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Al-Naseem AO, Al-Naseem AO, Cawley DT, Aoude A, Catanzano AA, Abd-El-Barr MM, Sharma A, Shafafy R. Does Spinal Cord Type Predict Intraoperative Neuro-Monitoring Alerts in Scoliosis Correction Surgery? A Systematic Review and Meta-Analysis of Operative and Radiologic Predictors. Global Spine J 2024:21925682241237475. [PMID: 38428951 DOI: 10.1177/21925682241237475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
STUDY DESIGN Systematic literature review and meta-analysis. OBJECTIVES Predicting patient risk of intraoperative neuromonitoring (IONM) alerts preoperatively can aid patient counselling and surgical planning. Sielatycki et al established an axial-MRI-based spinal cord classification system to predict risk of IONM alerts in scoliosis correction surgery. We aim to systematically review the literature on operative and radiologic factors associated with IONM alerts, including a novel spinal cord classification. METHODS A systematic review and meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search identifying all observational studies comparing patients with and without IONM alerts was conducted. Suitable studies were included. Patient demographics, radiological measures and operative factors were collected. RESULTS 11 studies were included including 3040 patients. Relative to type 3 cords, type 1 (OR = .03, CI = .01-.08, P < .00001), type 2 (OR = .08, CI = .03, P <.00001) and all non-type 3 cords (OR = .05, CI = .02-.16, P < .00001) were associated with significantly lower odds of IONM alerts. Significant radiographic measures for IONM alerts included coronal Cobb angle (MD = 10.66, CI = 5.77-15.56, P < .00001), sagittal Cobb angle (MD = 9.27, CI = 3.28-14.73, P = .0009), sagittal deformity angle ratio (SDAR) (MD = 2.76, CI = 1.57-3.96, P < .00001) and total deformity angle ratio (TDAR) (MD = 3.44, CI = 2.27-4.462, P < .00001). Clinically, estimated blood loss (MD = 274.13, CI = -240.03-788.28, P = .30), operation duration (MD = 50.79, CI = 20.58-81.00, P = .0010), number of levels fused (MD = .92, CI = .43-1.41, P = .0002) and number of vertebral levels resected (MD = .43, CI = .01-.84, P = .05) were significantly greater in IONM alert patients. CONCLUSIONS This study highlights the relationship of operative and radiologic factors with IONM alerts.
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Affiliation(s)
- Abdulrahman O Al-Naseem
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Spinal Surgery, Royal National Orthopaedic Hospital NHS Foundation Trust, Stanmore, UK
| | | | - Derek T Cawley
- Department of Spine Surgery, Mater Private Hospital, Dublin, Ireland
| | - Ahmed Aoude
- Montreal General Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Anthony A Catanzano
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA
| | - Muhammad M Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University Medical Centre, Durham, NC, USA
| | - Aman Sharma
- Department of Spinal Surgery, Royal National Orthopaedic Hospital NHS Foundation Trust, Stanmore, UK
| | - Roozbeh Shafafy
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Spinal Surgery, Royal National Orthopaedic Hospital NHS Foundation Trust, Stanmore, UK
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Cawley DT, Simpkin A, Abrahim E, Doyle T, Elsheikh N, Fallon J, Habash M, Phua RJ, Langille J, Matini E, McNamee C, Mohamed F, Gabhann CN, Noorani A, Oh J, O'Reilly P, O'Sullivan D, Devitt A. Intradiscal vacuum phenomenon matches lumbar spine degeneration patterns in an ageing population. Eur Spine J 2024:10.1007/s00586-024-08174-0. [PMID: 38416194 DOI: 10.1007/s00586-024-08174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/03/2024] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Intra-Discal Vacuum phenomenon (IDVP) is well-recognised, yet poorly visualised and poorly understood radiological finding in disc degeneration, particularly with regard to its role in spinal alignment. CT analysis of the lumbar spine in an aging population aims to identify patterns associated with IDVP including lumbopelvic morphology and associated spinal diagnoses. METHODS An analysis was performed of an over-60s population sample of 2020 unrelated abdominal CT scans, without acute spinal presentations. Spinal analysis included sagittal lumbopelvic reconstructions to assess for IDVP and pelvic incidence (PI). Subjects with degenerative pathologies, including previous vertebral fractures, auto-fusion, transitional vertebrae, and listhesis, were also selected out and analysed separately. RESULTS The prevalence of lumbar spine IDVP was 50.3% (955/1898) and increased with age (125 exclusions). This increased in severity towards the lumbosacral junction (L1L2 8.3%, L2L3 10.9%, L3L4 11.5%, L4L5 23.9%, and L5S1 46.3%). A lower PI yielded a higher incidence of IDVP, particularly at L5S1 (p < 0.01). A total of 292 patients had IDVP with additional degenerative pathologies, which were more likely to occur at the level of isthmic spondylolisthesis, adjacent to a previous fracture or suprajacent to a lumbosacral transitional vertebra (p < 0.05). CONCLUSIONS This study identified the prevalence and severity of IDVP in an aging population. Sagittal patterns that influence the pattern of IVDP, such as pelvic incidence and degenerative pathologies, provide novel insights into the function of aging spines.
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Affiliation(s)
| | | | | | - Thomas Doyle
- University of Galway, Galway, Republic of Ireland
| | | | - John Fallon
- University of Galway, Galway, Republic of Ireland
| | | | | | | | - Elvis Matini
- University of Galway, Galway, Republic of Ireland
| | | | | | | | - Ali Noorani
- University of Galway, Galway, Republic of Ireland
| | - Jieun Oh
- University of Galway, Galway, Republic of Ireland
| | | | | | - Aiden Devitt
- University of Galway, Galway, Republic of Ireland
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Cawley DT, Simpkin A, Abrahim E, Doyle T, Elsheikh N, Fallon J, Habash M, Phua RJ, Langille J, Matini E, McNamee C, Mohamed F, Nic Gabhann C, Noorani A, Oh J, O'Reilly P, O'Sullivan D, Devitt A. Natural History of IntraDiscal Vacuum Phenomenon and its role in Advanced Disc Degeneration. Spine (Phila Pa 1976) 2024:00007632-990000000-00580. [PMID: 38305407 DOI: 10.1097/brs.0000000000004945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
STUDY DESIGN Observational serial CT analysis of the lumbar spine in a normal-aging population. OBJECTIVE Assess the natural history of IntraDiscal Vacuum Phenomenon and its role in disc degeneration. Summary of Background Data: The natural history of disc degeneration is well described but our understanding of the end stage of pathogenesis remains incomplete. MRI loses accuracy with advanced degeneration, becoming hyporesonant and indistinct. Cadaveric specimens display adaptive changes in the disc with loss of the hydrostatic capacity of the nucleus, increased intra-discal clefts and end-plate impermeability. IDVP is associated with advanced disc degeneration and CT is the optimal modality to visualise this, yet these insights remain unreported. METHODS Subjects only included historic CT abdomen scans of those over 60 years of age without acute or relevant spinal pathology, with a diagnosis of at least one level with IDVP on the original CT scan and all of whom had a similar scan >7 years later. A history of clinically significant back pain was also recorded. RESULTS CT scans included 360 levels in 29 males and 31 females (mean 68.9 years), displaying 82 levels of IDVP, with a second scan included after a mean of 10.3 years, Most levels displayed the same level of severity (persisted, 45) compared to where some progressed (26), regressed (8) and fused (3) (P<0.01). There was also an increased incidence, 37/60 (62%) of developing IDVP at another level. Disc heights were reduced with increased severity of IDVP. A record of back pain was evident in 31/60 subjects, which was not significantly worse in those with worsening severity or additional level involvement over the study period. CONCLUSION As disc degeneration advances, the associated IDVP persists in most cases, displaying a plateauing of severity over long periods, but rarely with progression to autofusion.
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Baroncini A, Frechon P, Bourghli A, Smith JS, Larrieu D, Pellisé F, Pizones J, Kleinstueck F, Alanay A, Kieser D, Cawley DT, Boissiere L, Obeid I. Adherence to the Obeid coronal malalignment classification and a residual malalignment below 20 mm can improve surgical outcomes in adult spine deformity surgery. Eur Spine J 2023; 32:3673-3680. [PMID: 37393421 DOI: 10.1007/s00586-023-07831-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Coronal balance is a major factor impacting the surgical outcomes in adult spinal deformity (ASD). The Obeid coronal malalignment (O-CM) classification has been proposed to improve the coronal alignment in ASD surgery. Aim of this study was to investigate whether a postoperative CM < 20 mm and adherence to the O-CM classification could improve surgical outcomes and decrease the rate of mechanical failure in a cohort of ASD patients. METHODS Multicenter retrospective analysis of prospectively collected data on all ASD patients who underwent surgical management and had a preoperative CM > 20 mm and a 2-year follow-up. Patients were divided in two groups according to whether or not surgery had been performed in adherence to the guidelines of the O-CM classification and according to whether or not the residual CM was < 20 mm. The outcomes of interest were radiographic data, rate of mechanical complications and Patient-Reported Outcome Measures. RESULTS At 2 years, adherence to the O-CM classification led to a lower rate of mechanical complications (40 vs. 60%). A coronal correction of the CM < 20 mm allowed for a significant improvement in SRS-22 and SF-36 scores and was associated with a 3.5 times greater odd of achieving the minimal clinical important difference for the SRS-22. CONCLUSION Adherence to the O-CM classification could reduce the risk of mechanic complications 2 years after ASD surgery. Patients with a residual CM < 20 mm showed better functional outcomes and a 3.5 times greater odd of achieving the MCID for the SRS-22 score.
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Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Paul Frechon
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Ahmet Alanay
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Derek T Cawley
- Department of Spine Surgery, Mater Private Hospital, Dublin, Ireland
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
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McNamee C, Rakovac A, Cawley DT. Sustainable surgical practices: A comprehensive approach to reducing environmental impact. Surgeon 2023:S1479-666X(23)00093-8. [PMID: 37718181 DOI: 10.1016/j.surge.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
This paper presents a comprehensive overview of the environmental impact of surgical procedures and highlights potential strategies to reduce the associated greenhouse gas emissions. We discuss procurement, waste management, and energy consumption, providing examples of successful interventions in each area. We also emphasize the importance of adopting the Green Theatre Checklist as a useful tool for clinicians aiming to implement sustainable surgical practices.
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Affiliation(s)
- Conor McNamee
- University College Dublin, National University of Ireland, Belfield, Dublin 4, Ireland.
| | - Ana Rakovac
- Irish Doctors for the Environment, Ireland; Laboratory Medicine Department, Tallaght University Hospital, Dublin 24, Ireland
| | - Derek T Cawley
- Mater Private Hospital, Dublin 1, Ireland; Irish Doctors for the Environment, Ireland; Dept of Surgery, University of Galway, Ireland
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McNamee C, Rakovac A, Cawley DT. The Environmental Impact of Spine Surgery and the Path to Sustainability. Spine (Phila Pa 1976) 2023; 48:545-551. [PMID: 36580585 DOI: 10.1097/brs.0000000000004550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Narrative literature review. OBJECTIVE The aim of this study was to review published literature discussing sustainable health care and to identify aspects that pertain to spine surgery. SUMMARY OF BACKGROUND DATA In recent years, research has investigated the contribution of surgical specialties to climate change. To our knowledge, no article has yet been published discussing the impact specific to spinal procedures and possible mitigation strategies. METHODS A literature search was performed for the present study on relevant terms across four electronic databases. References of included studies were also investigated. RESULTS Spine surgery has a growing environmental impact. Investigations of analogous specialties find that procurement is the single largest source of emissions. Carbon-conscious procurement strategies will be needed to mitigate this fully, but clinicians can best reduce their impact by adopting a minimalist approach when using surgical items. Reduced wastage of disposable goods and increased recycling are beneficial. Technology can aid remote access to clinicians, and also enable patient education. CONCLUSIONS Spine-surgery-specific research is warranted to evaluate its carbon footprint. A broad range of measures is recommended from preventative medicine to preoperative, intraoperative, and postoperative spine care. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Conor McNamee
- University College Dublin, National University of Ireland, Belfield, Dublin, Ireland
| | - Ana Rakovac
- Irish Doctors for the Environment
- Laboratory Medicine Department, Tallaght University Hospital, Dublin, Ireland
| | - Derek T Cawley
- Mater Private Hospital, Dublin, Ireland
- Irish Doctors for the Environment
- Department of Surgery, University of Galway, Galway, Ireland
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Cawley DT, Divani K, Shafafy R, Devitt A, Molloy S. When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review. Brain Spine 2023; 3:101726. [PMID: 37383448 PMCID: PMC10293288 DOI: 10.1016/j.bas.2023.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 06/30/2023]
Abstract
Intoduction Mechanical complications from spinal fusion including implant loosening or junctional failure result in poor outcomes, particularly in osteoporotic patients. While the use of percutaneous vertebral augmentation with polymethylmethacrylate (PMMA) has been studied for augmentation of junctional levels to offset against kyphosis and failure, its deployment around existing loose screws or in failing surrounding bone as a salvage percutaneous procedure has been described in small case series and merits review. Research Question How effective and safe is the use of PMMA as a salvage procedure for mechanical complications in failed spinal fusion?. Materials and Methods Systematic search of online databases for clinical studies using this technique. Results 11 studies were identified, only consisting of two case reports and nine case series. Consistent improvements were observed in pre- to post-operative VAS and with sustained improvements at final follow-up. The extra- or para-pedicular approach was the most frequent access trajectory. Most studies cited difficulties with visibility on fluoroscopy, using navigation or oblique views as a solution for this. Discussion and Conclusions Percutaneous cementation at a failing screw-bone interface stabilises further micromotion with reductions in back pain. This rarely used technique is manifested by a low but increasing number of reported cases. The technique warrants further evaluation and is best performed within a multidisciplinary setting at a specialist centre. Notwithstanding that underlying pathology may not be addressed, awareness of this technique may allow an effective and safe salvage solution with minimal morbidity for older sicker patients.
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Affiliation(s)
- Derek T. Cawley
- Mater Private Hospital, Dublin, 1, Ireland
- Dept of Spinal Surgery, University of Galway, Ireland
| | | | - Roozbeh Shafafy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Aiden Devitt
- Dept of Spinal Surgery, University of Galway, Ireland
| | - Sean Molloy
- Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK
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Kieser DC, Yuksel S, Boissiere L, Yilgor C, Cawley DT, Hayashi K, Alanay A, Kleinstueck FS, Pellise F, Perez-Grueso FJS, Jean-Marc V, Bourghli A, Acaroglu ER, Obeid I. Impact of radiologic variables on item responses of ODI, SRS22 and SF-36. in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database. Eur Spine J 2022; 31:1166-1173. [PMID: 35059861 DOI: 10.1007/s00586-021-07088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if responses given to each question of the Scoliosis Research Society-22 (SRS22), Oswestry disability index (ODI) and Short Form-36 (SF-36) questionnaires are influenced by the radiological parameters. METHODS Patients enrolled in a multi-centre prospectively collected adult spinal deformity database who had complete SRS22, ODI and SF-36 data at baseline and at one-year follow-up were analysed. The presence of a differential item function of each question within each score in relation to radiological parameters was analysed using a mixed Rasch model with the radiological threshold value(s) determined. RESULTS Of those patients analysed (n = 1745; 1406 female, average age 51.0 ± 19.8 years), 944 were surgically and 801 were non-surgically treated. For the SRS22, questions (Q) 3, 5 and 18 were sensitive to almost all radiological parameters and the overall score was found sensitive to the Cobb angle. For the ODI, Q3, 6, 9 and 10 were not sensitive to any radiologic parameters whereas Q4 and 5 were sensitive to most. In contrast, only 3 of the SF-36 items were sensitive to radiological parameters. CONCLUSIONS 78% of the SRS-22, 60% of the ODI and 8% of the questions in the SF-36 are sensitive to radiological parameters. Sagittal imbalance is independently associated with a poor overall outcome, but affects mental status and function more than pain and self-image. The assembly of questions responsive to radiological parameters may be useful in establishing a connection between changes in radiologic parameters and HRQL.
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Affiliation(s)
- D C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, 8011, Christchurch, New Zealand.
| | - S Yuksel
- School of Medicine Ankara, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - L Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Yilgor
- Mater Private Hospital, Dublin, Ireland
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.,Mater Private Hospital, Dublin, Ireland
| | - K Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - F Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Vital Jean-Marc
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Bourghli
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | | | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
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Cawley DT, Boissiere L, Yilgor C, Larrieu D, Fujishiro T, Kieser D, Alanay A, Kleinstück F, Pérez-Grueso FS, Pellisé F, Obeid I. Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction. Spine Deform 2021; 9:1449-1456. [PMID: 33914299 DOI: 10.1007/s43390-021-00345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A normal sagittal vertical axis (SVA) after spinal deformity correction can yield mechanical complications of up to 30%. Post-operative compensatory pelvic orientation can produce a normal SVA. We assess relative pelvic version (RPV), an individualised measure, for persistent post-operative compensatory measures. METHODS Adult spinal deformity (ASD) patients who were treated operatively, with a normal SVA (< ± 50 mm) at 6-week follow-up were included, who were then followed-up after 2 years. These only included patients with fusion of > 4 vertebrae extending to L5 or below. Six-week subgroups were made regarding pelvis orientation, relative pelvic version (RPV: anteversion, aligned, moderate or severe retroversion) with analysis of patient-related outcome measures (PROMs), complications and spino-pelvic sagittal parameters. RESULTS At 6 weeks, 140 patients met the inclusion criteria, 5 (3.6%) patients had anteversion, 59 (42.1%) were aligned, 60 (42.9%) had moderate retroversion and 16 (11.4%) patients had severe retroversion. Follow-up after 2 years demonstrated increased RPV in all groups except the severe RPV group who were more likely to develop SVA > 50 mm. Complications occurred in all groups. Significant 2-year differences were observed between moderate and severe RPV for back pain and PROMs but not between other RPV groups. CONCLUSION Adult spinal deformity patients with a normal SVA after spino-pelvic instrumentation carry a significant risk of retroversion progression post-operatively, followed by increased positive sagittal balance. Relative pelvic version (RPV) measurements when categorised into anteversion, aligned, moderate retroversion and severe retroversion at 6 weeks were predictive of PROMs at 2 years.
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Affiliation(s)
- Derek T Cawley
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France. .,Mater Private Hospital, Eccles St, Dublin 1, Republic of Ireland.
| | - Louis Boissiere
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - Caglar Yilgor
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - Takashi Fujishiro
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.,Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - David Kieser
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Ahmet Alanay
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
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Cawley DT, Takemoto M, Boissiere L, Larrieu D, Kieser DC, Fujishiro T, Hayashi K, Bourghli A, Yilgor C, Alanay A, Perez Grueso FJ, Pelisse F, Kleinstück F, Vital JM, Obeid I. The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement? Eur Spine J 2021; 30:2033-2039. [PMID: 33900475 DOI: 10.1007/s00586-021-06786-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. METHODS This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. RESULTS A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. CONCLUSION Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.
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Affiliation(s)
- D T Cawley
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France.
- Mater Private Hospital, Dublin 1, Ireland.
| | | | - L Boissiere
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D Larrieu
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D C Kieser
- Christchurch School of Medicine, University of Otago, Dunedin, New Zealand
| | - T Fujishiro
- Osaka Medical College, Takatsuki-shi, Osaka, Japan
| | - K Hayashi
- Osaka City University Graduate School of Medicine, Juso Hospital, Osaka, Japan
| | | | - C Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - A Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | | | - F Pelisse
- Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - J M Vital
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - I Obeid
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
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Abstract
Aims Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. Methods A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. Results The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. Conclusion The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5–10
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Affiliation(s)
- Derek T. Cawley
- Department of Spinal Surgery, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Vijay Rajamani
- Department of Spinal Surgery, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Michael Cawley
- Department of Spinal Surgery, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Susanne Selvadurai
- Department of Spinal Surgery, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Alexander Gibson
- Department of Spinal Surgery, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
| | - Sean Molloy
- Department of Spinal Surgery, Royal National Orthopaedic Hospital Stanmore, Stanmore, UK
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12
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Cawley DT. Severe displaced fracture of the coccyx or sacrococcygeal junction causes trauma to the thecal sac: Author's reply to "Letter to editor: Cerebrospinal fluid leak after fracture of the sacrum or coccyx.". Spine J 2019; 19:2045. [PMID: 31759439 DOI: 10.1016/j.spinee.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Derek T Cawley
- St. Vincent's University Hospital, Elm Park, Dublin 4, Republic of Ireland.
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13
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Obeid I, Diebo BG, Boissiere L, Bourghli A, Cawley DT, Larrieu D, Pointillart V, Challier V, Vital JM, Lafage V. Single Level Proximal Thoracic Pedicle Subtraction Osteotomy for Fixed Hyperkyphotic Deformity: Surgical Technique and Patient Series. Oper Neurosurg (Hagerstown) 2019; 14:515-523. [PMID: 28973349 DOI: 10.1093/ons/opx158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Thoracic hyperkyphosis can display pathological deterioration, resulting in either hyperlordotic cervical compensation or sagittal malalignment. Various techniques have been described to treat fixed malalignment. Pedicle subtraction osteotomy (PSO) is commonly used in the lumbar spine and frequently limited to the distal thoracic spine. This series focuses on the surgical specificities of proximal thoracic PSO, with clinical and radiological outcomes. OBJECTIVE To report the surgical specificities and assess the clinical and radiological outcomes of proximal thoracic osteotomies for correction of rigid kyphotic deformities. METHODS This is a retrospective review of 10 consecutive patients who underwent single level proximal thoracic PSO (T2-T5). Preoperative and postoperative full-body EOSTM radiographs, perioperative data, and complications were recorded. The surgical technique and its nuances were described in detail. RESULTS Patients had mean age of 41.8 yr and 50% were female. The technique provided correction of segmental and global kyphosis, 26.6° and 29.5°, respectively. Patients reported reciprocal reduction in C2-C7 cervical lordosis (37.6°-18.6°, P < .001), significantly correlating with the reduction of thoracic hyperkyphosis (R = 0.840, P = .002). Mean operative time was 291 min, blood loss 1650 mL, and mean hospital stay was 13.8 d. Three patients reported complications that were resolved, including 1 patient who was revised because of a painful cross link. There were no neurological complications, pseudarthroses, instrumentation breakage, or wound infections at a minimum of 2-yr follow-up. CONCLUSION Proximal thoracic PSO can be a safe and effective technique to treat fixed proximal thoracic hyperkyphosis leading to kyphosis reduction and craniocervical relaxation.
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Affiliation(s)
- Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Bassel G Diebo
- Department of Orthopaedic Sur-gery, State University of New York, Down-state Medical Center, Brooklyn, New York
| | - Louis Boissiere
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Derek T Cawley
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Daniel Larrieu
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Vincent Pointillart
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Vincent Challier
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Jean Marc Vital
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, New York
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14
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Cawley DT, Barrett P, Moran B, McGoldrick NP, Gillham C, Codd M, O'Toole GC, Kieser DC. Primary appendicular soft-tissue sarcoma resection: What tumour parameters affect wound closure planning? Int Wound J 2019; 16:1553-1558. [PMID: 31606949 DOI: 10.1111/iwj.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022] Open
Abstract
Wound closure after wide, local excision of an appendicular soft-tissue sarcoma (STS) can be challenging. This study evaluates the value of magnetic resonance imaging (MRI)-based tumour parameters in planning wound closure. A total of 71 patients with a primary limb-based STS, excluding vascular or osseous involvement, excluding the shoulder or hand and hip or foot were included. Axial MRI images were used to measure the circumferences and cross-sectional areas of the limb, bone, and tumour. The tumour diameter, length, and depth at the level of maximal tumour dimension were measured to identify the tumour's relative contribution to the planning of optimal wound closure management through primary closure (PC) or reconstructive surgery (RS). Eighteen patients required planned wound RS. Wound complications occurred in 14% overall. Tumours, which were closed by PC, were of significantly greater depth, shorter radial diameter, and shorter tumour circumference relative to those closed by RS. On multivariate analysis, tumour depth was the greatest contributory factor in predicting type of wound closure. A quantitative analysis of MRI-based tumour parameters demonstrates tumour depth as the most predictive factor in planning for the type of wound closure and may prove beneficial in providing greater insight into planned wound management of sarcoma resection.
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Affiliation(s)
- Derek T Cawley
- Department of Trauma and Orthopaedic Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Peter Barrett
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Barry Moran
- Department of Trauma and Orthopaedic Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedic Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Charles Gillham
- Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland
| | - Mary Codd
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Gary C O'Toole
- Department of Trauma and Orthopaedic Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - David C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health Board, Christchurch, New Zealand
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15
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Cawley DT, Alzakri A, Fujishiro T, Kieser DC, Tavalaro C, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Carbon-fibre cage reconstruction in anterior cervical corpectomy for multilevel cervical spondylosis: mid-term outcomes. J Spine Surg 2019; 5:251-258. [PMID: 31380479 DOI: 10.21037/jss.2019.03.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Mid-term clinical and radiological evaluation of a carbon-fiber cage in multilevel cervical spondylosis (MCS). Anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMC) has shown satisfactory outcomes, but with subsidence of up to 20%. Conventional long-fiber carbon fiber cages have shown a safe profile in discectomy/fusion (ACDF) but with minimal data in the setting of corpectomy. Methods Retrospective review of a single centre multi-surgeon cohort of MCS patients from 2007-2012. Follow-up period was a minimum of 3.5 years, mean 6 years. Outcomes included peri-operative, clinical [Nurick, European Myelopathy, Visual Analogue Scores (VAS), modified Japanese Orthopaedic Association (mJOA) scores and radiographic (C2C7, Cobb & ROM angles)]. Results A total of 102 consecutive patients were included. Mean length of stay was 5.5 (SD 3.5) days, blood loss 322 (SD 358) mL and operative time 98 (SD 31) min. Corpectomy levels included 72 single-level ACCF and 30 multiple ACCF. Fourteen had peri-operative complications. Three patients required early cage revisions. Mean pain scores improved from VAS neck 4.6 to 2.6 (P<0.01) and VAS arm 5.1 to 2.0 (P<0.01). Mean Nurick score improved from 1.2 to 0.4/4 (P<0.01). Mean follow-up EMS was 15.9/18 and mJOA was 14.0/17. Seventy follow-up radiographs were obtained. Flexion-extension angulation differences of >3 mm across the instrumented level were present in 5 patients, all of which displayed fusion of either grade 1 or 2. 7 had C2C7 kyphosis. Severe subsidence (>3 mm) was seen in 9 cases (13%). Conclusions Mid-term outcomes of this carbon-fiber cage indicate that it is safe and durable for the treatment of MCS with a similar radiological profile to that of TMC.
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Affiliation(s)
- Derek T Cawley
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France.,Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Abdulmajeed Alzakri
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France.,Orthopaedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Takashi Fujishiro
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France.,Osaka Medical College, Takatsuki, Japan
| | - David C Kieser
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch, New Zealand
| | - Celeste Tavalaro
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France
| | - Louis Boissiere
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France
| | - Ibrahim Obeid
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France
| | - Vincent Pointillart
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France
| | - Jean Marc Vital
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France
| | - Olivier Gille
- l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France
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16
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Kieser DC, Boissiere L, Cawley DT, Larrieu D, Yilgor C, Takemoto M, Yoshida G, Alanay A, Acaroglu E, Kleinstück F, Pellisé F, Perez-Grueso FJS, Vital JM, Obeid I. Validation of a Simplified SRS-Schwab Classification Using a Sagittal Modifier. Spine Deform 2019; 7:467-471. [PMID: 31053317 DOI: 10.1016/j.jspd.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 12/29/2022]
Abstract
STUDY DESIGN Multicenter, prospective study of consecutive adult spinal deformity (ASD) patients. OBJECTIVE To Validate Schwab's classification accuracy for surgical indication, and to evaluate a simplified sagittal modifier. SUMMARY OF BACKGROUND DATA The SRS-Schwab Radiologic Classification based on clinical impact parameters, offers 27 different sagittal classification possibilities regarding sagittal vertical alignment (SVA), pelvic tilt (PT), and pelvic incidence-lumbar lordosis (PI-LL). The high number of classification possibilities makes it complex to use. METHODS Inclusion criteria were ASD patients, presenting at least 1 criteria: Cobb ≥ 20°, SVA ≥ 5 cm, thoracic kyphosis ≥ 60°, or PT ≥ 25°. A total of 1,004 patients (410 nonoperative and 594 operative) were classified regarding SVA, PT, and PI-LL (0, +, ++), and 27 possibilities were identified. Categories were formed by adding the number of + signs, considering PT, SVA, and PI-LL. Three specific categories were identified: Aligned: 0 +; Moderate deformity: 1 to 3+; and Severe deformity: 4 to 6+. A χ-square test was performed for surgical indication (operated or not) and an analysis of variance was performed to evaluate the relationship between categories and Oswestry Disability Index (ODI). Probability <.05 was considered significant. RESULTS Significant differences for HRQoL scores and surgical indication were found in the 27 sagittal parameter possibilities. For nonoperative patients, 230 (56.1%) were classified as aligned, 145 (35.4%) as moderate, and 35 (8.5%) as severe. For operative patients, there were 200 (33.7%), 215 (36.2%), and 179 (30.1%) in each respective subgroup. For HRQoL scores and surgical indication, no significant differences were found within each category, but significant differences were found when comparing the subgroups. CONCLUSIONS Despite the correlation between SRS-Schwab classification and surgical indication, it is complex to use, with a total of 27 possibilities regarding sagittal modifiers. This simplification into three categories offers more readability, without losing any significant information, and could replace Schwab sagittal modifiers. In association with other parameters, they could be used for decision-making. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- D C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand.
| | - L Boissiere
- Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - D T Cawley
- Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - D Larrieu
- Spine Unit 1, Bordeaux University Hospital, Bordeaux, France; ELSAN, Polyclinique Jean Villar, Bruges, France
| | - C Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - M Takemoto
- Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - G Yoshida
- Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - E Acaroglu
- Ankara ARTES Spine Center, Ankara, Turkey
| | - F Kleinstück
- Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - F Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - J M Vital
- Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - I Obeid
- Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
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17
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Cawley DT, Butler JS, Benton A, Altaf F, Rezajooi K, Kyriakou C, Selvadurai S, Molloy S. Managing the cervical spine in multiple myeloma patients. Hematol Oncol 2018; 37:129-135. [PMID: 30334279 DOI: 10.1002/hon.2564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022]
Abstract
Discuss the relevant literature on surgical and nonsurgical treatments for multiple myeloma (MM) and their complementary effects on overall treatment. Existing surgical algorithms designed for neoplasia of the spine may not suit the management of spinal myeloma. Less than a fifth of metastatic, including myelomatous lesions, occur in the cervical spine but have a poorer prognosis and surgery in this area carries a higher morbidity. With the advances of chemotherapy, early access to radiotherapy, early orthosis management, and high definition imaging, including CT and MRI, surgical indications in MM have changed. Medical decompression (or oncolysis), including in the presence of neurological deficit and orthotic stabilization, are proving viable nonsurgical options to manage MM. A key to decision making is the assessment and monitoring of biomechanical spinal stability as part of a multidisciplinary approach.
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Affiliation(s)
- Derek T Cawley
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Joseph S Butler
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Adam Benton
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Farhaan Altaf
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Kia Rezajooi
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Charalampia Kyriakou
- Department of Haematology, University College London & London North West Healthcare NHS Trust, London, UK
| | - Susanne Selvadurai
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Sean Molloy
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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18
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Cawley DT, Shenoy R, Benton A, Muthian S, Selvadurai S, Johnson JR, Molloy S. The evolution of partial undercutting facetectomy in the treatment of lumbar spinal stenosis. J Spine Surg 2018; 4:451-455. [PMID: 30069541 DOI: 10.21037/jss.2018.06.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Decompression of lumbar spinal stenosis is the most common spinal surgery in those over 60 years of age. While this procedure has shown immediate and durable benefits, improvements in outcome have not changed significantly. Technical aspects of surgical decompression have evolved significantly. The recently introduced ultrasonic bone cutter allows a precise and safe peri-neural bone resection. The principles of preservation of stability, as described by Getty et al. have remained as relevant as when these were described 40 years ago.
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Affiliation(s)
- Derek T Cawley
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Ravi Shenoy
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Adam Benton
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Senthil Muthian
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Susanne Selvadurai
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - John R Johnson
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Sean Molloy
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
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19
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Flanagan M, Cawley DT, Cassidy N. Cervical spine fracture through a cervical disc replacement. Int J Surg Case Rep 2018; 47:80-88. [PMID: 29753275 PMCID: PMC5994689 DOI: 10.1016/j.ijscr.2018.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We report a rare case of cervical spine trauma through a cervical disc replacement and adjacent multilevel disc fusions. Cervical disc replacement (CDR) is a viable option for the surgical treatment of degenerative disc disease however long term follow up data regarding this operative technique is poor specifically relating to traumatic complications. We know of no previous reports of bilateral cervical pedicle fractures occurring adjacent to CDR and anterior cervical spine instrumentation. PRESENTATION OF CASE A 46 year-old with a history of C6C7 CDR and C4-6 anterior cervical decompression and fusion was an unrestrained driver involved in a road traffic accident and suffered bilateral C7 pedicle fractures and a right C6C7 facet joint fracture-subluxation without neurological deficit. Reduction and fixation via a posterior approach achieved a satisfactory alignment and the patient made an uneventful recovery. DISCUSSION A significant force coupled with cervical fixation resulted in a bilateral pedicle fracture of the cervical spine with preserved neurological function. CONCLUSION The protective role of the CDR has not been previously demonstrated but may have played a role in this case. The authors believe the challenges encountered in the treatment of this patient provide valuable lessons in the management of complex cervical spine trauma in the setting of previous instrumentation.
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Affiliation(s)
- M Flanagan
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - D T Cawley
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - N Cassidy
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Kieser DC, Mazas S, Cawley DT, Fujishiro T, Tavolaro C, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Bisphosphonate therapy for spinal aneurysmal bone cysts. Eur Spine J 2018; 27:851-858. [DOI: 10.1007/s00586-018-5470-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/22/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
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Kieser DC, Cawley DT, Tavolaro C, Cloche T, Roscop C, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Erratum to: Delayed post-operative tension pneumocephalus and pneumorrhachis. Eur Spine J 2018; 27:238. [PMID: 29022042 DOI: 10.1007/s00586-017-5308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Unfortunately, two author names were missed out in author group of the original publication.
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Affiliation(s)
- D C Kieser
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Tavolaro
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - T Cloche
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Roscop
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - L Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - V Pointillart
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - J M Vital
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - O Gille
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
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22
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Alzakri A, Boissière L, Cawley DT, Bourghli A, Pointillart V, Gille O, Vital JM, Obeid I. L5 pedicle subtraction osteotomy: indication, surgical technique and specificities. Eur Spine J 2017; 27:644-651. [PMID: 29188373 DOI: 10.1007/s00586-017-5403-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/30/2017] [Accepted: 11/18/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment. METHODS A retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected. RESULTS All surgeries were revision surgeries. The mean lumbar lordosis before surgery was - 22.5° (range, 8° to - 33°) and improved to - 58.5° (range, - 40° to - 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage. CONCLUSIONS PSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.
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Affiliation(s)
- Abdulmajeed Alzakri
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France. .,Orthopaedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Louis Boissière
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Derek T Cawley
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Vincent Pointillart
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Olivier Gille
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Ibrahim Obeid
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
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Kieser DC, Cawley DT, Tavolaro C, Cloche T, Roscop C, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Delayed post-operative tension pneumocephalus and pneumorrhachis. Eur Spine J 2017; 27:231-235. [PMID: 28871507 DOI: 10.1007/s00586-017-5268-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/25/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The incidence of pneumocephalus and pneumorrhachis after spinal surgery is unknown, with a paucity of literature on this complication. MATERIALS AND METHODS We present the first published case of delayed onset tension pneumocephalus and pneumorrhachis associated with spinal surgery. RESULTS This complication occurred from a cerebro-spinal fluid (CSF) leak after posterior instrumentation removal and was successfully treated with emergent wound debridement and the formation of a CSF fistula. CONCLUSIONS This case illustrates that delayed post-operative tension pneumocephalus and pneumorrhachis can occur after spinal surgery in a patient with a CSF leak. It also illustrates that pneumocephalus and pneumorrhachis can be easily diagnosed with cross-sectional CT imaging. Furthermore, in a patient with rapid deterioration emergent surgical debridement may be necessary. Lastly, if the dural tear cannot be identified intra-operatively, the formalization of a CSF fistula should be considered.
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Affiliation(s)
- D C Kieser
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Tavolaro
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - T Cloche
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - Cecile Roscop
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - V Pointillart
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - J M Vital
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - O Gille
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
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Affiliation(s)
- Derek T Cawley
- Institut de la Colonne Vertebrale, CHU Pellegrin, Bordeaux, France
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Cawley DT, McCabe JP. Letter to the Editor. Lordoplasty: contribution of many factors in vertebral cement augmentation procedures. J Neurosurg Spine 2017; 26:768-769. [DOI: 10.3171/2016.11.spine161222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Power FR, Cawley DT, Curtin PD. Simultaneous bilateral total hip arthroplasties in nonagenarians. Ir J Med Sci 2017; 186:947-951. [PMID: 28185060 DOI: 10.1007/s11845-017-1572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
Total hip arthroplasty (THA) is an effective and durable treatment option for hip osteoarthritis (OA). As life expectancy continues to increase, so too will the demand for joint arthroplasty in the 10th decade of life, frequently in cases involving osteoarthritis of both hips. Simultaneous bilateral total hip arthroplasty (SBTHA) is a valuable therapeutic option in appropriately selected patients with bilateral degenerative hip disease, although its use in the very elderly is poorly reported on in the literature. A case of bilateral hip OA successfully treated with SBTHA in a nonagenarian is presented and the literature is reviewed.
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Affiliation(s)
- F R Power
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - D T Cawley
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - P D Curtin
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
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Lee MJ, Cawley DT, Ng JP, Kaar K. Trends in fractures and fatalities of farmyard injuries in Ireland: a 10 year analysis. Ir Med J 2017; 110:494. [PMID: 28657272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The farming and agricultural sector remains one of Ireland's primary industries. Fatality rates remain higher than the European average. The aim of this study was to analyze the national trend in hospital in-patient admissions for farmyard related fractures and related fatalities in Ireland from 2005 to 2014. Relevant socioeconomic trends were used for comparison. There were 2,064 farm-related fractures and 187 fatalities recorded over the same period. Despite a decrease in incidence of farmyard fractures over 2005-2014, fatality rates have increased indicating the alarming continued occupational hazards and severity of sustained injuries.
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Affiliation(s)
- M J Lee
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - D T Cawley
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - J P Ng
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - K Kaar
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Newcastle Road, Galway, Ireland
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Affiliation(s)
- Derek T Cawley
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Fiachra Power
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Martin Murphy
- St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Ng JP, Cawley DT, Beecher SM, Baker JF, McCabe JP. The Reverse Thomas Position for Thoracolumbar Fracture Height Restoration: Relative Contribution of Patient Positioning in Percutaneous Balloon Kyphoplasty for Acute Vertebral Compressions. Int J Spine Surg 2016; 10:21. [PMID: 27441179 DOI: 10.14444/3021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Standard positioning for percutaneous balloon kyphoplasty requires placing a patient prone with supports under the iliac crests and upper thorax. The authors believe that hip hyperextension maximises pelvic anteversion creating anterior longitudinal ligamentotaxis, thus facilitating restoration of vertebral height. METHODS Radiographic imaging including pre-operative, post-positioning, post balloon tamp inflation and post-operative lateral radiographs were analysed for anterior and posterior column height, wedge angle of the affected vertebra and 3-level Cobb angle in patients with recent fractures of T11-L1. Fracture dimensions of the index vertebra were expressed as percentage of the analogous dimension of the referent vertebra. RESULTS From a total of 149 patients, a full imaging sequence was available on 21 cases of vertebral compression fractures. The described positioning technique created a mean anterior column height increase from 68.3% to 75.3% with positioning (p = 0.15), increasing to 82.3% post balloon inflation. Average Cobb and wedge angle improvement of 4.7° (p = 0.004)and 3.6° (p = 0.002) from positioning along were also recorded. CONCLUSION The Reverse Thomas Position is a safe and effective technique for augmenting thoracolumbar fracture height restoration in percutaneous balloon kyphoplasty.
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Affiliation(s)
- Jonathan P Ng
- Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
| | - Derek T Cawley
- Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
| | - Suzanne M Beecher
- Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
| | - Joseph F Baker
- Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
| | - John P McCabe
- Department of Orthopaedic and Traumatology, Galway University Hospital, Republic of Ireland
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Ng JP, Cawley DT, Beecher SM, Lee MJ, Bergin D, Shannon FJ. Focal intratendinous radiolucency: A new radiographic method for diagnosing patellar tendon ruptures. Knee 2016; 23:482-6. [PMID: 26746043 DOI: 10.1016/j.knee.2015.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/10/2015] [Accepted: 09/30/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Diagnosis of patellar tendon rupture is usually based on clinical history and examination. In equivocal cases, imaging may be required. Lateral radiograph is a simple and cost-effective method for prompt diagnosis. However, no specific radiological sign has been described. Rather than utilising patella alta as an indirect measure of patellar tendon rupture, we hypothesise that a focal intratendinous radiolucency is another reliable and accurate radiological sign for diagnosis. Sensitivity and specificity analysis was undertaken to evaluate the diagnostic value of this radiographic sign. METHODS Lateral radiographs of mid-substance patellar tendon ruptures from 19 patients were analysed. These were then randomised with another 19 normal knee radiographs from age-matched patients to create a pool of 38 radiographs for interpretation. Six independent interpreters who were blinded to the diagnosis were requested to indicate whether rupture was present or absent based on the visualisation of a focal intratendinous radiolucency in the patellar tendon. The Insall-Salvati (IS), Caton-Deschamps (CD) and Blackburne-Peel (BP) ratios were measured in the same radiographs. Sensitivity and specificity for each of the radiographic measurements were calculated. Inter- and intraobserver correlations were reported in kappa statistics. RESULTS The average sensitivity and specificity for focal radiolucency in the patellar tendon substance were 82.5% and 95.2%, respectively. Sensitivity and specificity for the IS ratio were 84.2% and 78.9%, for CD was 68.4% and 84.2% and for BP was 68.4% and 89.4% respectively. CONCLUSION The presence of a focal intratendinous radiolucency in the patellar tendon is both accurate and reliable in diagnosing patellar tendon ruptures.
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Affiliation(s)
- Jonathan P Ng
- Dept of Trauma & Orthopaedic Surgery, Galway University Hospitals, Ireland.
| | - Derek T Cawley
- Dept of Trauma & Orthopaedic Surgery, Galway University Hospitals, Ireland
| | - Suzanne M Beecher
- Dept of Trauma & Orthopaedic Surgery, Galway University Hospitals, Ireland
| | - Matthew J Lee
- Dept of Trauma & Orthopaedic Surgery, Galway University Hospitals, Ireland
| | - Diane Bergin
- Dept of Radiology, Galway University Hospitals, Ireland
| | - Fintan J Shannon
- Dept of Trauma & Orthopaedic Surgery, Galway University Hospitals, Ireland
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Cawley DT, Carmody O, Dodds MK, McCormack D. Early limited instrumentation of scoliosis in Duchenne muscular dystrophy: is a single-rod construct sufficient? Spine J 2015; 15:2166-71. [PMID: 26070283 DOI: 10.1016/j.spinee.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/02/2015] [Accepted: 06/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Correction of scoliotic deformity in Duchenne muscular dystrophy (DMD) is performed to maintain adequate seating posture and facilitate comfort. Delaying surgery can predispose to greater morbidity as DMD exhibits progressive cardiorespiratory compromise. Early limited instrumentation may provide a solution to optimize patients with this condition. PURPOSE The aim was to assess outcomes for a cohort of DMD patients who had posterior single-rod instrumentation and bilateral spinal fusion of their neuromuscular scoliotic deformity. STUDY DESIGN This was a retrospective cohort study. PATIENT SAMPLE Forty-one consecutive patients were included. OUTCOME MEASURES Perioperative morbidity, seating outcomes, pulmonary function, deformity correction, and instrumentation integrity were assessed. METHODS Clinical and radiographic review was performed. RESULTS No perioperative mortality or neurologic deterioration was encountered. Total surgical time was 96 minutes, mean total blood loss was 2.3l, mean intensive care unit stay was 41 hours, and overall length of stay was 11 days. Mean Cobb angle improved from 24.3° to 15.6°, pelvic obliquity improved from 7° preoperatively to 5° postoperatively. Three patients had failure of fixation at a mean of 3.5 years. Forced vital capacity was 60% preoperatively and 56% at 1 year, forced expiratory volume/1 second was 67% and 62% at 1 year postoperatively. Seating and posture was satisfactory in all these patients. CONCLUSIONS The authors advocate early operative intervention using a limited instrumentation technique in patients with DMD to maintain seating balance and minimize perioperative morbidity.
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Affiliation(s)
- Derek T Cawley
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland
| | - Olan Carmody
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland
| | - Michael K Dodds
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland
| | - Damian McCormack
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland.
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Aljabi Y, El-Shawarby A, Cawley DT, Aherne T. Effect of epidural methylprednisolone on post-operative pain and length of hospital stay in patients undergoing lumbar microdiscectomy. Surgeon 2015; 13:245-9. [DOI: 10.1016/j.surge.2014.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 11/27/2022]
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Cawley DT, Barrett HL, Harrington P. Obliteration of the medullary canal in an atypical bisphosphonate-related femoral fracture. BMJ Case Rep 2015; 2015:bcr2014205439. [PMID: 25568263 PMCID: PMC4289787 DOI: 10.1136/bcr-2014-205439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/03/2022] Open
Abstract
We present a case of a patient with a bisphosphonate-related atypical femoral fracture. Her surgical management was complicated by obliteration of the medullary canal, which prohibited the passage of an intramedullary nail. The relevant literature is discussed.
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Cawley DT, Alexander M, Morris S. Multifidus innervation and muscle assessment post-spinal surgery. Eur Spine J 2013; 23:320-7. [PMID: 23975437 DOI: 10.1007/s00586-013-2962-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/21/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Assessment of the integrity of the multifidus muscles and corresponding nerve roots, post-open (OSS) versus minimally invasive spinal surgery (MISS) for lumbar spine fractures. METHODS We investigated the first six patients undergoing MISS in our institution and age- and sex-matched them with 6 random patients who previously had OSS. All had a similar lumbar fracture configuration without evidence of spinal cord injury. All were assessed using ultrasound muscle quantification and electromyographic studies at a minimum of 6 months post-operatively. Mean cross-sectional area (CSA) was measured at sequential levels within and adjacent to the operative field. Concentric needle electromyography was performed at instrumented and adjacent non-instrumented levels in each patient. RESULTS Mean CSA across all lumbar multifidus muscles was 4.29 cm(2) in the MISS group, 2.26 cm(2) for OSS (p = 0.08). At the instrumented levels, mean CSA was 4.21 cm(2) for MISS and 2.03 cm(2) for OSS (p = 0.12). At non-instrumented adjacent levels, mean CSA was 4.46 cm(2) in the MISS group, 2.87 cm(2) for OSS (p = 0.05). Electromyography at non-instrumented adjacent levels demonstrated nerve function within normal limits in 5/6 levels in the MISS group compared to 1/6 levels in the OSS (p = 0.03). Instrumented levels demonstrated nerve function within normal limits in 5/12 levels in the MISS group compared with 4/12 in the OSS group, including moderate-severe denervation at 5 levels in the OSS group (p = 0.15). CONCLUSIONS Posterior instrumented MISS demonstrates a significantly superior preservation of the medial branch of the posterior ramus of the spinal nerve and less muscle atrophy, particularly at adjacent levels when compared to OSS.
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Affiliation(s)
- Derek T Cawley
- Department of Trauma and Orthopedic Surgery, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland,
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Abstract
The optimum cementing technique for the tibial component in cemented primary total knee replacement (TKR) remains controversial. The technique of cementing, the volume of cement and the penetration are largely dependent on the operator, and hence large variations can occur. Clinical, experimental and computational studies have been performed, with conflicting results. Early implant migration is an indication of loosening. Aseptic loosening is the most common cause of failure in primary TKR and is the product of several factors. Sufficient penetration of cement has been shown to increase implant stability. This review discusses the relevant literature regarding all aspects of the cementing of the tibial component at primary TKR.
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Affiliation(s)
- D T Cawley
- Merlin Park Hospital, Department of Trauma & Orthopaedic Surgery, Galway, Ireland.
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Cawley DT, Curtin PT, McCabe JP. Hypokalaemic paralysis secondary to thiazide diuretic abuse: an unexpected outcome for cauda equina syndrome. Evid Based Spine Care J 2012; 2:51-3. [PMID: 23230407 PMCID: PMC3506142 DOI: 10.1055/s-0031-1274757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Study design: Case report. We present the case of a 55-year-old woman with cauda equina syndrome, and hypokalaemic paralysis secondary to thiazide diuretic abuse.
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Affiliation(s)
- Derek T Cawley
- Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Republic of Ireland
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Cawley DT, Kelly N, Simpkin A, Shannon FJ, McGarry JP. Full and surface tibial cementation in total knee arthroplasty: a biomechanical investigation of stress distribution and remodeling in the tibia. Clin Biomech (Bristol, Avon) 2012; 27:390-7. [PMID: 22079691 DOI: 10.1016/j.clinbiomech.2011.10.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/27/2011] [Accepted: 10/13/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aseptic tibial component loosening remains a major cause of total knee arthroplasty failure. The cementation technique used to achieve fixation may play a major role in loosening. Despite this, the optimum technique remains unanswered. This study aims to investigate stress and strain distributions in the proximal tibia for full cementation and surface cementation of the Genesis II tibial component. METHODS Principal cortical bone strains were measured experimentally in intact, surface cemented and fully cemented synthetic tibiae using strain gauges. Both axial and 15° flexion loading were considered. Finite element models were used to assess both cortical and cancellous bone stresses and strains. Using a bone remodeling algorithm potential sites of bone formation and resorption were identified post-implantation. FINDINGS Principal cortical bone strain results demonstrate strong correlations between the experimental and finite element analyses (R(2)≥0.81, RMSE(%)≤17.5%). Higher cortical strains are measured for surface cementation, as full cementation creates a stiffer proximal tibial structure. Simulations reveal that both cementation techniques result in lower cancellous stresses under the baseplate compared to the intact tibia, with greater reductions being computed for full cementation. The surface cementation model displays the closest cancellous stress distribution to the intact model. In addition, bone remodeling simulations predict more extensive bone resorption under the baseplate for full cementation (43%) than for surface cementation (29%). INTERPRETATION Full cementation results in greater stress reduction under the tibial baseplate than surface cementation, suggesting that surface cementation will result in less proximal bone resorption, thus reducing the possibility of aseptic loosening.
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Affiliation(s)
- Derek T Cawley
- Department of Orthopaedic Surgery, National University of Ireland, Galway, Ireland
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Cawley DT, Sexton P, Murphy T, McCabe JP. Optimal patient positioning for ligamentotaxis during balloon kyphoplasty of the thoracolumbar and lumbar spine. J Clin Neurosci 2011; 18:834-6. [PMID: 21489799 DOI: 10.1016/j.jocn.2010.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
Percutaneous balloon kyphoplasty aims to restore vertebral height, correct angular deformity and stabilize the spine in the setting of vertebral compression fractures. The patient is positioned prone with supports under the iliac crests and upper thorax to allow gravity to extend the spine. In the treatment of lumbar fractures, we evaluated patient positioning with the contribution of hip extension to increase anterior ligamentotaxis, thus facilitating restoration of vertebral height. Our positioning technique created a mean anterior height increase from 72% to 78% of the average height of the cranial and caudal vertebrae (p=0.037). Balloon inflation did not significantly further increase anterior or posterior vertebral height, or Cobb angle.
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Affiliation(s)
- D T Cawley
- Department of Orthopaedic and Trauma Surgery, Merlin Park Hospital, Galway University Hospitals, Galway, Ireland.
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