Nasir A Quraishi

St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia

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Publications (65)130.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECT A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosis-predicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.
    No preview · Article · Dec 2015 · Journal of neurosurgery. Spine
  • Ali Rajabian · Nasir A. Quraishi

    No preview · Article · Oct 2015
  • Ali Rajabian · Nasir A. Quraishi

    No preview · Article · Oct 2015

  • No preview · Article · Oct 2015
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    ABSTRACT: Surgery for symptomatic spinal metastases aims to improve quality of life, pain, function, and stability. Complications in the postoperative period are not uncommon; therefore, it is important to select appropriate patients who are likely to benefit the greatest from surgery. Previous studies have focused on predicting survival rather than quality of life after surgery. To determine preoperative patient characteristics that predict postoperative quality of life and survival in patients who undergo surgery for spinal metastases. In a prospective cohort study of 922 patients with spinal metastases who underwent surgery, we performed preoperative and postoperative assessment of EuroQol EQ-5D quality of life, visual analog score for pain, Karnofsky physical functioning score, complication rates, and survival. The primary tumor type, number of spinal metastases, and presence of visceral metastases were independent predictors of survival. Predictors of quality of life after surgery included preoperative EQ-5D (P = .002), Frankel score (P < .001), and Karnofsky Performance Status (P < .001). Data from the largest prospective surgical series of patients with symptomatic spinal metastases revealed that tumor type, the number of spinal metastases, and the presence of visceral metastases are the most useful predictors of survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and spinal and visceral metastases should be considered the 4 most important prognostic variables that influence patient management. ASA, American Society of AnesthesiologistsCI, confidence intervalQoL, quality of life.
    No preview · Article · Jul 2015 · Neurosurgery
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    ABSTRACT: Myeloma is one of the most common malignancies that results in osteolytic lesions of the spine. Complications, including pathological fractures of the vertebrae and spinal cord compression, may cause severe pain, deformity and neurological sequelae. They may also have significant consequences for quality of life and prognosis for patients. For patients with known or newly diagnosed myeloma presenting with persistent back or radicular pain/weakness, early diagnosis of spinal myeloma disease is therefore essential to treat and prevent further deterioration. Magnetic resonance imaging is the initial imaging modality of choice for the evaluation of spinal disease. Treatment of the underlying malignancy with systemic chemotherapy together with supportive bisphosphonate treatment reduces further vertebral damage. Additional interventions such as cement augmentation, radiotherapy, or surgery are often necessary to prevent, treat and control spinal complications. However, optimal management is dependent on the individual nature of the spinal involvement and requires careful assessment and appropriate intervention throughout. This article reviews the treatment and management options for spinal myeloma disease and highlights the value of defined pathways to enable the proper management of patients affected by it. © 2015 John Wiley & Sons Ltd.
    Full-text · Article · Jul 2015 · British Journal of Haematology
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    ABSTRACT: There is no consensus on the optimal method of local control in Ewing's sarcoma (ES) of the mobile spine. Recent reports have suggested that en bloc resection may improve local control and survival. The authors therefore performed a systematic review to answer the following questions: (1) What is the outcome of en bloc resection for ES of the mobile spine with respect to local control and disease-free survival (DFS)? (2) How should residual ES of the mobile spine be treated? Inclusion criteria were articles published between the years 1960 and 2014 in English that contained more than five patients. This yielded 204 articles, from which 4 were selected for detailed analysis. The literature was graded for quality, summarized, and presented to a group of spinal oncology experts with consensus recommendations made. All 4 studies were retrospective case series graded as very low quality evidence. Local control strategies included radiotherapy (RT) alone, surgery and RT, or surgery alone. There was no standardized outcome reported across studies with respect to the type of surgical procedure, margins, and outcomes of interest such as local recurrence (LR) and DFS. When the en bloc procedures were pooled together, 2 of the 21 patients with available LR data developed LR (9.5%), and 5 of the 7 patients with available DFS data were disease free at a mean of 76 months. The remaining 2 died at 10 and 29 months, respectively. No studies were identified detailing the treatment of residual ES of the mobile spine. There is no consensus on the optimal method of local control for spinal ES or the treatment of residual disease. A weak recommendation supports that when the en bloc resection is technically possible, in combination with RT, this appears to provide superior local control than RT alone, or incomplete excision and RT. The effect on survival is indeterminate.
    No preview · Article · Jul 2015 · Medicine

  • No preview · Article · May 2015 · Global Spine Journal

  • No preview · Article · May 2015 · Global Spine Journal
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    Full-text · Article · May 2015 · Global Spine Journal

  • No preview · Article · May 2015 · Global Spine Journal
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    ABSTRACT: Multicenter, ambispective observational study. To quantify local recurrence and mortality rates after surgical treatment of symptomatic spinal hemangiomas and identify prognostic variables for local disease control. 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. 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. 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). 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. 3.
    Full-text · Article · May 2015 · Spine
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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.
    Full-text · Article · Mar 2015 · The spine journal: official journal of the North American Spine Society

  • No preview · Article · Mar 2015 · The Spine Journal
  • Nasir A. Quraishi · Meric Enercan · J. Naresh-Babu · D. Chopin
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    ABSTRACT: The Scoliosis Research Society traveling fellowship was conceptualized in 1970, repeated in 1972, and, after a pause, restarted in 1993. International traveling fellows visiting North America first commenced in 2000 and have since alternated annually with the North American fellows. Although a senior fellow had always traveled with them, in 2012 the first senior international fellow traveled with the group. This year, the senior fellow was Daniel Chopin from the Neuro-Orthopedic Spine Unit, Lille University Hospital, France, and past Director of the Spine Center, Institut Calot Berck sur Mer (succeeding Dr. Cotrel). The junior fellows were Meric Enercan from the Florence Nightingale Hospital, Istanbul Spine Center, Turkey; J. Naresh-Babu from Mallika Spine Centre, Guntur, Andhra Pradesh, India; and Nasir A. Quraishi from the Centre for Spine Studies and Surgery, Queen's Medical Centre, Nottingham, UK. The host centers were initially suggested by Dr. Chopin, the senior fellow; after some minor tweaking and extensive planning from the Scoliosis Research Society office, the itinerary was confirmed. The researchers were to visit 7 centers in just over 3 weeks. All of the international fellows were going to have an extraordinary adventure although they had not met each other previously. As it turned out, the trip was indeed sensational—professionally stimulating and socially endearing. The following is a short report on this unforgettable experience.
    No preview · Article · Mar 2015
  • David Choi · Nasir Quraishi · Alan Crockard

    No preview · Article · Mar 2015 · The Spine Journal
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    ABSTRACT: There is no consensus on the optimal method of local control in Ewing's sarcoma (ES) of the mobile spine. Recent reports have suggested that en bloc resection may improve local control and survival. The authors therefore performed a systematic review to answer the following questions: (1) What is the outcome of en bloc resection for ES of the mobile spine with respect to local control and disease-free survival (DFS)? (2) How should residual ES of the mobile spine be treated?Inclusion criteria were articles published between the years 1960 and 2014 in English that contained more than five patients. This yielded 204 articles, from which 4 were selected for detailed analysis. The literature was graded for quality, summarized, and presented to a group of spinal oncology experts with consensus recommendations made.All 4 studies were retrospective case series graded as very low quality evidence. Local control strategies included radiotherapy (RT) alone, surgery and RT, or surgery alone. There was no standardized outcome reported across studies with respect to the type of surgical procedure, margins, and outcomes of interest such as local recurrence (LR) and DFS. When the en bloc procedures were pooled together, 2 of the 21 patients with available LR data developed LR (9.5%), and 5 of the 7 patients with available DFS data were disease free at a mean of 76 months. The remaining 2 died at 10 and 29 months, respectively. No studies were identified detailing the treatment of residual ES of the mobile spine.There is no consensus on the optimal method of local control for spinal ES or the treatment of residual disease. A weak recommendation supports that when the en bloc resection is technically possible, in combination with RT, this appears to provide superior local control than RT alone, or incomplete excision and RT. The effect on survival is indeterminate.
    Full-text · Article · Mar 2015 · The Spine Journal

  • No preview · Article · Mar 2015 · The Spine Journal
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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.
    Full-text · Article · Jan 2015 · Spine
  • H Mehdian · Belen Perez · N A Quraishi
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    ABSTRACT: Introduction A 78-year-old gentleman with Ankylosing Spondylitis was admitted to our emergency department following a fall after consumption of a moderate degree of alcohol. He complained of significant neck pain and presented with a new flexion deformity of his cervical spine. Neurologically, he was intact. His radiographs showed a C6/7 fracture subluxation (fig 1). He was initially fitted with a rigid collar and admitted to the ward for further investigations and assessment. Unfortunately, a few hours later, his breathing deteriorated and he was transferred to ITU where an emergency intubation was attempted. This failed due to his significant cervical deformity and tracheostomy was also unsuccessful. Methods The spinal team were contacted who applied a halo in the operating room. Controlled reduction of the fracture/subluxation was performed with traction and hyperextension. The patient remained fully alert and co-operative with his neurological assessments throughout. Results His head was brought from a flexed to neutral position. Following this, a halo vest was applied and the head secured. This allowed the anaesthesia and ENT teams to perform an awake intubation during which it was noted that his epiglottis was significantly swollen and so a tracheostomy was performed. Our patient’s general condition improved 2 weeks later, and he underwent a posterior cervical fusion with segmental screw fixation (fig 3). Conclusion This is the first report of closed reduction of a cervico-thoracic kyphotic deformity in a patient with Ankylosing Spondylitis who sustained a C6/7 fracture subluxation. The patient’s chin on chest deformity was successfully reduced at the fracture site by a combination of gentle traction and hyperextension. This manoeuvre not only corrected the deformity but also allowed the supporting teams to provide essential life support with intubation and subsequently a tracheostomy. We recommend performing this procedure in the awake patient in the operating room with anaesthesia and ENT support available.
    No preview · Technical Report · Jan 2015

Publication Stats

279 Citations
130.63 Total Impact Points

Institutions

  • 2015
    • St. Vincent's Hospital Melbourne
      Melbourne, Victoria, Australia
  • 2012-2015
    • Nottingham University Hospitals NHS Trust
      Nottigham, England, United Kingdom
    • University of Nottingham
      • Centre for Sports Medicine
      Nottigham, England, United Kingdom
  • 2008-2009
    • University of Toronto
      • Division of Neurosurgery
      Toronto, Ontario, Canada