Design of study: Prospective, observational

Purpose of the study: Obese and morbidly obese patients undergoing lumbar surgery can be a challenge to the operating surgeon. Reports on the perioperative data in this group of patients are scarce. The purpose of the study is to prospectively compare the perioperative data in patients with normal and high BMI, undergoing lumbar spine surgery.

Method: We conducted a prospective audit of 50 consecutive patients who underwent primary discectomy or single level decompression under the care of single spine surgeon. Initial Low Back Outcome Score, length of incision, distance from skin to spinous process, distance from skin to lamina, length of hospital stay, blood loss and complications were studied in detail.

Results: We used student t test to compare the two groups and Pearson Correlation to correlate the data against high BMI. We were unable to demonstrate a statistically significant difference between those with normal BMI and high BMI in any of the above parameters analysed.

Conclusion: A high BMI was not associated with an increased perioperative morbidity in this patient group. Contrary to other areas of orthopaedic surgery, there is no statistically significant difference in the Initial Low Back Outcome Score and perioperative data between patients with normal and high BMI undergoing lumbar discectomy and single level decompression.

Conflict of Interest: None

Source of Funding: None

Aims: We aim to investigate how often we needed extensive investigations to reach a speciþc diagnosis and whether we could identify symptoms and signs predictive of such diagnosis. Methods: We analysed the records of 60 children referred to our specialist clinics complaining of back pain. We statistically analysed the speciþcity of 9 parameters from history and clinical examination to predict the þnal diagnosis and checked the correlation between initial clinical diagnosis and þnal diagnosis following extensive investigations such as bone scan, CT and MRI scan. Results: The mean age of our group of patients was 12.3 years (range=3–18 years). We failed to reach a speciþc initial diagnosis after history taking, clinical examination and simple X-rays of the spine in 33 patients (55%). By the completion of investigations a speciþc diagnosis was not reached in only 18 (35%), and the difference was signiþcant compared to the other 65% (chi square(1)=4.41, p< 0.05). In 15 children specialist investigations clariþed a diagnosis of spondylolysis, Scheuermannñs disease and tumour. A hypothesised set of 9 clinical symptoms and signs was not predictive of speciþcity of initial clinical diagnosis (RL 2=0.12, chi square (9)=10.07, p> 0.05), but was predictive of þnal diagnosis (RL 2=0.35, chi square(9)=22.88, p< 0.01). A speciþc diagnosis was less likely in the presence of activity related pain or intermittent pain. There was a high degree of correlation between initial clinical diagnosis and þnal diagnosis. (phi=0.70, chi square(1)=25.07, p< 0.001). Conclusions: For about half our group of children, back pain was not a speciþc symptom. A set of common set of clinical symptoms and signs did not initially predict speciþcity. Based on these initial þndings we should continue to investigate in depth any referred child with back pain.