Introduction. Microdiscectomies and microdecompressions are traditionally defined as procedures performed with a small incision using magnification. There are no studies in the literature comparing the magnification techniques used in these operations. We compared magnifying loupes and microscopes as the senior author was trained with both instruments and was equally comfortable using both. Materials/Methods. This is a retrospective comparative study involving 51 consecutive patients in group A (loupes) and same number in group B (microscope). The study included all patients who had single level lumbar microdiscectomy or decompression in the period from the 11th of January 2009 to the 6th of April 2010. To avoid any bias, only patients who failed to attend their follow ups were excluded from the study. The senior author operated on all patients. We noted intra-operative and post-operative complications, further interventions, length of surgery and length of hospital stay. We conducted a telephone questionnaire to collect visual analysis score for pre-op and post-op pain and functional status to calculate Macnab's functional status score. 78 patients (75.6%) answered the questionnaire, 39 patients from each group. There was 1 dural leak in group A.1 patient had discitis in the group A and 1 patient had superficial infection in group B. 4 patients in group A and 1 patient in group B had residual pain requiring intervention. The average length of surgery was one hour and five minutes and one hour and eleven minutes, respectively. Mean hospital stay was 1.43 days and 1.78 days, respectively. The data in the group B was skewed due to one patient who stayed for 9 days after surgery. 25 patients (49%) in group A and 36 patients (70.5%) in group B returned to normal pre-prolapse function and physical activity within 3 months. Results. There were statistically significant differences found between the two groups with the rate of complications such as dural leak, deep infection and residual pain requiring intervention. Better visualization with microscope could explain the thoroughness of discectomy or decompression leading to less chance of persistent problems. The average length of surgery was slightly higher in the microscope group, as expected, due to draping and preparation time of microscope. Mean hospital stay was slightly higher in group B due to the average being skewed by one patient staying for nine days after operation. Moreover, statistically significant higher number of patients returned to pre-prolapse functional level within 3 months with the use of microscope

Intrathecal morphine (IM) is a common adjunct in paediatric spinal deformity surgery. We previously demonstrated with idiopathic scoliosis it provides safe and effective analgesia in the immediate postoperative period. This study represents our 25 year experience with IM in all diagnostic groups. Our prospective Pediatric Orthopaedic Spine Database (1993–2018) was reviewed to identify all patients undergoing spinal deformity surgery who received IM and who did not. Patients 21 years of age or less who had a posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI), and received 9–19 mcg/kg (up to 1 mg) of IM were included. Early onset scoliosis surgical patients were excluded. We assessed demographics, pain scores, time to first dose of opioids, diagnoses, surgical time, paediatric intensive care unit (PICU) admission and IM complications (respiratory depression, pruritus, nausea/ vomiting). There were 986 patients who met inclusion criteria. This included 760 patients who received IM and 226 who did not. IM was not used for short procedures (< 3 hrs), respiratory concerns, unsuccessful access of intrathecal space, paraplegia, and anesthesiologist decision. Both groups followed the same strict perioperative care path. The patients were divided into 5 diagnostic groups (IM / non IM patients): idiopathic (578/28), neuromuscular (100/151), syndromic (36/17), and congenital scoliosis (32/21) and kyphosis (14/9). Females predominated over males (697/289). The first dose of opioids after surgery was delayed for a mean of 10.6 hrs in IM group compared to 2.3 hrs in the non-IM group (p=0.001). The postoperative pain scores were significantly lower in the IM groups in the Post Anesthesia Care Unite (p=0.001). Only 17 IM patients (2%) were admitted to the PICU for observation secondary to respiratory depression, none required re-intubation. None of the IM group were re-intubated. Forty-nine patients (6%) experienced pruritus in the IM group compared to 4 of 226 patients (2%) in the non IM group. There were 169 patients (22%) of the IM patients and 21 patients (9%) of the non IM had nausea and vomiting postoperatively. Three patients (0.39%) had a dural leak from the administration of IM but did not require surgical repair. There were no other perioperative complications related to the use of IM. There were no significant group differences. Pre-incision IM is a safe and effective adjunct for pain management in all diagnostic groups undergoing spinal surgery. The IM patients had lower pain scores and a longer time to first administration of post-operative opioids. Although there is an increased frequency of respiratory depression, pruritus, and nausea/vomiting in the IM group, there were no serious complications

Introduction. Given the rising incidence of obesity in the adult population, it is more than likely that orthopaedic surgeons will be treating more obese patients with lumbar disc pathologies. The relationship between obesity and recurrent herniated nucleus pulposus (HNP) following microdiscectomy remains unclear. Objectives. To investigate the relationship between obesity and recurrent HNP following lumbar microdiscectomy. Methods. A retrospective review of case notes from 2008–2011 was conducted for all patients that underwent one level lumbar microdiscectomy, performed by a single surgeon. The standard criteria for microdiscectomy were used. Patient demographics, including Body Mass Index (BMI), collected from notes. Obese patients classified as BMI >/= 30. The primary clinical outcome measure was evidence of recurrent HNP on post operative MRI scan requiring further surgery. Results. A total of 283 patients were available for analysis: 190(67%) were in the non-obese group and 93 (32.9%) in the obese group. The average BMI was 28.1 and the average length of stay was 1.3days. Dural leak was seen in 11 patients(3.9%) out of which 8(4.2%) occurred in the non-obese group and 3(3.2%) in the obese group [p=0.04]. Recurrent symptomatic HNP was seen in 27(9.5%) patients confirmed by MRI scan. 19(10%) were in the non-obese group and 8(8.6%) in the obese group [p>0.8]. Conclusion. Obesity was not a predictor of recurrent HNP after lumbar microdiscectomy and did not have increased complication rates compared to the non-obese group

Objectives. To demonstrate that instrumented fusion of the paediatric cervical spine is possible and can be performed safely. Study Design. A retrospective review of paediatric patients who had instrumented fusion of the cervical spine. Materials and method. Sixteen paediatric patients (10 male, 6 female) with a mean age of 8 years who underwent instrumented cervical fusion were retrospectively reviewed. Surgery was performed for trauma (5 cases), spinal tuberculosis (3 cases), congenital anomalies (6 cases) and malignancies (2 cases). Fixation methods included occipito-cervical fusion, pedicle and lateral mass screws and anterior cervical plating. Ten posterior approaches, four anterior approaches and four combined anterior and posterior approaches were performed. We looked at fusion rates, blood loss, levels fused, theatre time, technique and complications. Results. All patients achieved radiological and clinical fusion. The average number of levels fused was 2.5, blood loss 418ml and theatre time 222 minutes for all patients. Anterior procedures had an average of 1 levels fused, blood loss 117ml and theatre time 98 minutes. Posterior procedures had an average number of 1.9 levels fused, blood loss of 306ml and theatre time of 131 minutes. For the combined anterior and posterior procedures the average levels fused were 5.5, blood loss 975ml and theatre time 248 minutes. Five surgery related complications were encountered. These consisted of dural leaks and wound sepsis which were all treated effectively. Conclusion. The use of modern segmental spinal instrumentation in the paediatric cervical spine is a viable option in this young population. Although our study sample was small we are able to demonstrate that no major surgical complications were encountered due to the use of cervical spinal instrumentation. NO DISCLOSURES