Background

Minimally invasive surgery is an alternative therapeutic option for treating unstable spinal pathologies to reduce approach-related morbidity inherent to conventional open surgery.

To investigate the effectiveness of surgical fusion for chronic low back pain (CLBP) compared to non-surgical intervention, databases were searched from 1966-2005. The meta-analysis was based on the mean difference in Oswestry Disability Index (ODI) change from baseline to follow-up. Four studies were eligible (634 patients). The pooled mean difference in ODI was 4.13 in favour of surgery (95% CI: -0.82-9.08; p=0.10; I2=44.4%). Surgery was associated with a 16% pooled rate of complication (95% CI: 12-20%, I2=0%).

The cumulative evidence does not support surgical fusion for CLBP due to the marginal improvement in ODI which is of minimal clinical importance.

Background: Chronic low back pain is the most common complaint of the working age population. Controversy exists regarding the benefit of surgical fusion of the spine for the treatment of chronic low back pain. We performed a meta-analysis of randomised controlled trials to investigate the effectiveness of surgical fusion for chronic low back pain compared to non-surgical intervention.

Methods: Several electronic databases (MEDLINE, EMBASE, CINAHL, Science Citation Index and Cochrane registry of clinical trials) were searched from 1966 to October 2005. Two authors independently extracted data on study characteristics and methodological quality and the number of patients with early complications from surgery. The random-effect meta-analysis comparison was based on the mean difference in Oswestry Disability Index (ODI) change from baseline to follow-up of patients undergoing surgical versus non-surgical treatment. Between-study heterogeneity was analyzed by means of I2.

Results: Four studies of 58 articles identified in the search were eligible with a total of 740 patients. One of the studies recruited patients with adult isthmic spondy-lolisthesis, whereas the other studies recruited patients with a history of chronic low back pain of at least 1 year duration. Surgical treatment involved posterolateral fusion with or without instrumentation or flexible stabilisation. Non-surgical treatment involved exercise programs with or without cognitive therapy. The follow-up period ranged from 1 to 2 years. The pooled mean difference in ODI between the surgical and non-surgical groups was statistically in favour of surgery (mean difference of ODI: 3.90; 95% confidence interval: 0.17–7.62; p=0.04; I2=21.4%). Surgical treatment was associated with a 13% pooled rate of early complication (95% confidence interval: 6–20%, I2=66.9%).

Conclusion: Surgical fusion for chronic low back pain favoured an improvement in the ODI compared to non-surgical intervention. This difference in ODI is of minimal clinical importance. Furthermore, surgery was associated with a significant risk of complications. Therefore, the cumulative evidence at present does not support routine surgical fusion for the treatment of chronic low back pain.

Aim: A meta-analysis of randomised controlled trials was performed to investigate the effectiveness of surgical fusion for chronic low back pain compared to non-surgical intervention.

Methods: Several electronic databases (MEDLINE, EMBASE, CINAHL and Science Citation Index) were searched from 1966 to October 2005. Two authors independently extracted data. The meta-analysis comparison was based on mean difference in Oswestry disability index (ODI) change from baseline to follow up of patients undergoing surgical versus non-surgical treatment.

Results: Four studies of 58 articles identified in the search were eligible with a total of 740 patients. One of the studies recruited patients with adult isthmic spondylolisthesis, whereas the other studies recruited patients with a history of chronic low back pain of at least 1 year duration. Surgical treatment involved pos-terolateral fusion with or without instrumentation and flexible stabilisation. Non-surgical treatment involved exercise programs with or without cognitive therapy. The follow-up period ranged from 1 to 2 years. The mean overall difference in ODI between the surgical and non-surgical groups was statistically in favour of surgery (mean difference of ODI: 3.90; 95% confidence interval: 0.17–7.62; p=0.04; I²=21.4%). Surgical treatment was associated with a 13% pooled rate of early complications (95% confidence interval: 6–20%).

Conclusion: Surgical fusion for chronic low back pain favoured an improvement in the ODI compared to non-surgical intervention; this difference in ODI is of minimal clinical importance. Furthermore, surgery is associated with a significant risk of complications. Therefore, the cumulative evidence at present does not support routine surgical fusion for the treatment of chronic low back pain.

Introduction: There has been controversy in recent publications for/against the value of intraoperative traction views under anaesthesia, both studies had patients with a mean standing cobb angle of 55o failing to show the predictive value of these views for curves greater than 60o.

Design: Compare predictive value of fulcrum bending views with intraoperative forced traction under anaesthesia (FTUGA) views in predicting curve flexibility; influencing the correction of curves greater than 60^o in scoliosis deformity.

Subjects: 35 patients with idiopathic scoliosis undergoing surgical correction; mean age was 19 yrs (9–40), the student’s t test and χ2 were used to assess the reliability of FTUGA views in predicting curve flexibility, degree of correction the fulcrum bending correction index (FBCI) used to measure curve flexibility and correction.

Results: The mean preoperative major curve standing and fulcrum bending views Cobb angle was 72^o (50–90), 59^o (20–82) respectively, and 37^o (14–54) on traction views. Posterior correction was performed in all patients. The mean postoperative major curve Cobb angle was 27 (10–54). The number of patients predicted for combined anterior release and posterior instrumentation was reduced from 22 to 3.

Predictive value for traction view according to standing Cobb angle was P=0.1 for Cobb angles (50–59), P=0.1 for Cobb angles (60–69), P= 0.01 for Cobb angle (70–79), P=0.01 for Cobb angle (80–90). P value for the difference between fulcrum bending views, traction views and post op correction P=0.001 in favour of traction views, the mean curve flexibility was 33%, 55% for fulcrum and traction respectively. Mean fulcrum bending and traction correction index were 232%, 123% respectively.

Conclusion: Forced Traction Under General Anaesthesia views were superior in predicting curve flexibility in curves that measured more than 70^o but weak predictor of final correction angle when performing posterior scoliosis correction.

Background: To assess reliability of traction views under GA in predicting curve flexibility when performing posterior correction of scoliosis deformity with pedicular screws.

Methods: Compare reliability of preoperative fulcrum bending film with intraoperative traction films in predicting and influencing the correction of scoliosis deformity using posterior pedicular screws. Twenty patients undergoing corrective surgery for scoliosis deformity the average age was 19 years old. The Lenke classification was used to classify the curves using pre-operative fulcrum bending views, the student’s t test was used to assess the reliability of x-ray views in predicting the end results.

Results: The mean preoperative major structural Cobb angle was 80 degrees and mean minor structural Cobb angle was 27, the mean major structural Cobb angle on fulcrum bending views was 49 degrees, the mean major structural Cobb angle on the traction views was 33.6, the minor structural Cobb angle was 9 degrees thus changing the lenke classification of the curve reducing the numbers of levels for fixation by at least one level either end of the curve. Posterior pedicular screws were used in all the patients. The number of patient at risk of combined anterior release and posterior instrumentation was reduced from 13 to 2. The P value for the difference between fulcrum bending views and traction views was P< 0.0001, for traction and end result P=0.18

Conclusion: The traction views under GA were superior in predicting curve flexibility when performing only posterior scoliosis correction with interpedicular screws reducing the number of levels required to incorporate and the number of procedures required to achieve adequate correction.

Background: To assess the correction of curves using the Fulcrum bending correction index FBCI with pedicular screws in posterior scoliosis surgery.

Methods: Compare preoperative upright and fulcrum bending views, intraoperative traction films with postoperative views to assess the correction of scoliosis deformity using posterior USS II interpedicular screws. Peri-operative complications are reviewed. Twenty patients undergoing corrective surgery for scoliosis deformity were reviewed the average age was 19 years old 4 males and 16 females, 17 were idiopathic adolescent scoliosis, 3 were neuromuscular scoliosis. The Lenke classification was used to classify the curves, the Fulcrum bending correction index (FBCI) as a percentage for assessing postoperative correction.

Results: The mean preoperative major structural Cobb angle was 80 degrees and mean minor structural Cobb angle was 27 degrees, the mean major structural Cobb angle on fulcrum bending views was 49 degrees, the mean major structural Cobb angle on the traction views was 37 degrees. Pedicular screws were used in all the patients for posterior correction; only two patients required combined anterior release. The average inter-operative blood loss was 2200 ml, the initial results suggest an of FBCI of 181% compared to Luk et al results 100.2% to 109.1% 4 different methods of posterior stabilisation.

Conclusion: Pedicular screws provided excellent segmental correction and stabilisation for posterior scoliosis correction.

We followed up 82 patients who under went 92 Furlong Hydroxyapatite coated uncemented femoral stem, and threaded acetabular component. All hips had a 28mm ceramic heads.

These hips were inserted between the periods 1989–1992. The mean age of the patients at the time of surgery was 54(31–67).

At the ten year follow up there were 64 patients with 70 hips. 5 hips were revised. 3 for acetabular component loosening, 2 for infection. 8 patients died from unrelated causes, 3 refused to attend but filled in the Oxford hip score by mail, 2 were lost to follow up.

At 10 years follow-up the mean age was 64(41–77) years. The Oxford, and the Harris hip scores were used to Asses the patients clinically, and a standard AP pelvis X-Ray showing both hips was performed

Clinically we found that the mean Harris hip score was 90 (51 – 100), the mean Oxford hip score 20 (12 – 45).

Radiographic assessment showed good component fixation with uniform bone growth around the components. The average angle of the Acetabular component was 52 (40– 60). 21 hips showed polyethylene wear in the acetabular component, 5 had more than 2mm wear, and 1 had more than 3mm of poly wear.

36 (52%) of the hips showed proximal calcar remodelling.

We conclude that the Furlong HA coated THR is an excellent THR for the young patient who has a higher activity demand with a cumulative survival rate of 94.29% (CI ±5.2).