Background: More patients are turning to the Internet for health-related information. Studies indicate that this information is being used to make decisions about their management. The aim of this study was to assess the information available specific to scoliosis on the Web using four common search engines.

Methods: Four search engines (Google, Yahoo, Hotmail and Ask Jeeves) were used in scanning the Web for the following key word- “Scoliosis”. Both U.K. only and World Wide sites were accessed. Four Spinal Surgery Consultants independently graded each site for layout, content, relevance to patients as opposed to medical professionals, ease of use and links to other sites. Each point was marked on a scale of 0–2 and a total of 10 points available. Web sites were assessed via U.K. search engines and forty via World Wide search engines. Good was awarded to a site with a score of 7–10; an average awarded for a score of 4–7 and poor was given to a site with a score of 0–4.

Results: For the U.K. search engines, twenty sites were evaluated and five common sites identified (spineuniverse.com, S.A.U.K.org, orthoteers.co.uk, B.O.A.ac. uk and scoilosis.info). From these sites only two were given a rating of good. For the World Wide Web search engines eighteen sites evaluated and seven common sites identified (SRS, spineuniverse.com, scoliosis.org, orthinfo.aaos.org, iscoliosis.com, scoliosisrx.com and scoliosis-world.com). From these sites four were given a rating of good. It was evident that the Scoliosis Association of United Kingdom did not appear in three of the search engines but only in Hotmail.

Conclusion: These results suggest that there are good sites available for patients to access information with regards to their condition and treatment options but there are also very poor sites available where incorrect information is available. Commonly, unfamiliar users of the Web will not search U.K. sites specifically and could easily miss the S.A.U.K. site, which is an excellent site and was one of the two sites via the U.K. search engine awarded a good score. Obviously, there were more good sites via the World Wide Web due to the American healthcare system. We recommend that leaflets should be available to parents and patients with scoliosis with information from the BSS of the condition and available Web sites with good ratings. Also we recommend that these sites be linked to the Royal College of General Practitioners Web site to provide reference on good practice.

Purpose: Chondroblastomas are a lesion of immature cartilage found in a typically epiphyseal location. The peak incidence is in teenagers. Current surgical treatment is a balance between complete excision, with potential for physeal and articular cartilage damage, and local recurrence. A minimally invasive technique with a low complication rate providing effective treatment may be provided by radiofrequency (RF) thermocoagulation. Already the treatment of choice for Osteoid Osteoma – another lesion that can occur in the epiphysis.1,2,3 Literature to date on clinical use of RF thermocoagulation in chondroblastoma is scarce.4 The high water content of chondroblastoma should ensure its sensitivity to RF ablation. Our units experience in osteoid osteoma has been extended to RF thermocoagulation of chondroblastoma.

Patients: Four patients were treated with RF thermocoagulation for a chondroblastoma. Minimum follow up one year.

Methods: A RITA Starburst probe thermocoagulates the lesion for at least 5 minutes at 90 degrees centigrade. Overnight stay and outpatient follow up until skeletal mature, or two years following treatment.

Results: Two chondroblastomas were in the proximal tibia, one in the distal femur and one in the proximal humerus. One patient had surgery previously and one patient presented with collapse of the proximal tibial plateau. All patients were treated successfully and are pain free. All patients, accepting the one with pre-existing collapse, have a full range of movement. There has been no local recurrence at one year.

Conclusion & Discussion: Our experience suggests that radiofrequency thermocoagulation is a safe and effective treatment method for patients with chondroblastoma.

Introduction: (1) Determine whether initial MRI findings correlate with clinical outcome.(2) Study the reproducibility of MRI measurements of large disc prolapses.(3) Estimate the ability to predict CES based on MRI alone.(4) Does CES only occur in degenerate discs?

Method: 31 patients with CES were identified and invited to attend clinic. 19 patients who underwent discectomy were identified. Digital photographs of all 50 MRIs were obtained. Observers: 1 Radiologist, 2 Spinal Surgeons and 1 Trainee did not know the number of patients in each group. Observers estimated the percentage spinal canal compromise on each view (0–100%), indicated whether they thought the scan findings could produce CES and commented on disc degeneration. Measurements were repeated after 2 weeks.

Results: 26 patients attended clinic – mean follow up 51 months (range 25–97). 12 of the 26 patients with CES had, on average, > 75% canal compromise. No significant correlations were found between MRI canal compromise and clinical outcome. Kappa values for intra-observer reproducibility of measurements ranged from 0.4–0.85 and inter-observer 0.63–5. Based on MRI, the correct identification of CES has sensitivity 68%, specificity 78%, positive predictive value 84% and negative predictive value 58%. Over 80% of the CES causing discs were degenerate.

Discussion: Canal compromise does not appear to predict clinical outcome. MRI measurement reproducibility has substantial agreement. CES is a clinical diagnosis supported by an MRI scan. In less clear cases the presence of a large disc on an MRI scan supports a diagnosis of CES (PPV 84%). CES occurs in degenerate discs.

Background: There has been an exponential rise in Internet use over recent years with over 11 million homes in the United Kingdom currently having access to the Internet. Previous studies have shown that up to 50% of orthopaedic outpatients have researched their condition on the Internet and that this percentage is dependent upon the condition from which they are suffering. The aim of our study was therefore to assess the prevalence of Internet usage among three groups of orthopaedic outpatients and to further determine how the patients felt their Internet research compared to the information received at consultation.

Methods: Data was collected from 150 patients / parents attending three outpatient clinics; 50 consecutive patients attending scoliosis clinic; 50 patients attending paediatric orthopaedic clinic; 50 patients attending back pain clinic.

Results: 58% of scoliosis, 22% of general paediatric and 30% of back pain patients had researched their condition on the Internet. 83% of scoliosis, 64% of paediatric and 80% of back pain patients found this information useful. Nearly all patients, however, would trust their doctor more than the Internet.

Conclusion: We believe therefore that clinicians need to keep up to date with information available on the Inter-net and provide recommended websites to patients wishing to consolidate their knowledge of their condition.

Introduction: Current evidence suggests that CES should be operated within 48 hours from onset of sphincteric symptoms in order to maximise chances of recovery. Measurement reproducibility of large disc prolapses and clinical correlations have not previously been studied.

Objectives: (1) Determine whether initial MRI findings correlate with clinical outcome (2) Study the reproducibility of MRI measurements of large disc prolapses (3) Estimate the ability to predict CES based on MRI alone.

Study Design: 31 patients with CES were identified, the case notes reviewed and the patients invited to attend clinic. Outcome consisted of history and examination, and several validated questionnaire assessments. 19 patients who underwent discectomy for persistent radiculopathy were identified. None had sphincteric symptoms. All had a significant surgical target. Digital photographs of all 50 MRIs were obtained showing the T2 mid-sagittal image and the axial image with the greatest disc protrusion. The Observers: 1 Consultant Radiologist, 2 Consultant Spinal Surgeons and 1 SHO did not know the number of patients in each group. Observers estimated the percentage spinal canal compromise on each view and indicated whether they thought the scan findings could produce CES. Measurements were repeated after 2 weeks.

Results: 26 patients attended clinic mean follow up 51 months (25 to 97). As expected, the % canal compromise differed significantly between the two groups (p0.001). 12 of the 26 patients with CES had, on average, over75% canal compromise. No significant correlations were found between MRI canal compromise and clinical outcome. Canal compromise did predict whether the patient would fail their Trial Without Catheter (p0.05). Based on MRI alone, the correct identification of CES has sensitivity 68%, specificity 78%, positive predictive value 84% and negative predictive value 58%. Kappa values for intra-observer reproducibility ranged from 0.4 to 0.85 for sagittal compromise, axial compromise and correct prediction of CES. All three interobserver kappa values for these measurements were 0.64.

Conclusions: This is the largest radiological case series of CES with 4 years clinical follow up. Canal compromise on MRI does not appear to directly predict clinical outcome. Reproducibility of MRI measurements of large disc protrusions has substantial agreement. MRI could be of help in equivocal cases if the scan shows a large disc.

Objective: Determine factors influencing outcome after surgery for cauda equina syndrome with particular attention sphincteric recovery. Subjects:56 patients with evidence of a sphincteric disturbance who underwent urgent surgery between 1994 and 2002 were identified and invited for follow up.

Outcome Measures: History and examination, Oswestry Disability Index, Short Form 36, Visual Analogue Score, Low Back Outcome Score, Modified Somatic Perception Score, Modified Zung Depression Score, International Prostate Severity Score, Male Sexual Health Questionnaire and Sheffield Female Pelvic Floor Questionnaire.

Results: 42 patients attended with a mean follow up of 60 months (25 to 114 months). Mean age at onset was 41 years (24 to 67 years) with 23 males and 19 females. 25 patients had sudden onset of symptoms in less than 24 hours. 26 patients were operated on within 48 hours of onset. At presentation urinary retention was associated with acute onset of less than 24 hours (p0.01), leg weakness (p0.01), abnormal leg sensation (p0.05) and abnormal rectal tone (p0.05). Bilateral radiculopathy was associated with leg weakness (p0.005). All patients with abnormal rectal tone (21) had abnormal rectal sensation. At follow up significantly more females had urinary incontinence (p0.001) and bowel disturbance (p0.05), higher VAS scores (p0.05) and lower SF36 Pain and Energy scores (p0.05) than males. Urinary disturbance at presentation did not affect the outcomes. Bowel disturbance at presentation was associated with sexual problems (0.005) and abnormal rectal tone (p0.05) at follow up. Objective reduced perianal sensation at onset persisted in a significant number at follow up (21/32 patients; p0.05) as did leg weakness (14/23; p0.005). There was a weak association between delay to operation and bowel disturbance (p0.05) at follow up. Eight patients had faecal soiling and faecal incontinence at follow up and this was associated with sudden onset of symptoms, initial abnormal rectal tone and time to operation (p0.05). The SF36 scores at follow up were reduced compared to age matched norms in the population. The mean ODI was 29, LBOS 42 and VAS 4.5.

Conclusions: In our series the duration of symptoms and speed of onset prior to surgery appears to influence bowel but not bladder outcome two years after surgery. Based on the SF36, LBOS and ODI scores, patients who have had CES do not return to a normal status. Patient counselling about this would therefore be appropriate.

Introduction: Current evidence suggests CES should be operated < 48 hours from onset. MRI scanning is often not available 24 hours a day.

Objectives: (1) Determine whether MRI findings correlate with clinical outcome. (2) Study the reproducibility of MRI measurements of large disc prolapses. (3) Estimate the ability to predict CES based on MRI alone.

Study Design: 31 CES patients were identified,contactedand invited to follow up. Clinical outcome consisted of history and examination, and validated questionnaire assessments. 19 patients who underwent discectomy were identified. T2 mid-sagittal and axial digital photographs of all 50 MRIs were obtained. Observers did not know the number of patients in each group (1 Consultant Radiologist, 2 Consultant Spinal Surgeons and 1 SHO). They estimated the percentage spinal canal compromise on each view (0–100%) and indicated whether they thought the scan findings could produce CES. Measurements were repeated after 2 weeks.

Results: 26 patients attended clinic (mean follow up 51 months). There were no significant correlations found between MRI canal compromise and clinical outcome. Kappa values for the measurements ranged 0.52–0.85 and 0.61–0.75 for intra- and inter-observer reproducibility. Based on MRI alone correct identification of CES has sensitivity 67%, specificity 81%, positive predictive value 85% and negative predictive value 60%.

Conclusions: Canal compromise on MRI does not predict the outcome of patients with CES. Reproducibility of MRI measurements of large disc protrusions has substantial agreement. MRI could be of help in equivocal cases if the scan shows a large disc.

Numerous studies have examined the biomechanical properties of the vertebral body following PMMA cement augmentation for the treatment of osteoporotic vertebral body fractures. To date there is no published literature reporting the effects of Vertebroplasty on internal intervertebral disc biomechanics which in turn have been shown to reflect loading patterns of the vertebral column.

To study effects of PMMA cement augmentation of vertebral body fractures on intervertebral disc biomechanics using stress prolifometry to assess differential anterior and posterior vertebral column loading.

Eight cadaveric motion segments were individually loaded on a hydraulically powered materials testing machine under 1.5kN of axial compression. Following fracture induction the lower vertebral body underwent Vertebroplasty.

Profiles of the vertically acting compressive stress were obtained by pulling a pressure sensitive transducer along the mid-sagittal diameter of the intervertebral disc. “Stress profile” measurements were obtained before fracture, following fracture, and after vertebro-plasty both in extension and flexion.

Stress profiles were integrated over area to calculate the compressive force across the disc. The compressive load acting on the neural arch was calculated by subtracting the disc force from the applied 1.5kN load.

In flexed postures posterior column loading increased from 17.1% to 42.2% following fracture (p< 0.01) and then decreased significantly from 42.2% to 23.68% following vertebroplasty (p< 0.03). There was no significant difference between pre-fracture and post-vertebroplasty status (p=0.11). In extended posture, fracture produced increased posterior column loading 72.9% vs 51.8% (p< 0.005) and following vertebroplasty there was no significant change (p=0.2).

In moderate degrees of flexion, vertebroplasty produces normalisation of load bearing through the anterior vertebral column and hence offloads the posterior elements to a significant degree. This could be postulated, to partly account for the analgesic effect seen following vertebroplasty in the clinical setting.