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The Bone & Joint Journal
Vol. 102-B, Issue 6 | Pages 655 - 657
1 Jun 2020
Minhas Z Ganau M Thakar C Reynolds J Rothenfluh D Bojanic S Grannum S Chaudhary BR Pyrovolou N Sikander M Bowden G Patel UJ Nnadi C


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 50 - 50
1 Jun 2012
Gillies M Bojanic S Ritchie R Leslie T
Full Access

Purpose

We present results of high intensity focussed ultrasound (HIFU) therapy on 2 patients with recurrent sacrococcygeal chordoma with the aim to promote recruitment of patients into a larger clinical trial

Method

Extracorporeal high intensity focussed ultrasound, outcome measure: radiological evidence of involution, clinical status at follow up.

Sacrococygeal chordomas are rare, histologically benign tumours that tend to grow inexorably causing pain, and loss of function in the lower limbs and genitor-urinary symptoms. Results after surgical resection with conventional radiotherapy have been generally disappointing. Carbon ion therapy has been reported to be more successful, but this is not available in the UK.

Both patients presented some years after surgical resection with recurrent sacral chordoma, causing intractable pain, and declining mobility. The patients underwent several (4 and 2) sessions of HIFU, using a protocol adapted for renal cell carcinoma and without any adverse events. Follow up MRI 2 weeks and 3 months post procedure showed reduction in tumour enhancement in targeted areas. This correlated with a patient-reported improvement in pain control and improving lower limb function sustained during a 3 month period.

We propose the establishment of a clinical trial examining the utility of HIFU on recurrent sacral/coccygeal chordoma in adults after surgical resection. The outcomes measured will be pain scores, functional status using validated scoring scales to allow systematic comparisons with other treatments, and survival. We aim to recruit at least 14 patients initially. Side-effects and complications of the treatment will be recorded. Treatment and follow up of patients will take place in the Churchill Hospital, Oxford, UK.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 334 - 334
1 Nov 2002
Bojanic S Shad A Adams. C
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Objective: To demonstrate the safety, surgical efficacy and advantages of the Posterior Lumbar Interbody Fusion (PLIF) technique using posterior elements as graft material when combined with pedicle screw fixation.

Design: Retrospective study assessing the Oswestry Score and Pain Intensity Score pre and post-operatively in patients undergoing disc excision and PLIF with the above technique.

Subjects: Eighteen patients (6 male), mean age 44 years (range 24 – 59) with a mean follow-up of 11 months (range 9 – 14). Four subjects had undergone previous lumbar surgery. All subjects had a history of back pain with or without sciatica.

Outcome measures: Pre and post-operative assessment of functional ability and pain using the Oswestry Score and Pain Intensity Score.

Results: Following surgery there was marked improvement in the Oswestry Score from a mean score of 36 (+/−12) to 19 (+/−9), P< 0.0001. Likewise there was an improvement in the Pain Intensity Score from a pre-operative mean score of 4 (+/−1) to a post-operative score of 1 (+/−1), P< 0.0001. Seventeen of the eighteen patients indicated that they would have the operation again.

Conclusion: Our technique is safe, effective and the results are comparable with published data. This technique provides the added benefit of utilisation of posterior elements of the spine as bone graft and hence avoids donor site problems and the risks associated with insertion of block grafts.