To analyse if patients with pain improvement following a nerve root block had better outcomes following lumbar microdiscectomy.

Fifty-six patients who had a lumbar microdiscectomy were retrospectively followed up to 1 year. All patients had a selective nerve root block (SNRB) as a primary treatment or diagnostic procedure. VAS pain scores were measured daily for 1 week following injection. Patients were grouped into responders and non-responders at 1 week. The 2 groups of patients were followed at 1 year following a lumbar microdiscetomy (LMD).

A total of 118 patients had SNRB over a period of 3 years. Of the 56 patients studied retrospectively, 52% and 36% of patients had a VAS score improvement of more than 2 points at 4 days and 1 week respectively. At 1 year post op, 85% of patients had better outcomes in the responder group compared to 74% in the non responder group. Although there was a difference this was not statistically significant.

Improvement with SNRB is not a positive predictor of good response with surgery. The ability to evaluate the effect of diagnostic or therapeutic blocks on surgical outcomes is limited by a lack of randomized studies and wide-ranging discrepancies with regard to injection techniques, surgical technique, and outcome measures. More research is needed to determine if diagnostic screening blocks can improve surgical outcomes.

Introduction: A high incidence of pin loosening, infection and discomfort as well as pressure ulceration from the jacket were noted in a study performed in 1986¹ we aimed to compare our figures with published literature.

Methods: A retrospective case note review (1994–2004). One investigator reviewed the case notes and corroborated these with a spinal database, theatre database and microbiology results system.

Results: 74 halos were applied in the 10-year period. A complete dataset was obtained for 37 patients (others had been destroyed either entirely or relevant volumes). Age range was 22–83 years (median 49), 20 males and 17 females.

28 were applied under local anaesthetic (LA), one with LA and sedation and 8 were applied under general anaesthetic (either for another trauma procedure or due to head injury). All halos applied were Bremer Halo Crown with Classic or Classic II vest (DePuy Spine, Warsaw, IN, USA).

Indications for application included fractures (n=21), tumours (n=6) or subluxations (n=10).

8 patients required pin repositioning. This was due to poor position (n=2), pain (n=5) and pin loosening (n=1, 3%).

Pin site infection was diagnosed using an accepted definition². This occurred in 5 patients. 3 settled with antibiotics, one with debridement and one with repositioning. Overall infection rate was 13.5%, which compares favourably with published rates of 20–22%. Pin site infection dropped significantly after introduction of a pin care regimen introduced and published by our limb reconstruction team² from three patients to one patient. Pin torque was also checked daily for seven days followed by weekly thereafter.

The halo vest was a cause of significant morbidity in terms of pressure ulceration (3 patients) pneumonia (3 ventilated ITU patients of whom 2 died) and pain in one patient.

Conclusion: Our pin loosening rate was significantly lower than published figures, which we ascribe to regular torque checking and use of a 0.90 Nm torque wrench³. Our pin site infection rate dropped significantly after use of our limb reconstruction teams pin care regimen. We now utilise this regimen in all halo patients with good effect. A prospective study is ongoing.

Introduction: A high incidence of pin loosening, infection and discomfort as well as pressure ulceration from the jacket were noted in a study performed in 1986¹ we aimed to compare our figures with published literature.

Methods: A retrospective case note review (1994–2004). One investigator reviewed the casenotes and corroborated these with a spinal database, theatre database and microbiology results system.

Results: 74 halos were applied in the 10-year period. A complete dataset was obtained for 37 patients (others had been destroyed either entirely or relevant volumes). Age range was 22–83 years (median 49), 20 males and 17 females.

28 were applied under local anaesthetic (LA), one with LA and sedation and 8 were applied under general anaesthetic (either for another trauma procedure or due to head injury). All halos applied were Bremer Halo Crown with Classic or Classic II vest (DePuy Spine, Warsaw, IN, USA).

Indications for application included fractures (n=21), tumours (n=6) or subluxations (n=10).

8 patients required pin repositioning. This was due to poor position (n=2), pain (n=5) and pin loosening (n=1, 3%). Pin site infection was diagnosed using an accepted definition2. This occurred in 5 patients. 3 settled with antibiotics, one with debridement and one with repositioning. Overall infection rate was 13.5%, which compares favourably with published rates of 20–22%. Pin site infection dropped significantly after introduction of a pin care regimen introduced and published by our limb reconstruction team² from three patients to one patient. Pin torque was also checked daily for seven days followed by weekly thereafter.

The halo vest was a cause of significant morbidity in terms of pressure ulceration (3 patients) pneumonia (3 ventilated ITU patients of whom 2 died) and pain in one patient.

Conclusion: Our pin loosening rate was significantly lower than published figures, which we ascribe to regular torque checking and use of a 0.90 Nm torque wrench³.

Our pin site infection rate dropped significantly after use of our limb reconstruction teams pin care regimen. We now utilise this regimen in all halo patients with good effect. A prospective study is ongoing.

Aprotinin has been shown to reduce blood loss in a number of surgical specialities. Patients with Duchenne Muscular Dystrophy (DMD) bleed more during surgical procedures than patients without this condition. The aim of this study was to evaluate the effect of aprotinin in reducing blood loss in scoliosis correction surgery in patients with DMD.

A retrospective analysis of case notes was performed. Thirty two patients diagnosed with DMD who underwent surgical correction for scoliosis over the last 25 years were included. All patients underwent posterior spinal fusion and instrumentation, between the levels T3 and L3. All procedures were carried out by the same lead surgeon. Patient age, body weight, length of procedure, and estimated blood loss were recorded. Blood loss as a percentage of total circulating volume was calculated and compared between patients who had not received aprotinin (seven patients), and those who did (25 patients). Blood loss as a percentage of total circulating volume in the group of patients with aprotinin (range 37% – 107% mean 67%) was significantly lower (P< 0.05) than the group without aprotinin (range 67% – 157% mean 111%). There was found to be no statistically significant relationship between blood loss and length of procedure. There was no statistically significant difference in the duration of the procedure between the two groups of patients. Despite the small number of patients this study shows a beneficial effect for aprotinin in reducing blood loss during scoliosis correction surgery in patients with DMD.