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(2022)ThesisBackground: Anterior lumbar interbody fusion (ALIF) remains one of the mainstay surgical approaches in treating painful degenerative disc disease with or without segmental instability in the lower spine. The risk factors and complication profile for ALIF differs significantly from other established fusion techniques. Objectives: The goal of the first part of this thesis is to establish the factors associated with long-term clinical outcome (Chapter 2) and short-term perioperative outcomes (Chapter 3) following ALIF. Chapter 4 focuses on the long-term radiographic evidence for biomaterial alternatives for ALIF implants, namely titanium (Ti)-coated PEEK integrated cages. Methods and Results: From a prospective cohort analysis of 147 patients undergoing ALIF, elderly age (≥64 years old) was associated with an increased rate of subsidence but does not affect clinical outcomes. Obesity was not associated with postoperative complications or follow-up patient-reported outcomes. Failed fusion was significantly higher for smokers, and they were significantly more likely than non-smokers to experience postoperative complications such as pseudoarthrosis. To assess risk factors for perioperative complications and readmissions after ALIF, the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was analysed. ALIF was associated with prolonged length of stay and higher rate of return to operating theatre compared to posterior lumbar fusion. Obesity and alcohol intake increased the risk of 30-day readmissions. Discharge to non-home destination following ALIF was independently associated with wound complications and venous thromboembolism. Finally, a prospective follow-up study was performed to determine the long-term radiographic outcome following ALIF using Ti-coated PEEK cages with allograft and INFUSE. Effective fusion was achieved at up to 24-month follow-up for various indications including degenerative spine/disc disease, low grade lumbar isthmic spondylolisthesis, spondylotic radiculopathy and discogenic low back pain. Conclusions: Collectively, this thesis highlights the importance of personalising the care of an ALIF surgery patient, through identification and optimization of individual risk factors for short-term and long-term outcomes, as well as through choice of implant biomaterial and design.
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(2020)ThesisThe "ophthalmohelioses" represent a conglomeration of ocular surface and adnexa disease strongly influenced by increased ultraviolet light B exposure. Despite overlapping pathogenesis pathways, the severity of these differs across the different spectrums. Ocular surface squamous neoplasia (OSSN), pterygium and conjunctival melanocytic lesions represent the three most impacting subtypes of such "ophthalmohelioses" affecting the ocular surface. OSSN represents a broad class of squamous dysplastic lesions ranging from benign papillomas till invasive squamous cell carcinomas. Melanocytic tumours such as primary acquired melanosis have a great propensity to become malignant, especially if cells are atypical. Finally, pterygium is a benign growth commonly treated with surgical excision, but patients often face an endless remitting-relapsing cycle of pterygium recurrence and repeat surgery. If untreated, patients sight limitation secondary to visual axis invasion. The early detection of OSSN, pterygium and melanocytic lesions is non-existent and often disease requires to be excised and subsequently microscopically analysed before a formal conclusion is made. For pterygium, the identification of Fuchs' Flecks at the head of pterygium may serve as satellite cells ahead of the main pterygium body. Handedness may serve a role in the eye in which pterygium is worse or develops. From a therapeutic point of view, these three "ophthalmohelioses" tend to recur consistently despite optimized treatments. This therapeutic dilemma presents themes of concern, including vision disruption, secondary to repeat surgeries given the relapsing-remitting characteristic of all three disease entities. Topical eye drops such as interferon alfa-2b combined with retinoic acid serve as a potential solution which offer superior tumour-free follow-up and rapid tumour resolution of OSSN or primary acquired melanosis lesions. The viral influence of human papilloma virus upon OSSN may be mitigated with the application of topical cidofovir. Additionally, specialized pterygium surgery may be an effective alternative to otherwise other subtypes of pterygium excision, others often being anatomically more destructive. At essence, a focus of novel therapeutic options that target pathways within "ophthalmoheliosis" pathogenesis is being presented within this thesis which may hopefully improve and expand ophthalmologist's arsenal against disease spectrums very relevant to the Australian populace.
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(2021)ThesisThe following thesis examines the implementation of objective methods to measure patient physical capabilities within the spine surgery setting. With a broad aim to introduce accurate and robust assessment tools that are not influenced by subjective patient factors and experiences our methods have been devised after a wide literature search to examine the current state-of-play. Following this literature review two separate arms have been conducted, one in the clinical setting on a large scale using affordable and accurate devices while a second arms aim’s to examine range-of-motion as a potential outcome measure. The latter arm within the scope of the thesis is limited to a validation study with 2 separate emerging technologies; an inertial based sensor system and a digital goniometer. Together these two arms pave way for clinicians not just in the spine surgery setting to employ similar assessment methods in aims to achieve safe, affordable, remote and objective measures of patient outcome. Briefly we have been able to validate the digital goniometer for clinical use, while our accelerometer data is promising for use in the large volume outpatient setting.