Introduction

The aim of this study was to assess patients and healthcare professionals (HCPs) opinions on the validity of using a biopsychosocial model rather than a biomedical model in alleviating patient symptoms/pain.

The outcome of surgery for recurrent lumbar disc herniation is debatable. Some studies show results that are comparable with those of primary discectomy, whereas others report worse outcomes. The purpose of this study was to compare the outcome of revision lumbar discectomy with that of primary discectomy in the same cohort of patients who had both the primary and the recurrent herniation at the same level and side.

A retrospective analysis of prospectively gathered data was undertaken in 30 patients who had undergone both primary and revision surgery for late recurrent lumbar disc herniation. The outcome measures used were visual analogue scales for lower limb (VAL) and back (VAB) pain and the Oswestry Disability Index (ODI).

There was a significant improvement in the mean VAL and ODI scores (both p < 0.001) after primary discectomy. Revision surgery also resulted in improvements in the mean VAL (p < 0.001), VAB (p = 0.030) and ODI scores (p < 0.001). The changes were similar in the two groups (all p > 0.05).

Revision discectomy can give results that are as good as those seen after primary surgery.

Cite this article: Bone Joint J 2013;95-B:90–4.

Background

Fractures of the odontoid peg are one of the commonest cervical spinal injuries in the elderly population. In this population there is a higher risk of morbidity and mortality as a result of the injury. The magnitude of the mortality risk has not been quantified in the literature.

Background

The relationship between obesity and cauda equina syndrome (CES) has not been previously evaluated or defined.

Aim

To compare outcomes of revision lumbar discectomy to primary surgery in the same patient cohort.

Background

Minimally invasive surgery is an alternative therapeutic option for treating unstable spinal pathologies to reduce approach-related morbidity inherent to conventional open surgery.

Background

The relationship between obesity and cauda equina syndrome (CES) has not been previously evaluated or defined.

Background

Fractures of the odontoid peg are one of the commonest spinal injuries in the elderly population. In this population there is a higher risk of morbidity and mortality as a result of the injury. The magnitude of this risk has not been quantified in the literature.

Venous Thromboembolism (VTE) is the most common complication following major joint surgery. While attention has focused on VTE following joint arthroplasty their exists a gap in the literature examining the incidence of VTE in spinal surgery; with a shortage of epidemiological data, guidelines for optimal prophylaxis are limited.

This survey, undertaken at the 2009 BASS Annual Meeting, sought to examine prevailing trends in VTE thromboprophylaxis in spinal surgery and to compare selections made by Orthopaedic and Neurosurgeons.

We developed a questionnaire based around eight clinical scenarios. Participants were asked to supply details on their speciality (orthopaedics or neurosurgery) and level of training (grade) and to select which method(s) of thromboprophylaxis they would employ for each scenario. Thirty-nine participants provided responses to the eight scenarios; complete details, including speciality and grade of those surveyed, were complied for 27 of the 39 questionnaires completed.

LMWH was the preferred pharmacological method of thromboprophylaixs selected 31% and 72% of the time by orthopaedic and neurosurgeons respectively. For each of the eight clinical scenarios LMWH and BK TEDS were selected more frequently by neurosurgeons than orthopaedic surgeons who elected to employ early mobilisation and mechanical prophylaxis. Neurosurgeons were more likely to employ more than method of thromboprophylaxis.

Thromboprophylactic selections differed between the two groups; Neurosurgeons preferred LMWH and BK TEDS whilst Early Mobilisation and Mechanical prophylaxis were the preferred methods of thromboprophylaxis amongst orthopaedic surgeons. Based on the results of this survey neurosurgeons more closely adhered to guidelines outlined by NICE/BASS.

To evaluate the effect of wait time to surgery on patient derived generic and disease-specific functional outcome following lumbar surgery.

Study cohort of seventy patients undergoing elective posterior lumbar spinal surgery for degenerative conditions. Prospectively collected SF-36 and Oswestry Disability questionnaires administered preoperatively, six weeks, six months, one year postoperatively. Time intervals from onset of symptoms to initial consultation by family physician through investigations, spinal surgical consultation and time spent on the surgical waiting list to surgery quantified. Time intervals compared to patient-specific improvements in reported outcome following surgery using Cox-Regression analysis. The effect of patient and surgical parameters on wait time was evaluated using median time as a reference for patients with either a longer or shorter wait.

Patient follow-up completed in fifty-three (76%). Improvements in patient derived outcome were observed comparing post-operative to pre-operative baseline scores (p< 0.05). The greatest improvements were observed in aspects relating to physical function and pain. A longer wait to surgery was associated with less improvement in surgical outcome (p< 0.05, SF-36 domains BP, GH, RP, VT, and Physical Component Scores). The greatest impact observed was a prolonged surgical wait-list time on SF-36 PCS scores following surgery (Hazard’s ratio 3.53). Patients requiring spinal fusion had a longer wait when compared to those not requiring fusion (p< 0.05).

A longer wait time to spinal surgery can negatively influence surgical results as quantified by patient derived functional outcome measures. Surgery resulted in the greatest improvement in pain severity and physical aspects of function, however, these areas also appeared the most impacted by a longer wait to surgery.

Revision discetomy is a procedure often assumed to give similar results to primary discectomy. There is no level one or level two evidence to support this view and no publications with pre and post surgical spine specific outcome measures.

This aim of this study was to evaluate the surgical outcomes of revision discectomies using standard spine instruments and to identify factors which influence the outcome. A prospective cohort study was performed between 1996 and 2004. A revision discectomy was defined as surgery at the same lumbar level as a previous discectomy with a minimum three month interval from the index surgery. Outcome measures were available for all 20 patients from the index primary discectomy. Questionnaires were given to the patients preoperatively and at 2 year follow-up. Among the outcomes measures used were the Oswestry Disability Index (ODI), the Low Back Outcome(LBO), and a Visual Analogue Score(VAS). 20 revision discectomies were performed on 11 males and 9 females, 7 at L4/5 and 13 at L5/S1. The mean age was 41(30–56) and the mean follow-up was 27(24–36) months. The preoperative ODI, LBO and VAS at the index primary discectomy averaged 54(22–82), 19(7–42) and 8(5–10) respectively. The preoperative ODI, LBO and VAS at the revision discectomy averaged 63(34–82), 18(1–46) and 8(1–10) respectively. The ODI, LBO and VAS all improved significantly at follow-up. The ODI averaged 27(2–66) (p< 0.05), the LBO averaged 47 (14–70) (p< 0.05) and the VAS 4(3–9) (p< 0.05). The outcome of revision discectomies is favourable, in this series the average improvement in ODI was 36 points, a clinically significant change. The risk factors which influence the outcome are preoperative ODI, preoperative VAS and Age (p< 0.05). Sex, preoperative LBO, duration between recurrent disc herniation, level of disc herniation and incidental durotomies were not predictive of outcome.

The purpose of the study and background: The effect a claim for whiplash has on somatic symptoms, psychological state and prognosis is very complex. The severity of the injury predicts both the prognosis and the likelihood of suing. The use of psychological tests to predict prognosis is controversial and they have never been used to predict those who will claim or if they change after settlement.

The methods and the results: This prospective study recruited patients attending the Accident and Emergency department. All were reviewed one week following their injury. Accident data, Visual Analogue Score (VAS), Distress Risk Assessment Method ((DRAM – modified Zung Depression Index (MZDI) and Modified Somatic Perception Questionnaire(MSPQ)) and clinical findings were recorded. At 2 years follow-up a further postal questionnaire was sent including a VAS, MZDI, MSPQ and whether or not they had recovered and /or made a claim. We reviewed 57 patients with a mean follow-up of 31 months. Ten patients were lost to follow-up, 35 made a claim and 12 did not. All claims had been settled at review. 24/35 who claimed fully recovered compared to 5/12 who did not. Initially, the mean VAS in the claimants was 5.8 compared to 3.6 in the non-claimants. The MZDI and MSPQ were 31 and 11 and 13 and 8 respectively. Post-claim the VAS was 2.6 and 1.4, the MZDI 20 and 13 and the MSPQ 7 and 2.

Conclusion: The DRAM is a good predictor of claimants and shows they are an ‘at risk’ group. The outcome is not affected by claiming.

Purposes of the study and background: We set out to demonstrate whether there is a significant difference in the outcome of patients treated surgically and non-surgically for lumbar spine stenosis at two-year follow-up. In the literature, few prospective controlled trials exist which compare non-surgical to surgical treatment in spinal stenosis. Therefore, evidence for the best management of this condition is limited.

Methods: From prospectively collected data between January 1993–January 1999 two groups were identified. To minimize differences in baseline characteristics patients were matched for age, sex and Oswestry score at the outset. The outcome measures recorded were an Oswestry Disability index/Spine Function Questionnaire (including Visual Analogue Score)/Modified Somatic Perception and Modified Zung Depression Index (at initial visit and two year follow-up).

Results: Twenty matched pairs were identified: twelve male and eight female. One hundred percent follow-up was achieved in each group. The mean follow-up was two years. In the surgical group, twelve were instrumented and eight uninstrumented. The extent of the decompression and fusion was as follows: three were a single-level fusion, ten two-level, four three-level and three four-level. In the non-surgical group, two received no treatment, thirteen a single form of treatment (Physiotherapy/Root canal injection/Salmon Calcitonin) and five received two or more of the above treatments. The differences in the outcomes between the groups at baseline and two years were not statistically significant except for pain (p< 0.05). However, all measures improved in both groups over the two years.

Conclusion: Surgical decompression for lumbar spinal stenosis significantly decreases pain at two year follow-up compared to those treated non surgically.