Nasir A Quraishi

Nottingham University Hospitals NHS Trust, Nottigham, England, United Kingdom

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Publications (45)124.27 Total impact

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    ABSTRACT: There have been no previous studies looking at the outcome of surgical decompression (+/-stabilisation) for various grades of epidural spinal cord compression (ESCC) due to spinal metastases. To determine the outcome of surgical treatment in patients with ESCC using the Bilsky 6-point scale. Retrospective cohort review of prospectively collected data PATIENT SAMPLE: A consecutive series of 101 patients managed over the period of 3 years for ESCC due to spinal metastases in a tertiary spine surgery referral unit were included. Data on age, gender, revised Tokuhashi score, pre-operative Frankel grade, tumour histology, MRI scan based Bilsky cord compression grade, post-operative Frankel grade at last follow up, complications and survivorship data were collected. Frankel grading system for function was used to evaluate the patient's pre- and post-operative neurological status. Patient survival and post-operative complications were also collected. Average patient age was 64.7 years (13-88); 62 male and 39 female. Mean follow-up: 7.3 months (3-23.3). Most primary tumours were prostate, breast, renal, lung and the blood dyscrasias. Within the lower grade of compression (Group 1) (Bilsky Gr 0,1a, 1b,1c) (n= 40), 29 (72.5%) patients had no Frankel grade improvement, 7 (17.5%) improved while 4 (10%) deteriorated neurologically post-surgery. Within the higher compression grade (Group 2) (Bilsky Gr 2 and 3) (n = 61), 37 (60%) did not experience neurological change, 20 (33%) improved while neurology worsened in 4 (7%). When compared to Group 2; Group 1 patients had a better pre-operative Frankel scores and improved more significantly post-operatively. The mean revised Tokuhashi score for Group 1 and Group 2 was 10 and 9.1 respectively (p=0.1). The complication rate for Group 1 and 2 was 25% and 42.6% respectively (p=0.052). Survival analysis showed no difference between groups (Group 1: median 376 days (12-1052); group 2: median 326 days (12-979), p=0.62) CONCLUSION: Surgery can achieve improvements in neurology even in higher grades of cord compression. There is a trend towards more complications and worse survival with spinal surgery in patients with higher grades of compression. Copyright © 2015 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 03/2015; DOI:10.1016/j.spinee.2015.03.040 · 2.80 Impact Factor
  • The Spine Journal 03/2015; 15(3):S62. DOI:10.1016/j.spinee.2014.12.068 · 2.80 Impact Factor
  • The Spine Journal 03/2015; 15(3):S65. DOI:10.1016/j.spinee.2014.12.076 · 2.80 Impact Factor
  • The Spine Journal 03/2015; 15(3):S65. DOI:10.1016/j.spinee.2014.12.075 · 2.80 Impact Factor
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    ABSTRACT: BACKGROUND CONTEXT: The surgical treatment in spinal metastases has been shown to improve function and neurological outcome. Unplanned hospital readmissions can be costly and cause unnecessary harm. PURPOSE: Our aim was to firstly analyse the re-operation rate and indications for this revision surgery in spinal metastases from an academic tertiary spinal institute and secondly, to make comparisons on outcome (neurology and survival) against patients who underwent single surgery only. STUDY DESIGN/SETTING: An ambispective review of all patients treated surgically over 8 year period considering their neurological and survival outcome data. Statistical analysis was performed using IBM SPSS 20. Since all scale values did not follow the normal distribution and significant outlier values existed, all descriptive statistics and comparisons were made using median values and the Median test. Crosstabs and Pearson's correlation were used to calculate differences between percentages and ordinal/ nominal values. For two population proportions the Z Test was used to calculate differences. The Log Rank Mantel-Cox analysis was used to compare survival. PATIENT SAMPLE: During the 8 years' study period, there were 384 patients who underwent urgent surgery for spinal metastasis. Of these, 289 patients were included who had sufficient information available. There were 31 re-operations performed (10.7%; mean age 60 years; 13M, 18F). Exclusion criteria included patients treated solely by radiotherapy, patients who had undergone surgery for spinal metastasis prior to the study period and those patients who had other causes for neurological dysfunction such as stroke. OUTCOME MEASURES: Revised Tokuhashi score, preoperative/postoperative Frankel scores and survival. METHODS: We performed an ambispective review of all patients treated surgically from our comprehensive database during the study period (October 2004-October 2012). We reviewed all patient records held on the database, including patient demographics and re-operation rates. RESULTS: During the 8 years' study period, there were 31 re-operations performed (10.7%; mean age 60 years; 13M, 18F) in the 289 patients. Re-operations were performed in the same admission in the majority of patients (20), whilst 11 patients had their second procedure in subsequent hospitalisation. The reasons for their revision surgery were as follows: Surgical Site Infection (SSI) [13/31, (42%)], failure of instrumentation [9/31, (29%)], local recurrence [5/31, (16%)], haematoma evacuation [2/31, (6%)] and others [2/31, (6%)]. When comparing the 'Single Surgery' and 'Revision Surgery' groups, we found that the median preoperative and postoperative Frankel scores were similar at grade 4 (range: 1- 5) for both groups (preoperative p= 0.92, postoperative p=0.87). However, 20 (8%) patients from the Single surgery group and 7 (23%) from the Revision group had a worse postoperative score and this was significantly different (p=0.01). No significant difference was found (p=0.66) in the revised Tokuhashi score. The median number of survival days was similar (p=0.719) - Single Surgery Group (250 days, range: 5- 2597) and Revision Group (215 days, range: 9-1352). CONCLUSION: There was a modest re-operation rate (10.7%) in our patients treated surgically for spinal metastases over an 8 year period. Most of these were for SSI (42%), failure of instrumentation (26%) and local recurrence (16%). Patients with metastatic disease could benefit from revision surgery with comparable median survival rates but relatively poorer neurological outcomes. This study may help to assist with informed decision making for this vulnerable patient group.
    Spine 01/2015; 15(3). DOI:10.1016/j.spinee.2015.01.005 · 2.45 Impact Factor
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    ABSTRACT: Study Design. Multicenter, ambispective observational study. Objective. To quantify local recurrence and mortality rates after surgical treatment of symptomatic spinal hemangiomas and identify prognostic variables for local disease control. Summary of Background Data. Spinal hemangiomas are the most common primary tumors of the spine and are generally benign and usually asymptomatic. Because of the rarity of symptomatic spinal hemangiomas, optimal surgical treatment remains unclear. Methods. AOSpine Knowledge Forum Tumor Investigators created a multicenter database of primary spinal tumors including demographics, presentation, diagnosis, treatment, survival, and recurrence data. Tumors were classified according to Enneking and Weinstein-Boriani-Biagini. Descriptive statistics were summarized and time to mortality and recurrence was determined. Results. Between 1996 and 2012, 68 patients (mean age = 51 yr, SD = 16) underwent surgical treatment of a spinal hemangioma. Epidural disease was present in 55% of patients (n = 33). Pain and neurological compromise were presenting symptoms in 82% (n = 54) and 37% (n = 24) of patients, respectively. Preoperative embolization was performed in 35% of patients (n = 23), 10% (n = 7) had adjuvant radiotherapy, and 81% (n = 55) underwent posterior-alone surgery. The local recurrence rate was 3% (n = 2). Mortality secondary to spinal hemangioma was not observed (mean follow-up = 3.9 yr, SD = 3.8). Conclusion. This is the largest multicenter surgical cohort of spinal hemangiomas. Symptomatic spinal hemangiomas are a benign tumor despite frequently presenting with epidural disease and neurological compromise. Thus, formal en bloc resection is not required, and excellent rates of local control and long-term survival can result from aggressive intralesional resection during index surgery. Level of Evidence: 3
    Spine 01/2015; 40(9):656-664. DOI:10.1097/BRS.0000000000000840 · 2.45 Impact Factor
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    ABSTRACT: Sacral chordomas (SC) are rare, locally invasive, malignant neoplasms. Despite surgical resection and adjuvant therapies, local recurrence (LR) is common and overall survival (OS) is poor. The objective of this study was to identify prognostic factors that have an impact on the local recurrence-free survival (LRFS) and OS of patients with SC. Utilizing the AOSpine Knowledge Forum Tumor multicenter ambispective database, surgically treated SC cases were identified. Cox regression modeling was used to assess the effect of several clinically relevant variables on OS and LRFS. A total of 167 patients with surgically treated SC were identified. The male/female ratio was 98/69 with a mean age of 57 ± 15 years at the time of surgery. The LR was 35 % (n = 57), death occurred in 30 % of patients (n = 50) during the study period. The median OS was 6 years post-surgery and LRFS was 4 years. In the univariate analysis, previous tumor surgery at the same site (P = 0.002), intralesional resection (P < 0.001), and larger tumor volume (P = 0.030) were significantly associated with LR. Increasing age (P < 0.001) and a preoperative motor deficit of C or D (P = 0.003) were significantly associated with poor OS, and nerve root sacrifice showed a trend towards significance (P = 0.088). In the multivariate models, previous surgery and intralesional resection were significantly related to LR, while increasing age and motor deficit of C or D were associated with poor OS. This study identified two predictive variables for LRFS (previous tumor surgery and type of surgical resection) and two for OS (age and impaired motor function) in surgically treated SC patients. Our results indicate that en bloc resection reduces LR but does not influence OS. However, this was likely due to short follow-up (3.2 years).
    European Spine Journal 12/2014; 24(5). DOI:10.1007/s00586-014-3728-6 · 2.47 Impact Factor
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    ABSTRACT: Object The National Institutes of Health recommends strategies to obtain evidence for the treatment of rare conditions such as primary tumors of the spine (PTSs). These tumors have a low incidence and are pathologically heterogeneous, and treatment approaches are diverse. Appropriate evidence-based care is imperative. Failure to follow validated oncological principles may lead to unnecessary mortality and profound morbidity. This paper outlines a scientific model that provides significant evidence guiding the treatment of PTSs. Methods A four-stage approach was used: 1) planning: data from large-volume centers were reviewed to provide insight; 2) recruitment: centers were enrolled and provided the necessary infrastructure; 3) retrospective stage: existing medical records were reviewed and completed with survival data; and 4) prospective stage: prospective data collection has been implemented. The AOSpine Knowledge Forum Tumor designed six modules: demographic, clinical, diagnostic, therapeutic, local recurrence, survival, and perioperative morbidity data fields and provided funding. Results It took 18 months to implement Stages 1-3, while Stage 4 is ongoing. A total of 1495 tumor cases were captured and diagnosed as one of 18 PTS histotypes. In addition, a PTS biobank network has been created to link clinical data with tumor pathology and molecular analysis. Conclusions This scientific model has not only aggregated a large amount of PTS data, but has also established an international collaborative network of spine oncology centers. Access to large volumes of data will generate further research to guide and enhance PTS clinical management. This model could be applied to other rare neoplastic conditions. Clinical trial registration no.: NCT01643174 ( ClinicalTrials.gov ).
    Journal of Neurosurgery Spine 09/2014; 21(5):1-7. DOI:10.3171/2014.7.SPINE13954 · 2.36 Impact Factor
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    ABSTRACT: Coccygectomy may be indicated for the treatment of debilitating coccygodynia unresponsive to non-operative treatment. Perineal contamination and postoperative wound infection following coccygectomy remains a major concern. We present a rare post-coccygectomy complication of rectal-cutaneous fistula. To our knowledge no such case has been previously described.
    European Spine Journal 09/2014; DOI:10.1007/s00586-014-3579-1 · 2.47 Impact Factor
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    ABSTRACT: Complete intraspinal canal rod migration with posterior bone reconstitution has never been described in the adolescent idiopathic scoliosis (AIS) population. We present an unusual but significant delayed neurological complication after spinal instrumentation surgery.
    European Spine Journal 06/2014; DOI:10.1007/s00586-014-3367-y · 2.47 Impact Factor
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    ABSTRACT: Patients presenting with metastatic spinal cord compression (MSCC) due to an unknown primary tumour (UPT) present an interesting problem with limited literature available to provide guidance on management. Our aim was twofold-first, to analyse all our patients with MSCC due to a UPT pre-operatively, to review their treatment and outcome; second, make comparisons with those patients who presented with MSCC due to a known primary tumour (KPT) during the same period. All data was collected retrospectively from October 2004 to October 2009, then prospectively from October 2009 to October 2012 (8 years). We reviewed all patient records held on the database, including patient demographics, primary tumour, neurological outcome (Frankel grade), complications and survival. During the 8-year study period, out of the 382 patients who underwent emergency surgery for MSCC, 285 patients were included in whom complete information was available. Of these, 17 patients presented with MSCC due to a UPT (6 %; mean age 61 years, 5 M, 12 F). When compared to those with a known primary, the UPT group trended to a longer duration of symptoms prior to surgery (200 vs. 156 days, p = 0.86). They had a similar neurological outcome (88 % remained the same or improved post-operatively vs. 90 % in KPT group; p = 0.42), similar complication rate (23.5 vs. 33.6 %; p = 0.32) and survival (222 vs. 251 days, p = 0.42). The primary site in the UPT group was confirmed in 10/17 (58.8 %)-all 10 were adenocarcinoma [lung (6) and GI (4)]. In our series, the incidence of MSCC due to an unknown primary was 6 %. They had similar overall outcome (neurology post-operatively, complications and survival) to those patients with MSCC from a known primary. Our experience would suggest that we need to treat these patients expeditiously with thorough evaluation and urgent treatment.
    European Spine Journal 04/2014; 23(7). DOI:10.1007/s00586-014-3274-2 · 2.47 Impact Factor
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    K M I Salem, J Visser, N A Quraishi
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    ABSTRACT: Neuroblastoma is the most common extra-cranial solid tumour in children. Metastasis in children to the upper cervical spine are quite rare. An 8-year-old boy was referred to our service following a relapse of a right adrenal stage 4 neuroblastoma with a metastatic deposit in C2. This anterior tumour mass was pressing on the spinal cord with increasing pain in the base of skull, but without gross neurological deficit. He underwent urgent MRI and CT scans and then emergent surgery. The first stage was a posterior stabilization from occiput to C5 with a posterior decompression from C1 to C3 followed by a trans-oral approach to resect the main anterior tumour mass and reconstruction. This is the first report of the use of a trans-oral approach to address a neuroblastoma lesion in the axial spine. This approach was used effectively to achieve local tumour clearance confirmed at 1-year follow-up. Pertinent information to the spinal surgeon on neuroblastoma and the use of the trans-oral approach to the axial spine are discussed.
    European Spine Journal 02/2014; 24(1). DOI:10.1007/s00586-014-3216-z · 2.47 Impact Factor
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    ABSTRACT: Giant herniated thoracic discs (GHTD) remain a surgical challenge. When combined with calcification, these discs require altered surgical strategies and have only been infrequently described. Our objective was to describe our surgical approaches in the management of calcified GHTD. This was a retrospective cohort study of all patients with calcified GHTD operated between 2004 and 2012. Data were collected from review of patients' notes and radiographs and included basic demographic and radiological data, clinical presentation and outcome, operative procedure and complications. During the study period, there were 13 patients with calcified GHTD, including 6 males and 7 females (mean age 55 years, range 31-83 years). The average canal encroachment was 62 % (range 40-90 %); mean follow-up 37 months (12-98). All patients were treated with anterior thoracotomy, varying degrees of vertebral resection, removal of calcified disc and with or without reconstruction. The average time for surgery was 344 min (range 212-601 min) and estimated blood loss 1,230 ml (range 350-3,000 ml). Post-operatively, 8 patients improved by 1 Frankel grade (62 %), 2 improved by 2 grades (15 %) and 3 did not change their grade (23 %). The complication rate was 4/13 (31 %; 3 patients with durotomies (2 incidental, 1 intentional) and 1 with recurrence). Calcified GHTD remain a surgical challenge. Anterior decompression through a thoracotomy approach, and varying degrees of vertebral resection with or without reconstruction allowed us to safely remove the calcified fragment. All patients remained the same (23 %) or improved by at least 1 grade (77 %) neurologically, without radiographic failure at final follow-up.
    European Spine Journal 02/2014; 23(S1). DOI:10.1007/s00586-014-3210-5 · 2.47 Impact Factor
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    ABSTRACT: Study Type Retrospective cohort. Introduction The treatment of rare neoplastic conditions is challenging, especially because studies providing high levels of evidence are often lacking. Such is the case with primary tumors of the spine (PTS), which have a low incidence, are pathologically heterogeneous, and have diverse treatment approaches.1 Despite these difficulties, appropriate evidence-based care of these complex patients is imperative. Failure to follow validated oncologic principles may lead to unnecessary mortality and profound morbidity. Objective With the aim of offering patients the most appropriate treatment based on the best available evidence, a novel scientific model was developed and employed. This article outlines this model, which has not only provided significant evidence guiding treatment of this rare condition, but we believe is readily transferrable to other similarly rare conditions. Methods A four-stage approach was employed. (1) Planning: Data from large volume centers were reviewed together with results from a feasibility questionnaire to provide insight into epidemiology, patient volumes, tumor pathology, treatment modalities, and outcomes. (2) Recruitment: Centers with sufficient volume and valid data were enrolled and provided with the necessary infrastructure. This included study coordinators and a secure, Web-based database (REDCap, Vanderbilt University, Nashville, Tennessee, United States) to capture international data from six modules comprising: demographic, clinical, diagnostic, therapeutic, local recurrence, perioperative morbidity fields, and a cross-sectional survey to update survival information. The AOSpine Knowledge Forum Tumor designed these modules and provided funding. Each center received institutional ethics approval. (3) Retrospective stage: Prospectively collected data from all recruited centers were reviewed and analyzed retrospectively. (4) Prospective stage: Following interim analysis, prospective data collection has been implemented. In addition, a PTS bio-bank network has been created to link clinical data with tumor pathology and molecular analysis. Results It took 18 months to implement stages 1 to 3 of this model and stage 4 is ongoing. A total of 1,495 tumor cases were captured and diagnosed as one of the 18 primary spine tumor subtypes listed (Fig. 1). The most prevalent diagnosis was chordoma (n = 344, 23%). There were 674 females and 821 males with a mean age of 43 ± 19 years at the time of surgery. Surgical treatment was performed between 1981 and 2012. The survival at 5 and 10 years postsurgery was 71.9 and 53.3%, respectively, with a median survival of 13 years postsurgery (Fig. 2). Conclusions To date, this is the largest international collection of PTS. This novel scientific model has not only aggregated a large amount of PTS data, but has also established an international collaborative network of spine oncology centers. The access to large volumes of clinical and bio-bank data will generate further research to guide and enhance the clinical management of PTS. This novel scientific model could be of similar tremendous value if applied to other rare neoplastic conditions.
    10/2013; 4(2):160-2. DOI:10.1055/s-0033-1357365
  • The Spine Journal 09/2013; 13(9):S68-S69. DOI:10.1016/j.spinee.2013.07.193 · 2.80 Impact Factor
  • The Spine Journal 09/2013; 13(9):S70-S71. DOI:10.1016/j.spinee.2013.07.197 · 2.80 Impact Factor
  • The Spine Journal 09/2013; 13(9):S129. DOI:10.1016/j.spinee.2013.07.334 · 2.80 Impact Factor
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    ABSTRACT: BACKGROUND: Thoracic cerebrospinal fluid (CSF) hygroma is a rare and potentially devastating complication of the anterior thoracic approach to the spine. We present two cases in which this complication resulted in acute cranial nerve palsy and discuss the pathoanatomy and management options in this scenario. CASE REPORTS: Two male patients presented to our department with neurological deterioration due to a giant herniated thoracic disc. The extruded disc fragment was noted pre-operatively to be calcified in both patients. A durotomy was performed at primary disc prolapse resection in the first patient, whereas an incidental durotomy during the procedure caused complication in the second patient. These were repaired primarily or sealed with Tachosil(®). Both patients re-presented with acute diplopia. Imaging of both patients confirmed a massive thoracic cerebrospinal fluid hygroma and evidence of intracranial changes in keeping with intracranial hypotension, but no obvious brain stem shift. The hemithorax was re-explored and the dural repair was revised. The first patient made a full recovery within 3 months. The second patient was managed conservatively and took 5 months for improvement in his ophthalmic symptoms. CONCLUSIONS: The risk of CSF leakage post-dural repair into the thoracic cavity is raised due to local factors related to the chest cavity. Dural repairs can fail in the presence of an acute increase in CSF pressure, for example whilst sneezing. Intracranial hypotension can result in subsequent hygroma and possibly haematoma formation. The resultant cranial nerve palsy may be managed expectantly except in the setting of symptomatic subdural haematoma or compressive pneumocephaly.
    European Spine Journal 06/2013; 22(9). DOI:10.1007/s00586-013-2818-1 · 2.47 Impact Factor
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    ABSTRACT: INTRODUCTION: Despite numerous descriptive publications, the guidelines for treatment of cervical spinal tuberculosis (TB) are not very clear. The authors report a case of a young girl with cervico-thoracic spinal TB extending from C5 to T3 vertebrae presenting with weakness of the right hand and unsteady gait. CASE REPORT: An 11-year-old female who is an immigrant to the UK from Afghanistan, presented to our clinic with a 10-day history of difficulty in walking with an unsteady gait and 3-month history of progressive weakness in both her arms, the right side more affected than the left. Her immunisation history was unclear. Examination of the arms showed bilateral thenar and hypothenar wasting, more so on the right than the left. An MRI scan revealed a large para-spinal abscess extending from C3/4 to T4/5 with a significant anterior epidural cord compression from C5/6 to T2/3. Therapeutic/diagnostic aspiration was performed under ultrasound guidance and the aspirate was sent for microbiology. She was started empirically on multidrug anti-tubercular treatment and steroids. Although Ziehl-Neelsen stain was negative for acid-fast bacilli, microbiological confirmation of TB was obtained by positive TB culture sensitive to all first-line anti-TB drugs. She made a dramatic improvement within 3 weeks of anti-tubercular treatment. A follow-up MRI scan at 8 months showed complete resolution of the abscess. At 2 years of follow-up, she was a healthy looking child, back to her school with no residual clinical signs/symptoms of the disease. CONCLUSION: Our case of cervico-thoracic tuberculous abscess in a young child suggests that even with incomplete neurological deficit caused by epidural cord compression, ultrasound (or CT)-guided aspiration and anti-tubercular medication provide acceptable results at 2 years of follow-up.
    European Spine Journal 04/2013; 22(7). DOI:10.1007/s00586-013-2729-1 · 2.47 Impact Factor
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    N A Quraishi, T Hammett, K M I Salem, H Mehdian
    Acta Neurochirurgica 02/2013; 155(5). DOI:10.1007/s00701-013-1636-x · 1.79 Impact Factor

Publication Stats

210 Citations
124.27 Total Impact Points

Institutions

  • 2012–2014
    • Nottingham University Hospitals NHS Trust
      Nottigham, England, United Kingdom
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2008–2009
    • University of Toronto
      • Division of Neurosurgery
      Toronto, Ontario, Canada
  • 2007
    • Toronto Western Hospital
      Toronto, Ontario, Canada