Exeter Spinal Surgery Unit

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Research outputs from the Exeter Spinal Surgery Unit. The Spinal Unit comprises of 5 consultant spinal surgeons in addition to offering clinical fellowships to surgical trainees from around the world. For more information visit the Exeter Spinal Surgery Unit website.

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Recent Submissions

Now showing 1 - 5 of 43
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    Delayed tension pneumocephalus and pneumorrhacis after routine cervical spine surgery treated successfully without burr holes
    (Royal College of Surgeons, 2023-06-01) Lim, Y.; Dahapute, A.; Clarke, A.; Hutton, M.; Selbi, W.
    Tension pneumocephalus (TP) after spinal surgery is very rare with only a few cases reported in the English literature. Most cases of TP occur rapidly after spinal surgery. Traditionally, TP is managed using burr holes to relieve intracranial pressure. However, our case highlights a rare delayed presentation of TP and pneumorrhacis 1 month after routine cervical spine surgery. It is to our knowledge the first case of TP after spinal surgery to be treated using dural repair and supportive care. A 75-year-old woman presented with TP after having routine cervical decompression and stabilisation for cervical myelopathy. She re-presented 1 month after her initial operation with a leaking wound and altered mental status, which deteriorated rapidly shortly after admission. This, in combination with her radiographic features, influenced the decision to explore her surgical wound emergently. She made a full recovery and was discharged after 2 weeks in hospital. We hope to emphasise the need for a high index of suspicion for cerebrospinal fluid leaks and the low threshold to return to theatre to repair a potential dural defect, as well as illustrate that TP after spinal surgery can be treated successfully without burr holes.
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    Magnet Fracture within a Magnetically Controlled Growing Rod: A Case Report of a New Mechanism of Failure
    (Indian Orthopaedic Research Group, 2021-08-01) Jones, Conor S; Rushton, Paul; Hutton, Michael; Stokes, Oliver M
    Introduction: Magnetically controlled growing rods (MCGRs) have been widely adopted in the management of early-onset scoliosis since they were first described in 2012. Recent reports have highlighted concerns around their safety. To date, little is understood about the risk factors and modes of failure in these devices.
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    Management of malignant pleural effusion associated with trapped lung syndrome
    (SAGE, 2008-04-03) Qureshi, R. A.; Collinson, S. L.; Powell, R. J.; Froeschle, P. O.; Berrisford, R. G.
    Management of recurrent malignant pleural effusion associated with trapped lung syndrome remains problematic. An alternative treatment using a pleural catheter has been advocated. Between August 1999 and August 2002, 127 patients underwent thoracoscopy for malignant pleural effusion. Of these, 52 (41%) with trapped lung were managed by insertion of a pleural catheter. Mean age was 66 years (range, 42-89 years). The most frequent diagnosis was breast cancer. Spontaneous pleurodesis (drainage < 10 mL) occurred in 25 (48%) patients whose catheter was removed after 30 to 255 days (mean, 93.8 days). Symptomatic relief was achieved in 49 (94%) patients. Mean dyspnea score improved significantly from 3.0 to 1.9. Complications comprised catheter blockage, surgical emphysema, cellulitis, and loculated effusion in 2 patients each. Mean length of hospital stay was 3 days (range, 1-16 days). Median survival was 126 days (range, 10-175 days). We conclude that long-term placement of a pleural catheter provides effective palliation for malignant pleural effusion associated with trapped lung syndrome.
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    Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons
    (Cell Press, 2021-05-01) Davies, Benjamin M.; Francis, Jibin J.; Butler, Max B.; Mowforth, Oliver; Goacher, Edward; Starkey, Michelle; Kolias, Angelos; Wynne-Jones, Guy; Hutton, Mike; Selvanathan, Senthil; Thomson, Simon; Laing, Rodney J. C.; Hutchinson, Peter J.; Kotter, Mark R. N.
    Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches. METHODS: An electronic survey was developed and piloted by the investigators using SurveyMonkey. Collected data was categorical and is presented using summary statistics. Where applicable, statistical comparisons were made using a Chi-Squared test. The level of significance for all statistical analyses was defined as p < 0.05. All analysis, including graphs was performed using R (R Studio). RESULTS: 127 surgeons, from 30 countries completed the survey; principally UK (66, 52%) and North America (15, 12%). Respondents were predominantly Neurosurgeons by training (108, 85%) of whom 84 (75%) reported Spinal Surgery as the principal part of their practice. The majority indicated they selected their surgical procedure for multi-level DCM on a case by case basis (62, 49%). Overall, a posterior approach was more popular for multi-level DCM (74, 58%). Region, speciality or annual multi-level case load did not influence this significantly. However, there was a trend for North American surgeons to be more likely to favour a posterior approach. CONCLUSIONS: A posterior approach was favoured and more commonly used to treat multi-level DCM, in an international cohort of surgeons. Posterior techniques including laminectomy, laminectomy and fusion or laminoplasty appeared to be equally popular.
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    MRI versus CT: a retrospective investigation of the feasibility and agreeability in post-operative evaluation of screw position after posterior lumbar interbody fusion.
    (Springer, 2021-01-01) Battleday, F. M.; Williams, M.; Rankine, J.; Timothy, J.
    PURPOSE: Many patients receive magnetic resonance (MR) and computed tomography (CT) scans post-operatively to review screw placement. Traditionally, CT is diagnostic but as metal artefact reduction sequences are advancing in MR, the necessity for both MR and CT scans is questionable. The objective is to establish the statistical agreeability of MR and CT for evaluation of adequate screw placement in posterior lumbar interbody fusion. METHODS: This opportunistic retrospective study of 58 patients investigated 297 images of 296 implanted screws. Post-operative MR and CT images were scrutinised for depiction of lumbar pedicle screw position using a 5-point scale. Kappa value for statistical agreeability tested MR against CT. RESULTS: The 297 images of screws resulted in strong to near-perfect agreement between MR and CT (n?=?297 k?=?0.8042 p?