To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation. A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre’s MRI database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p < 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs).Aims
Methods
Aims. To address the natural history of severe post-tuberculous (TB)
kyphosis, with focus upon the long-term neurological outcome, occurrence
of restrictive lung disease, and the effect on life expectancy. . Patients and Methods. This is a retrospective
Background. Advances in surgical and anesthetic technique have resulted in a reducing length of stay for lumbar decompression, with the first day case procedure published in the literature in 1980. Current evidence suggests day case surgery is associated with improved patient satisfaction, faster recovery, reduced infection rates and financial savings. Following the introduction of a locally agreed day case protocol for lumbar microdiscectomy, we reviewed our 30-day postoperative complication rates. Aims. To review postoperative complication rates for patients who underwent day case primary lumbar microdiscectomy. Methods. We studied all patients that met a locally agreed day case protocol for lumbar microdiscectomy and were operated upon between 1. st. March 2013 and 31. st. December 2015. Results. 134 patients underwent primary day case microdiscectomy (70 males, 64 females). The cohort had a mean age of 41 years (16–82). 96% (n=129) were single level procedures, 93% were unilateral (n=125). 81% (n=109) took place at either L4/L5 or L5/S1. All patients were discharged on the same day as admission and operation. 3% (n=4) of patients re-presented to hospital within 30 days of which 75% (n=3) were reviewed and discharged from the emergency department within 4 hours, following a satisfactory
Between 1993 and 2008, 41 patients underwent total coccygectomy for coccydynia which had failed to respond to six months of conservative management. Of these, 40 patients were available for
Background. Rotatory subluxation of the atlantoaxial joint has been thoroughly documented in children. However, pure traumatic atlantoaxial rotatory subluxation (TAARS) is a rare injury in adults with only a few cases reported in the English literature. Aim. To report two cases of TAARS in adults. Methods. A case note, clinical and radiological review. Results. Both patients were female. There was a history of a motor vehicle collision in both cases. There was no neurological impairment at presentation in either case. The injury in both cases was identified by plain X-ray and confirmed by CT scan. Both were managed by conservative treatment, initially with halo traction, followed by immobilisation in a rigid collar. Final
Introduction. Cauda Equina is a condition requiring urgent operative intervention to avoid debilitating long term neurological compromise. The recommended maximium time delay before lack of surgical decompression results in persisting neurological deficit has been suggested to be 24 hrs and more recent studies have even indicated 48 hours as acceptable. We wanted to assess if any persisting neurological deficit occurred in our practice when treated at 12 hours or less. Aim. To assess if patients treated within half of the maximum recommended time for surgical decompression following cauda equina i.e 12 hours, are still pre-disposed to persisting neurological compromise. Methods. We reviewed all patients who underwent a spinal decompression for cauda equina, based on clinical presentation, examination and magnetic resonance imaging at our institution. Over a seven year period, seven patients were found to have operative findings consistent with cauda equina syndrome. The clinical presentation, time from presentation to operative decompression and type of procedure done, as well as the
We have treated 15 patients with massive lumbar disc herniations non-operatively. Repeat MR scanning after a mean 24 months (5 to 56) showed a dramatic resolution of the herniation in 14 patients. No patient developed a cauda equina syndrome. We suggest that this condition may be more benign than previously thought.
We carried out a prospective study to determine whether the addition of a recombinant human bone morphogenetic protein (rhBMP-2) to a machined allograft spacer would improve the rate of intervertebral body fusion in the spine. We studied 77 patients who were to undergo an interbody fusion with allograft and instrumentation. The first 36 patients received allograft with adjuvant rhBMP-2 (allograft/rhBMP-2 group), and the next 41, allograft and demineralised bone matrix (allograft/demineralised bone matrix group). Each patient was assessed clinically and radiologically both pre-operatively and at each follow-up visit using standard methods. Follow-up continued for two years. Every patient in the allograft/rhBMP-2 group had fused by six months. However, early graft lucency and significant (>
10%) subsidence were seen radiologically in 27 of 55 levels in this group. The mean graft height subsidence was 27% (13% to 42%) for anterior lumbar interbody fusion, 24% (13% to 40%) for transforaminal lumbar interbody fusion, and 53% (40% to 58%) for anterior cervical discectomy and fusion. Those who had undergone fusion using allograft and demineralised bone matrix lost only a mean of 4.6% (0% to 15%) of their graft height. Although a high rate of fusion (100%) was achieved with rhBMP-2, significant subsidence occurred in more than half of the levels (23 of 37) in the lumbar spine and 33% (6 of 18) in the cervical spine. A 98% fusion rate (62 of 63 levels) was achieved without rhBMP-2 and without the associated graft subsidence. Consequently, we no longer use rhBMP-2 with allograft in our practice if the allograft has to provide significant structural support.