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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 39 - 39
1 Feb 2016
Treanor C O'Brien D Bolger C
Full Access

Objectives:

To establish the demand, referral pathways, utility and patient satisfaction of a physiotherapy led post operative spinal surgery review clinic.

Methods:

From July 2014 to January 2015 a pilot physiotherapy led clinic was established. The following clinic data was collected: number of patients reviewed, surgical procedure, outcome of clinic assessment, numbers requiring further investigation, numbers requiring review in the consultant led clinic and adverse events. A patient satisfaction survey was also administered to all English speaking patients. Patients were asked to rate the ease of getting through to the service by phone, length of wait, time spent with the clinician, answers to questions, explanation of results, advice about exercise and return to activities, the technical skills of the clinician, their personal manner and their overall visit. Data was anonymised and inserted into an excel spreadsheet for analysis. Descriptive statistical analysis was undertaken.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 8 - 8
1 Jun 2012
Ali Z Murphy RKJ McEvoy L Bolger C
Full Access

Object

Giant thoracic discs (occupying more than 40% of the spinal canal) are a difficult surgical pathology. They are increasingly being recognized as or particular subset of thoracic disc pathology. It has been recommended that an aggressive surgical approach of open 2 level verteberectomy and instruments should be utilized.21 However Retropleural thoracotomy provides the shortest direct route to the anterior thoracic spine and avoids pleural cavity entry making it an ideal if infrequently used approach to access ventral thoracic and thoracolumbar spine abnormalities. We present a detailed description of our experience utilising this approach, for the treatment of Giant Thoracic discs without the need for vertebrectomy or instrumentation

Methods

A prospective cohort of patients with Giant thoracic discs operated on utilizing the mini open retropleural thoracotomy technique was used, intra-operative and post-operative complications and length of post-op stay. Functional outcome and pain scores, were also prospectively recorded using SF-36, Oswestry Disability Index (ODI), and visual analogue pain scores (VAS).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 141 - 141
1 Apr 2012
Murphy R McEvoy L Ali Z Bolger C Young S
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The “Wallis” implant is indicated to stabilize symptomatic degenerative lumbar spine segments, relieving low back pain related to instability and thus delaying the need for irreversible, more invasive surgical management. The purpose of this study was to provide the first objective clinical evaluation of the “Wallis” lumbar dynamic stabilisation system.

An independent prospective observational study was carried out utlising SF-36, Oswestry Disability Index (ODI) and visual analogue pain scores (VAS). Surgical pathologies in which this technique was used, the intra-operative and post-operative complications and length of post-op stay were recorded. 102 patients underwent Wallis insertion between June 2007- May 2009, Median age 51.5 (range 28-108). 94% of patients completed questionnaires and were followed up at 3, 6 and 12 month time points. ODI scores decreased from pre-op 39 to 27 at twelve months (p<.0016). VAS back pain scores decreased 59 to 36 (p<0.0001). Leg scores decreased 50 to 39 (p<0.0002). SF 36 scores improved significantly, physical functioning 46 to 59, physical health 30 to 54 and social functioning 47 to 68. 50% of patients believed their health to be better 12 months post-op. Pre-operatively 28% of patients were employed and working with 26% off work due to back problems. This rate increased steadily with 42% employed at 12 months. Two implants were removed, one due to non-benefit with subsequent arthrodesis and one due to infection. One superficial wound infection occurred.

The Wallis dynamic stabilization system provides a superficial and easily reversible surgical procedure with a lower complication rate than conventional athrodesis. Used in patients with painful degenerative lumbar conditions their quality of life objectively approached values of the age- and gender-matched general population.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 51 - 51
1 Apr 2012
Collis RA Kelleher M McEvoy L Bolger C
Full Access

Several surgical options have been utilised to treat patients with back dominant lumbar disc disease. The purpose of our study was to compare the outcomes in patients who underwent lumbar fusion with an expandable interbody device (B-TWIN) using different surgical techniques (PLIF, TLIF or posterolateral screws alone)

Observational study, retrospective analysis of prospectively collected data. Patients underwent a single level lumbar fusion. Group A: PLIF with B-Twin cage; Group B: TLIF with B-Twin cage and unilateral pedicle screw fixation and Group C: bilateral posterolateral screw fixation alone.

Functional outcomes were assessed using: SF-36, Oswestry Disability Index (ODI), Distress and Risk Assessment Method scores (DRAM) and the visual analogue pain scores (VAS).

There were 32 patients, 24 female and 8 male. Average age was 45 (range 33-63). Average follow up was12 months (range 2-36). Level of spinal fusion was 2 L3/4, 11 L4/5 and 13 L5/S1. Mean hospital stay was 5.8 days.

VAS improved in all 3 groups A 5.83 – 5; B 8 – 4.83; C 5.71 – 2.3.

ODI improved in all 3 groups A 0.5 – 0.35; B 0.51 – 0.44, C 0.42 – 0.16.

There was no statistical difference on comparison of the three groups.

There were no operative complications. One patient broke her interdody device during a all in the first post-operative week requiring a subsequent procedure.

Lumbar interbody fusions can safely be performed using an expandable interbody device. Good functional outcomes can be achieved in the majority of well selected patients


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 480 - 480
1 Sep 2009
Thomas P Sattar T Nagaria J Bolger C
Full Access

INTRODUCTION: Atlanto-axial instability due to Rheumatoid arthritis has been treated by posterior C1/C2 wiring techniques supplemented with bone graft. Magerls technique of Transarticular fixation provides a three-point fixation by eliminating motion, promoting fusion, increased mechanical strength and treating instability. It allows fixation across the plane of movement and prevents basilar invagination.

The clinical results of transarticular fixation are satisfactory in terms of clinical outcome with few complications. However there are concerns that these patients develop subaxial kyphosis. It is important to highlight that none of these patients in our series had supplementary wiring techniques with TAS The purpose of this study is to analyse postoperative Xrays of patients who have undergone transarticular atlantoaxial fixation and look at the following parameters;

What percentage of patients develop subaxial kyphosis?

Are the ADI and PADI maintained postoperatively?

Is there a late failure rate of TAS despite the absence of supplementary wiring techniques?

MATERIALS & METHODS: 15 patients underwent pre and postoperative cervical spine X-rays in the AP and lateral projections. In addition flexion/extension views were also obtained pre and postoperatively.

We analysed the following parmeters:

Pre and Postoperative ADI and PADI.

C0/C1, C1/C2, C1/C7, C2/C7 angles

C2/C3 slip and C2/C3 osteoarthritis

Any breakage or pullout of screws.

Postoperative basilar invagination.

It is important to highlight that all these 15 patients had bony fusion at the C1/C2 joints and these findings have been analysed and published in the clinical counterpart of this study (Fusion rates 97% in 36/37 patients).

RESULTS: As highlighted, the clinical outcome of these patients has been published. We would like to present the radiological parameters of this subgroup of patients. The ADI improved in 13 patients with a preoperative median of 7 and postoperatively 3.5. The preoperative and postoperative PADI remained at 15. The C0/C1 angle changed from 12 to 17 postoperatively. The C2/C7 angle changed from 21 to 26 postoperatively. C1/C7 angle changed from 39 to 41. The spinal cord diameter remained at 15 pre and postoperatively.

There was only 1 patient with C2/C3 slip on flexion/extension views. 2 patients developed subaxial kyphosis with evidence of significant disc degeneration on preoperative imaging.

There are some interesting conclusions from these 15 xrays.

Only 2 out of 13 patients have developed a subaxial kyphosis.

The 2 patients that have developed subaxial kyphois had subaxial disc degeneration at the level of the kyphois

There was only 1 patient with a C2/C3 spondylolisthesis on flexion/extension.

The ADI and SAC were maintained at the craniocervical junction.

There is no late failure rate despite the absence of a modified gallie fusion


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 448 - 448
1 Aug 2008
Nagaria J McEvoy L Bolger C
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Objective: To review the clinical outcome of 37 consecutive patients undergoing C1– C2 transarticular fixation for patients with Rheumatoid Arthritis.

Design: Prospective Observational Study.

Methods: There were 37 patients at 2 centres. Age range was 37– 82 years. The time since diagnosis to treatment was 2– 23 years. Clinical presentation included suboccipital pain in 26/ 37 patients and neck pain in 29/37 patients. 22 patients had presented with myelopathy ( Ranawat grade II or III A). The preoperative imaging included Plain X Rays, CT scans and MRI scans. All patients underwent C1/ C2 transarticular screws ( Stealth guided) except 4 patients in which an aberrant course of the vertebral artery was identified.

Outcome measures: Functional outcome, Complications, Postoperative Neurological Status, Neck Disability index, Myelopathy disability index.

Results: 1 patient had died at 12 month followup. Neck pain improved in 22( 75%) of patients by > 5 points on the VAS. Suboccipital pain had improved in all patients. 17 patients (80%) improved following operation on the Ranawat Grading, 2 patient were worse and 3 patients remained the same.

> 70% patients reported improvement in neck disability index and > 50% patients reported improvement in myelopathy disability index.

Conclusions: C1/ C2 Transarticular fixation with spinal navigation is a safe technique for treating atlantoaxial instability in patients with Rheumatoid Arthritis. This study demonstrates improvement in all domains including neck disability, myelopathy scores and functional outcome.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 458 - 458
1 Apr 2004
Bolger C
Full Access

Stereotactic navigation in cranial surgery is a well-established technique, in routine clinical use since the turn of the century. The advent of computer guided stereotaxis since the early 1990’s has led to an explosion in applications for the technology in cranial surgery, with the development of new surgical techniques, minimal access and consequent claimed reduction in morbidity and mortality.

Computer guidance also allows application of stereotactic techniques in spinal surgery. Early interventions have concentrated on the insertion of pedicle screws with improvement in accuracy and certainty of optimal screw placement. The use of fluoroscopic guidance allows the insertion of percutaneous pedicle screws and truly minimal access fusion techniques for the lumbar spine. More recently the development of improved registration has allowed the application of this technology to thoracic spinal surgery and to the cervical spine. Percutaneous techniques for C1/C2 arthrodesis, image guided vertebrectomy and transoral surgery, have been reported. The technology allows the development of surgical techniques designed not only for individual pathology but adapted to the anatomy of the individual patient. Disadvantages include a significant learning curve, especially for cervical spine surgery, the cost and need for registration which may be time consuming. Advantages include claimed accuracy in decompression, hardware placement, minimal access techniques and a three-dimensional solution to what is essentially a three dimensional problem. More recently non-computer based navigation systems have become available with improved hardware placement without the problems associated with computer based systems.

The purpose of this paper is to review computer guided spinal surgery, present new techniques based on its application to the adult spine, discuss advantages and disadvantages of those techniques and present the results of studies on the new non-computer based navigation systems.