Papers by Hilali Noordeen
Journal of Bone & Joint Surgery, British Volume, 2006
Background: To quantify the distraction forces required to lengthen a standard subcutaneous domin... more Background: To quantify the distraction forces required to lengthen a standard subcutaneous domino linked two rod construct. This was a seminal piece of work as part of a project to design a magnetic coil driven micro electromechanical internal device that would mitigate the need for surgical lengthenings of these growth rod constructs. Methods: A distraction tool with strain gauge was designed and built in the RNOH Department of Biomechanics and following calibration and testing was used to perform five distraction procedures. Subjects were five patients with early onset progressive scoliosis unresponsive to conservative treatment modalities who have previously had a subcutaneous rodding procedure and are hence having regular lengthenings. Forces were transduced and collected on a laptop computer in theatre running a piece of software specifically written for the experiment. Results: Forces will be displayed in graphical format with correlation with pre- and post-lengthening radiographs. Conclusion: The magnitude of force required to achieve distraction is compatible with that achievable via a magnetic coil driven internal micro electromechanical device that we are currently in the design phase of producing.
The journal of bone and joint surgery, Mar 1, 1996
Background: To assess whether modern instrumentation systems are biomechanically strong enough to... more Background: To assess whether modern instrumentation systems are biomechanically strong enough to allow instrumented fusion to pelvis on the concavity of the major curve only and if this confers a significant advantage with respect to complications rates and disadvantages with respect to correction achieved and fusion rates. Methods: A retrospective review from the notes and radiographs of blood loss, operation time, complication rates, degree of correction and fusion rates. Comparisons drawn with neuromuscular curves of similar aetiology treated by same surgeon using more traditional two rod fusion techniques. Subjects were high risk children with progressive neuromuscular scoliosis of varying aetiology requiring stabilisation. (7 cases to date) We compared operation times, blood loss, complication rates, degree of correction and fusion rates with standard segmental fusion techniques in a similar cohort of children. Basic statistical analysis only required to compare the two groups...
The journal of bone and joint surgery, Sep 1, 2001
European Spine Journal, Sep 27, 2008
A variety of treatments has been described in the literature for the treatment of HV. We report t... more A variety of treatments has been described in the literature for the treatment of HV. We report the results of early surgical anterior instrumented fusion with partial preservation of the HV and posterior non-instrumented fusion in the treatment of progressive congenital scoliosis in children below the age of six. Between 1996 and 2006, 31 consecutive patients with 33 lateral HV and progressive scoliosis underwent short segment fusions. Mean age at surgery was 2 years and 10 months. Mean follow-up period was 6.1 years. The major scoliotic curve improved from 41°preoperatively to 17°on follow-up. Preoperative segmental Cobb angle averaging 39°was corrected to 15°a fter surgery, being 15°at the last follow-up (62% of improvement). Compensatory cranial and caudal curves corrected by 47 and 45%, respectively. The angle of segmental kyphosis averaged 16°before surgery, 11°after surgery, and 11°at follow-up. There were two wound infections requiring surgical debridment, one intraoperative fracture of the vertebral body and one case lost correction due to implant failure. All went on to stable bony union. There were no neurological complications. Early diagnosis and early and aggressive surgical treatment are mandatory for a successful treatment of congenital scoliosis and prevention of the development of secondary compensatory deformities. Anterior instrumentation is a safe and effective technique capable of transmitting a high amount of convex compression allowing short segment fusion, which is of great importance in the growing spine.
European Spine Journal, Jul 4, 2015
The achievement of shoulder balance is an important measure of successful scoliosis surgery. No p... more The achievement of shoulder balance is an important measure of successful scoliosis surgery. No previously described classification system has taken shoulder balance into account. We propose a simple classification system for AIS based on two components which include the curve type and shoulder level. Altogether, three curve types have been defined according to the size and location of the curves, each curve pattern is subdivided into type A or B depending on the shoulder level. This classification was tested for interobserver reproducibility and intraobserver reliability. A retrospective analysis of the radiographs of 232 consecutive cases of AIS patients treated surgically between 2005 and 2009 was also performed. Three major types and six subtypes were identified. Type I accounted for 30 %, type II 28 % and type III 42 %. The retrospective analysis showed three patients developed a decompensation that required extension of the fusion. One case developed worsening of shoulder balance requiring further surgery. This classification was tested for interobserver and intraobserver reliability. The mean kappa coefficients for interobserver reproducibility ranged from 0.89 to 0.952, while the mean kappa value for intraobserver reliability was 0.964 indicating a good-to-excellent reliability. The treatment algorithm guides the spinal surgeon to achieve optimal curve correction and postoperative shoulder balance whilst fusing the smallest number of spinal segments. The high interobserver reproducibility and intraobserver reliability makes it an invaluable tool to describe scoliosis curves in everyday clinical practice.
Spine, Jul 1, 2014
Objective. To determine whether there is improvement in pulmonary function in children with early... more Objective. To determine whether there is improvement in pulmonary function in children with early-onset scoliosis (EOS) using magnetic growth rods (MGRs). Summary of Background Data. EOS deformities have large impacts on lung function and volumes. Deterioration of pulmonary function in scoliosis is multifactorial, including severity, location of apex vertebra, and medical comorbidities. MGR insertion has benefi ts including reduction in operative procedures with repeated anesthetics, cost-effectiveness, and minimizing surgical and psychological distress. Pulmonary function tests provide objective and quantitative information about functional impairment caused by scoliosis. This is the fi rst study that observes the MGR lengthening and changes in pulmonary function during a minimum period of 2.2 years. Methods. Six cases of EOS secondary to neuromuscular disease were identifi ed. Mean age at diagnosis was 2.8 year (2.1-4.9 yr),
Orthopaedic Proceedings, Apr 1, 2012
Orthopaedic Proceedings, Jul 1, 2012
Purpose The aim of this study is to assess the safety and efficacy of a remote-operated magnetic ... more Purpose The aim of this study is to assess the safety and efficacy of a remote-operated magnetic growth rod in the treatment of 11 patients with progressive early onset scoliosis (EOS). Introduction The Growth rod technique (GR) has been a viable treatment option for progressive early onset scoliosis (EOS). However, an increased complication rate has been associated with conventional GR due to frequent surgeries required for lengthening. The safety and efficacy of a remote-operated magnetic growth rod (RO-MGR) has been previously reported in a porcine model. We are reporting the preliminary clinical results of this device which obviates the need for repeated surgeries. Methods Prospective analysis of early clinical and radiographic data of 11 patients, with EOS, undergoing index RO-MGR treatment and at least 3 distractions. The mean age was 8 years (Range 5-12 years). Four patients had single rod (SR) instrumentation and the remaining 7 had a dual rod (DR) construct. Diagnosis was idiopathic 3, neuromuscular 3, congenital 3, syndromic 1 and neurofibromatosis one. In total, 57 rod distractions were performed. Distractions were performed in the clinic without anesthesia or analgesics. The mean preoperative Cobb angle was 68° (range 46°-108°). The mean preoperative T1-S1 length was 304mm (range 243-361mm). Results Average distraction was 3.2 per patient. The mean lag before the first distraction was 66 days (28-112) and between distractions was 43 days (42-98). Superficial infection occurred in 1 (SR), prominent rod in 1 (DR), hook pull-out in 1(DR), iatrogenic shortening 1(DR) and loss of length in 2 patients (6/57 rod distraction, 11%, all SR), this loss was regained in subsequent distractions. Apart from a case of proximal rod trimming, no further surgery was required in our group of patients. Mean follow-up was 8 months (6-13). Conclusion Preliminary results indicate that RO-GR appears to be safe and provided a comparable distraction to the standard GR procedure without the need for repeated open surgeries. No major complications were observed in the short follow up period.
Orthopaedic Proceedings, Jun 1, 2012
Study Design. Prospective, intraoperative force measurement in consecutive lengthening procedures... more Study Design. Prospective, intraoperative force measurement in consecutive lengthening procedures in a series of growing-rod patients undergoing lengthening. Objective. The purpose of this study was to measure the forces and amount of distraction over time in early onset scoliosis patients treated with growing rods. Summary of Background Data. Growing rods are one of the current techniques used in the treatment of early onset scoliosis, and the goal of the growing-rod technique is to achieve deformity correction, maintaining spinal growth at the same time. Gradual stiffening or spontaneous fusion of the spine can interfere with the ability to lengthen. In addition, diminished acquired length with serial distraction are common observations and need to be evaluated and quantifi ed. Methods. Distraction forces were measured prospectively during 60 consecutive lengthening procedures in 26 patients. All patients had single submuscular rod constructs with side-to-side connectors. For each measurement, output from a transducer on a dedicated pair of distraction calipers was recorded at zero load status and the force was then recorded at every 1 mm lengthening; length was obtained at each event and was recorded in millimeters. Results. The force required to distract the spine doubled at the 5th lengthening procedure (mean 368 N ± 54 N), and the distraction force was signifi cantly higher at the fi fth lengthening compared with the previous lengthening (P < 0.01). Mean length achieved at each distraction decreased over time such that by the fi fth lengthening, consistently 8 mm or less was achieved.
Orthopaedic Proceedings, Jun 1, 2012
IntroductionThe change of position of the distal pedicle screws with growing rods in relation to ... more IntroductionThe change of position of the distal pedicle screws with growing rods in relation to vertebral bodies was described as pedicle screws migration. Pedicle screws are subjected to serial distractive forces pushing them down with every distraction; additionally there is continuous growth of the vertebral bodies during the treatment period. These two factors can affect the change of position of the pedicle screws in relation to the vertebrae during the use of growing rods. To our knowledge, this finding has never been studied, confirmed, or quantified.MethodsThis is a retrospective review of the radiographs and operative notes of 23 consecutive cases of early-onset scoliosis treated with single growing rods. Age at index surgery ranged from 4 years 2 months to 8 years 9 months, and the number of distractions was four to 11 per patient. Measurements were done on post-index and latest follow-up true lateral radiographs. With optimum initial position of the screws in the pedicle, we calculated the dis...
International Journal of Surgery, Nov 1, 2015
Informed consent is essential so patients are aware of the benefits and potential risks of surger... more Informed consent is essential so patients are aware of the benefits and potential risks of surgery. The objective of this audit was to assess whether patients were consented appropriately for total knee replacement (TKR) and total hip replacement (THR). We used "Orthoconsent" which is endorsed by the British Orthopaedic Association as the set standard. Methods: This was a retrospective audit undertaken within a London Teaching Hospital. Data was collected for 10 patients undergoing TKR and 10 patients undergoing THR. Participants were identified from ward lists and all had capacity to give consent. Results: THR consent forms had 71% documented completion of the benefits and occurring risks required to make informed consent. TKR consent forms were completed with 42% accuracy. In many instances, important risks that are specific to these operations were not stated. Conclusion: Inadequate consent can lead to false expectations and may lead to litigation. The use of template consent forms (TCF) may improve consent for TKR and THR by providing the information required to responsibly consent for the operation. Patients can raise concerns before signing the consent form, allowing for "Informed Consent". We have developed TCFs for use in our hospital and strongly recommend there use nationally.
Spine, Mar 1, 2010
Study Design. Retrospective clinical and radiologic evaluation of a single-stage partial corpecto... more Study Design. Retrospective clinical and radiologic evaluation of a single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion. Objective. To determine the safety and efficacy of a new technique in the management of progressive congenital spinal deformities due to failure of formation in the very young age. Summary of Background Data. Several techniques have been reported for the surgical treatment of young children with congenital spinal deformities. There have been concerns regarding epidural bleeding, neurologic complications, pedicle screws placement, implant failure, and prominence of posterior constructs in this very young age group. A single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion can offer a new alternative which can avoid these concerns. Methods. Twelve patients with progressive congenital spinal deformities due to failure of formation were retrospectively reviewed after adopting the above mentioned technique. All patients included in the study presented with a single hemivertebra. The mean age at time of surgery was 2 years 7 months (range, 1 year and 9 months to 3 years and 10 months). The average follow-up period was 3 years and 1 month (range, 2 years to 4 years and 5 months). Results. There were no cases of intra or postoperative neurologic or implant related complications. There was 1 superficial infection. All patients showed solid radiologic fusion. The mean scoliosis angle improved from 48.3°(range, 34°-58°) preoperative to 17.2°(range, 11°-25°). The mean angle of kyphosis improved from 23.2°(range, 16°-57°) before surgery to 11.7°(range, 4°-16°). Conclusion. A single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion offers a safe alternative method in treating patients with congenital hemivertebra under the age of 4 years.
Journal of Biomedical Materials Research Part B: Applied Biomaterials, 2017
ABSTRACTRecently the use of dissimilar metals in spine instrumentation has increased, especially ... more ABSTRACTRecently the use of dissimilar metals in spine instrumentation has increased, especially in the case of adult deformities, where rods made from Cobalt Chrome alloys (CoCr) are used with Titanium (Ti) screws. The use of dissimilar metals increases the risk of galvanic corrosion and patients have required revision spine surgery due to severe metallosis that may have been caused by corrosion. We aimed to assess the presence of corrosion in spine implant retrievals from constructs with two types of material combinations: similar (Ti/Ti) and dissimilar (CoCr/Ti). First, we devised a grading score for corrosion of the rod‐fixture junctions. Then, we applied this score to a collection of retrieved spine implants. Our proposed corrosion grading score was proven reliable (kappa > 0.7). We found no significant difference in the scores between 4 CoCr and 11 Ti rods (p = 0.0642). There was no indication that time of implantation had an effect on the corrosion score (p = 0.9361). We r...
European Spine Journal, 2015
Orthopaedic Proceedings, Jun 1, 2012
Introduction There is an unresolved controversy in the published work about the effect of screws ... more Introduction There is an unresolved controversy in the published work about the effect of screws crossing the neuro-central cartilage (NCC) on spinal canal dimension in very young children and in animals. Anterior vertebral body screws with fusion can invade and damage the NCC, especially at the site of screw insertion; however, this finding has never been studied. Methods This study is a retrospective, clinical and radiological analysis of seven consecutive children aged 1–2 years treated with anterior vertebral instrumentation and fusion by downsized rod screw systems. The mean age at time of surgery was 2 years 4 months (range 1 year 9 months to 2 years 10 months). The average follow-up period was 3 years 3 months (2 years 6 months to 4 years 5 months). 16 screws inserted anteriorely were evaluated by a follow-up CT scan. Spinal canals were divided with known anatomical landmarks into right and left hemicanals. The relation of the anterior screws to the NCC and the spinal canal dimension were studied. All clinical and radiological complications were recorded. Results Only 11 screws were suitable for measurement. There was a difference of 10–20% between the surface areas of the two hemicanals in six levels in which the screw heads were passing through or encroaching on the NCC; the canal was smaller ipsilateral to the affected NCC. The hemicanals were almost symmetrical in five levels in which the screw heads were away from the NCC, except in one in which it was touching the NCC. For the 16 screws evaluated there were no recorded complications apart from one screw breaching the adjacent end plate. Conclusions Anterior vertebral body screws with fusion can encroach on the NCC when inserted in very young children, which seems to decrease the ipsilateral canal dimension between 10% and 20%. Apart from this finding, anterior instrumentation is safe when used in very young children aged 1–2 years. Canal asymmetry had no clinical effect in childhood; however, long-term follow-up of these children is needed to measure its clinical significance. Change of screw position with time is a frequent occurrence in the distal pedicle screws with single growing rods. There are two different types identified. With growing rods some degree of distal pedicle screw migration in this paediatric age group may not be regarded as a complication of treatment.
Archives of Disease in Childhood, 1994
treatment for respiratory distress in preterm infants but when babies below 28 weeks' gestation d... more treatment for respiratory distress in preterm infants but when babies below 28 weeks' gestation did not usually survive. As the specialty has changed and grown, so has the Cleveland textbook. The latest edition has 36 contributors, all bar one from the US, and many from Cleveland itself. The authors have kept the combination of neonatal physiology and practical advice on management which was a successful feature of previous editions. There are 19 chapters, two completely new and the remainder brought up to date. The chapters cover all the important aspects of neonatal care, although one on the dysmorphic infant would be welcome. Those on antenatal and intrapartum care, the physical environment, care of the parents, respiratory problems, and the heart are particularly good. A new chapter on ethical issues in the perinatal period addresses the question 'who makes the decision about forgoing life-sustaining treatment for a patient?' in the light of the 1984 'Baby Doe' law. The answer is the doctors and parents in partnership, taking account of the expected quality of life of the infant, a view most UK paediatricians accept and practise. The other new chapter is on nursing practice in the neonatal intensive care unit. This is excellent, particularly on the topics of light, noise, handling, positioning, and skin care of very immature infants. Overall the book has an air of authority and the views expressed are usually cautious and sensible. Neonatal intensive care units should add it to their libraries. NICHOLAS RUTTER Reader in child healthlhonorary consultant paediatrician Consultanit orthopaedic surgeon 455
Introduction The use of thoracic pedicle screws for the treatment of adolescent idiopathic scolio... more Introduction The use of thoracic pedicle screws for the treatment of adolescent idiopathic scoliosis (AIS) has gained widespread popularity. Many techniques has been described to increase the accuracy of free hand placement; however the placement of pedicle screws in the deformed spine poses unique challenges because of possible neurologic and vascular complications. We are describing a universal way of insertion of pedicle thoracic screws which has been applied in many pathologies including the deformed spine. Methods Our technique includes exposure of the superior facet of the corresponding body to identify its lateral border border which together with the superior border of the TP denotes our entry point which is just lateral to this crossing, we make a short entry with a straight Lenke probe then continue the track with a strong ball probe to go safely through the cancellous bone of the body. This is retrospective review of radiographs and clinical notes of all the patients who ...
Background: To stimulate a debate as to whether neurological compromise as a result of spinal ins... more Background: To stimulate a debate as to whether neurological compromise as a result of spinal instrumentation is the result of direct or indirect cord injury of more the result of cord ischaemia due to the highly abnormal vascular anatomy encountered in these patients. Methods: Review of three cases of neuromuscular scoliosis who underwent angiograms under general anaesthetic. Graphical comparisons with normal patterns spinal vascular anatomy Results: Vascular anatomy was found to be so abnormal in these patients that the series was discontinued due to the perceived risk of paraplegia as a result of the angiogram procedure itself. Conclusion: We plan to perform CT angiograms in patients with neuromuscular scoliosis to further elucidate the vascular anatomy in these patients
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Papers by Hilali Noordeen