The NASCIS studies reported improved long-term neurological recovery when high dose methylprednisolone was administered following spinal cord injury.

To determine if there is correct implementation of the NASCIS protocols. Prospective observational study. The admission Frankel grade and ASIA neurological classification were recorded.

100 patients with complete or incomplete spinal cord injuries were studied during a 24 month period.

Outcome Measures: Correct administration of methyprednisolone.

The mean ASIA score was 192 and median Frankel grade was C. Only 25% of the patients received methyl-prednisolone according to the NASCIS regime.

“Evidence Based Medicine” is not being adopted.

Pedicle screws allow for biomechanically secure fixation of the spine. However if they are misplaced they may effect the strength of the fixation, damage nerve roots or compromise the spinal cord. For these reasons image guidance systems have been developed to help with the accuracy of screw placement. The accuracy of pedicle screw placement outside the lumbar spine is not well published. To determine the accuracy of pedicle screw placement using CT scanning post operatively. Cortex perforations were graded in 2mm steps.

Prospective observational study. Plain x-rays are inaccurate for determining screw placement and therefore high definition CT scanning was used. The screw positioning on the post-operative CT scans was independently determined by a research registrar who was not present at the time of surgery. Screw position and clinical sequelae of any malposition.

Thirty patients (13 F:17 M) with segmental instability. Twelve were for metastatic disease, seven for trauma, seven for spondylolisthesis, three for atlanto-axial instability and one for a vertebral haemangioma. All patients were operated on by the senior author.

One hundred and seventy six pedicle screws were inserted in the thirty patients over the 20 month study period. Six screws violated the lateral cortex of the pedicle but none perforated the medial cortex. There were no adverse neurological sequelae.

The findings from this study will serve as a good comparison with future studies on pedicle screw placement, which may claim to improve accuracy and safety by the use of image guidance systems, electrical impedance or malleable endoscopes.

Objective: To assess the safety and efficacy of a novel Artificial Cervical Disc.

Design: Compare the Bryan prosthesis to Anterior Cervical Discectomy and Fusion (ACDF), by using the pre-defined objective performance criteria (OPC) derived from a literature meta-analysis of ACDF in which a success rate of 73% was established. The Null hypothesis is that the success rate for the Bryan prosthesis is greater or equal to the OPC (Objective Performance Criteria) of 85%. Secondary Objectives studied included the range of motion after implantation; adverse events from implantation onwards; maintenance of the disc space height; amount of subsidence. Radiology was assessed by an independent radiologist. Improvement in the quality of life for the patient (SF-36) was also recorded at six weeks, six months and one year. Data was collected by an independent research practitioner.

Subjects: Multicentre study seven European centres: 107 patients Male 51, Female 66. Age ranged from 27 to 71. Mean age was 42 years with a clinical diagnosis of cervical radiculopathy or myelopathy, and single level disc disease on MRI.

Outcome Measures: Odom Criteria, SF-36, radiological range of movement.

Results: The Bryan Cervical Disc was associated with a clinical success according to Odom’s criteria of 87%. Radiological success occurred in 97%. SF-36 analysis revealed a statistically significant improvement in all domains.

Conclusion: The Bryan Disc has been successfully implanted in 107 patients with good clinical results and at one-year follow-up there is radiological evidence of preserved motion.