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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_11 | Pages 32 - 32
1 Nov 2022
Bernard J Bishop T Herzog J Haleem S Ajayi B Lui D
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Abstract

Aims

Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis allowing correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected.

Methods

A retrospective analysis of 20 patients (M:F=19:1 – 9–17 years) between January 2014 to December 2016 with a mean five-year follow-up (4 to 7).


Bone & Joint Open
Vol. 3, Issue 2 | Pages 123 - 129
1 Feb 2022
Bernard J Bishop T Herzog J Haleem S Lupu C Ajayi B Lui DF

Aims

Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected.

Methods

We conducted a retrospective analysis of clinical and radiological data of 20 patients aged between 9 and 17 years old, (with a 19 female: 1 male ratio) between January 2014 to December 2016 with a mean five-year follow-up (4 to 7).


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 11 - 11
1 Sep 2021
Abdullahi H Fenner C Ajayi B Fragkakis EM Lupu C Bishop T Bernard J Lui DF
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Introduction

Scoliosis surgery is a life-changing procedure, but not devoid of perioperative complications. Often patients' scoring systems do not cover their real-life needs, including return to pre-surgery activity.

Return to school, physical education (PE) is an important indirect marker of recovery. Although anterior spinal fusion (ASF) may have advantages, compared to posterior spinal fusion (PSF), because of motion-saved segments, there is a paucity of literature about post-operative return to school/PE in the compared groups.

Aim

To determine the recovery time for patients with scoliosis who underwent anterior spinal fusion (ASF) and posterior spinal fusion (PSF)


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 13 - 13
1 Sep 2021
Patankar A Fragkakis EM Papadakos N Fenner C Ajayi B Beharry N Lupu C Bernard J Bishop T Lui DF
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Introduction

Degenerative spondylosis (DS) represents a challenging condition to diagnose and treat. There are multiple modalities to investigate DS including X-ray, MRI and CT, but symptoms may not be equivocal to DS to support the clinical findings. The investigation of metastases commonly utilises SPECT/CT for identification of areas of increased osteoblastic activity to denote disease.

The aim of the study was to analyse the prevalence of asymptomatic DS in a consecutive hospital cohort of oncology patients who had SPECT/CT for investigation of metastases.

Methods

Oncology patients who underwent SPECT/CT at St. George's Hospital were analysed between 2015–2019.

Exclusion criteria: back pain, inflammatory disorders, metastases, trauma, infection. Radiology reports were examined for DS and anatomical distribution of tracer uptake.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 17 - 17
1 Sep 2021
Sivasubramaniam V Fragkakis A Ho P Fenner C Ajayi B Crocker MJ Minhas P Lupu C Bishop T Bernard J Lui DF
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Introduction

Treatment of spinal metastatic disease has evolved with the advent of advanced interventional, surgical and radiation techniques. Spinal Oligometastatic disease is a low volume disease state where en bloc resection of the tumour, based on oncological principles, can achieve maximum local control (MLC). Hybrid therapy incorporating Separation surgery (>2mm clearance of the thecal sac) and Stereotactic Ablative Radiotherapy (SABR) offer an alternative approach to achieving MLC. Hybrid therapy is also a viable option in patients eligible for SBRT who have failed conventional radiation therapy. En-bloc surgery may be a suitable option for those patients who are ineligible for or have failed SBRT. A multidisciplinary approach is particularly important in the decision-making process for these patients. Metal free instrumentation is aiding the optimization of these surgeries. The authors present a supra-regional centre's experience in managing spinal oligometastases.

Methods

Retrospective review of oligometastatic spinal disease at a supra-regional centre between 2017 and 2021. Demographics, operative course, complications and Instrument type are examined.


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Introduction

Missile injuries are very serious injuries particularly in the cervical region. They are classified into high and low missile injuries when it involves the cervical spine. In modern guerrilla warfare, one must be aware of ballistic pathology with bullets as well as from explosives. In particular, improvised explosive devices commonly known as IED's play a new and important pathophysiology whether they are suicided vests or roadside bombs. They usually produce severe or lethal injuries and serious neurovascular deficit is frequent. We present the details of 40 patients with local experience on how to handle serious penetrating cervical missile injuries.

Methods

All cases were collected from the record of Basrah University Hospital, Iraq. Healthy military gentlemen with ages ranging between 20–35 years were included.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 4 - 4
1 Sep 2021
Tsang E Lone A Fenner C Ajayi B Haleem S Bernard J Bishop T Lui D
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Introduction

Thoracic wall surgery can cause severe pain and inhibition of coughing with effects. (1) Various local anaesthetic (LA) techniques have been tried successfully to mitigate the use of opioids alone. We believe this is the first time that a serratus plane block using an epidural catheter (SABER)has been studied in anterior spinal fusion (ASF) procedures. Our aim was to ascertain how it would affect ASF compared to gold standard posterior spinal fusion (PSF) surgery.

Materials and Methods

We identified 43 patients from the years 2017 to 2019. 24 had ASF and 19 had PSF. Detailed data were collected on local anaesthetic infusion (LAI) SaBER, mean pain scores(MPS), morphine, chirocaine usage and hospital length of stay (HLOS). We divided the patients into 4 groups: Short PSF (SPSF), Long PSF (LPSF), Thoracic anterior fusion (TA) and Thoracolumbar anterior fusion (TLA) surgery. 4 patients in the SPSF and 4 in the LPSF group had LAI because they had a costoplasty. All patients in the anterior group had SaBER.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 5 - 5
1 Sep 2021
Raza M Sturt P Fragkakis A Ajayi B Lupu C Bishop T Bernard J Abdelhamid M Minhas P Lui D
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Introduction

Tomita En-bloc spondylectomy (TES) of L5 is one of the most challenging spinal surgical techniques. A 42-year-old female was referred with low back pain and L5 radiculopathy with background of right shoulder excision of liposarcoma. CT-PET confirmed a solitary L5 oligometastasis. MRI showed thecal sac indentation and therefore was not suitable for stereotactic ablative radiotherapy (SABR) alone.

Planning Methodology

First Stage: Carbon fibre pedicle screws were planned from L2 to S2AI-Pelvis, aligned to her patient-specific rods. Custom 3D-printed navigation guides were used to overcome challenging limitations of carbon instruments. Radiofrequency ablation (RFA) of L5 pedicles prior to osteotomy was performed to prevent sarcoma cell seeding. Microscope-assisted thecal sac-tumour separation and L5 nerve root dissection was performed. Novel surgical navigation of the ultrasonic bone cutter assisted inferior L4 and superior S1 endplate osteotomies.

Second stage: We performed a vascular-assisted retroperitoneal approach to L4-S1 with protection of the great vessels. Completion of osteotomies at L4 and S1 to en-bloc L5: (L4 inferior endplate, L4/5 disc, L5 body, L5/S1 disc and S1 superior endplate). Anterior reconstruction used an expandable PEEK cage obviating the need for a third posterior stage. Reinforced with a patient-specific carbon plate L4-S1 promontory. Sacrifice of left L5 nerve root undertaken.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 6 - 6
1 Sep 2021
Sriram S Hamdan T Al-Ahmad S Ajayi B Fenner C Fragkakis A Bishop T Bernard J Lui DF
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Thoracolumbar injury classification systems are not used or researched extensively in paediatric population yet. This systematic review aims to explore the validity and reliability of the two main thoracolumbar injury classification systems in the paediatric population (age ≤ 18). It also aims to explore the transferability of adult classification systems to paediatrics. The Thoracolumbar Injury Classification System (TLICS) published in 2005 and the AO Spine published in 2013 were assessed in this paper because they both provide guidance for the assessment of the severity of an injury and recommend management strategies. A literature search was conducted on the following databases: Medline, EMBASE, Ovid during the period November 2020 to December 2020 for studies looking at the reliability and validity of the TLICS and AO Spine classification systems in paediatric population. Data on validity (to what extent TLICS/ AO Spine recommended treatment matched the actual treatment) and reliability (inter-rater and intra-rater reliability) was extracted.

There is an “almost perfect validity” for TLICS. There is a “strong association” between the validity of TLICS and AO Spine. The intra-rater reliability is “moderate” for TLICS and “substantial” for AO Spine. The intra-rater reliability is “substantial” for TLICS and “almost perfect” for AO Spine.

The six studies show a good overall validity and reliability for the application of TLICS and AO Spine in pediatric thoracolumbar fractures. However, implication of treatment and anatomical differences of the growing spine should be explored in detail. Therefore, AO Spine can be used in absence of any other classification system for paediatrics.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 12 - 12
1 Sep 2021
Rose L Williams R Al-Ahmed S Fenner C Fragkakis A Lupu C Ajayi B Bernard J Bishop T Papadakos N Lui DF
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Background

The advent of EOS imaging has offered clinicians the opportunity to image the whole skeleton in the anatomical standing position with a smaller radiation dose than standard spine roentgenograms. It is known as the fifth modality of imaging. Current NICE guidelines do not recommend EOS scans over x-rays citing: “The evidence indicated insufficient patient benefit in terms of radiation dose reduction and increased throughput to justify its cost”.

Methods

We retrospectively reviewed 103 adult and 103 paediatric EOS scans of standing whole spines including shoulders and pelvis for those undergoing investigation for spinal deformity in a tertiary spinal centre in the UK. We matched this against a retrospective control group of 103 adults and 103 children who underwent traditional roentgenograms whole spine imaging at the same centre during the same timeframe. We aimed to compare the average radiation dose of AP and lateral images between the two modalities. We utilised a validated lifetime risk of cancer calculator (www.xrayrisk.com) to estimate the additional mean risk per study.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 16 - 16
1 Sep 2021
Bernard J Herzog J Bishop T Fragkakis A Fenner C Ajayi B Lui DF
Full Access

Introduction

Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through Growth Modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemi-epiphysiodesis concept. The other modality is Anterior Scoliosis Correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected.

Methods

Retrospective analysis of clinical and radiographic data of 20 patients between 2014 to 2016 with a mean 5 year follow (range 4–6).


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 9 - 9
1 Sep 2021
Taha A Houston A Al-Ahmed S Ajayi B Hamdan T Fenner C Fragkakis A Lupu C Bishop T Bernard J Lui D
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Introduction

Pulmonary Tuberculosis (TB) can be detected by sputum cultures. However, Extra Pulmonary Spinal Tuberculosis (EPSTB), diagnosis is challenging as it relies on retrieving a sample. It is usually discovered in the late stages of presentation due to its slow onset and vague early presentation. Difficulty in detecting Mycobacterium Tuberculosis bacteria from specimens is well documented and therefore often leads to culture negative results. Diagnostic imaging is helpful to initiate empirical therapy, but growing incidence of multidrug resistant TB adds further challenges.

Methods

A retrospective analysis of cases from the Infectious Disease (ID) database with Extra Pulmonary Tuberculosis (EPTB) between 1st of January 2015 to 31st of January. Two groups were compared 1) Culture Negative TB (CNTB) and 2) Culture Positive TB (CPTB). Audit number was


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 8 - 8
1 Sep 2021
Abdalla M Nyanzu M Fenner C Fragkakis E Ajayi B Lupu C Bishop T Bernard J Willis F Reyal Y Pereira E Papadopoulos M Crocker M Lui D
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Introduction

Spine is a common site for haematological malignancies. Multiple myeloma affects the spine in 70% of cases. New guidelines were published in 2015 to help manage spinal haematological malignancies.

Despite neural compression or spinal instability, instrumentation of the spine should be avoided. Surgery carries significant risks of wound complications and more importantly delaying the definitive chemotherapy and radiotherapy. Cement augmentation and bracing for pain and prevention of deformity is key to the new strategies.

We aimed to evaluate the different treatment modalities adopted in the spine unit at St George's hospital for spinal haematological malignancies. We compared our practice to the current guidelines published in 2015.

Methods

Retrospective review of all spinal haematological malignancy patients who were discussed in the spinal MDT and managed through the spine unit at St George's hospital in the period between April 2019 and February 2021. We analysed the demographics of the patients treated in this period and compared the management modalities adopted in the unit to the current British haematological guidelines.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 15 - 15
1 Sep 2021
Kawsar KA Gill S Ajayi B Lupu C Bernard J Bishop T Minhas P Crocker M Lui D
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Background

Carbon fibre (CF) instrumentation is known to be radiolucent and has a tensile strength similar to metal. A specific use could be primary or oligometastatic cancer where regular surveillance imaging and Stereotactic Radiotherapy are required.

CT images are inherently more prone to artefacts which affect Hounsfield unit (HU) measurements. Titanium (Ti) screws scatter more artefacts. Until now it has been difficult to quantify how advantageous the radiolucency of carbon fibre pedicle screws compared to titanium or metallic screws actually is.

Methodology

In this retrospective study, conducted on patients from 2018 to 2020 in SGH, we measured the HU to compare the artifact produced by CF versus Ti pedicle screws and rods implanted in age and sex matched group of patients with oligometastatic spinal disease.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_11 | Pages 19 - 19
1 Sep 2021
Lui D Ajayi B Fenner C Fragkakis A Bishop T Bernard J
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INTRODUCTION

The correct placement of pedicle screws is a major part of spine fusion and it requires experienced trained spinal surgeons. In the era of European Working Time Directive (EWTD), surgical trainees have less opportunity to acquire skills. Josh Kauffman (Author of The First 20 Hours) examined the K. Anders-Ericsson study that 10,000 hours is required to be an expert. He suggests you can be good at anything in 20 hours following 5 methods. This study was done to show the use of accelerated learning in trainees to achieve competency and confidence on the insertion of pedicle screws.

METHODS

Data was collected using 3 experienced spine surgeons, 8 trainees and 1 novice (control) on the cadaveric insertion of pedicle screws over a 4 day didactic lecture in the cadaver lab. Each candidate had 2 cadavers and 156 screw placements over 4 hour shifts. Data was collected for time of pedicle screw insertion for each level on the left and right side. A pre-course and post-course questionnaire (Likert scale) was conducted.


Bone & Joint Open
Vol. 2, Issue 8 | Pages 661 - 670
19 Aug 2021
Ajayi B Trompeter AJ Umarji S Saha P Arnander M Lui DF

Aims

The new COVID-19 variant was reported by the authorities of the UK to the World Health Organization (WHO) on 14 December 2020. We aim to describe the clinical characteristics and nosocomial infection rates in major trauma and orthopaedic patients comparing the first and second wave of COVID-19 infection.

Methods

A retrospective analysis of a prospectively collected trauma database was reviewed at a level 1 major trauma centre from 1 December 2020 to 18 February 2021 looking at demographics, clinical characteristics, and nosocomial infections and compared to our previously published first wave data (26 January 2020 to 14 April 2020).


Bone & Joint Open
Vol. 1, Issue 7 | Pages 330 - 338
3 Jul 2020
Ajayi B Trompeter A Arnander M Sedgwick P Lui DF

Aims

The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era.

Methods

A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after.