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Warrington, United Kingdom

Suchomel P.,Neurocentre | Jurak L.,Neurocentre | Antinheimo J.,University of Helsinki | Pohjola J.,University of Helsinki | And 8 more authors.
European Spine Journal | Year: 2014

Purpose: Recent studies describe significant rates of heterotopic ossification (HO) after cervical total disc replacement (CTDR). Little is known about the reasons, and one aspect that requires further in vivo investigation is the biomechanical alteration after CTDR and the role of the implant-related centre of rotation (CORi) in particular. The role of the sagittal position of the CORi on functional outcome in two versions of a semi-constrained disc prosthesis with sagittally different CORi is the topic of this study. Methods: Patients were candidates for single-level CTDR between C3 and C7 who suffered from CDDD and received a standard or flat version of activ C™ (Aesculap AG, Tuttlingen). Clinical and radiographic assessments were determined preoperatively, intraoperatively, at discharge and again at 6 weeks, 6 months, 1 and 2 years. Radiographic examinations were performed independently using specialized quantitative motion analysis software. Results: Clinical outcome improved significantly regarding NDI as well as VAS on neck and arm pain with no differences in mean improvement by study group. Segmental angle measures show a significantly better lordotic alignment for both groups after surgery, but the degree of correction achieved is higher in the flat group. Correlation analysis proves that the more anterior the CORi is positioned, the higher the lordotic correction is achieved (Pearson rho -0.385). Segmental ROM decreased in the standard group but was maintained for flat implants. At present, our data do not demonstrate a correlation between CORi and ROM at 2 years. Two years after surgery, severe HO grade III-IV was present in 31.6 % standard and 13.1 % flat cases with significant differences. Grouping according to HO severity showed comparable sagittal positions of CORi for flat implants but a more posterior position in the severe HO group for standard implants. Conclusions: Our results confirm the influence of CORi location on segmental alignment, kinematics and HO for a semi-constrained CTDR, but it also indicates a multifactorial process. © 2014 Springer-Verlag. Source


Singhal R.,Alder Hey Childrens Hospital | Perry D.C.,Alder Hey Childrens Hospital | Prasad S.,Warrington District General Hospital | Davidson N.T.,Alder Hey Childrens Hospital | Bruce C.E.,Alder Hey Childrens Hospital
European Spine Journal | Year: 2013

Purpose: This study sought to quantify the frequency of previously unidentified spinal cord anomalies identified by routine preoperative magnetic resonance imaging (MRI), in patients planned for surgical scoliosis correction. Methods: Our study group comprised 206 patients with idiopathic scoliosis who underwent deformity correction from 1998 to 2008. Clinical records of all the patients were retrospectively reviewed to ascertain the proportion having a neural abnormality on preoperative MRI scan. Results: Twenty of 206 patients (9.7 %) were diagnosed with an unexpected intraspinal anomaly on routine preoperative MRI. In all cases, a neurosurgical opinion was sought prior to further intervention. Of the 20 patients, 11 underwent a neurosurgical procedure (de-tethering of cord, decompression of Chiari, decompression of syrinx). There was no statistically significant difference between the group of patients who had intrinsic spinal cord anomalies on preoperative MRI and those did not have a cord abnormality with regard to age at presentation, gender, side of dominant curve and degree of curve (p < 0.05). Conclusion: The high frequency of spinal cord abnormalities unidentified by preoperative neurological examination, and the frequent need for subsequent neurosurgical intervention, suggests that MRI assessment prior to deformity correction is important in the management of idiopathic scoliosis. © 2012 Springer-Verlag Berlin Heidelberg. Source


Alsaffar H.,Warrington District General Hospital | Woodger K.,Warrington District General Hospital | Losa I.,Macclesfield District General Hospital
Journal of Vaccines and Vaccination | Year: 2014

Following advice and recommendations by the Joint Committee on Vaccination and Immunisation (JCVI), and in line with standing commitments on patient rights under the NHS constitution on implementing such recommendations, a series of changes to England's national immunisation programme took place from July 2013 including the introduction of Rotavirus vaccine (Rotarix® by GlaxoSmithKline Biologicals s.a.) into the routine childhood UK schedule for babies from 2 months of age [1]. © 2014 Alsaffar H, et al. Source

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