Patients had traditionally relied on health care professionals for advice and treatment options for most orthopaedic conditions including degenerative lumbar spine disease. However the unprecedented access to heath care information offered by the internet is changing the way how patients gather information and make treatment choices.

Aims & Methods: The purpose of this study was to determine the influence of the internet on patients presenting to orthopaedic clinics with degenerative lumbar spine disease and its influence on decision making.

A power calculation was done to determine appropriate sample size needed for the study. Questionnaires were handed to willing patients who were attending back clinic for more 6 months and diagnosed to have degenerative lumbar spine disease.

Each participant filled a 25 point survey and a total of 105 surveys were collected.

Results: Out of the 79% who had access to the internet, 55% accessed it from home which is in comparison to the national statistics of 57%. The rest of 24% access internet at other places. Internet usage was found to be directly proportional to education and earnings with 100% in professionals and then dropping significantly. 80% living in urban areas used internet to access health information. Topics commonly searched include causes (74%), symptoms (70%), treatment/surgical options (82%). Only few people looked at the choice of surgeons (30%) and hospitals (30%) as the practice is mostly NHS based. Around 50% made clinical decisions based on their search. 86% used general search engines like yahoo, google, 14% used sites like med line, NHS. UK. Health professionals had more influence in decision making than internet (80%).

Conclusions: Internet is evolving as a powerful source of health information and influencing more an more patients in clinical decision making with a 5% growth in internet usage every year (national statistics).

Background: The Wallis Interspinous implant was developed as a minimally invasive and anatomically conserving procedure without recourse to rigid fusion procedures. The initial finite element analysis and cadaver biomechanical studies showed that the Wallis ligament improves stability in the degenerate lumbar motion segment. Unloading the disc and facet joints reduces intradiscal pressures at same and adjacent levels allowing for the potential of the disc to repair itself.

Aims & Methods: The purpose of this prospective study is to demonstrate the survivorship and clinical effectiveness of Wallis implant against low back pain and functional disability in patients with degenerative lumbar spine disease. Patients were assessed pre operatively and post operatively every 6 months by VAS pain score, Oswestry Disability Index, SF-36. All the patients had pre operative radiographs, MRI scans and followed up with interval radiographs. The results were assessed in three sub groups. Group-1 is decompression and stabilisation, group-2 is stabilisation alone, and group- 3 is “Topping off” a fusion.

Results: A total of 211 Wallis Ligaments were inserted in 203 patients between July 2003 and November 2006. In total 179 patients were reviewed with mean age of 54(24–85) were followed for an average 30 months (6–40). The most common level is L4/5 (59%) followed by L3/4. In all the subgroups pain scores and oswestry disability index improved by 50%. And similarly SF-36 scores improved. There is 75–80% good clinical outcome with a survivorship of 98–99%.

Low infection rate of 1.1%. Two cases of prolapsed discs at the same level requiring further discectomy and one case of iatrogenic L4 paraesthesia.

Conclusions: The Wallis ligament represents a successful non fusion alternative in treatment of degenerative lumbar spine disease with least soft tissue damage, quick rehabilitation, less morbidity and associated low complication rate.

The Wallis implant treats pain, preserves mobility, anatomy and stability while being fully reversible, therefore leaving all subsequent options open.

Background: The major problem achieving lumbar spinal fusion is developing pseudarthrosis. At present the gold standard in achieving fusion is the use of autograft from pelvis or posterior elements of the spine. However the potential limitations of insuffient quantity and donor site morbidity have led to search for bone graft alternatives like DBM which contains osteinductive BMPs.

Aims & Methods: A Prospective Randomized Control trial comparing the effectiveness of demineralised Bone Matrix (DBM Putty)/autograft composite with autograft in lumbar spinal fusion.

35 patients were included in the trial; they were randomized to have DBM and autograft on one side, and autograft alone on other side to side. Patients were followed up with interval radiographs for total of 24mons. To date 20 patients have completed minimum 12mons follow up. The mineralization of fusion mass lateral to the instrumentation on each side was graded Absent, Mild (< 50%), Moderate (> 50%) or Complete fusion (100%). The assessment was made by two orthopaedic consultants and a musculoskeletal radiologist who were blinded to graft assignment.

Results: The sex distribution was 11:9 male to females with a mean age of 55.2 (21–87 years) and an average follow up of 18mons (12–24mons). Nine patients had single level fusion and the remainder had more than one level fusion. At 12 months on the side of DBM, 15% (6 of 20) had complete fusion, 80% (16 of 20) had moderate fusion, and 5% had no fusion mass. During the same period on the other side, 25% did not show any sign of fusion. There was no correlation with number of levels, age or sex.

Conclusions: Osteoinductive properties of DBM would appear to help in achieving early and higher union rates in lumbar spinal fusion. DBM reduces the amount of harvested autograft graft and also minimises the morbidity of donor site complications.

OBJECTIVE: To evaluate a peri-operative protocol developed to facilitate day case open shoulder procedures that historically have required overnight hospital admission.

METHODS: 75 consecutive day-case open shoulder procedures were performed in 75 patients (aged 18 – 65) followed up prospectively for a minimum of 6 months. The procedures included Open Primary Anterior Capsulo-Labral Reconstruction (ACLR) (24), open Revision ACLR (4), open Posterior Capsulo-Labral Reconstruction (1), mini-arthrotomy and rotator cuff repair (6), mini-arthrotomy and subacromial decompression (27), modified Weaver Dunn Reconstruction of Acromio-clavicular joint (ACJ) (2), decompression of ACJ (7), open release (Ozaki procedure) for frozen shoulder (1). Exclusion criteria included concomitant medical problems, and patients who would have no assistance in their care for the first 24 post operative hours. All patients received fast track general anaesthesia, peri-operative analgesia using intravenous Fentanyl, and Diclofenac (PR), and local Bupivicaine 0.5% to incisions and intra-articular spaces; patients were discharged with oral analgesics.

MAIN OUTCOME MEASURES: Patient satisfaction with overall experience, pain control, the incidence of nausea that was difficult to manage, the incidence of unplanned admission, attendance or delayed admission to hospital, postoperative complications.

RESULTS: 98% of patients were satisfied with their pain management. None of the patients suffered intractable post operative pain nausea or vomiting or required unplanned hospital admission or unexpected re-admission. All the patients were satisfied with their experience. There were no short or long term post operative complications.

CONCLUSION: The anaesthetic protocol and surgical techniques used in this study permitted same day discharge for a wide variety of open shoulder procedures. For selected patients, open shoulder surgery as a day case appears safe effective and acceptable to the patient.