Browsing by Author "Dunn, R. N."

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    Instrumentation of the paediatric cervical spine
    (Champagne Media, 2014) Dunn, R. N.; Botha, A. H.
    BACKGROUND: Paediatric cervical fusion surgery is challenging. Traditional techniques such as external stabilisation, onlay fusions and wiring techniques resulted in unsatisfactory outcomes due to inferior biomechanical stability. METHODS: A retrospective review was performed of paediatric patients who underwent instrumented cervical fusion surgery under 16 years of age. Fusion rates, blood loss, levels fused, theatre time, technique and complications were assessed. RESULTS: An average of 2.5 levels was fused, with an estimated blood loss of 428 ml and surgical duration of 159 min. Anterior procedures had an average of one level fused with blood loss of 117 ml and surgical duration of 98 min. Posterior procedures had an average number of 1.9 levels fused, blood loss of 306 ml and surgical time of 131 min. Combined procedures had an average of 5.5 levels fused, blood loss 810 ml and surgical duration of 241 min. Four surgery-related complications were encountered. These consisted of dural leaks and wound sepsis which were all treated effectively. All patients achieved radiological fusion. CONCLUSION: The use of modern segmental spinal instrumentation in the paediatric cervical spine is a viable option. Although the study sample was small we are able to demonstrate that no major surgical complications were encountered due to the use of adult cervical spinal instrumentation techniques in the paediatric group.
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    Shallow-water spinal injuries : devastating but preventable
    (Health and Medical Publishing Group (HMPG), 2010) Vlok, A. J.; Petersen, I.; Dunn, R. N.; Stander, J.
    Background: Shallow-water diving injuries have devastating consequences for patients and their families, requiring intensive use of resources in both the acute and rehabilitative phases of injury. With the final clinical outcome often poor, the question is raised as to whether a target group can be identified for whom to implement a preventive programme. Objective: To evaluate the demographics, clinical features and outcomes of shallow-water diving injuries in an acute spinal cord injury (ASCI) unit. Materials and methods: All patients admitted to the ASCI unit with diving-related injuries were entered into the study. Data regarding demographics, injury profile and subsequent management were collated. All case notes and X-rays were reviewed. Ethical approval was obtained. Results: Forty-six patients were reviewed from 19 April 2003 to 8 February 2009. A steady annual increase in diving injuries was noted. A very specific patient profile was identified: 91% male incidence, average age 23 years, 37% admitted alcohol use, with a summer-time prevalence. Compression-flexion type injuries were most prevalent, with an orthopaedic level of C5 and neurological level of C4 being the most common injury sites. A third of diving injuries occurred in the sea, 20% in swimming pools, 20% in rivers, 11% in tidal pools and 4% in dams. Conclusion: A very specific patient profile was identified, and the severity of shallow-water diving injuries was confirmed. No current preventive programme exists except for a single television advertisement. These data will be used to motivate further educational and preventive programmes for reducing the incidence of diving-related injuries.