Browsing by Author "Botha, A. H."

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    Costotransversectomy in thoracic spinal tuberculosis
    (Champagne Media, 2016) Botha, A. H.; Davis, J. H.
    BACKGROUND: The escalating global pandemic of tuberculosis infections results in 8 million new cases diagnosed each year. The thoracic and thoracolumbar spine is the most prevalent area involved in musculoskeletal tuberculosis. Deformity with associated neurological compromise, requiring extended in-patient treatment and rehabilitation, is common. Multidrug-resistant tuberculosis is prevalent and tissue samples are needed to obtain bacterial culture and sensitivity. Decompression of the spinal canal, directly or indirectly, should accelerate neurological recovery METHODS: A retrospective study was performed at Tygerberg Hospital to evaluate the efficacy of costotransversectomy in spinal thoracic tuberculosis with regard to neurological recovery and deformity. Neurological status was compared at 6 months post-operatively with the pre-surgical status. The end deformity was compared with Rajasakeran's equation RESULTS: Thirty patients met the inclusion criteria, with an average age of 37 years. Fifteen patients were HIV positive, and ten of them on highly active antiretroviral therapy (HAART). The average CD4 count was 235. The mean neurological status of the group was classified as Frankel C, but this improved to Frankel D at 6 months post-surgery. Initial sagittal deformity was 18.7°, which increased to 26° one year post-operatively. This was not significantly different from the 25.6° kyphosis predicted by the Rajasekaran formula. A 67% positive culture yield for TB was obtained which compared favourably to percutaneous transpedicular needle biopsies performed at the same institute which had a yield of 56% CONCLUSIONS: Costotransversectomy is a simple procedure resulting in indirect decompression of the spinal cord, improving the microbiological diagnosis of spinal tuberculosis, and possibly leading to earlier neurological recovery, without the risk of creating further instability and greater deformity
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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.