Determine the detection rate of modern spinal implants using the current technology.

There is a paucity of data regarding detection rates of modern spinal implants using modern walk-through pulsed archway metal detectors (AMDs). No published reports compare detection capability with hand-held metal detectors (HHMDs).

ex-vivo & in-vivo comparison of detection rates using AMD & HHMD (set to maximum DoT sensitivities), in patients of varying Body Mass Index (BMI), implants, implant mass/density and alloys.

40 patients with: lumbar disc replacement (CoCr) (n=8), cervical disc replacement (CoCr) (1), posterior deformity instrumentation (17), anterior deformity instrumentation (2), anterior reconstruction (2), PLIF (6), interspinous distraction device (1), anterior cervical plate (2) ALIF (1), All implants were titanium unless indicated. Mean metal mass was 98g (range 6g-222g).

The AMD did not detect any instrumentation individually or in combination up to a titanium mass totalling 215g. The HHMD detected all instrumentation at a distance of 5cm; with the minimum mass being 2g

No implants were detected in patients by the AMD. The HHMD did not detect any anterior lumbar or thoracic surgical implants. It detected anterior cervical implants. The HHMD detected all posterior surgical implants. There was no significant relationship between detection, BMI, total metal mass, and metal density/segment.

AMD detectors do not detect modern spinal implants. HHMD detect all modern posterior spinal implants; this has implications for patient documentation.

Aim

To evaluate morbidity and outcome associated with lumbar spine decompression for central spinal stenosis in the elderly compared with younger age groups.

Aim: To evaluate morbidity and outcome associated with lumbar spine decompression for central spinal stenosis in the elderly compared with younger age groups.

Patients & Methods: Case notes review of patients with symptomatic and MRI proven central lumber canal stenosis, under the care of a single surgeon. The study population was 3 age groups: patients < 60 year of age (Group 1, n=19), patients between 61 and 79 years(Group 2, n=54), and > age of 80 years (Group 3, n=15).

The number of levels decompressed & grade of surgeon were noted.

Outcome data: Length of operation & hospital stay, blood loss, and intra and post operative complications. Subjective variables: Pain (VAS), walking distance, Oswestry Disability score (ODI) and patient satisfaction scores.

Results: The duration of operation (p< 0.05), and intra-operative complication rate (p< 0.025) was dependent on the seniority of the surgeon.

There was a statistically significant improvement in VAS score for leg pain (p< 0.05) and back pain (p< 0.05) after surgery for each group. The average walking distance improved by factor 5 in group 1 and 2 and by factor 2.5 in group 3 (p< 0.05)

Conclusions: Surgery for neurogenic claudication in the octogenarian is associated with a higher complication rate. The outcomes in this patient group is however comparable to younger patients.