The mean Constant score in those manipulated was 36 (26 to 66) before treatment, 58.5 (24 to 90) at two months (paired t-test, p = 0.001) and 59.5 (23 to 85) at six months (paired t-test, p = 0.0006). In the hydrodilatation group it was 28.8 (18 to 55) before treatment, 57.4 (17 to 80) at two months (paired t-test, p = 0.0004) and 65.9 (28 to 92) at six months (paired t-test, p = 0.0005). The Constant scores in the hydrodilatation group were significantly better than in the manipulated group over the six-month period of follow-up (p = 0.02).

The range of movement improved in all patients over the six months, but was not significantly different between the groups. At the final follow-up, 94% of patients (17 of 18) were satisfied or very satisfied after hydrodilatation compared with 81% (13 of 16) of those receiving a manipulation.

Most of our patients were treated successfully, but those undergoing hydrodilatation did better than those who were manipulated.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 5 | Pages 732 - 733
1 Jul 2003
Quraishi NA Davidson RN Steele N Grand F

We report the case of an 82-year-old man with a pathological fracture of the hip caused by infection with Histoplasma capsulatum var capsulatum. He was treated by a hemiarthroplasty and with oral itraconazole.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 7 | Pages 1036 - 1039
1 Sep 2002
Tai CC Want S Quraishi NA Batten J Kalra M Hughes SPF

Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of infection of the disc space. It is still not known which antibiotics are able to penetrate the intervertebral disc effectively. In a prospective, randomised, double-blind clinical study, we examined the penetration of the intervertebral discs of two commonly used antibiotics, cefuroxime and gentamicin. The patients, randomised into two groups, received either 1.5 g of cefuroxime or 5 mg/kg of gentamicin prophylactically two hours before their intervertebral discs were removed. A specimen of blood, from which serum antibiotic levels were determined, was obtained at the time of discectomy.

Therapeutic levels of antibiotic were detectable in the intervertebral discs of the ten patients who received gentamicin. Only two of the ten patients (20%) who received cefuroxime had a quantifiable level of antibiotic in their discs although therapeutic serum levels of cefuroxime were found in all ten patients. Our results show that cefuroxime does not diffuse into human intervertebral discs as readily as gentamicin. It is possible that the charge due to ionisable groups on the antibiotics can influence the penetration of the antibiotics. We therefore recommend the use of gentamicin in a single prophylactic dose for all spinal procedures in order to reduce the risk of discitis.