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Papers by pat kiely

As many as 85% of adults experience back pain that interferes with their work and leisure activit... more As many as 85% of adults experience back pain that interferes with their work and leisure activities, and 25% of people between the ages of 30-50 years report lower back symptoms. Much of the pain and discomfort in later life results from an untreated condition during adolescence. Stress fractures of the vertebral lumbar laminae are given the clinical name spondylolysis. This vertebral defect is an acquired fracture with 7% prevalence in the paediatric population. This fracture has a mechanical aetiology, and fair evidence exists to support the role of facet tropism (geometric asymmetry) as a predisposing factor. Tests were carried out on porcine lumbar vertebrae, on which a series of angular asymmetries were simulated. Strain was recorded using 3-element stacked rosette strain gauges placed on the vertebral laminae. These tests showed that as each subsequent step of asymmetry is applied there is an increase in both Von Mises stress and strain on the ipsilateral side, this increase has a complex non-linear progression and pathological values for strain (>3000µε) are recorded indicating potential damage, which is supported by an average 17% reduction in facet/laminae stiffness (N/mm). An FEA model of the vertebra was created using µCT scans and published formulae linking bone mineralisation to material properties. This model successfully replicated both the facet/laminae stiffness (N/mm) and strains that were measured during test. The degree to which facet asymmetry is a predisposing factor and the knowledge of potentially pathological strain levels in the vertebra are important parameters when evaluating new implant devices and surgical techniques.

Irish Journal of Medical Science, Apr 15, 2008

Background Basic competency in musculoskeletal medicine is essential for many specialties being p... more Background Basic competency in musculoskeletal medicine is essential for many specialties being particularly relevant to primary care. Aim The purpose of this study was to objectively assess the adequacy of musculoskeletal education at multiple levels of medical training from undergraduate level to primary care. Methods A previously validated musculoskeletal examination was administered to 303 volunteers consisting of medical students, orthopaedic specialist registrars, general practice trainees and general practitioners. Results Forty (71%) general practitioners and 74 (71.8%) general practice trainees failed to obtain the passing score of 70. Sixty-three (87.5%) medical students who had completed an intensive 1-week long course in musculoskeletal medicine failed the examination. The pass rate improved significantly for general practitioners who had completed a postgraduate rotation in musculoskeletal medicine (47.8 vs 18.1%, P \ 0.01). Conclusions These findings suggest that training in musculoskeletal medicine is inadequate at multiple levels of medical education with reform urgently required.

Journal of The Mechanical Behavior of Biomedical Materials, Feb 1, 2018

If the articular facets of the vertebra grow in an asymmetric manner, the developed bone geometry... more If the articular facets of the vertebra grow in an asymmetric manner, the developed bone geometry causes an asymmetry of loading. When the loading environment is altered by way of increased activity, the likelihood of acquiring a stress fracture may be increased. The combination of geometric asymmetry and increased activity is hypothesised to be the precursor to the stress fracture under investigation in this study, spondylolysis. This vertebral defect is an acquired fracture with 7% prevalence in the paediatric population. This value increases to 21% among athletes who participate in hyperextension sports. Tests were carried out on porcine lumbar vertebrae, on which the effect of facet angle asymmetry was simulated by offsetting the load laterally by 7 mm from the mid-point. Strain in the vertebral laminae was recorded using six 3-element stacked rosette strain gauges placed bilaterally. Specimens were loaded cyclically at a rate of 2 Hz. Fatigue cycles; strain, creep, secant modulus and hysteresis were measured. The principal conclusions of this paper are that differences in facet angle lead to an asymmetry of loading in the facet joints; this in turn leads to an initial increase in strain on the side with the more coronally orientated facet. The strain amplitude, which is the driving force for crack propagation, is greater on this side at all times up to fracture, the significance of this can be observed in the increased steady state creep rate (p = 0.036) and the increase in yielding and toughening mechanisms taking place, quantified by the force-displacement hysteresis (p = 0.026).

Physiotherapy Practice and Research, Jun 4, 2016

Spinal pathology commonly features in physiotherapy caseloads and a detailed knowledge of the fea... more Spinal pathology commonly features in physiotherapy caseloads and a detailed knowledge of the features of Cauda Equina Syndrome (CES) is essential. While CES is a rare presentation, if missed the consequences of permanent bladder, bowel and sexual dysfunction are devastating. CES has a varied presentation in terms of chronology and symptomatology, leading to difficulty in accurate diagnosis in a clinical setting. The case study of a 48 year old female who developed CES while attending physiotherapy is presented. Her subjective and physical examination findings together with her lumbar Magnetic Resonance Imaging (MRI) findings are outlined. The patient underwent an L 5 /S 1 subtotal laminectomy and discectomy and the patient's status at eight months post-operatively is presented. A comprehensive review of the aetiology, sub-classifications and clinical features of CES is also provided.

Brain and Spine, Dec 31, 2022

Spine, 2015

A quality-control Internet-based study using recognized quality-scoring systems. To evaluate the ... more A quality-control Internet-based study using recognized quality-scoring systems. To evaluate the quality of information available on the Internet. Quality of health information on the Internet is of much concern and the emphasis for appraisal of Internet Web sites is needed. This study is to determine if it has improved with the surge in Internet usage. The 3 most commonly used search engines were identified and a search for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Discectomy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; was performed on each. Two reviewers categorized the Web sites according to their types and the quality of each was assessed using recognized scoring systems including the Journal of the American Medical Association (JAMA) benchmark, DISCERN score, and discectomy-specific content score. The quality of the information was also assessed according to the presence and absence of the Health on the Net code. Fifty-three Web sites were identified, and analyzed. Commercial Web sites were predominant, 24 of them were identified, 7 were governmental, 6 were produced by physicians, none were produced by allied health professionals, 3 were academic, 4 were public health information Web sites, 4 were attached to social media and discussion groups, 3 were related to media, and 2 were unspecified. Internet sites with a Health on the Net code demonstrated significantly higher quality than those without the code (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Public health information Web sites attained the highest overall DISCERN and discectomy-specific scores followed by Web sites of the government and nonprofit organizations. The overall quality of information regarding discectomy remains poor and variable despite an exponential increase in the number of users and Web sites, with a slight trend toward improvement, only 20% to 30% are of good quality, compared with that 10 years ago (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10%). Presence of Health on the Net code is a very reliable marker for health information quality.

Global Spine Journal, Apr 1, 2016

Physiotherapy, May 1, 2015

All patients participate in extra-curricular sporting activity with 80% of our patients participa... more All patients participate in extra-curricular sporting activity with 80% of our patients participating 4-7 days per week compared to just 17% of the general population. • The results of this study demonstrate excellent results for the Ponseti method in the management of CTEV, in pain, functional ability and participation in sport • OLCHC functional outcomes reported with the Ponseti method correlate well with previously published data. Sporting participation amongst this cohort is excellent with participation in extracurricular sporting activities far exceeding that of the general population. Implications: The Ponseti method is now accepted as gold standard world-wide in the treatment of CTEV. While many published papers have assessed functional outcome of CTEV managed via Ponseti treatment, these have all been static functional measurements. This is the first study to look at sporting participation in patients with Idiopathic CTEV treated with the Ponseti method. One of the most common causes for concern for parents is their childs' ability to participate in normal childhood activities as they grow. The results of this study show that these questions can be confidently answered in the affirmative for the idiopathic CTEV population.

Global Spine Journal, Nov 14, 2022

Study Design Systematic review and meta-analysis Objectives This study’s objective is to provide ... more Study Design Systematic review and meta-analysis Objectives This study’s objective is to provide a critical review of the current literature regarding the changes in pulmonary function (PF) in Adolescent idiopathic scoliosis (AIS) patients who have undergone posterior spinal fusion and instrumentation (PSF), with and without thoracoplasty (TP). Methods A comprehensive search was performed using the following databases: EMBASE, PubMed, EBSCOhost (CINAHL and Medline) and OpenGrey. Our focus was on studies that compared pre-and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume in 1 second (%FEV1) in AIS patients who had undergone PSF, with and without TP, with a minimum 2-year follow-up. The risk of bias for included studies was assessed using the ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”) tool. Mean change scores were depicted using forest plots. Results Fifteen studies met our inclusion criteria. The results of our analysis suggest that PSF with TP caused a significant deterioration of %FVC in individuals with moderate AIS, with no significant effect on %FEV1. It also showed a minor improvement of FEV1% in individuals with moderate AIS after PSF only, but no significant change in %FVC. Conclusions PSF with TP caused a significant deterioration of % FVC while PSF alone caused a minor improvement of FEV1% in individuals with moderate AIS with a minimum 2-year follow-up.

Journal of Pediatric Orthopaedics

Background: Early-onset scoliosis (EOS) is frequently associated with complex spine and chest wal... more Background: Early-onset scoliosis (EOS) is frequently associated with complex spine and chest wall deformities that may lead to severe cardiopulmonary impairment and malnutrition. The aim of this study is to evaluate the change in the nutritional status of EOS patients after treatment with magnetically controlled growing rod instrumentation (MCGR) in a single center. Methods: We prospectively collected data of patients treated with MCGR for EOS in a single center. Exclusion criteria were <2 years’ follow-up and incomplete weight-for-age Z-scores (WAZ) data. Preoperative and postoperative WAZ, radiographic parameters, including major coronal curve, kyphosis angle, space available for lung ratios, thoracic height, and unplanned returns to the operating room (UPROR), were analyzed. SD and 95% Confidence intervals (CI) are presented with means. Results: Sixty-eight patients (37 males/31 females) were included. The mean age at surgery was 8.2 years (SD 2.8, range 1.8–14.2), and the me...

Clinical Nutrition, 2014

ABSTRACT Rationale: Although several studies demonstrate a comparably lower weight and body mass ... more ABSTRACT Rationale: Although several studies demonstrate a comparably lower weight and body mass index (BMI) in adolescents with idiopathic scoliosis (AIS), no study has yet quantified unintentional postoperative weight loss after major spinal deformity surgery in this already ‘thin’ patient population, and examined its impact on outcomes. Methods: Seventy seven consecutive and eligible patients with AIS who underwent posterior spinal fusion (PSF) were prospectively follow-up from hospital admission (Jan 2010-April 2012). Pre- and postoperative anthropometric measurements were collected (weight, height, BMI) and unintentional weight loss from admission to hospital discharge recorded. Using the British 1990 growth reference data, BMI values were standardised by conversion to age- and gender-specific Z-scores (Z-score < -2 defined as Grade 2/3 undernutrition). Sociodemographic, biochemical, nutritional and perioperative complication data were obtained. Descriptive statistics using SPSS® was performed; Student’s t test or Mann-Whitney U test were used for comparisons between groups. Results: The majority of patients were female (93.5%) with a mean age of 15 years. From admission to discharge, the proportion of patients having a BMI Z-score < -2 increased from 6.5% to 26.4%, respectively. Clinically severe weight loss greater than 10%, was identified in 22 patients (30.6%). A non-significant trend towards increased minor (81.8% vs. 70%, P = 0.449) and major (9.1% vs. 4%, P = 0.756) complications and a slightly longer hospital stay (median 9.5 days vs. 9 days, P = 0.608) was observed in patients who lost > 10% (vs. ≤ 10%) body weight. These groups did not differ as regards parenteral nutrition provision. A significantly increased incidence of superficial wound infection was the only clinical outcome under analysis associated with > 10% weight loss (13.6% vs. 2%, P = 0.047). Conclusion: Clinically severe postoperative weight loss greater than 10% was identified in almost one third of AIS patients following PSF in this study. Findings demonstrate that such severe postoperative weight loss is significantly associated superficial wound infection occurrence suggesting a possible role for routine pre and postoperative nutritional screening and more aggressive nutritional support after PSF in this patient population.

Irish Journal of Medical Science (1971 -), 2015

Background Posterior spinal instrumentation and fusion for correction of adolescent idiopathic sc... more Background Posterior spinal instrumentation and fusion for correction of adolescent idiopathic scoliosis (AIS) typically requires lengthy operating time and may be associated with significant blood loss and subsequent transfusion. This study aimed to identify factors predictive of duration of surgery, intraoperative blood loss and transfusion requirements in an Irish AIS cohort. Methods A retrospective review of 77 consecutive patients with AIS who underwent single-stage posterior spinal instrumentation and fusion over a two-year period at two Dublin tertiary hospitals was performed. Data were collected prospectively and parameters under analysis included pre-and postoperative radiographic measurements, intraoperative blood loss, surgical duration, blood products required, laboratory blood values and perioperative complications. Results Mean preoperative primary curve Cobb angle was 62.3°; mean surgical duration was 5.6 h. The perioperative allogeneic red blood cell transfusion rate was 42.8 % with a median requirement of 1 unit. Larger curve magnitudes were positively correlated with longer fusion segments, increased operative time and greater estimated intraoperative blood loss. Preoperative Cobb angles greater than 70°[Relative Risk (RR) 4.42, p = 0.003] and estimated intraoperative blood loss greater than 1400 ml (RR 3.01, p = 0.037) were independent predictors of red blood cell transfusion risk. Conclusion Larger preoperative curve magnitudes in AIS increase operative time and intraoperative blood loss; preoperative Cobb angles greater than 70 o and intraoperative blood loss greater than 1400 ml are predictive of red blood cell transfusion requirement in this patient group.

Global Spine Journal

Case Reports in Orthopedics, 2015

A 10-year-old boy presented with severe left lower leg pain, uncontrolled with increasing analges... more A 10-year-old boy presented with severe left lower leg pain, uncontrolled with increasing analgesia after appendicectomy. A diagnosis of acute compartment syndrome was made after a delayed referral to the orthopaedic service. The patient subsequently underwent an emergency fasciotomy and made a good functional recovery. To the best of our knowledge this is the first reported case of paediatric lower leg compartment syndrome after appendicectomy in the literature. The case report serves to highlight the importance of maintaining a high index of suspicion for compartment syndrome.

European Spine Journal, 2012

Purpose No information exists on the level of internet use among parents of pediatric patients wi... more Purpose No information exists on the level of internet use among parents of pediatric patients with scoliosis. The internet may represent a medium through which to provide information to augment the outpatient consultation. The aim of this research was to establish the prevalence of internet use amongst a cohort of parents attending a pediatric scoliosis outpatient clinic. Methods A previously used questionnaire (Baker et al., Eur Spine J, 19:1776-1779, 2010) was distributed to parents attending a dedicated scoliosis outpatient clinic with their children. Demographic data and details about use of the internet were collected. Results Fifty-eight percent of respondents had used the internet to search for information on scoliosis, and 94 % were interested in a local internet provided information provision. A positive history of corrective surgery and possession of health insurance were independent positive predictors of internet use. Conclusions As surgeons we need to be aware of our patients' use of the internet, and there is the opportunity to use this medium to provide additional education.

Spine, Jan 15, 2014

Prospective study. To assess the timing and predictors of return to short-term functional activit... more Prospective study. To assess the timing and predictors of return to short-term functional activity in patients with adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF). Few studies have examined the timing and rate of return to short-term functional activity in patients with AIS after PSF. No study has yet evaluated the timing and factors that predict a delayed return to school/college--a topic relevant to patients who have had or anticipate having spinal fusion, and their treating surgeons. Seventy-seven eligible subjects with AIS who underwent PSF and correction (January 2010 to April 2012) were followed up until return to the functional outcomes under analysis. Timing of return to school/college and physical activity, as per the patients' preoperative level or better, was assessed. Binary logistic regression analysis was used to determine predictors of delayed return to school/college full-time (>16 wk) and unrestricted physical activity…

Orthopaedic Proceedings, Feb 21, 2018

Our aim was to use CT Scanogram to evaluate fibular growth, and thus calculate normal growth velo... more Our aim was to use CT Scanogram to evaluate fibular growth, and thus calculate normal growth velocity, which may aid in determining the timing of epiphysiodesis. Current understanding of normal lower limb growth and growth prediction originates in the work of Anderson et al published in the 1960s. There now exist several clinical and mathematical methods to aid in the treatment of leg length discrepancy, including the timing of epiphysiodesis. Early research in this area provided limited information on the growth of the fibula. It is now well recognized that abnormal growth of paired long bones may evolve into deformity of clinical significance. Existing work examining fibular growth used plain film radiography only. Computed Tomography (CT) scanogram is now the preferred method for evaluating leg length discrepancy in the paediatric population. We calculated fibular growth for 28 children (n = 28, 16 girls and 12 boys) presenting with leg length discrepancy to our unit. Mean age at presentation was 111.1 months (range 33 – 155 months). For inclusion, each child had to have at least five CT scanograms performed, at six monthly intervals. Fibular length was calculated digitally as the distance from the proximal edge of the proximal epiphysis to the most distal edge of the distal epiphysis. For calculation purposes, mean fibular length was determined from two measurements taken of the fibula. A graph for annual fibular growth was plotted and fibular growth velocity calculated. CT Scanogram may be used to calculate normal fibular growth in children presenting with leg length discrepancy.

A synthetic spine is a model fabricated from artificial materials consisting of the vertebrae, in... more A synthetic spine is a model fabricated from artificial materials consisting of the vertebrae, intervertebral discs and ligaments for spinal testing. The synthetic spine overcomes many difficulties associated with biological specimens such as handling, biohazard concerns, high costs, and limited availability of specimens, quality and large inter-specimen variability. This paper presents the design and development of an Artificial Intervertebral Disc (AID) to mimic the behaviour of the paediatric intervertebral disc for use in synthetic spine. The natural intervertebral disc consists of soft nucleus pulposus surrounded by annulus fibrosis and cartilaginous end plate at the top and bottom of the disc. Its main function is to transmit and attenuate compression, torsional, bending load from one vertebral body to the next and to stabilise the intervertebral joints. Early in the research, silicone materials were used to model a simple component disc, but it became apparent that the materi...