We carried out a prospective study looking at the functional outcome and post-procedure segmental instability after lumbar decompression using a flip osteotomy technique that involved unilateral subperiosteal muscle dissection with hinging of the spinous processes thereby preserving the integrity of the posterior elements for unilateral or bilateral lumbar spine decompression.

Between February 2007 and February 2008, 51 patients (29 male and 22 female) diagnosed with degenerative and congenital lumbar stenosis with an average age of 60, underwent central and lateral canal decompression using the flip osteotomy technique. An average of two segments (range 1-3 segments) was decompressed. Patients with a history of previous spinal surgery, spinal fusion, existing degenerative spondylolisthesis or cauda equina syndrome were excluded.

All patients were followed up for a mean of 1.5 years. Five outcome measures were used – visual analogue scale for pain, Likert scale for functional status, symptom specific well-being score, general well-being score, number of days incapacitated in last 4 weeks. The outcomes measures were recorded pre-operatively, 6 weeks and one year post-operatively. Successful surgical outcome was defined as an improvement in at least four out of five outcome measures.

90% (46 patients) of patients had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (p<0.005) at the 6-week post-operative mark as compared to pre-operatively, with marginal improvement at one year post-surgery. There was no evidence of progressive lumbar segmental instability at one year post-operatively using our flip osteotomy technique

Decompression of the lumbar spine for lumbar stenosis using the flip osteotomy technique is a safe approach for one or multi-level stenosis with good outcomes and no evidence of significant iatrogenic segmental spinal instability.

We declare no conflict of interest and ethical approval was obtained

One thousand patients who received 1112 total joint replacements between 1966 and 1980 were followed up prospectively for an average of six years. These patients were not advised to take antibiotics prophylactically to cover subsequent dental or surgical procedures and, so far, only three cases of haematogenous infection at the site of the joint replacement have developed. Two hundred and twenty-four patients did subsequently undergo dental or surgical procedures and 284 patients developed infections in the respiratory tract, urinary tract or at multiple sites; none of these patients developed haematogenous infection. But of 40 patients who suffered recurrent skin ulceration and infection, three (7.5%) developed haematogenous infection of the replaced joint; two of these belonged to a group of 134 patients with rheumatoid arthritis. These results suggest that transient bacteraemia is not likely to infect a replaced joint in otherwise healthy patients. But an infected skin lesion producing chronic bacteraemia, or septicaemia due to a virulent organism, may well do so and patients with rheumatoid arthritis are at greater risk than those with osteoarthritis.

Two comparable groups of patients with fractures of the trochanteric region of the femur were studied. One hundred and sixty-five fractures had been fixed with conventional nail-plates and 132 with Ender's nails. Ender's nails gave superior results in the treatment of trochanteric fractures. The operation was quicker and less traumatic than that using conventional nail-plates and both the mortality rate and the time in hospital were reduced. More patients in the group with Ender's nails who were initially independent returned to an independent existence.