Aim: We present a pilot study on the conservative treatment of chronic low back pain (LBP) using an orthosis. It consists of a pneumatic custom made lumbar vest (Orthotrac), which permits both support-stabilisation and decompression. This system allows patients to perform any activity while wearing it.

Material: The study included 9 patients with radicular pain due to degenerative discopathy including: dark disc, discal protrusion with neural foramina involvement, stenosis of the foramina. Patients had to wear the Orthotrac vest according to a precise protocol, 60 minutes 3 times a day for 5 weeks.

Results: 5 patients (55.5%) have showed a significant subjective and clinical improvement with subsequent better quality of life. All patients referred a decrease or disappearance of radicular pain. Outcome measures were evaluated VAS pain scale and SF-36 follow up questionnaires. Two (22.2%) patients reported to have no benefit.

Conclusion: The pneumatic vest can play an important role in non-surgical therapy for low back pain. The system seems to give an effective spinal decompression and deserves a careful consideration when lumbar discal disease is treated non operatively.

Introduction: Spinal stenosis may present as intermittent claudication and may be indistinguishable from vascular claudication as both could co exist. These patients often required expertise from both the speciality. Combined Vascular and spinal clinic after primary screening with the help of MRI scan may reduce the waiting time to the appropriate speciality.

Aim: We prospectively reviewed all the patients referred to senior author from vascular unit to assess the final outcome and evaluate whether primary to referral to vascular surgeon was unnecessary.

Study Design: Prospective study from November 2004 to May 2005

Methodology: Review of Hospital case notes – 23 patients were referred to us from one of the vascular surgeons’ unit after excluding vascular etiology as the cause of the leg pain and MRI confirmation of spinal stenosis.

Result: Mean waiting time to see the spine consultant 103 days [20–195] from the date of referral by the vascular team. The waiting time to primary referral to vascular team was 164 days [43–194]. 43.5% of the referred patients required to have spinal decompression.

Conclusion: To improve the waiting time primary physician should have access of MRI scan to delineate the pathology and combined vascular and spinal clinic may achieve waiting time target.

Introduction: Sliding screws has been described to use in hip fractures since 1950s. Failure of fixation varies from 16 – 23%. We aim to assess the effect of audit and re auditing the failure rate after introduction of the Tip apex distance concept since January 2000 to December 2004.

Methodology: We measured the tip apex distance in 161 (93 in the audit group and the rest re audit patients, 140 available for analysis. Their mean age at diagnosis 82.2 years [range 56.2–100.6 years] and male and female ratio was 1:6. Average time to Operation 1.7 days form the day of admission. The average Hospital Stay was 15.8 days

Result & discussion: We found that Patients had recorded Lag screw length 92.6mm [75–115], Side plate: 4 hole:6 hole = 4:1, Measured TAD 27.6 mm [6.3–66.4] in 140 patients,

The mean radiation time was 38.27 sec (7–71) and the dosage 0.68 Cgycm2 (0.93–2.06),

The mean Tip Apex Distance in the failed fixation group of 16 patients with cut out screw (13 in the audit group and 3 in the re audit group) is 43.05 [27.2–65.8]

Conclusion: We found the auditing and re auditing could potentially improve the surgical outcome. Although the Risk of cut out depends on many variable such as increasing age, Unstable fracture, poor reduction, high angle side plate 150deg, TAD is the stronger predictor than any other variable. This variable can be controlled by regular audit of the surgical practice.

Aim: To establish the effectiveness of using the intra-operative cell saver in spinal surgery.

Methods: Patients undergoing posterior instrumental lumber spine fusion with iliac crest bone graft were selected to have intra-operative red cell salvage using the cell saver machine (Dideco Electra-Auto-transfusion Cell Separator). 20 patients were in the study group. The control group consisted of 28 patients who had undergone similar surgery prior to introducing the cell saver. The parameters identified were: pre and post operative haemoglobin, clotting state, volume of transfused allogenic blood, volume of transfused autollogous blood using the cell saver and indications for transfusion. Statistical analysis: the chi-square and the t-test.

Results: The average age in the cell saver group was 43.8 years and in the control group 48.3 (p> 0.09). The number of levels fused was comparable between the two groups (p> 0.1). There was no difference in the pre and post operative haemoglobin level in the two groups (p> 0.7 & p> 0.3 respectively). No patient had a pre-operative coagulopathy. Two patients (10%) in the cell saver group received an intra-operative allogenic transfusion, 14 patients (50%) in the non-cell saver group received a transfusion. The difference was significant (p< 0.004). Conclusion: The use of the cell saver significantly reduces the need for allogenic blood transfusion in major spinal surgery. We therefore recommend its routine use in such procedures.

We describe 12 children with idiopathic scoliosis who had a persistent absent superficial abdominal reflex (SAR) on routine neurological examination. MRI showed syringomyelia to be present in ten. The average age at detection of the scoliosis was 4.3 years and at diagnosis of syringomyelia 6.6 years. In all ten children the SAR was consistently absent on the same side as the convexity of the curve. In two it was the only abnormal neurological sign. An absent SAR in patients with scoliosis is an indication for investigation for underlying syringomyelia. In the children with syringomyelia, six had thoracic and four thoracolumbar curves. The clinical features differed in the two groups. Patients with thoracic curves were generally asymptomatic. Their neurological signs were subtle and none had any motor signs. By contrast, patients with thoracolumbar curves had symptoms and neurological signs. Abnormal gait was present in all four patients with thoracolumbar curves. In three this was due to considerable motor weakness. In eight children syringomyelia was associated with a Chiari-I malformation. In seven the syrinx was treated surgically by decompression of the foramen magnum.