This study assessed the frequency of acute injury to the spinal cord in Irish Rugby over a period of ten years, between 1995 and 2004. There were 12 such injuries; 11 were cervical and one was thoracic. Ten occurred in adults and two in schoolboys. All were males playing Rugby Union and the mean age at injury was 21.6 years (16 to 36). The most common mechanism of injury was hyperflexion of the cervical spine and the players injured most frequently were playing at full back, hooker or on the wing. Most injuries were sustained during the tackle phase of play. Six players felt their injury was preventable. Eight are permanently disabled as a result of their injury.

Objective: To date the principal focus of the mechanism of cervical spine fracture has been directed at head/ neck circumference and spinal canal dimensions. However the role of other measurements, including chest diameter and head/neck/chest proportional ratios, in a standard cervical fracture population has not yet been studied in detail. Cervical fractures often involve flexion/ extension type mechanisms of injury, with the head and cervical spine flexing/extending, using the thorax as a fulcrum.

Study design: We prospectively studied all patients with cervical spine fractures who were admitted to the spinal injuries unit from 1st July, 2000 to 1st March 2001. Anthropometrical measurement of head circumference, neck circumference, chest circumference, and neck length were analysed. Ages ranged from 18 – 55yrs, and all patients with concomitant cervical pathology were excluded from the study. Mechanism of injury involved flexion/extension type injuries in all cases; those with direct axial loading were excluded. A control group of 30 patients (age 18–55yrs) involved in high velocity trauma with associated long bone fractures, in whom cervical injury was suspected but without any cervical fracture, or associated pathology, were measured.

Results: Our analysis revealed a statistically significant increase in chest size in the male control group versus the fracture group 98.89cm v. 94.19cm (P< 0.05, t-test). There was a correspondingly significant increase in chest circumference between the female control versus the fracture group 94.33cm v. 88.88cm(P< 0.05, t-test). Our results revealed no statistical difference in either head circumference, neck circumference, or neck length between each of the groupings. However we found a statistically significant increase in head/neck/chest ratios between each of the groups. These results indicate a proportionately larger chest may be protective in cervical spine fractures.

Herniated intervertebral disc tissue has been shown to produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain.

We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E₂ (PGE₂) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay.

There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively).

The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.

We have carried out a blind, prospective study of 50 consecutive patients undergoing replacement arthroplasty of the hip using two different approaches. Clinical assessment, including the Harris hip score and a modified Trendelenberg test, and electrophysiological examination of the abductor muscles of the hip were undertaken before and three months after surgery. We found that 48% of patients had preoperative evidence of chronic injury to the superior gluteal nerve. Perioperative injury to the nerve occurred commonly with both approaches to the hip.

We did not find a significant correlation between injury to the superior gluteal nerve and clinical problems.

We have reviewed 59 patients with injury to the spinal cord to assess the predictive value of the sparing of sensation to pin prick in determining motor recovery in segments which initially had MRC grade-0 power.

There were 35 tetraplegics (18 complete, 17 incomplete) and 24 paraplegics (19 complete, 5 incomplete), and the mean follow-up was 29.6 months. A total of 114 motor segments initially had grade-0 power but sparing of sensation to pin prick in the corresponding dermatome. Of these, 97 (85%) had return of functional power (≥ grade 3) at follow-up. There were 479 motor segments with grade-0 power but no sparing of sensation to pin prick and of these only six (1.3%) had return of functional power. Both of the above associations were statistically significant (chi-squared test, p < 0.0001).

After injury to the spinal cord, the preservation of sensation to pin prick in a motor segment with grade-0 power indicated an 85% chance of motor recovery to at least grade 3.