Denys Gibbons | Trinity College Dublin (original) (raw)

Papers by Denys Gibbons

Introduction Perinatal lumbar discectomy for lumbar disc herniation or cauda equina syndrome is a... more Introduction Perinatal lumbar discectomy for lumbar disc herniation or cauda equina syndrome is a rare clinical scenario. This case series outlines the surgical management of this clinical scenario at a national tertiary referral centre over a 10-year period Methods A retrospective review of all females who underwent discectomy / decompression for lumbar disc herniation or cauda equina syndrome in the perinatal period at a national tertiary referral centre for spine surgery over a 10-year period between January 2008 to December 2017. Results 6 cases required surgical intervention. All patients were successfully managed with surgical decompressive procedures and recovered well in the postoperative period without complication. Conclusions The principles of management remain the same in the pregnant and non-pregnant populations, although treatment options are complicated by the desire to avoid risk to the developing foetus. Surgical intervention is safe to both mother and baby and if p...

The Surgeon, 2021

INTRODUCTION Major trauma has seen a demographic shift in recent years and it is expected that th... more INTRODUCTION Major trauma has seen a demographic shift in recent years and it is expected that the elderly population will comprise a greater burden on the major trauma service in the near future. However, whether a similar trend exists in those undergoing operative intervention for spinal trauma remains to be elucidated. AIMS To compare the presentation and outcomes of patients ≥65 years of age sustaining spine trauma to those <65 years at a national tertiary referral spine centre. METHODS The local Trauma Audit Research Network (TARN) database was analysed to identify spinal patients referred to our institution, a national tertiary referral centre, between 01/2016 and 05/2019. Patients were divided into a young cohort (16-64 years old) and an elderly cohort (> 64 years old). No explicit distinction was made between major and minor spine trauma cases. Variables analysed included patient demographics, injury severity, mortality, interventions, mechanism of injury and length of hospital stay. RESULTS A total of 669 patients were admitted of which 480 patients underwent operative intervention for spinal trauma. Within the elderly cohort, this represented 75.3% of cases. Among the younger population, road traffic collisions were the most common mechanism of injury (37.1%), while low falls (<2 m) (57.4%) were the most common mechanism among the older population. Patients ≥65 years old had significantly longer length of stay (21 days [1-194] v 14 days [1-183]) and suffered higher 30-day mortality rates (4.6% [0-12] v 0.97% [0-4]). CONCLUSION Orthopaedic spinal trauma in older people is associated with a significantly higher mortality rate as well as a longer duration of hospitalization. Even though severity of injury is similar for both young and old patients, the mechanism of injury for the older population is of typically much lower energy compared to the high energy trauma affecting younger patients.

The Surgeon, 2021

INTRODUCTION The Orthopaedic Trauma Association has recommended limitation of in-person encounter... more INTRODUCTION The Orthopaedic Trauma Association has recommended limitation of in-person encounters to absolute necessity. One method of ensuring standard patient care within these guidelines is through the implementation of telemedicine. AIMS To evaluate the efficacy of telemedicine for elective orthopaedic patients in the recovery and/or rehabilitation period. METHODS A systematic review and meta-analysis of articles in Medline/PubMed and The Cochrane Library databases was performed according to the PRISMA guidelines for prospective randomised controlled trials to compare clinical and symptomatic measures for elective patients managed routinely with remote care compared to those managed with standard in-clinic management. To be included for meta-analysis, parameters must be evaluated in ≥3 studies. RESULTS Eleven studies were included in the meta-analyses. Both telemedicine and control cohorts were comparable for patient satisfaction (RR, 0.98; 95% CI, 0.90-1.07; I2 = 0%; p = 0.52) and patient retention analysis (RR, 1.25; 95% CI, 0.51-3.06; p = 0.54; I2 = 0%). Similarly, there was no statistical difference appreciated between cohorts for overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (p = 0.30), Timed Up and Go Test (p = 0.40), and Stair Test (p = 0.18). Significant difference did exist for visual analogue scale (VAS) scores (p = 0.02) in favour of in-clinic management. CONCLUSION Telemedicine will serve an integral aspect of healthcare delivery throughout the current COVID-19 pandemic and beyond in an effort to deliver safe, efficient and time-sensitive care to the orthopaedic patient population. The results of our meta-analyses indicate that virtual consultations are as effective as traditional in-person consultations for the care of elective orthopaedic patients in the recovery and rehabilitation period. However, further studies are needed to evaluate for initial consultations and certain sub-specialties of orthopaedics.

Clinical Spine Surgery: A Spine Publication, 2020

Surgical intervention is commonly required in the management of cervical spondylotic myelopathy t... more Surgical intervention is commonly required in the management of cervical spondylotic myelopathy to arrest the progression of myelopathic symptoms.1 This can be achieved through an anterior, posterior, or circumferential decompression, with or without instrumented fusion.1,2 Posterior cervical decompression and fusion (PCDF) is considered safe and efficacious, and can be performed with pedicle screws or lateral mass screws, with current controversy regarding the more efficacious mode of instrumentation.3 The purpose of this article is to debate the advantages of each screw fixation technique.

Clinical Spine Surgery: A Spine Publication, 2020

Sarcopenia is characterized by progressive age-related and systematic loss of skeletal muscle mas... more Sarcopenia is characterized by progressive age-related and systematic loss of skeletal muscle mass, strength, and function. It was classified as an independent disease in 2016; thus, there is a sparsity of research on the association of sarcopenia with lower back pain and spinal diseases. Its prevalence is around 10% worldwide and it has been shown to be detrimental to quality of life in the elderly. Sarcopenia can be clinically identified by assessing muscle mass and physical performance measurements to show reduced strength (eg, grip strength chair rise and knee extensions) or function (eg, walking speed or distance). Radiographic imaging techniques such as computed tomography, ultrasound, or magnetic resonance imaging help diagnose sarcopenia in the lumbar spine by measuring either the cross-sectional area or the fatty infiltrate of the lumbar musculature. The presence of sarcopenia in patients preoperatively may lead to worse postoperative outcomes. Research in the treatment options for sarcopenia presurgery is still in its infancy but exercise (both aerobic and resistance exercise have been found to slow down the rate of decline in muscle mass and strength with aging) and nutrition have been utilized to varying success and show great promise in the future.

Clinical Spine Surgery: A Spine Publication, 2020

The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institute of ... more The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institute of Health initiative to improve the measurement of clinically important symptoms and outcomes. Patient-Reported Outcomes capture health outcomes that are relevant to the daily functioning of the patient and include the monitoring of physical, mental, and social health. PROMIS offers a standardized tool to measure Patient-Reported Outcomes for use in both the clinical and research setting. It is a flexible and dynamic tool for both patient and clinician, and its use is continuing to grow internationally. This article discusses the rationale and design of this tool, as well as its advantages to both research and clinical practice.

Clinical Spine Surgery: A Spine Publication, 2020

Finite element analysis is a computational technique to predict how different materials will reac... more Finite element analysis is a computational technique to predict how different materials will react when a range of forces are applied. In the field of orthopedics, this technique has predominantly been used for implant design and testing. As the technology improves, increasing clinical applications are being developed, offering promise in the areas of surgical planning and the opportunity to tailor implants to individual patient characteristics. This article introduces the various preclinical mechanical tests available, as well as providing a brief overview of the finite element analysis technology.

The Bone & Joint Journal, 2020

Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient... more Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital features that provide the surgeon with an improved view of the surgical field, often through a narrow portal. There is emerging evidence that procedure-related complications and intraoperative blood loss can be reduced if the new technologies are used by appropriately trained surgeons. Acceptance of the role of surgical robots has increased in recent years among a number of surgical specialities including general surgery, neurosurgery, and orthopaedic surgeons performing major joint arthroplasty. However, ethical challenges have emerged with the rollout of these innovations, such as ensuring surgeon competence in the use of surgical robotics an...

Clinical Spine Surgery, 2019

Ж у р н а л м е ж д у н а р о д н о г о п р а в а и м е ж д у н а р о д н ы х о т н о ш е н и й №... more Ж у р н а л м е ж д у н а р о д н о г о п р а в а и м е ж д у н а р о д н ы х о т н о ш е н и й № 3-2 0 1 4 73

Clinical Spine Surgery, 2019

Lower back pain is a commonly reported symptom during pregnancy. However, herniated lumbar disk d... more Lower back pain is a commonly reported symptom during pregnancy. However, herniated lumbar disk disease is an uncommon cause for such pain. Cauda equina syndrome (CES) during pregnancy is a rare clinical scenario. This review highlights the epidemiology, diagnostic and treatment strategies, and challenges encountered when managing herniated lumbar disk disease and CES in pregnancy. Magnetic resonance imaging is the diagnostic modality of choice. Nonoperative treatment strategies are successful in the vast majority of cases in patients with a herniated disk in the absence of CES. CES and progressive neurological deficits remain absolute indications for surgical intervention regardless of gestational age. For such patients or those with debilitating symptoms refractory to nonoperative treatment strategies, surgery has been demonstrated to be safe in the pregnant patient population. However, surgery should be performed with obstetric and midwifery support should complications occur to the fetus.

Clinical Spine Surgery, 2019

Spine surgery has seen considerable advancements over the last 2 decades, particularly in the fie... more Spine surgery has seen considerable advancements over the last 2 decades, particularly in the fields of image-guidance and robotics. These technologies offer the potential to overcome the various technical challenges in spinal surgery, such as physical and mental fatigue, hand tremor, difficulties with manual dexterity, and surgical precision. This review provides an overview of the image-guidance and robotics systems currently available. It will also provide an insight into the emerging technologies in development in the field of spine surgery. Image-guided and robotic-assisted surgical systems have been demonstrated to be safe, accurate, and timeefficient. Future advancements in the field include "augmented reality" systems, which build on these navigation platforms, but are yet to come to market. These developing technologies have considerable potential to improve the field of spine surgery. Further research is required in this area to determine superiority of these developing technologies over conventional techniques before widespread use should be adapted.

The Surgeon, 2019

Background: A significant proportion of patients presenting with suspected cauda equina syndrome ... more Background: A significant proportion of patients presenting with suspected cauda equina syndrome (CES) do not have associated radiological evidence to support the diagnosis, often termed 'scan-negative'. Due to the limited number of studies regarding the matter, there is no clear understanding for this presentation. As a result, no treatment protocol exists for the scan-negative group. The purpose of this review is to assess the potential contributing factors leading to the presentation of suspected CES with normal imaging. Methods: A systematic review was conducted on PubMed and Cochrane databases. Bibliographies of key articles and Google Scholar were searched for additional results. The search strategy provided 204 results. Of those, 8 had no identifiable causation for suspected CES and were included for systematic review. Results: 6 of 8 studies investigated for a difference in clinical presentation between cohorts that may indicate a normal scan. Studies were either inconclusive and contradictory. Two studies suggest a functional somatic disorder as reasoning for negative MRI, with positive provisional findings. Conclusion: A psychogenic hypothesis is plausible and warrants further investigation. The need for additional studies is essential to scheming a potential treatment protocol for the scan-negative population, which currently does not exist.

Clinical Spine Surgery, 2019

F of the odontoid peg (type I, II, III) represent the most common acute cervical spine fracture i... more F of the odontoid peg (type I, II, III) represent the most common acute cervical spine fracture in the elderly population.1,2 With an ever-increasing aging population, the incidence of this fracture is therefore predicted to rise. Type II odontoid peg fractures are considered a relatively unstable fracture and are associated with a significant mortality of up to 41% 1-year postinjury.3 Considerable controversy exists regarding best practice for management of these fractures in the geriatric population. Traditionally, debate centered on operative versus nonoperative management in this patient cohort. Because of the increased number of comorbidities, reduced physiological reserve, increased anesthetic risk and compromised bone quality, operative intervention has reported complications rates in excess of 50% and in hospital mortality rates of 35%.4,5 Complications associated with surgical intervention include acute respiratory failure, pulmonary embolism, surgical site infections and implant failure which may necessitate revision surgical intervention.6 In addition, dysphagia, aspirations, requirement for tracheostomy, and prolonged hospital stay are also reported.3,7 Therefore, the goal of treatment has shifted from aiming for osseous union to stable fibrous union in elderly patients wherever possible.1,8–10 The halothoracic vest (HV) provides rigid external immobilization and was traditionally the nonoperative management of choice. However, these are poorly tolerated in the elderly population with some series quoting complication rates of 66% and mortality rates of 42%.11 Cervical collars provide nonrigid external immobilization and are considered the other option in the nonoperative management of these injuries. However, we propose that a third nonoperative measure exists—no immobilization. As stated above, considerable complications are associated with the use of HV in the elderly and this has led to a reduction in their use in this cohort. Moreover, treatment with cervical collars is far from benign. Complications such as skin breakdown and decubitus ulcer formation due to prolonged collar use, discomfort, and hygiene obstacles can lead to considerable morbidity.12,13 Ackland et al14 noted that full thickness occipital ulcers have the potential to manifest as early as 5 days following application of a cervical collar in major trauma patients. In reference to this patient cohort, who are often frail with poor physiological reserve and high risk of decubitus ulcer development, the average collar immobilization period is ∼3 months.15 Therefore, the use of cervical collars carries significant risk in the elderly population. In addition, studies of HV and cervical collar immobilization demonstrate significantly reduced range of motion (ROM) at both C1–2 and C2–3 of the intact spine. However, the HV provides far superior reduction in ROM compared with cervical collars. Despite the reductions in ROM achieved by collars, movement is not entirely restricted. A cadaveric study by Richter et al16 who simulated a type II odontoid peg fracture found a reduction of flexion/extension of only 59% and an 80% reduction in torque with a Miami J collar. Therefore, a considerable degree of movement remains in collar use. It is therefore unsurprising that the movement permitted by cervical collars exceeds the strain required for bone healing by relative stability and results in pseudarthrosis formation, the new therapeutic target in elderly type II fractures. Therefore, the question arises as to the role that cervical collars play. Does the limitation of movement achieved by collars allow pseudarthrosis formation but prevent a complete nonunion? We posit that patients are capable of self-restricting their ownmovement. For example, the use of flexion/extension cervical spine radiographs are still used today to evaluate cervical spine stability. When performing this test, patients are asked to flex and extend their neck to the point of pain, but not beyond and the x-ray is taken at the point of extreme flexion and extension. We therefore propose that patients, through pain feedback, will limit their cervical movement to an acceptable range to promote pseudarthrosis formation. Received for publication January 20, 2019; accepted February 19, 2019. From the *School of Medicine, University College Dublin; †School of Medicine, Trinity College Dublin; ‡Department of Trauma & Orthopaedic Surgery, Spine Service, Tallaght University Hospital; and §National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland. The authors declare no conflict of interest. Reprints: Daniel P. Ahern, MB BCh BAO, Department of Surgery, School of Medicine, Trinity College Dublin, Dublin D02R590, Ireland (e-mail: daniel.ahern@umail.ucc.ie). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. CONTROVERSIES IN SPINE SURGERY

European Cells and Materials, 2019

Priming towards a discogenic phenotype and subsequent cryopreservation of microencapsulated bone ... more Priming towards a discogenic phenotype and subsequent cryopreservation of microencapsulated bone marrow stromal cells (BMSCs) may offer an attractive therapeutic approach for disc repair. It potentially obviates the need for in vivo administration of exogenous growth factors, otherwise required to promote matrix synthesis, in addition to providing 'off-the-shelf' availability. Cryopreserved and primed BMSC microcapsules were evaluated in an in vitro surrogate co-culture model system with nucleus pulposus (NP) cells under intervertebral disc (IVD)-like culture conditions and in an ex vivo bovine organ culture disc model. BMSCs were microencapsulated in alginate microcapsules and primed for 14 d with transforming growth factor beta-3 (TGF-β3) under low oxygen conditions prior to cryopreservation. For the in vitro phase, BMSC microcapsules (unprimed or primed) were cultured for 28 d in a surrogate co-culture model system mimicking that of the IVD. For the ex vivo phase, microcapsules (unprimed or primed) were injected into the NP of bovine discs that underwent nucleotomy. In vitro results revealed that although NP cells produced significantly more matrix components in co-culture with BMSC microcapsules regardless of the differentiation state, unprimed microcapsules were inadequate at synthesising matrix as compared to primed microcapsules. However, this difference was diminished when evaluated in the ex vivo organ culture model, with both unprimed and primed BMSC microcapsules accumulating large amounts of sulphated glycosaminoglycan (sGAG) and collagen and filling the defect cavity. Both models demonstrated that cryopreservation of BMSC microcapsules may offer a feasible strategy for predesigned delivery through cryobanking for on-demand regeneration of the IVD.

Neurogastroenterology & Motility, 2019

Objective: We identified a pedigree over 5 generations with 49 members, some of whom had chronic ... more Objective: We identified a pedigree over 5 generations with 49 members, some of whom had chronic megacolon presenting in adolescence or adulthood. We aimed to assess the genetic cause of chronic megacolon through clinical and DNA studies.

United European gastroenterology journal, 2016

Gastrointestinal symptoms are frequent in multiple endocrine neoplasia (MEN) 2B and may be relate... more Gastrointestinal symptoms are frequent in multiple endocrine neoplasia (MEN) 2B and may be related to megacolon. The objective of this article is to review the clinical features of patients with MEN 2B, particularly megacolon. We used natural language processing of electronic medical records of Mayo Clinic patients over 20 years: Eight patients with definite MEN 2B were identified; of these, four had megacolon. From these patients' records, three others with paper medical records were identified through familial association. We used a standard data sheet to identify features of the disease with particular emphasis on megacolon. Of the 11 patients identified with MEN 2B, seven (63%) had megacolon, typically presenting with constipation in infancy or megacolon in childhood. In addition, three patients had esophageal manifestations (two achalasia and one Zenker's diverticulum). Megacolon often required surgical intervention for intractable constipation, abdominal distension and...

Mesentery and Peritoneum, 2020

Journal of Frailty, Sarcopenia and Falls

activities of daily living (ADLs), in addition to increased rates of hospitalization and overall ... more activities of daily living (ADLs), in addition to increased rates of hospitalization and overall mortality 3,4. Of importance to this study, sarcopenia has been hypothesised as an influential factor in the prevalence of back pain 5,6 .

Introduction<br>Small for gestational age (SGA) defines infants whose birth weight or crown... more Introduction<br>Small for gestational age (SGA) defines infants whose birth weight or crown-heel length is 2 standard deviations (SDs) below the mean for their appropriate gestational age (AGA). Approximately 3-5% of neonates are born SGA. This cohort is estimated to account for 1 in 5 children (and adults) who are short in stature. SGA is associated with poor outcomes in terms of growth and metabolism. Understanding population distributions of growth outcomes will aid consideration of treatments such as growth hormone in a paediatric population. Data from the 'Growing Up in Ireland' (GUI) longitudinal study is explored.<br><br>Materials and MethodsBirth height was standardised according to gestational age and sex. Childhood growth measures were standardised for sex. Distributions of outcome variables were examined using robust graphical methods. Univariate poisson regression was employed to examine the relative risk of SGA on quintiles of growth outcomes a...

The Surgeon, 2021

Clinical Spine Surgery: A Spine Publication, 2020

The Bone & Joint Journal, 2020

Clinical Spine Surgery, 2019

The Surgeon, 2019

Clinical Spine Surgery, 2019

European Cells and Materials, 2019

Neurogastroenterology & Motility, 2019

United European gastroenterology journal, 2016

Mesentery and Peritoneum, 2020

Journal of Frailty, Sarcopenia and Falls