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Derby, United Kingdom

Magaji S.A.,Queens Medical Center Nottingham | Debnath U.K.,Queens Medical Center Nottingham | Mehdian H.S.,Queens Medical Center Nottingham
Spine | Year: 2010

Study Design: Observational study of a case with a rare complication of lower limb compartment syndrome following total lumbar disc replacement via anterior retroperitoneal approach. Objective: To describe a patient with lower limb compartment syndrome, following total lumbar disc replacement via anterior retroperitoneal approach. Summary of Background Data: Compartment syndrome is a rare complication of spinal surgery. Previously, there were very few reported cases of compartment syndrome following posterior approachthrough a knee chest position. We are reporting the first case of lower limb compartment syndrome following total lumbar disc replacement through anterior retroperitoneal approach. Methods: Case report and literature review. RESULT.: Total lumbar disc replacement through anterior retroperitoneal approach led to a vascular complication (left iliac vein injury) with failed attempt at surgical repair. At 48 hours, the patient developed left lower limb compartment syndrome. Surgical decompression of the compartment prevented serious sequel with a successful outcome. Conclusion: Total disc replacement in the lumbar spine complicated with an acute compartment syndrome due to the left common iliac vein injury is reported for the first time. A vigilant postoperative work-up in an unconscious patient resulted in the diagnosis and decompression with a successful outcome. © 2010, Lippincott Williams & Wilkins.


Sama A.,Queens Medical Center Nottingham | Constable J.,Queens Medical Center Nottingham | McClelland L.,Queens Medical Center Nottingham
Rhinology | Year: 2014

Background: Frontal sinus mucocoeles require a structured approach to their surgical management. We share our experience of a novel method of positional classifcation for frontal mucocoele and corresponding surgical algorithm.Methods: A retrospective case-note review examined all frontal sinus surgery for mucocoele, spanning three years (2008-2010). Patients had pre-operative nasendoscopy, multi-planar CT and MRI when indicated. Several important variables (position, drainage dimensions, fronto-ethmoidal cells and degree of neo-osteogenesis) were noted. A systematic algorithm was used for surgical drainage based on these characteristics. The three year outcomes using this approach are presented.Results: Thirty-six patients were identifed with a total of 43 frontal mucocoeles. Using our classifcation, 30 mucocoeles were medial; seven were intermediate; six were lateral. Thirty-four patients underwent a primary endoscopic procedure; six required a combined primary osteoplastic-fap (OPF) and endoscopic approach. Six patients required revision surgery for polypoidal change or neo-ostium stenosis. All patients were eventually rendered asymptomatic.Conclusion: Implementation of our positional classifcation and surgical algorithm was successful with a revision rate of 19%. Presence of frontal sinus wall dehiscence and extra-sinus mucocoele extension are invalid indicators for external approach. We feel our classifcation and treatment algorithm, with its associated indicators for surgical escalation (i.e. limited dimensions of frontal ostium, presence of Type III/IV front-ethmoidal cells etc), are applicable for future management of frontal mucocoeles. © 2014, University Hospital Utrecht. All rights reserved.

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