Introduction

Despite the lack of robust evidence, numerous different track and trigger warning systems have been implemented. The MEWS (Modified Early Warning Score system) is one such example, and has not been validated in an emergency traumasetting. A considerable proportion of trauma admissions are elderly patients with co-morbidities. Early recognition of physiological deterioration and prompt action could therefore be lifesaving.

Introduction and Aims: To confirm whether bacteria were present in disc material harvested at the time of discectomy; and to determine whether the presence of bacteria correlated with elevation of Anti Lipid S antibody levels; and to compare these results with antibody levels and disc specimens from patients undergoing surgery for indications other than radiculitis.

We have previously demonstrated significantly elevated IgG titres (ELISA) to a glycolipid antigen found in the cell wall of most gram-positive bacteria in patients with discogenic sciatica. This raised the possibility that the inflammation associated with disc protrusion might be initiated or accelerated by bacteria.

Method: A prospective study was performed using disc material harvested with stringent aseptic precautions from 207 microdiscectomy and 27 trauma, tumor or scoliosis patients (controls). Serology was obtained for all patients.

Results: In the Microdiscectomy group 76/207 (37%) had positive cultures after seven days incubation, of which 26 (34%) had positive serology. Forty-nine patients had Propionibacteria, 11 Coagulase-negative-Staphylococci (CNS), eight Propionibacteria and CNS, four other organisms and four mixed growth.

One hundred and thirty one (63%) patients had negative cultures of whom 15% had positive serology. There was a significant difference between patients with positive serology and culture, compared with those with negative serology and culture (Fischer exact test P< 0.01). In some patients, organisms were visible on microscopy prior to culture. Two of the patients undergoing surgery for other indications had positive cultures (P.acnes) of whom one had positive serology. Of those with negative cultures, six had positive serology.

There was a significant difference between positive cultures in those with sciatica and controls (P< .001).

Conclusion: A significant proportion of patients with discogenic radiculitis have positive cultures with low-virulence Gram-positive organisms (predominantly Propionibacteria ) and in proportion, a corresponding appropriate antibody response.

Objective: We present our recent experience in the management of tumours of the cervical spine and in particular comparing patterns of presentation of benign and malignant tumours and highlighting any delays of treatment.

Design: A retrospective study of 40 patients treated operatively at a regional spinal centre between 1995 and 2001.

Results: Twenty-five patients had metastastic disease and fifteen had primary tumours, five of which were malignant. Patients with malignant disease were older at diagnosis (55 vs 40) and had a shorter duration of symptoms (3m vs 19m). All patients with metastases reported good pain relief and improvement in neurological function where myelopathy or radiculopathy was present. Eight of these twenty-five patients have died at a mean of eleven months postoperatively. The longest survivor is now 31 months surgery. There were some excessive delays in treatment in benign and malignant cases. There were five cases of missed or wrong diagnosis and three patients waited more than six months for investigations.

Conclusions: Surgery for metastatic disease in the cervical spine has been successful in improving the quality of life in all of the patients although it should be stressed that each case must be dealt with on an individual basis with a multidisciplinary approach. It was noteworthy that some patients were subjected to extraordinary delays in diagnosis.