INTRODUCTION: To audit the workload of an Orthopaedic Surgeon sent on deployment to the Middle East. The cases seen and treated are discussed. The audit was to determine the lessons for the future. DISCUSSION: 86 in patient admissions occurred between 12.01.2002 and 10.04.2002. A break up of speciality was a follows: Orthopaedic 38, Medical 27, General Surgical 16 and Psychiatric 5. A breakdown of the Orthopaedic cases were as follows: Ankle Injury 5, Arthralgia 3, Closed Fracture 4, Elbow Injury 1, Knee Injury 5, Low Back Pain 5, Multiple Soft Tissue Injury 3, Open Injury 3, Sciatica 1, Shoulder Injury 2, Soft Tissue Injury 3, and Stress Fracture 3. The 3 suspected stress fractures and the 2 gun shot wounds required special mention. 31 of 38 Orthopaedic patients were sent back to the UK through the Aeromedical chain. These patients were subclassified according to the requirement of evacuation through the Aeromedical chain. Seventeen patients, though not fit for theatre were able to undertake their own flight back. A trial of sending them back on unaccompanied flights failed. All patients were then evacuated through the Aeromedical chain. On average this meant one medical attendant per 2 patients. If civilian flights were taken this would have meant an extra expenditure of £4,800 (£600 x 8). Illness behaviour was noted in 10 of the 38 Orthopaedic patients. All these patients were evacuated to the UK. Malingering as tested by the Burns bench test, modified Schobers test, Hoover test and Inappropriate Waddells signs were positive in 4 of these patients whose initial complaint was of low back pain. CONCLUSION: It is proposed that the category of patients who are unfit for theatre but fit to fly unaccompanied should be recognised. It is also proposed that patients potentially deployable but showing illness behaviour should be discharged from the services earlier as it causes unnecessary expenditure and enforces extra work on other sincere and fit personnel.
This study was designed to determine the point prevalence of musculoskeletal pain among deployed personnel. 150 questionnaires were randomly distributed through the cashier and the mess at RAF Thumrait. 112 questionnaires were returned. The questionnaire, although a general musculoskeletal one, focused mainly on spine pain and also contained the Short Form 36. 107 males and 5 females responded. 85 (75.89%) personnel reported presence of some pain either in their spine and/ or limbs. There was no difference in the report of pain between the various age groups mentioned (p=0.76). There were significant differences among the different occupational branches (p=0.0023). There was no correlation however between spinal pain and lifting (p=0.79), standing (p=0.28), sitting (p=0.98), or running / jumping/ climbing (p=0.77). Though the 22 smokers reported higher pain than non-smokers this did not show statistical significance. There was negative correlation between the VAS report of pain and the Physical Component of Health (p=0.0001) and between stress at work and the Mental Component of Health (p=0.001) and between stress at work and the Mental component of health (p=0.001). 85 (75.9%) of the 112 personnel who had completed the questionnaire had some pain either in the spine or limbs. The lower back was the single anatomical region where pain was reported (n=68,60.7%) most frequently. It is interesting to note that all these personnel were on active duty in the armed forces and considered medically fit to deploy. It only shows to reinforce that low back pain in particular and musculoskeletal pain in general is common and normal and does not always imply disease and disability.
Recent years have seen the popularization of minimally invasive approaches to the spine. However, the use of the balloon assisted retroperitoneal approach has not been widely described, moreover there has been no direct comparison between this mini-ALIF (anterior lumbar interbody fusion) and the conventional open method in the literature. Comparison of peri and intra-operative parameters between the rnini-ALIF (using the balloon assisted dissector and Synframe retractor system) and the open midline approach for single and double level anterior lumbar interbody fusions in order to assess the efficacy of this procedure. An independent retrospective evaluation of 35 patients who underwent single or double level ALIF under the care of the senior author at the University Hospital, Nottingham during the period from 1997 to 2000. The patients were split between those undergoing a mini-ALIF (balloon assisted retroperitoneal dissection) or the conventional approach via a larger midline incision. The groups were matched for age, sex and number of levels. Data was collated from the medical notes with regards to intra-operative blood loss, operative time, intra-operative complications, PCA requirements, time to mobilisation and length of hospital stay. A statistically significant (p=0. 01) reduction in time to mobilisation (mean 2. 1 days vs 3. 9 days) and operative time (mean 175mins vs 265mins) was found for the single level mini-ALIF. This reflects the greater number of L5/SI fusions in this group. The number of vascular injuries was also greater in the approach to L4/5. No difference was found between the two groups for double level procedures. The immediate advantages of a less invasive approach both to the patient and hospital do not appear to be borne out by this study. Cosmesis was not assessed and the long term functional outcome awaits later confirmation.
Conclusion: The immediate advantages of a less invasive approach both to the patient and the hospital do not appear to be borne out by this study. Cosmesis was not assessed and long term functional outcome awaits later review.
Advances in laparoscopic technology have popularised minimally invasive approaches to the anterior lumbar spine. The use of the balloon assisted retroperitoneal approach however has not been widely described; moreover there has been no direct comparison between this mini anterior lumbar interbody fusion (ALIF) and the conventional open method in the literature. Comparison of peri and intra-operative parameters between the mini-ALIF (using the balloon assisted dissector) and the open midline approach for single and double level anterior lumbar interbody fusions in order to assess the efficacy of this procedure. An independent retrospective evaluation of 35 patients who underwent single or double level ALIF. A single surgeon at the University Hospital, Nottingham, performed the procedures during the period from 1997 to 2000. The patients were split between those undergoing a mini-ALIF (balloon assisted retroperitoneal dissection) and the conventional approach via a larger midline incision. The groups were matched for age, sex and number of levels. Data was collated from the medical notes with regards to intra-operative blood loss, operative time, intra-operative complications, Patient Controlled Analgesic (PCA) requirements, time to mobilisation and length of hospital stay. A statistically significant reduction in operative time (mean 178mins Vs 255mins) and time to mobilisation (mean 2.2 days Vs 3.7days) was found for the single level mini-ALIF. No other significant difference was detected for the other criteria between the two groups for either single or double level procedures. Complications in the form of vascular injuries were almost equal in both groups. Although operating time was significantly shortened using the balloon-assisted dissector other perioperative parameters were not. The question of cosmesis of the surgical scar was not explored in this study, this may have been more favorable in the mini-ALIF group but given the above results one must question whether the added expense of this innovative device is justified when there was no detected difference in all other measured criteria.
To determine the current practice and to review the literature regarding administration of high dose Methylprednisolone for acute spinal cord injury (SCI). Administration of high dose Methylprednisolone for Acute Spinal Cord Injury has been widely practised following the publication of the three National Acute Spinal Cord Injury Studies (NASCIS). NASCIS recommends a bolus intravenous dose of 30mg/kg of Methylprednisolone in 15 minutes, followed by a 45 min pause and then followed by a maintenance dose of 5.4 mg / kg / hr for 23 hours. This regime has been recommended by the Advanced Trauma Life Support. The Cochrane reviews also extol the three NASCIS randomised controlled trials. The mechanism of neuroprotection by Methylprednisolone is based on its inhibition of lipid peroxidation. Three hundred questionnaires were sent to Consultants practising Spinal surgery, Neurosurgery and Accident &
Emergency to determine the popular thought regarding the use of Methylprednisolone for Acute SCI. A thorough review of current medical literature was also performed. The literature search showed contradictory evidence regarding the use of high dose Methylprednisolone. The current popular thought, the diversity of responses between the three groups, the results of the 3 NASCIS trials and a recent review of literature is presented.