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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_6 | Pages 31 - 31
1 Apr 2014
Keenan A Henderson L Michaelson C Tsirikos A
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Aim:

To present the results of multi-modal IOM in 298 patients who underwent spinal deformity correction.

Method:

We reviewed the notes, surgical and IOM charts of all patients who underwent spinal surgery with the use of cortical and cervical SSEPs, as well as upper/lower limb transcranial electrical MEPs under the senior author. We recorded IOM events which we categorised as true, transient true and false (+) or (−). We correlated the IOM events with surgical or anaesthetic incidents.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 94 - 94
1 Sep 2012
Henderson L Mc Donald S Eames N
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Introduction

Traditionally complex spinal surgery in Belfast has been performed at the Royal Victoria Hospital (RVH). Since an amalgamation the RVH has become effectively the level 1 trauma centre for the province. The ever increasing complexity of spinal surgery in addition to changes in practice such as the management of metastatic spinal cord, are placing significant demands on the service. At a time when resources are scarce trends in patient profiles are highly important to allow adequate planning of our service.

Aim

To establish trends in patient profiles in a level one trauma centre also managing spinal pathology over the last 10 years and to examine the impact of this on our service.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 118 - 118
1 Sep 2012
Brownson N Anakwe R Henderson L Rymaszewska M McEachan J Elliott J Rymaszewski L
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Introduction

Although the majority of adult distal humeral fractures are successfully treated with ORIF, the management in frail patients, often elderly with multiple co-morbidities and osteoporotic bone, remains controversial. Elbow replacement is frequently recommended if stable internal fixation cannot be achieved, especially in low, displaced, comminuted fractures. The “bag-of-bones” method ie early movement with fragments accepted in their displaced position, is rarely considered as there has been little in the literature since 10 successful cases were reported by Brown & Morgan in 1971 (JBJS 53-B(3):425–428). We present the experience of three units in which conservative management has been actively adopted in selected cases.

Methods

44 distal humeral fractures were initially treated conservatively - 2004–2010. Mean age 73.9 yrs (40–91) and 34 F: 10 M. Clinical and radiological review at a mean follow-up of 2 years (1–6).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIV | Pages 27 - 27
1 Jul 2012
Henderson L Johnston A Stokes M Corry I Nicholas R
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Anterior cruciate ligament (ACL) reconstruction is a commonly performed operation. A variety of graft options are used with the most popular being bone-patellar-tendon-bone and hamstring autograft. There has been an increase in the popularity of hamstring autograft over the past decade.

The aim of the study was to assess the ten year subjective knee function and activity level following four-strand semitendinosis and gracilis (STG) anterior cruciate ligament reconstruction.

86 patients underwent anterior cruciate reconstruction by two knee surgeons over a 12 month period (January 1999 to December 1999). 80 patients meet the inclusion criteria of arthroscopic ACL reconstruction. The same surgical technique was used by both surgeons involving four-strand STG autograft, single femoral and tibial tunnels and aperture graft fixation with the Round headed Cannulated Interference (RCI) screw. Patient evaluation was by completion of a Lysholm Knee Score and Tegner Activity Level Scale at a minimum of ten years from reconstructive surgery. This was by initial postal questionnaire and subsequent telephone follow-up.

80 patients underwent anterior cruciate reconstruction with average age 30.9 years (15 to 58 years). There was a 77.5% (62 patients) response at ten years to the questionnaire.

The median Lysholm Knee Score at ten years was 94 (52 to 100). The median activity level had decreased from 9 to 5 at ten years according to the Tegner Activity Scale. 73% of patients reported a good or excellent outcome on the Lysholm score. The group of patients was further divided into those that required meniscal surgery and those that did not. The patients that did not require meniscal surgery had a median Lysholm score of 94 and those that required meniscal surgery had a similar median Lysholm score of 92.5. However it was noted that 8 patients required medial and lateral partial menisectomies at the time of original reconstruction. This group of patients had a median Lysholm Knee Score of 83.5 and Tegner Activity Scale of 4 at ten years following reconstruction. 17 of the 62 patients (27.4%) required re-operation because of further knee symptoms, with 4 patients requiring revision of the anterior cruciate following re-rupture.

In conclusion anterior cruciate ligament reconstruction with four-strand STG hamstring autograft provides a reliable method of restoring knee function, with a 6% revision rate for re-rupture at ten years. Combined partial medial and lateral menisectomy at the time of the initial reconstruction is a poor prognostic indicator of function at ten years.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 35 - 35
1 Jun 2012
Henderson L Kulik G Richarme D Theumann N Schizas C
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Purpose of the study

The aim of this work was to study the influence of the slice orientation of T2 axial images in numerical measurements of DSCA and study the effect that this change of slice angle would have on the morphological grading assessment.

Methods and Results

TSE T2 three dimensional aquisition MRI studies reconstructed with OsiriX DICOM viewer from 32 patients were used. Patients included were a series of consecutive cases with either suspected spinal stenosis or low back pain. A total of 97 disc levels were studied and axial reconstructions were made at 0°, +10°, +20°, +30° relative to the disc space orientation. For each image, DSCA was digitally measured and a severity grade was assigned by two observers according to the recently-published 4-point (A-D) morphological grading system. Interobserver kappa score was 0.71. Statistical analysis of DSCA measurements was performed using kappa and t-tests. Comparing DCSA between 0° at each level and +10°, +20° and +30° slice orientation, a significant increase in surface area was found in each case (P<0.0001). % change in DSCA combining all disc levels comparing 0° and +10°: range -15.48% to +31.89% (SD 18.40%); 0° and +20°: range -24.00% to +143.82% (SD 20.45%); 0° and +30°: range -29.35% to +231.13% (SD 26.52%). At 13 disc levels, DSCA was <100mm2 at 0°, but changed to >100mm2 in three cases by a +10° increase, in five cases by a +20° increase and in 10 cases by a +30° increase. In only two out of 97 levels studied did the morphological grading change as the angle increased, one of which was not amongst those above (change in DSCA from <100mm2 to >100mm2).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XX | Pages 6 - 6
1 May 2012
Adams CI McAree C Henderson L Glasby M
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Purpose

To compare the incidence and nature of ‘neurophysiological events’ identified, post hoc, by a consultant neurophysiologist with those identified intra-operatively by clinical physiologists, before and after intervention(s).

Methods

The IOM wave-recordings, event-logs and reports of all spinal deformity cases conducted by a team of clinical physiologists from April to June 2009 (Group 1) were reviewed retrospectively by the same, experienced clinical neurophysiologist, (MG).

Interventions were then agreed. The first was to alter the IOM report document to drop down menus. The second was to arrange a series of teaching sessions for the clinical physiologists on a variety of aspects of IOM. Finally during these teaching sessions recent cases were brought to review in an informal setting to discuss.

Following implementation of the interventions a further review from April to June 2010 (Group 2) was carried out in the same manner.

The clinical physiologists did not know the time periods over which the review would be taking place.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 115 - 116
1 Feb 2004
Leung Y Grevitt M Henderson L Smith N
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Objective: Recent reports have suggested a low incidence of neurological complications following anterior deformity surgery; however in patients with co-existing intra-spinal anomalies no quantification of this risk has been made. Also, whether SSEP monitoring and soft clamping of segmental vessels prior to their division is necessary for these anterior procedures is controversial.

The aims of this study were to determine the incidence of significant SSEP changes in patients undergoing anterior spinal deformity surgery; to ascertain whether the ‘at risk’ cord was more likely to demonstrate significant intraoperative SSEP changes and what proportion of these changes yielded post operative neurological deficit.

Design: Retrospective analysis of operative notes and somatosensory evoked potential (SSEP) traces of patients who underwent anterior spinal deformity surgery between 1990–2001.

Subjects: All patients who underwent anterior spinal deformity surgery between 1990–2001, who had complete data sets (preoperative MRI scan, patient and procedural documentation and intraoperative SSEP traces) were included in the study.

Outcome measures: All post operative neurological deficits and significant SSEP changes were noted, whether or not patients had a ‘cord at risk’.

Results: In total, 871 patients had elective anterior spinal deformity surgery. Preoperative MRI revealed 95 patients (11%) demonstrated intraspinal anomalies on MRI but of these only 27 showed abnormal pre-operative SSEP i.e. cord at risk (CAR). Seventeen (2% of total) of this group developed abnormal intraoperative SSEP responses and ten (1.3%) occurred in the normal group. The incidence of post-operative paraparesis for the whole series was 0.6% (n=5): four in the CAR group, one in the normal cord group. Sensitivity of SSEPs in detecting potential neurological deficit was 100%; specificity 98.6%, positive predictive value 29.4% and negative predictive value 100%. Significant intraoperative SSEP changes occurred more frequently in the CAR group and were more likely to have post operative paraparesis.

Conclusions: SSEP monitoring is a sensitive and specific test, which in experienced hands yields no false positive results. Spinal cord monitoring and soft clamping of segmental vessels should be performed in patients with CAR undergoing anterior spinal deformity surgery to minimise the risk of post operative paraparesis.