Intra-Discal Vacuum Phenomenon (IDVP) represents an intradiscal nitrogen gas accumulation where a cavity opens in a supine position, lowering intra-discal pressure and generating a bubble. IDVP has been observed in up to 20% of elderly patients and reported in almost 50% of chronic LBP patients. With a highly accurate detection on CT, its significance lacks clarity and consideration within normative data. IDVP occurs with patterns of lumbar and/or lumbopelvic morphology and associated diagnoses. Over-60s population based sample of 2020 unrelated CT abdomen scans without acute spinal presentations, with sagittal reconstructions, inclusive of T12 to femoral heads, were analyzed for IDVP and pelvic incidence (PI). Subjects with diagnostic morphological associations of the lumbar spine, including previous fracture, autofusion, transitional vertebra and listhesis, were selected out and analyzed separately. Subjects were then equally grouped into low, medium and high PI. Prevalence of lumbar spine IDVP is 41.3%. 125 cases were excluded. 1603 subjects yielded 663 IDVP. This was increased in severity towards the lumbosacral junction (L1L2 9.4%, L2L3 10.9%, L3L4 13.7%, L4L5 19.9%, L5S1 28.5%) and those with low PI, while distribution was more even with high PI. 292 had positive diagnostic associations, which were more likely to occur at the level of isthmic spondylolisthesis, adjacent to a previous fracture or suprajacent to lumbosacral transitional vertebra (p<0.05).

This study has identified normative values for prevalence and severity of IDVP in a normal aging population. Morphological patterns that influence the pattern of IVDP such as pelvic incidence and diagnostic associations provide novel insights to the function of the aging spine.

Discogenic low back pain affects 42% of patients suffering low back pain. Degenerative disc disease is described as failure in cellular response to external stresses leading to physiologic dysfunction. Glycosylation patterns of tissues give insights into the spatially and temporally regulated inflammatory and degenerative processes. These glycoconjugates participate in many key biological processes including molecular trafficking and clearance, receptor activation, signal transduction, and immunomodulation. We hypothesise that glycoprofile of the the intervertebral disc(IVD) is temporally and spatially distinct in health and degeneration. The glycoprofile of the IVD has been studied in murine, bovine and ovine models for injury and aging. In this study, healthy(n=2) and degenerated(n=2) human IVD samples received from Utrecht(UU, ND) with ethical approval(NUIG), were compared using lectin histochemistry. The N-glycan profile of human degenerated IVD samples was characterised by high resolution quantitative UPLC-MS. Healthy and degenerated human discs present distinct glycosylation trends intracellularly/extracellularly in annulus fibrosus(AF) and nucleus pulposus(NP) tissue. There are quantitative and spatial differences in glycosylation in healthy and degenerated tissue. These findings are consistent with previous studies of IVD in murine, bovine and ovine models. The human N-glycan profile of degenerated surgical tissues is distinct from other cited tissue profiles such as human plasma⁵. These studies offer validation of previous animal models of IVD injury and degeneration, demonstrating similar changes in the glycoprofile in both animals and humans. Glycoprofiling may offer insight into disease progression, offering new realms of disease classification in patient specific manner while also elucidating potentials therapeutic targets, inhibiting disease progression.

Background The internet is an increasingly utilised resource for accessing information regarding a variety of heath conditions. YouTube is a popular video sharing platform used to both seek and distribute information online.

Background

New marker free motion analysis systems are being used extensively in the area of sports medicine and physiotherapy. The accuracy and validity of use in an orthopaedic setting have not been fully assessed for these newer marker free motion analysis systems. The aim of this study is to compare leg length and varus/valgus knee measurements performed by leg measurement x-ray, and performed using the new marker free motion analysis system (Organic motion biostage).

Introduction

The classical Colles fracture (extraarticular, dorsally angulated distal radius fracture) in patients with osteoporotic bone is becoming increasingly more frequent. There still appears to be no clear consensus on the most appropriate surgical management of these injuries. The purpose of this study is to appraise the use of percutaneous extra-focal pinning, in the management of the classical colles fracture.

Introduction: The position of the L4/5 disc inter-space is commonly believed to be represented by a line drawn between the two highest points of the iliac crests. This line is used frequently as a pre-operative guide for incision placement, in patients undergoing spinal surgery.

Aim: To investigate whether a line drawn between the two highest points on the iliac crests corresponds to the L4/5 disc inter-space, in varying patient age groups.

Patients and Methods: We reviewed 450 AP and lateral lumbar spine radiographs in patients ranging in age from 20 – 90 years. Patients with an obvious deformity or previous spinal surgery were excluded from the study. In the AP films, a line was drawn between the two highest points on the iliac crests. From this line, the distance to the midpoint of the L4/5 disc was measured.

Results: In all age groups measured, the true L4/5 disc inter-space lay below the line between the iliac crests, at an average of 4.33mm below the supracristal plane. The plane intersected the spine at the L4/5 interspace in only 31.9% of cases and was found to lie at the lower half of the L4 body or above in 49.3% of cases.

Conclusions: These results show that, using a line drawn between the two highest points on the iliac crests as a guide to the position of the L4/5 disc interspace may lead to unintentionally cranial positioning of an incision or cannulation in this area. Therefore, it is advisable to perform a pre-operative AP and lateral radiograph of the lumbar spine, to enable accurate incision placement when performing spinal surgery in this area.

Introduction: The position of the L4/5 disc inter-space is commonly believed to be represented by a line drawn between the two highest points of the iliac crests. This line is used frequently as a pre-operative guide for incision placement, in patients undergoing spinal surgery.

Aim: To investigate whether a line drawn between the two highest points on the iliac crests corresponds to the L4/5 disc inter-space, in varying patient age groups.

Patients and Methods: We reviewed 450 AP and lateral lumbar spine radiographs in patients ranging in age from 20 – 90 years. Patients with an obvious deformity or previous spinal surgery were excluded from the study. In the AP films, a line was drawn between the two highest points on the iliac crests. From this line, the distance to the midpoint of the L4/5 disc was measured. This was achieved in the lateral films, by finding the midpoint between the two iliac crests and again measuring the distance from this point to the midpoint of the L4-5 disc.

Results: In all age groups measured, the true L4-5 disc inter-space lay below the line between the iliac crests. In the patient group a 20–30 yrs, the inter-iliac crest line lay on average 1.86 mm above the true l4–5 disc space. In the patients aged 30–40 yrs the line was on average 2.49 mm above the disc space. Patients aged 40–50 yrs the line was 6.05 mm above the disc space. In patients aged 50–60 yrs and 60–70 yrs, the line was 3.17 mm above the disc space. In the 70–80 yrs age group, the line was 4.5 mm above the true disc space. In the oldest group of patients studied (80–90 yrs), the line was positioned 9.06 mm above the true disc space. The results were analysed using the ANOVA system to assess their statistical significance. Comparison of the patients aged 20–30 yrs versus patients aged 80–90 yrs yielded a p value of p=0.0045. Patients aged 60–70 yrs versus patients aged 80–90 yrs, p=0.0049. Patients aged 50–60 yrs versus patients aged 80–90 yrs, p=0.0023. Patients aged 30–40 yrs versus patients aged 80–90 yrs, p=0.0004. Patients aged 70–80 yrs versus patients aged 80–90 yrs, p=0.03. Comparison of other patient groups, were of low statistical significance

Conclusions These results show that, while the L4/5 disc inter-space does broadly correspond to a line drawn between the iliac crests, there is a significant variation between different age groups and within individual age groupings. Therefore, it is advisable to perform a pre-operative AP and lateral radiograph of the lumbar spine, to enable accurate incision placement when performing spinal surgery in this area.

Aim: Prosthetic loosening has emerged as a most serious long-term complication after Joint Arthroplasty and the most common cause for revision. Arthroplasty is performed either under a general anaesthesia or a spinal/ epidural or a combination of the two. During general anaesthesia Sevoßurane is used for induction and maintenance. We investigated the effect of Sevoßurane on bone cement in an in vitro setting. Materials & Methods:. 40 beads of roughly the same size were prepared from 2 mixes in a sterile condition in vacuum. 20 of these beads were scanned initially under an electron microscope at 2 levels of magniþcation. The surface images of all the cement beads were analysed. Equal numbers of scanned and unscanned beads were separated into 2 groups of 20 each. They were immersed into 2 jars of normal saline. One was connected to the anaesthetic apparatus and exposed to Sevoßurane at a concentration of 2.5%. The other group (control) was exposed to oxygen. This was performed for 2 hours in an orthopaedic theatre. All the beads were then scanned. Results & Conclusions: The post Sevoßurane exposure images revealed a large number of pits of irregular dimensions on the surface. There were no changes on the surface of control beads. This suggests that in clinical concentrations Sevoßurane can affect the surface of bone cement and its mechanical properties. This can in turn affect the bone cement interface and be a potential cause of prosthetic loosening.

Introduction: There is still controversy regarding the treatment of acute Lumbar Radicular pain. Most authorities recommend bed rest, anti-inflammatory medication and physical therapy (Riew et al JBJS 1982 and Tulder ET AL Spine 22–1997) Comparing the outcome of operative and conservative treatment in selected patients many authors (Weber et al, Hakelius et al) did not find any significant difference after first year and no difference after 4 years. However many patients treated conservatively complains of persistent pain and seek further intervention.

Aim: We did a prospective study to determine the effectiveness of selective nerve root injection in relieving pain in patients with Lumbar radicular pain.

Material and Methods: We included 27 consecutive patients in our study, who had selective nerve root block. Inclusion criteria were Degenerative Lumbar Radicular pain or spinal stenosis, MRI correlating with Lumbar radiculopathy and no benefit from 6 weeks Anti-inflammatory medication, Rest, Physical treatment and activity modification. Informed consent taken from all patients for this study. Each patient was given Low Back Pain outcome score questionnaire of Greenough and Fraser and Oswestry Disability index of Fairbank, to be filled pre and post injection in day ward and at regular intervals up to 3 months post-injection. Adcortyl 20mg with 1 ml of 1% Lignocaine were injected under image in theatre after confirming the site with radioculogram and pain replication.

Results: From the total of 27 patients, 25 (92%) showed improvement in their symptoms in first week. Out of these 25 patients, 18(66%) had long-term improvement and 7(26%) showed short-term relief. Statistically significant improvement at every stage of assessment was observed.

Conclusion: The selective nerve root block combined with careful history, physical examination and quality radiolographic studies, is an important tool in the diagnosis and treatment of patients with predominant Lumbar radicular symptoms. It gives acceptable results in form of pain relief in 3 months. It has a role in lumbar Radicular pain largely in patients where surgery is not appropriate for whatever reasons.

Compression foot pumps are widely used for the prevention of postoperative venous thrombosis. We tested the efficiency of the pump in ten healthy subjects; the velocity of venous blood flow in the common femoral vein was measured in the horizontal, Trendelenberg (foot-up) and reverse-Trendelenberg (foot-down) positions.

Application of the foot pump produced an increase in the venous velocity in all subjects. The mean increase in the horizontal position was 27.2% and in the Trendelenberg position 15.4%. In the reverse-Trendelenberg position, the foot pump produced a mean increase of 102.8%.

The efficiency of the compression foot pump in increasing venous return is improved by adopting the reverse-Trendelenberg position. This may increase its thromboprophylactic effect.