Back pain/neck pain was the presenting complaint in 100% whereas neurological signs were found in 37% and systemic manifestations present in 38%. To control the disease, spinal surgical procedures was needed in 44% of cases. Approximately 30% of them had partial recovery and 9% had complete recovery.
Tuberculosis continues to increase in England. London accounted for a substantial proportion of cases in 2005 (43%) and had the highest rate of disease. Spinal TB is the most common skeletal manifestation. The diagnostic evaluation of spinal TB is hampered by the difficulty of MRI interpretation and failing to keep a high index of suspicion. The mode of presentation of spinal tuberclosis, surgical procedures and outcome of patients were highlighted. Various dermographic parameters were evaluated. A prospective cohort study was conducted. Cross sectional sampling of patients presented with spinal TB between the years of 1999–2006 in two main hospitals covering large population of East London, Royal London Hospital and King George Hospital. One hundred and twenty three patients (mean age: 34 years) were identified. Asians represent the highest group affected (63%), then appear Afrocarribean (28%). White British represent only 6.5%. Frequency of occurence was as follows: dorsal spine 45%, lumbar spine 33%, multiple regions 11%. Delayed diagnosis was made in 34% of patients, 44% of whom were over 6/12. Backpain or neckpain was the presenting complaint in all of the patients (100%), whereas neurological signs were found in 37%. Systemic manifestations presented in 38%. Spinal surgical procedures were needed in 44% of cases. Approximately 30% of them had partial recovery and 9% had complete recovery. The incidence of spinal TB is on the increase. A high index of suspecion is required to avoid delay in the diagnosis. Knowledge of the patients’ background may help making appropriate early referral for MRI.
During the period of January 1999 and August 2004 there was a policy in our institution of removal for metalwork from patients who underwent open reduction and internal fixation of an ankle fracture. We were not able to find any evidence in the literature as to whether implant removal confers long-term benefit or disability in these patients. Between January 1999 to August 2003, all patients who underwent ankle metalwork removal were reviewed. Most patients with mechanical symptoms were improved by implant removal. The two infections resolved. In those patients with pain, about two thirds found were improved. Following this study the practice in our institution has changed. We do not feel routine removal of metalwork is warranted unless there are specific indications; mainly mechanical symptoms, infection and pain. We are particularly keen to counsel patients from the latter category, that surgery may not resolve their symptoms.
All multidisciplinary audit projects from January 1998 to March 2002 involving an Orthopaedic department were assessed to measure their impact on improving clinical practice. Data were derived from reports formulated by the Trust’s Audit department, which listed findings, conclusions and proposals for each project. Among 41 studies performed, 37 listed a formal proposal of actions. 4 projects had a completed outcome of which 2 closed the loop with re-audit. 9 other projects recommended re-audit but none had been initiated. Although Trusts actively partake in regular audit, it seems more as a service or training commitment, rather than contributing towards improving the quality of healthcare.
