Harry Akoto | University of Cape Coast (original) (raw)
Papers by Harry Akoto
Spine Deformity
STUDY DESIGN Retrospective review of consecutive series. OBJECTIVE To assess the clinical and rad... more STUDY DESIGN Retrospective review of consecutive series. OBJECTIVE To assess the clinical and radiographic outcomes after surgical management of post-tuberculous kyphosis. Post-tuberculous (TB) kyphosis can lead to progressive pulmonary and neurological deterioration. Surgery is indicated to decompress neural elements and correct the spine deformity. Although posterior vertebral column resection (PVCR) has been established as the treatment of choice for severe TB kyphosis, there is paucity of studies on the clinical outcomes among patients treated in West Africa. METHODS Clinical and radiographic data of 57 patients (pts) who underwent surgical correction of post-TB kyphosis at a single site in West Africa between 2013 and 2018 (≥ 2-year follow-up in 36 pts, ≥ 1-year FU in 21 pts). Pre- and post-op SRS scores and radiographic outcomes were compared using Paired t test. RESULTS 57 patients, 36M:21F. Mean age 19 (11-57 years). 22/57 pts (39.3%) underwent pre-op halo gravity traction (HGT) for an average duration of 86 days (8-144 days). HGT pts had a higher baseline regional kyphosis (125.1 ± 20.9) compared to non-HGT pts (64.6 ± 31.8, p < 0.001). Post-HGT regional kyphosis corrected to 101.2 ± 23 (24° correction). 53 pts (92.9%) underwent posterior-only surgery and 4 (7.0%) combined anterior-posterior surgery. 39 (68.4%) had PVCR, 11 (19.3%) PSO, and 16 (28.1%) thoracoplasty. Intraoperative neuromonitoring (IOM) signal changes occurred in 23/57 pts (≈ 40%), dural tear in 5 pts (8.8%), pleural tear in 3 pts (5.3%), ureteric injury in 1 pt (1.7%), and vascular injury in 1 pt (1.7%). Post-op complications included four (7.0%) infection, three (5.3%) implant related, two (3.5%) radiographic (one PJK and one DJK), one (1.7%) neurologic, one (1.7%) wound problem, and two (3.5%) sacral ulcers. IOM changes were similar in the VCR (48.7%) and non-VCR (23.5%) pts, p > 0.05. Complication rates were similar among HGT and non-HGT groups. Significant improvements from baseline were seen in the average SRS Total and domains scores and radiographic measurements for patients who attained 2-year follow-up. CONCLUSION PVCR ± HGT can provide safe and optimal correction in cases of severe post-TB kyphosis with good clinical and radiographic outcomes in underserved regions.
Spine Deformity, 2022
STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate ... more STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction. Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studies have looked at the effect of implant density on severe curves > 100 deg or treated with vertebral column resection (VCR). METHODS 250/311 pts with 2-year f/u enrolled in the FOX pediatric database from 17 international sites were queried for the impact of implant density and surgical outcomes. Patients were grouped into three implant density categories for comparative analysis Group 1 (density ≤ 1), Group 2 (1 < density < 1.5) and Group 3 (density; 1.5-2). RESULTS 250 pts: 47 (Grp1)/99 (Grp2) /104 (Grp3); Pre-op age and etiology and curve types were similar in all groups, but body mass index (BMI) was higher in Grp3. Grps 1 and 2 had significantly higher sagittal deformity angular ratio (S-DAR) compared to Grp 3 (p < 0.001). Pre-op Halo Gravity Traction (HGT) was used in 55.3%/44.4%/31.7%, p = 0.017; Grp1/Grp2/Grp3, respectively. Average duration of surgery (min) was higher in Grp3 relative to Grp1 only: 352.5/456.5/515.0, p = 0.0029. Blood loss was similar in all Grps. Rate of VCR, PSO and SPO was similar in all Grps. Pre-op Coronal Cobb avg 96.1/83.6/88.6, p = 0.2342, attained similar correction after HGT (24.6%/27.2%/23.2%, p = 0.4864. Coronal Cobb corrections at 2-year follow-up (FU) were (37.1%/40.3%/53.5%, p = 0.0004). Pre-op sagittal Cobb was (105.4/101.9/75.9, p < 0.01.), achieved similar %correction in HGT (19.1%/22.3%/22.5%, p = 0.6851) and at 2-year FU (39.6%/41.4%/29.8%, p = 0.1916). After adjusting for C-DAR, S-DAR, pre-op coronal and sagittal Cobb, etiology, curve types, age, BMI and number of rods in multivariate analysis, the odds of developing post-operative implant complication was 11 times greater in group 1 compared to group 3 (OR = 11.17,95% CI 2.34-53.32). There was significant improvement in SRS scores in all Grps at 2-year FU. CONCLUSION Although higher implant density was observed to be associated with greater curve correction and lower rates of post-operative implant-related complication and revision in heterogeneous case groups, the results may not imply causality of implant density on the outcomes in severe pediatric spine reconstruction.
Global Spine Journal, 2021
Study Design: Retrospective review of consecutive series. Objective: The study sought to assess t... more Study Design: Retrospective review of consecutive series. Objective: The study sought to assess the effect of prolonged pre-operative halo gravity traction (HGT) on the c-spine radiographs Methods: Data of 37 pediatric and adult patients who underwent ≥ 12wks pre-op HGT prior to definitive spine surgery from 2013-2015 at a single site in West Africa was reviewed. Radiographic assessment of the c-spine including ADI, SVA and C2-C7 Lordosis were done at pre HGT and at 4 weekly intervals. Paired T-Test was performed to evaluate changes in these parameters during HGT. Results: 37pts, 18/19 (F/M). Average age 18.2yrs. Diagnoses: 22 idiopathic, 6 congenital, 3 Post TB, 2 NM and 4 NF. Average duration of HGT: 125 days. Baseline coronal Cobb:130 deg, corrected 30% in HGT; baseline sagittal Cobb:146 deg, corrected 32% post HGT. Baseline ADI (3.17 ± 0.63 mm) did not change at 4wks ( P > 0.05) but reduced at 8wks (2.80 ± 0.56 mm) and 12wks (2.67 ± 0.51 mm) post HGT ( P < 0.05). Baseline ...
Ghana Medical Journal, 2021
Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haem... more Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) incomplex spine surgery. Design: Prospective comparative cohort studySetting: A private orthopaedic hospital in GhanaPatients: Seventy-six patients who underwent complex spine deformity surgeryInterventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution(ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively.Main Outcome Measures: Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications.Results: The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Bloo...
Clinical Research and Clinical Trials, 2021
Objectives: This study assesses the knowledge, attitude, practice and perceived barriers to subje... more Objectives: This study assesses the knowledge, attitude, practice and perceived barriers to subject recruitment into randomized controlled trials, and determine strategies to maximize subject recruitment and retention. Methods: A cross sectional, quantitative survey of 73 physicians working in Ghana was conducted assessing their knowledge and attitude towards randomized controlled trials, subject recruitment practices, self-reported barriers to subject recruitment and strategies to enhance subject recruitment. Results: Responses from 73 Ghanaian physicians were analyzed. 23 (31.5%) respondents knew of ongoing clinical trials in their specialty in Ghana while 32 (43.8%) physicians knew about trials in their specialties in various places in the world. 23 (31.5%) physicians responded that they had referred patients for recruitment into clinical trials before. 49 (67.1%) respondents had never referred any patient for recruitment into clinical trials. Conclusion: Most Ghanaian doctors ar...
Spine Deformity, 2020
Study Design Prospective case series Objective Results of surgical treatment of complex vertebral... more Study Design Prospective case series Objective Results of surgical treatment of complex vertebral transposition "Gamma Deformity" > 180 degrees with halo gravity traction (HGT) and vertebral column resection (VCR). Summary of background data We recently published a novel classification system for complex spine deformities of which complex vertebral transposition > 180 degrees (Gamma; type 3) was described. Halo gravity traction (HGT) has been shown to mitigate surgical risk in complex spine deformity correction and in some cases obviates the need for three-column osteotomy. However, we are not aware of report of its utilization in treating Gamma deformities with or without vertebral column resection (VCR). Methods A consecutive series of 13 patients with Gamma deformity (GD) were prospectively enrolled at a single site in West Africa. Standard radiographs and 3D computerized tomography (CT) were done to assess coronal and sagittal vertebral transposition (CVT and SVT). The HGT with 50% of body weight was applied over several weeks followed by VCR. Demographics, operative data, radiographic parameters, and complications data were collected. Results 13 pts with GD underwent HGT for an avg of 110 days prior to definitive surgery. Etiologies were Congenital-11 pts and Neurofibromatosis-2 pts. Average age: 17.8 years; Pts were reviewed at 3 months post-op and at minimum 2-year follow-up. Preop myelopathy was present in five patients. Pre-op CVT avg 75% and was corrected in all cases post-op. SVT avg 211 deg and improved with HGT by 36% and corrected to 53 deg (74% correction) post-op. Thoracic kyphosis avg-42 deg and averaged 48 deg post-op. Intra-op spinal cord monitoring (SCM) alerts occurred in 8 pts (61%). Post-operative LEM deficits occurred in 5 pts: 2 fully recovered by 3 months and 2 year follow-up, while the remaining 3 improved but had residual motor deficits at final follow-up. There was one post-operative mortality. Conclusion The management of complex vertebral transposition (Gamma deformity) > 180 degrees with HGT prior to VCR is not only effective in some patients, but also associated with high SCM alerts and neurologic injury rates. Myelopathic patients with thoracic deformities are at higher risk of developing permanent neurologic deficits. Surgeons should be aware of this rare and unusual deformity and consider HGT and VCR bearing in mind the technical challenges and high complication rate.
Spine Deformity, 2020
Study design Prospective multicenter international observational study. Objective To investigate ... more Study design Prospective multicenter international observational study. Objective To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery. Summary of background data The SRS M&M reports identify pediatric patients as having higher rate of new neurologic deficit compared with adults, while congenital and neuromuscular deformities are associated with higher new neurologic risks. Very few studies have had the large numbers of pediatric patients with curves exceeding 100 deg to ascertain the new neurologic deficit (NND) rates and recovery patterns as it relates to curve laterality and diagnosis. Method The FOX pediatric database from 17 international sites was queried for New Neurologic Deficit (NND) as characterized by change in American Spinal Injury Association (ASIA) Lower or Upper Extremity Motor Score. Recovery rates at specific intervals were recorded and related to the curve type and etiology. Results Data of 286 consecutive patients with normal pre-operative neurologic exams were reviewed. There were 160 females vs 125 males with an average age of 14.6 years. NND occurred in 27 patients (9.4%) in the immediate post-operative period. Diagnostic categories included idiopathic scoliosis (3 patients); idiopathic kyphoscoliosis(5 patients); congenital scoliosis (7 patients); congenital kyphoscoliosis (4 patients); congenital kyphosis (6 patients), other kyphosis (1 patient) and syndromic (1 patient). 1 patient was lost to follow-up (f/u) after discharge; 1 had chronic deficits at the first post-operative erect visit (from discharge to 9 months f/u) and was subsequently lost to follow-up; 2 patients were improving at 1-year f/u but lost to subsequent f/u. 16 patients had normal neurologic function by the time of the first post-operative erect visit, 21 patients at 1-year f/u and 21 patients at the 2-year f/u. 2 patients (0.69%) had improved NND at 2-year mark. Conclusion A significant proportion of patients with complex spine deformity experience NND. However, significant improvement in neurologic function can be expected over time as seen in this study without additional surgical intervention in most cases. Congenital deformities accounted for 63% of the patients experiencing NND.
![Research paper thumbnail of Corrigendum to Incidence and Risk Factors for Major Surgical Complications in Patients With Complex Spinal Deformity: A Report From an SRS GOP Site [Spine Deformity 3 (2015) 57–64]](https://attachments.academia-assets.com/96513591/thumbnails/1.jpg)
](Spine Deformity, 2019
The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papad... more The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papadopoulus'' in the article. The correct name of the author should be displayed as ''Elias C. Papadopoulos''. The authors would like to apologise for any inconvenience caused.
![Research paper thumbnail of Corrigendum to Surgical Risk Stratification Based on Preoperative Risk Factors in Severe Pediatric Spinal Deformity Surgery [Spine Deformity 2 (2014) 340–349]](https://attachments.academia-assets.com/96513588/thumbnails/1.jpg)
](Spine Deformity, 2019
The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papad... more The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papadopoulus'' in the article. The correct name of the author should be displayed as ''Elias C. Papadopoulos''.
Spine Deformity, 2015
Study Design: Retrospective analysis of a prospectively collected single-center database. Objecti... more Study Design: Retrospective analysis of a prospectively collected single-center database. Objectives: To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site. Summary of Background Data: Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown. Methods: A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits. Results: Major complications were seen in 85 cases, which consisted of neurologic deficits (n 5 27; 17 transient and 10 permanent), wound infections (n 5 17), implant-related problems (n 5 35), progressive deformity (n 5 13), and death (n 5 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA
Spine Deformity, 2018
Large stiff curves achieve comparable correction to flexible curves using preop HGT. The HGT pati... more Large stiff curves achieve comparable correction to flexible curves using preop HGT. The HGT patients had better maintenance of curve correction at over 2 year f/u indicating its effects may persist the long term effects of HGT. Hypothesis: HGT results in improved initial correction and subsequent maintenance of correction in patients with large stiff curves. Introduction: Treatment of severe scoliosis with HGT prior to MCGR has not been previously reported. Complication rates range from 0-100%. With an ave 44% initial correction of the major curve reported in the literature. Loss of correction and diminishing returns are the norm. Methods: IRB approved retrospective single site cohort study of a prospective database. 42 patients underwent MCGR between 2014-17, 12 with prior growing constructs were excluded, 30 patients were included, 12 patients underwent preop HGT. Results: HGT group major curve averaged 90o (69-114o) vs 77o (56-113o) in the non HGT group p5 0.018. Preop bending films accounted for 72% of the total correction achieved in the non-HGT group vs 27% in the non-HGT group. An additional 45% of the total correction was achieved in traction. Comparable correction occurred intratop. See table 1. At most recent followup the HGT group maintained their correction better than the nonHGT group p50.019 gaining 2 o of correction vs a 6 o loss of in the nonHGT group. Ave follow-up was 878vs 804 days in the HGT vs nonHGT groups. Conclusion: Large, rigid curves can achieve equivalent correction to flexible curves with HGT. 43% of the total correction achieved occurred in traction. 30% of the total correction occurred intraoperatively in the HGT group vs 28% in the non-HGT group. At most recent follow-up HGT patients had maintained their major curve correction better than the non-HGT while the numbers are small they are significant because you would expect them to do worse. Indicating that HGT continues to effect the patient positively long past the initial implantation.
Background Pulmonary complications are important cause of morbidity and mortality in patients fol... more Background Pulmonary complications are important cause of morbidity and mortality in patients following spinal surgeries. There is paucity of literature on pulmonary complications following complex spine deformity surgery in underserved regions. This study sought to assess the incidence and risk factors of pulmonary complication following complex spine deformity surgery Methods Data of 276 complex spine deformity patients aged 3-25yrs who were consecutively treated at a single site were retrospectively reviewed. Data was analyzed using Stata 14 software. Patients were labelled into two groups: Grp 1: patients with pulmonary complications(N=17) vs Grp 2: patients with no pulmonary complications (N=259). Comparative analysis for risk factors included independent t-test and chi square test for independence. Multivariate logistic regression analysis was also performed. Results The incidence proportion of pulmonary complication was 17/276 (6.1%) (Grp 1) whiles 259 pts had no pulmonary ev...
Spinal Cord, 2016
Introduction: Spinal cord injury (SCI) is a devastating injury, with its effect going beyond the ... more Introduction: Spinal cord injury (SCI) is a devastating injury, with its effect going beyond the injured patient to the care givers and family and with economic implications that can be long lasting. The study determined the occurrence and patterns of SCI and spine injury patterns, treatment and treatment outcomes in a large tertiary health facility in Ghana. Methods: This was a retrospective review of health records of patients at the Korle bu Teaching Hospital, Ghana. Data on 185 patients were collected over a period of 18 months from September 2012 to February 2014. Data were collected on basic demographic characteristics (age distribution), cause of SCI, type and severity of injuries, mode of transportation to the hospital and treatment modalities. In addition, data were collected on the imaging techniques used, waiting time and delays encountered, complications and follow-up. Descriptive statistics were used to analyze data using Windows Excel 2007 version. Results: A total of 185 patients were treated in the study period, 125 (67.6%) patients had cervical spine injury, 33 (17.8%) had thoracic spine injuries and 27 (14.6%) had lumbar injuries. In all, 141 (76%) were males. The age range of patients was 4 years to 86 years; mean age was 36.25±13.62 years. Spinal injuries were most common in the 31-45-year age group, followed by 16-30-year group. Most prevalent cause of spinal injury was road traffic accident (RTA), 130 (70.3%), whereas assault was the least common, 5 (2.7%). Delay in getting imaging studies conducted was high; 43 (23%) of the computed tomography scans required were performed after 48 h of admission. Only 76 (41%) patients were able to afford the cost of magnetic resonance imaging. Pressure sore (23%) and pneumonia (21%) were the most common complication during admission. Conclusion: RTA was the most common cause of spinal injuries and occurred in the relatively young population, especially among men. Structured public education and enforcement of road safety measures are imperative. Rapid response to management of patients with SCI at the teaching hospital needs attention by hospital management.
Spine Deformity, 2021
Study design A retrospective review of prospectively collected from patients recruited at a singl... more Study design A retrospective review of prospectively collected from patients recruited at a single center. Purpose To test whether safe and optimal correction can be obtained with preoperative halo-gravity traction and posterior spinal fusion with adjunctive procedures but without VCR. Summary and background Posterior vertebral column resection(VCR) is gaining popularity for correction of severe spinal deformity. However, it is a highly technically demanding procedure with potential risk for complications and neurological injury. Methods In total, 72 patients with severe spinal deformity (Cobb angle > 100º) who underwent HGT followed by definitive PSF with PCO, with or without concave rib osteotomy and thoracoplasty. Demographic and surgical data were collected. Conventional coronal and sagittal radiographic measurements were obtained pre-traction, post-traction, post-op and at follow-up to determine the final deformity correction. Postoperative neurological and major complications were reviewed. We used Chi-square to compare proportion between groups and t test to compare groups in quantitative/ordinal variables. Results There were 72 patients (35 females, 37 males). The etiology was congenital (21),idiopathic (45), neurofibromatosis (2) and neuromuscular (4). The mean was: age 18 ± 4.6 years; duration of HGT 103 ± 35 days; coronal Cobb angle before traction 131.5 ± 21.4º vs 92. ± 15.9º after HGT (30% correction) and 72.8 ± 12.7º after fusion (47% correction); kyphosis angle before traction 134.7 ± 32.3º vs 97.1 ± 22.4º after HGT and 73.7 ± 21.3º post-fusion. Number of fusion levels 14 ± 1; EBL 1730 ± 744 cc; number of PCOs done 5 ± 2; number of concave rib osteotomies (2 ± 2). There were 16 patients with postoperative complications (22.2%), 10 medical, one wound infection, 2 implant related and 3 post-op neuro-deficits (all of whom recovered at follow-up). There was one death (cardiac arrest). Conclusion HGT and one-stage posterior fusion with PCO, with or without concave rib resection and thoracoplasty, without VCR, achieved satisfactory correction of rigid complex spine deformity with minimal neurological complications. The results compare favorably with previous reports of similar deformities treated with VCR. Level of Evidence III.
SPINE
Study Design. Retrospective review of prospective cohort. Objective. We sought to examine the rol... more Study Design. Retrospective review of prospective cohort. Objective. We sought to examine the role of halo gravity traction (HGT) in reducing preoperative surgical risk. Summary of Background Data. The impact of HGT on procedure choice, preoperative risk factors, and surgical complications has not been previously described. Methods. Patients treated with HGT before primary surgery were included. The FOCOS Score (FS) was used to quantify operative risk. FS was calculated using patient-factors (ASIA, body mass index, etiology), procedure-factors (PcF; osteotomy planned, number of levels fused, etc.), and curve magnitude (CM). Scores ranged from 0 to 100 with higher scores indicating increased risk. FS was calculated before and after HGT to see how changes in FS affected complication rates. Results. A total of 96 patients were included. Halo-related complications occurred in 34% of patients but revision was required in only 8.3%. Average FS improved by 18 points after HGT. CM, PcF, and patient-factors all improved (P < 0.05). The greatest changes were in CM and PcF. The planned rate of three-column osteotomies dropped from 91% to 38% after HGT. FS (area under the curve [AUC]: 0.68, P = 0.023) and change in FS (AUC: 0.781, P < 0.001) was successfully able to predict the rate of surgical complications. A preoperative FS of 74 was identified as a cut-off for a higher rate of surgical complications (sensitivity 58.8%, specificity 74.7%). Patients with a reduction in FS < = 10pts were five times more likely to have a complication (relative risk 5.2, 95% confidence interval: 1.9–14.6, P < 0.001). A multivariate regression showed that change in FS was an independent predictor of complication rates (P < 0.05). Conclusion. FS can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative HGT can reduce FS and surgical risk by improving CM, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after HGT predicts a lower rate of surgical complications. Level of Evidence: 3
European Spine Journal
Purpose For spine curvatures with Cobb angles > 100°, curve classification and characterization b... more Purpose For spine curvatures with Cobb angles > 100°, curve classification and characterization become more difficult with conventional radiographs. 3-D computerized axial tomography scans add relevant information to categorize and describe a new classification to aid preoperative assessment in communication and patient evaluation. The purpose of this study is to describe a radiographic classification system of curves exceeding 100°. Methods A consecutive series of patients with curves exceeding 100° underwent a full spine radiographic review using conventional radiographs and 3-D CT. A descriptive analysis was performed to categorize curves into 4 main types (1, 2, 3 and 4) and 6 subtypes (1C, 1S, 1CS, 2P, 2D and 2PD) based on the location of the Cobb angle of the major scoliotic and kyphotic deformity as well as the location of the upper/lower end vertebra relative to the apical vertebra. Results A total of 98 patients met the inclusion criteria. There were 51 males and 47 females with an average age of 17.8 ± 4.5 years. The diagnosis included idiopathic (48); congenital (24); neuromuscular (4); and neurofibromatosis (2). The mean major coronal and sagittal Cobb (kyphosis) were 131.2° ± 23.4° and 154 ± 45.6, respectively. The classification scheme yielded 4 main types (1, 2, 3 and 4) and 6 subtypes under types 1 and 2 (1C, 1S, 1CS, 2P, 2D and 2PD). Conclusions Our study describes a novel method of classifying severe spinal curvatures exceeding 100° using erect AP/ lateral radiographs and 3-D CT reconstructive images. We hope that the descriptive analysis and classification will expand our understanding of these complex deformities.
World neurosurgery, Jan 5, 2016
Treatment of hydrocephalus by shunting procedure is associated with variable outcomes, depending ... more Treatment of hydrocephalus by shunting procedure is associated with variable outcomes, depending on the setting. Results from some published series in sub-Saharan Africa are not as good and various reasons have been given. This study presents preliminary findings of 109 cases of shunted hydrocephalus in children in a three-year period. The main aim of the study was to evaluate the complications of the procedure in a tertiary care centre. It also seeks to identify ways of reducing such complications where appropriate in subsequent shunt placement procedures. A single-institutional, retrospective study was conducted by reviewing124 patients who had ventriculoperitoneal shunting (VPS) including revisions and subgroup analysis was done in 109 patients less than 18 years old classified as children who had first-time shunt placement;between January 2011 and December 2013. Data analysis was done using Microsoft Excel and SPSS (Version 20.0). The mean age at shunt insertion of the subgroup ...
Spine Deformity
STUDY DESIGN Retrospective review of consecutive series. OBJECTIVE To assess the clinical and rad... more STUDY DESIGN Retrospective review of consecutive series. OBJECTIVE To assess the clinical and radiographic outcomes after surgical management of post-tuberculous kyphosis. Post-tuberculous (TB) kyphosis can lead to progressive pulmonary and neurological deterioration. Surgery is indicated to decompress neural elements and correct the spine deformity. Although posterior vertebral column resection (PVCR) has been established as the treatment of choice for severe TB kyphosis, there is paucity of studies on the clinical outcomes among patients treated in West Africa. METHODS Clinical and radiographic data of 57 patients (pts) who underwent surgical correction of post-TB kyphosis at a single site in West Africa between 2013 and 2018 (≥ 2-year follow-up in 36 pts, ≥ 1-year FU in 21 pts). Pre- and post-op SRS scores and radiographic outcomes were compared using Paired t test. RESULTS 57 patients, 36M:21F. Mean age 19 (11-57 years). 22/57 pts (39.3%) underwent pre-op halo gravity traction (HGT) for an average duration of 86 days (8-144 days). HGT pts had a higher baseline regional kyphosis (125.1 ± 20.9) compared to non-HGT pts (64.6 ± 31.8, p < 0.001). Post-HGT regional kyphosis corrected to 101.2 ± 23 (24° correction). 53 pts (92.9%) underwent posterior-only surgery and 4 (7.0%) combined anterior-posterior surgery. 39 (68.4%) had PVCR, 11 (19.3%) PSO, and 16 (28.1%) thoracoplasty. Intraoperative neuromonitoring (IOM) signal changes occurred in 23/57 pts (≈ 40%), dural tear in 5 pts (8.8%), pleural tear in 3 pts (5.3%), ureteric injury in 1 pt (1.7%), and vascular injury in 1 pt (1.7%). Post-op complications included four (7.0%) infection, three (5.3%) implant related, two (3.5%) radiographic (one PJK and one DJK), one (1.7%) neurologic, one (1.7%) wound problem, and two (3.5%) sacral ulcers. IOM changes were similar in the VCR (48.7%) and non-VCR (23.5%) pts, p > 0.05. Complication rates were similar among HGT and non-HGT groups. Significant improvements from baseline were seen in the average SRS Total and domains scores and radiographic measurements for patients who attained 2-year follow-up. CONCLUSION PVCR ± HGT can provide safe and optimal correction in cases of severe post-TB kyphosis with good clinical and radiographic outcomes in underserved regions.
Spine Deformity, 2022
STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate ... more STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction. Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studies have looked at the effect of implant density on severe curves > 100 deg or treated with vertebral column resection (VCR). METHODS 250/311 pts with 2-year f/u enrolled in the FOX pediatric database from 17 international sites were queried for the impact of implant density and surgical outcomes. Patients were grouped into three implant density categories for comparative analysis Group 1 (density ≤ 1), Group 2 (1 < density < 1.5) and Group 3 (density; 1.5-2). RESULTS 250 pts: 47 (Grp1)/99 (Grp2) /104 (Grp3); Pre-op age and etiology and curve types were similar in all groups, but body mass index (BMI) was higher in Grp3. Grps 1 and 2 had significantly higher sagittal deformity angular ratio (S-DAR) compared to Grp 3 (p < 0.001). Pre-op Halo Gravity Traction (HGT) was used in 55.3%/44.4%/31.7%, p = 0.017; Grp1/Grp2/Grp3, respectively. Average duration of surgery (min) was higher in Grp3 relative to Grp1 only: 352.5/456.5/515.0, p = 0.0029. Blood loss was similar in all Grps. Rate of VCR, PSO and SPO was similar in all Grps. Pre-op Coronal Cobb avg 96.1/83.6/88.6, p = 0.2342, attained similar correction after HGT (24.6%/27.2%/23.2%, p = 0.4864. Coronal Cobb corrections at 2-year follow-up (FU) were (37.1%/40.3%/53.5%, p = 0.0004). Pre-op sagittal Cobb was (105.4/101.9/75.9, p < 0.01.), achieved similar %correction in HGT (19.1%/22.3%/22.5%, p = 0.6851) and at 2-year FU (39.6%/41.4%/29.8%, p = 0.1916). After adjusting for C-DAR, S-DAR, pre-op coronal and sagittal Cobb, etiology, curve types, age, BMI and number of rods in multivariate analysis, the odds of developing post-operative implant complication was 11 times greater in group 1 compared to group 3 (OR = 11.17,95% CI 2.34-53.32). There was significant improvement in SRS scores in all Grps at 2-year FU. CONCLUSION Although higher implant density was observed to be associated with greater curve correction and lower rates of post-operative implant-related complication and revision in heterogeneous case groups, the results may not imply causality of implant density on the outcomes in severe pediatric spine reconstruction.
Global Spine Journal, 2021
Study Design: Retrospective review of consecutive series. Objective: The study sought to assess t... more Study Design: Retrospective review of consecutive series. Objective: The study sought to assess the effect of prolonged pre-operative halo gravity traction (HGT) on the c-spine radiographs Methods: Data of 37 pediatric and adult patients who underwent ≥ 12wks pre-op HGT prior to definitive spine surgery from 2013-2015 at a single site in West Africa was reviewed. Radiographic assessment of the c-spine including ADI, SVA and C2-C7 Lordosis were done at pre HGT and at 4 weekly intervals. Paired T-Test was performed to evaluate changes in these parameters during HGT. Results: 37pts, 18/19 (F/M). Average age 18.2yrs. Diagnoses: 22 idiopathic, 6 congenital, 3 Post TB, 2 NM and 4 NF. Average duration of HGT: 125 days. Baseline coronal Cobb:130 deg, corrected 30% in HGT; baseline sagittal Cobb:146 deg, corrected 32% post HGT. Baseline ADI (3.17 ± 0.63 mm) did not change at 4wks ( P > 0.05) but reduced at 8wks (2.80 ± 0.56 mm) and 12wks (2.67 ± 0.51 mm) post HGT ( P < 0.05). Baseline ...
Ghana Medical Journal, 2021
Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haem... more Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) incomplex spine surgery. Design: Prospective comparative cohort studySetting: A private orthopaedic hospital in GhanaPatients: Seventy-six patients who underwent complex spine deformity surgeryInterventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution(ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively.Main Outcome Measures: Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications.Results: The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Bloo...
Clinical Research and Clinical Trials, 2021
Objectives: This study assesses the knowledge, attitude, practice and perceived barriers to subje... more Objectives: This study assesses the knowledge, attitude, practice and perceived barriers to subject recruitment into randomized controlled trials, and determine strategies to maximize subject recruitment and retention. Methods: A cross sectional, quantitative survey of 73 physicians working in Ghana was conducted assessing their knowledge and attitude towards randomized controlled trials, subject recruitment practices, self-reported barriers to subject recruitment and strategies to enhance subject recruitment. Results: Responses from 73 Ghanaian physicians were analyzed. 23 (31.5%) respondents knew of ongoing clinical trials in their specialty in Ghana while 32 (43.8%) physicians knew about trials in their specialties in various places in the world. 23 (31.5%) physicians responded that they had referred patients for recruitment into clinical trials before. 49 (67.1%) respondents had never referred any patient for recruitment into clinical trials. Conclusion: Most Ghanaian doctors ar...
Spine Deformity, 2020
Study Design Prospective case series Objective Results of surgical treatment of complex vertebral... more Study Design Prospective case series Objective Results of surgical treatment of complex vertebral transposition "Gamma Deformity" > 180 degrees with halo gravity traction (HGT) and vertebral column resection (VCR). Summary of background data We recently published a novel classification system for complex spine deformities of which complex vertebral transposition > 180 degrees (Gamma; type 3) was described. Halo gravity traction (HGT) has been shown to mitigate surgical risk in complex spine deformity correction and in some cases obviates the need for three-column osteotomy. However, we are not aware of report of its utilization in treating Gamma deformities with or without vertebral column resection (VCR). Methods A consecutive series of 13 patients with Gamma deformity (GD) were prospectively enrolled at a single site in West Africa. Standard radiographs and 3D computerized tomography (CT) were done to assess coronal and sagittal vertebral transposition (CVT and SVT). The HGT with 50% of body weight was applied over several weeks followed by VCR. Demographics, operative data, radiographic parameters, and complications data were collected. Results 13 pts with GD underwent HGT for an avg of 110 days prior to definitive surgery. Etiologies were Congenital-11 pts and Neurofibromatosis-2 pts. Average age: 17.8 years; Pts were reviewed at 3 months post-op and at minimum 2-year follow-up. Preop myelopathy was present in five patients. Pre-op CVT avg 75% and was corrected in all cases post-op. SVT avg 211 deg and improved with HGT by 36% and corrected to 53 deg (74% correction) post-op. Thoracic kyphosis avg-42 deg and averaged 48 deg post-op. Intra-op spinal cord monitoring (SCM) alerts occurred in 8 pts (61%). Post-operative LEM deficits occurred in 5 pts: 2 fully recovered by 3 months and 2 year follow-up, while the remaining 3 improved but had residual motor deficits at final follow-up. There was one post-operative mortality. Conclusion The management of complex vertebral transposition (Gamma deformity) > 180 degrees with HGT prior to VCR is not only effective in some patients, but also associated with high SCM alerts and neurologic injury rates. Myelopathic patients with thoracic deformities are at higher risk of developing permanent neurologic deficits. Surgeons should be aware of this rare and unusual deformity and consider HGT and VCR bearing in mind the technical challenges and high complication rate.
Spine Deformity, 2020
Study design Prospective multicenter international observational study. Objective To investigate ... more Study design Prospective multicenter international observational study. Objective To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery. Summary of background data The SRS M&M reports identify pediatric patients as having higher rate of new neurologic deficit compared with adults, while congenital and neuromuscular deformities are associated with higher new neurologic risks. Very few studies have had the large numbers of pediatric patients with curves exceeding 100 deg to ascertain the new neurologic deficit (NND) rates and recovery patterns as it relates to curve laterality and diagnosis. Method The FOX pediatric database from 17 international sites was queried for New Neurologic Deficit (NND) as characterized by change in American Spinal Injury Association (ASIA) Lower or Upper Extremity Motor Score. Recovery rates at specific intervals were recorded and related to the curve type and etiology. Results Data of 286 consecutive patients with normal pre-operative neurologic exams were reviewed. There were 160 females vs 125 males with an average age of 14.6 years. NND occurred in 27 patients (9.4%) in the immediate post-operative period. Diagnostic categories included idiopathic scoliosis (3 patients); idiopathic kyphoscoliosis(5 patients); congenital scoliosis (7 patients); congenital kyphoscoliosis (4 patients); congenital kyphosis (6 patients), other kyphosis (1 patient) and syndromic (1 patient). 1 patient was lost to follow-up (f/u) after discharge; 1 had chronic deficits at the first post-operative erect visit (from discharge to 9 months f/u) and was subsequently lost to follow-up; 2 patients were improving at 1-year f/u but lost to subsequent f/u. 16 patients had normal neurologic function by the time of the first post-operative erect visit, 21 patients at 1-year f/u and 21 patients at the 2-year f/u. 2 patients (0.69%) had improved NND at 2-year mark. Conclusion A significant proportion of patients with complex spine deformity experience NND. However, significant improvement in neurologic function can be expected over time as seen in this study without additional surgical intervention in most cases. Congenital deformities accounted for 63% of the patients experiencing NND.
Spine Deformity, 2019
The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papad... more The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papadopoulus'' in the article. The correct name of the author should be displayed as ''Elias C. Papadopoulos''. The authors would like to apologise for any inconvenience caused.
Spine Deformity, 2019
The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papad... more The corresponding author regret that co-author name was incorrectly published as ''Elias C. Papadopoulus'' in the article. The correct name of the author should be displayed as ''Elias C. Papadopoulos''.
Spine Deformity, 2015
Study Design: Retrospective analysis of a prospectively collected single-center database. Objecti... more Study Design: Retrospective analysis of a prospectively collected single-center database. Objectives: To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site. Summary of Background Data: Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown. Methods: A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits. Results: Major complications were seen in 85 cases, which consisted of neurologic deficits (n 5 27; 17 transient and 10 permanent), wound infections (n 5 17), implant-related problems (n 5 35), progressive deformity (n 5 13), and death (n 5 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA
Spine Deformity, 2018
Large stiff curves achieve comparable correction to flexible curves using preop HGT. The HGT pati... more Large stiff curves achieve comparable correction to flexible curves using preop HGT. The HGT patients had better maintenance of curve correction at over 2 year f/u indicating its effects may persist the long term effects of HGT. Hypothesis: HGT results in improved initial correction and subsequent maintenance of correction in patients with large stiff curves. Introduction: Treatment of severe scoliosis with HGT prior to MCGR has not been previously reported. Complication rates range from 0-100%. With an ave 44% initial correction of the major curve reported in the literature. Loss of correction and diminishing returns are the norm. Methods: IRB approved retrospective single site cohort study of a prospective database. 42 patients underwent MCGR between 2014-17, 12 with prior growing constructs were excluded, 30 patients were included, 12 patients underwent preop HGT. Results: HGT group major curve averaged 90o (69-114o) vs 77o (56-113o) in the non HGT group p5 0.018. Preop bending films accounted for 72% of the total correction achieved in the non-HGT group vs 27% in the non-HGT group. An additional 45% of the total correction was achieved in traction. Comparable correction occurred intratop. See table 1. At most recent followup the HGT group maintained their correction better than the nonHGT group p50.019 gaining 2 o of correction vs a 6 o loss of in the nonHGT group. Ave follow-up was 878vs 804 days in the HGT vs nonHGT groups. Conclusion: Large, rigid curves can achieve equivalent correction to flexible curves with HGT. 43% of the total correction achieved occurred in traction. 30% of the total correction occurred intraoperatively in the HGT group vs 28% in the non-HGT group. At most recent follow-up HGT patients had maintained their major curve correction better than the non-HGT while the numbers are small they are significant because you would expect them to do worse. Indicating that HGT continues to effect the patient positively long past the initial implantation.
Background Pulmonary complications are important cause of morbidity and mortality in patients fol... more Background Pulmonary complications are important cause of morbidity and mortality in patients following spinal surgeries. There is paucity of literature on pulmonary complications following complex spine deformity surgery in underserved regions. This study sought to assess the incidence and risk factors of pulmonary complication following complex spine deformity surgery Methods Data of 276 complex spine deformity patients aged 3-25yrs who were consecutively treated at a single site were retrospectively reviewed. Data was analyzed using Stata 14 software. Patients were labelled into two groups: Grp 1: patients with pulmonary complications(N=17) vs Grp 2: patients with no pulmonary complications (N=259). Comparative analysis for risk factors included independent t-test and chi square test for independence. Multivariate logistic regression analysis was also performed. Results The incidence proportion of pulmonary complication was 17/276 (6.1%) (Grp 1) whiles 259 pts had no pulmonary ev...
Spinal Cord, 2016
Introduction: Spinal cord injury (SCI) is a devastating injury, with its effect going beyond the ... more Introduction: Spinal cord injury (SCI) is a devastating injury, with its effect going beyond the injured patient to the care givers and family and with economic implications that can be long lasting. The study determined the occurrence and patterns of SCI and spine injury patterns, treatment and treatment outcomes in a large tertiary health facility in Ghana. Methods: This was a retrospective review of health records of patients at the Korle bu Teaching Hospital, Ghana. Data on 185 patients were collected over a period of 18 months from September 2012 to February 2014. Data were collected on basic demographic characteristics (age distribution), cause of SCI, type and severity of injuries, mode of transportation to the hospital and treatment modalities. In addition, data were collected on the imaging techniques used, waiting time and delays encountered, complications and follow-up. Descriptive statistics were used to analyze data using Windows Excel 2007 version. Results: A total of 185 patients were treated in the study period, 125 (67.6%) patients had cervical spine injury, 33 (17.8%) had thoracic spine injuries and 27 (14.6%) had lumbar injuries. In all, 141 (76%) were males. The age range of patients was 4 years to 86 years; mean age was 36.25±13.62 years. Spinal injuries were most common in the 31-45-year age group, followed by 16-30-year group. Most prevalent cause of spinal injury was road traffic accident (RTA), 130 (70.3%), whereas assault was the least common, 5 (2.7%). Delay in getting imaging studies conducted was high; 43 (23%) of the computed tomography scans required were performed after 48 h of admission. Only 76 (41%) patients were able to afford the cost of magnetic resonance imaging. Pressure sore (23%) and pneumonia (21%) were the most common complication during admission. Conclusion: RTA was the most common cause of spinal injuries and occurred in the relatively young population, especially among men. Structured public education and enforcement of road safety measures are imperative. Rapid response to management of patients with SCI at the teaching hospital needs attention by hospital management.
Spine Deformity, 2021
Study design A retrospective review of prospectively collected from patients recruited at a singl... more Study design A retrospective review of prospectively collected from patients recruited at a single center. Purpose To test whether safe and optimal correction can be obtained with preoperative halo-gravity traction and posterior spinal fusion with adjunctive procedures but without VCR. Summary and background Posterior vertebral column resection(VCR) is gaining popularity for correction of severe spinal deformity. However, it is a highly technically demanding procedure with potential risk for complications and neurological injury. Methods In total, 72 patients with severe spinal deformity (Cobb angle > 100º) who underwent HGT followed by definitive PSF with PCO, with or without concave rib osteotomy and thoracoplasty. Demographic and surgical data were collected. Conventional coronal and sagittal radiographic measurements were obtained pre-traction, post-traction, post-op and at follow-up to determine the final deformity correction. Postoperative neurological and major complications were reviewed. We used Chi-square to compare proportion between groups and t test to compare groups in quantitative/ordinal variables. Results There were 72 patients (35 females, 37 males). The etiology was congenital (21),idiopathic (45), neurofibromatosis (2) and neuromuscular (4). The mean was: age 18 ± 4.6 years; duration of HGT 103 ± 35 days; coronal Cobb angle before traction 131.5 ± 21.4º vs 92. ± 15.9º after HGT (30% correction) and 72.8 ± 12.7º after fusion (47% correction); kyphosis angle before traction 134.7 ± 32.3º vs 97.1 ± 22.4º after HGT and 73.7 ± 21.3º post-fusion. Number of fusion levels 14 ± 1; EBL 1730 ± 744 cc; number of PCOs done 5 ± 2; number of concave rib osteotomies (2 ± 2). There were 16 patients with postoperative complications (22.2%), 10 medical, one wound infection, 2 implant related and 3 post-op neuro-deficits (all of whom recovered at follow-up). There was one death (cardiac arrest). Conclusion HGT and one-stage posterior fusion with PCO, with or without concave rib resection and thoracoplasty, without VCR, achieved satisfactory correction of rigid complex spine deformity with minimal neurological complications. The results compare favorably with previous reports of similar deformities treated with VCR. Level of Evidence III.
SPINE
Study Design. Retrospective review of prospective cohort. Objective. We sought to examine the rol... more Study Design. Retrospective review of prospective cohort. Objective. We sought to examine the role of halo gravity traction (HGT) in reducing preoperative surgical risk. Summary of Background Data. The impact of HGT on procedure choice, preoperative risk factors, and surgical complications has not been previously described. Methods. Patients treated with HGT before primary surgery were included. The FOCOS Score (FS) was used to quantify operative risk. FS was calculated using patient-factors (ASIA, body mass index, etiology), procedure-factors (PcF; osteotomy planned, number of levels fused, etc.), and curve magnitude (CM). Scores ranged from 0 to 100 with higher scores indicating increased risk. FS was calculated before and after HGT to see how changes in FS affected complication rates. Results. A total of 96 patients were included. Halo-related complications occurred in 34% of patients but revision was required in only 8.3%. Average FS improved by 18 points after HGT. CM, PcF, and patient-factors all improved (P < 0.05). The greatest changes were in CM and PcF. The planned rate of three-column osteotomies dropped from 91% to 38% after HGT. FS (area under the curve [AUC]: 0.68, P = 0.023) and change in FS (AUC: 0.781, P < 0.001) was successfully able to predict the rate of surgical complications. A preoperative FS of 74 was identified as a cut-off for a higher rate of surgical complications (sensitivity 58.8%, specificity 74.7%). Patients with a reduction in FS < = 10pts were five times more likely to have a complication (relative risk 5.2, 95% confidence interval: 1.9–14.6, P < 0.001). A multivariate regression showed that change in FS was an independent predictor of complication rates (P < 0.05). Conclusion. FS can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative HGT can reduce FS and surgical risk by improving CM, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after HGT predicts a lower rate of surgical complications. Level of Evidence: 3
European Spine Journal
Purpose For spine curvatures with Cobb angles > 100°, curve classification and characterization b... more Purpose For spine curvatures with Cobb angles > 100°, curve classification and characterization become more difficult with conventional radiographs. 3-D computerized axial tomography scans add relevant information to categorize and describe a new classification to aid preoperative assessment in communication and patient evaluation. The purpose of this study is to describe a radiographic classification system of curves exceeding 100°. Methods A consecutive series of patients with curves exceeding 100° underwent a full spine radiographic review using conventional radiographs and 3-D CT. A descriptive analysis was performed to categorize curves into 4 main types (1, 2, 3 and 4) and 6 subtypes (1C, 1S, 1CS, 2P, 2D and 2PD) based on the location of the Cobb angle of the major scoliotic and kyphotic deformity as well as the location of the upper/lower end vertebra relative to the apical vertebra. Results A total of 98 patients met the inclusion criteria. There were 51 males and 47 females with an average age of 17.8 ± 4.5 years. The diagnosis included idiopathic (48); congenital (24); neuromuscular (4); and neurofibromatosis (2). The mean major coronal and sagittal Cobb (kyphosis) were 131.2° ± 23.4° and 154 ± 45.6, respectively. The classification scheme yielded 4 main types (1, 2, 3 and 4) and 6 subtypes under types 1 and 2 (1C, 1S, 1CS, 2P, 2D and 2PD). Conclusions Our study describes a novel method of classifying severe spinal curvatures exceeding 100° using erect AP/ lateral radiographs and 3-D CT reconstructive images. We hope that the descriptive analysis and classification will expand our understanding of these complex deformities.
World neurosurgery, Jan 5, 2016
Treatment of hydrocephalus by shunting procedure is associated with variable outcomes, depending ... more Treatment of hydrocephalus by shunting procedure is associated with variable outcomes, depending on the setting. Results from some published series in sub-Saharan Africa are not as good and various reasons have been given. This study presents preliminary findings of 109 cases of shunted hydrocephalus in children in a three-year period. The main aim of the study was to evaluate the complications of the procedure in a tertiary care centre. It also seeks to identify ways of reducing such complications where appropriate in subsequent shunt placement procedures. A single-institutional, retrospective study was conducted by reviewing124 patients who had ventriculoperitoneal shunting (VPS) including revisions and subgroup analysis was done in 109 patients less than 18 years old classified as children who had first-time shunt placement;between January 2011 and December 2013. Data analysis was done using Microsoft Excel and SPSS (Version 20.0). The mean age at shunt insertion of the subgroup ...