Purpose and background of the study The occupational health department for the London Ambulance Service (LAS) had numbers of employees reporting low back pain (LBP). The purpose of the study was to determine the lifetime, and point prevalence of LBP and to report the Fear Avoidance Beliefs of this study population within the LAS.

Summary of the methods used and the results The cross-sectional study involved 2448 Accident & Emergency (A& E) operational employees (Paramedics and Qualified Ambulance Technicians). A questionnaire with covering letter was posted to a randomly selected number of A& E staff (n=1000). The questionnaire included a validated version of the Fear Avoidance Beliefs Questionnaire (FABQ) and the General Health Questionnaire (GHQ).

The response rate was 50% (n= 504). 91% of the responding sample had a lifetime prevalence of LBP and also answered the modified FABQ questions. The mean of the activity fears scale was 4.18 (SD = 1.14) and the mean of the work fears was 4.91 (SD = 1.08), indicating that most respondents held very negative beliefs regarding LBP in relation to work and activities. Those who had experienced LBP reported more psychological problems on the GHQ.

Statement of conclusion The prevalence of low back pain amongst responding A& E staff is high compared to National surveys. This population also demonstrated very negative fear avoidance beliefs for LBP. Responses to the GHQ indicated the sample population to be just on the positive side of mid-point. The reporting of LBP was significantly associated with psychological problems.

Aims: We undertook an analysis to determine the prognostic indicators of successful outcome following decompression for radiculopathy from lumbar spinal stenosis. Methods: 203 patients underwent spinal decompression in a þve year period till June 2001 and were subsequently followed up. Age, sex, number of levels, the speciþc levels involved, type of stenosis, symptoms, duration, bilaterality were preoperative factors looked at. The type of decompression, number of levels decompressed, the speciþc levels and intra-operative complications were noted. Postoperative resolution of pain, duration to alleviation of pain were assessed. Patient satisfaction and discharge from clinic indicated successful outcome. Referral to the pain clinic reßected a failure of treatment. Results: 65% of patients who had primary decompression experienced satisfactory improvement in symptoms. Logistic Regression analysis showed that the presence of radicular pain at þrst review signiþcantly increased the likelihood of failure of surgery and referral to the pain clinic for (p=0.02) for leg symptoms. 57% of patients who had decompression following previous surgery at the same level were relieved of leg pain. The duration of leg pain alone adversely affected þnal outcome (p=0.01) amongst all the factors assessed including complications from surgery. The complication rate from revision surgery (7/30) was signiþcantly greater (p=0.01) than primary decompression (16/173). Conclusions: Persistance of radicular pain early after decompression increases the likelihood of eventual failure to improve symptoms Patients with long periods of pain prior to decompression following previous back surgery should be cautioned about the decreased likelihood of success and an increased risk of complications.