Browsing by Author "Dunn, Robert"
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- ItemOpen AccessEvaluation of diagnostic advances in musculoskeletal tuberculosis; the automated xpert MTB/RIF assay(2016) Held, Michael; Zar, Heather; Dunn, RobertThe aim of this thesis was to investigate the diagnostic accuracy of Xpert for musculoskeletal TB and for rifampicin resistance against a gold standard of culture or histology. Site of disease, HIV status, and age of patients, and accuracy in spinal compared to extraspinal TB were investigated as secondary objectives. The overarching hypothesis was that Xpert is more accurate and would provide results faster than the gold standard for musculoskeletal TB, and that it would have a higher yield in HIV infected patients, adult patients, and patients with spinal disease.
- ItemOpen AccessHow does pre-reduction MRI affect surgeon's behaviour when reducing Distraction-Flexion injuries of the cervical spine?(2013) Fleming, Mark Alexander; Dunn, RobertIncludes abstract. Includes bibliographical references.
- ItemOpen AccessOccipito-cervical fusion(2011) Bick, Simon Millard; Dunn, RobertThe aim of this study is to review the different surgical indications, techniques and outcomes of occipito-cervical fusion, including C2 fixation methods, the influence on clinical outcome, patient scoring systems and complications.
- ItemOpen AccessPosterior segmental spinal fixation in Scoliosis surgery(2001) Dunn, Robert; Edgar, M A; Du Toit, GSpinal deformity was recognised in the ancient works for philosophy, religion, myths, and fairy tales dating back as far as 3500BC[1,6]. Scoliosis was first described in the 5th century BC by Hippocrates. He recommended treatment with axial distraction on an extension apparatus (figure 1).
- ItemOpen AccessRadiographic and clinical outcomes in adolescent idiopathic scoliosis corrective fusion surgery: a one year follow up(2024) Blankson, Benjamin; Dunn, RobertIntroduction Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine, characterized by a Cobb angle of at least 10 degrees. The goal of surgery is not only to prevent progression, but restoration of sagittal and coronal balance, protection of cardiopulmonary function and improvement of cosmesis. In this study, we reviewed the impact of deformity correction surgery in terms of radiology and patient reported outcomes. Method Data extracted from a prospectively maintained database (2003 – 2022) was retrospectively analysed for pre- and post-operative patient reported outcome measures, captured using the Scoliosis Research society-22 (SRS-22) questionnaire, as well as radiological parameters. Forty-four patients with AIS were identified with pre- and post-operative PROMs. The average age at surgery was 15yrs with 84% female. 38% had a Lenke 1 curve and 3 patients had Lenke 6 curves. 73% had posterior approach surgery. Results There was a total improvement in SRS-22 scores by 7.8% with 75% achieving MCID. Patients reported significant satisfaction with treatment 4.8/5 and improvement in self-image with a change of 1.1 (p0.05). Overall, proximal thoracic (PT) curves improved from 240 to 110 (p<0.05).
- ItemOpen AccessSurgeon directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery: A review of viability, safety and efficacy(2020) Magampa, Ramanare; Dunn, RobertAims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury facilitating early intervention which has a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon directed intra-operative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon directed TcMEP is presented in terms of viability, safety and efficacy. Methods A retrospective review was performed on a single surgeon's prospectively maintained database from 2010 to 2017 where TcMEP monitoring was utilised. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude of the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analysed. Results Of the 299 cases were reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No case with normal traces had a post-operative clinical neurological deficit. True alerts occurred in 20 (6.7%) cases. The alert group diagnoses included adolescent idiopathic scoliosis 9 (45%) and congenital scoliosis 6 (30%). The incidence of deterioration based on diagnosis AIS was 9/153 (6%), congenital 6/30 (20%) and TB spine 2/16 (12.5%). Deterioration in congenital is much more common (p=0.02) when compared to AIS. 65% of alerts occurred during rod instrumentation and 15% during decompression of the internal apex in vertebral column resection surgery. 4 (20%) alert cases awoke with clinically detectable neurological compromise Conclusion Surgeon directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress and immediate intervention. In resource constrained environments, surgeon directed TcMEP is a viable and effective method of intra-operative spinal cord monitoring. Clinical relevance • Surgeon directed TcMEP monitoring has a 100% negative predictive value. • In resource constrained environments, surgeon directed TcMEP is viable and effective • Level 3 evidence