Introduction

The majority of spine patients present with discogenic low back pain, originating from either degenerative disc disease (DDD) or internal disc disruption (IDD). Successful treatment of this patient population relies on obtaining precision diagnosis and careful patient selection, as well as matching the pathology with reliable technology. Total disc replacement (TDR), as an alternative to spinal fusion in the treatment of DDD or IDD, has been studied and reported for several decades in long-term follow-up studies and in several randomized control trials. This prospective study presents a single surgeon experience with two-level CHARITÉ® TDR in 84 consecutive patients, with minimum follow-up of 5 years. The aims of the study were to assess the clinical outcomes of two-level TDR in patients with DDD/IDD. Based on the literature review conducted, this study is considered the largest single surgeon series experience with the two-level CHARITÉ® TDR in the treatment of lumbar DDD, with a minimum follow-up of 5 years reported to date.

Aims

The BOA/BAPRAS guidelines for the management of open tibial fractures (2009) recommend early senior combined orthoplastics input and appropriate facilities to manage a high caseload. St Georges Hospital is one of four London Trauma Centres fulfilling these criteria. Our aim is to determine whether becoming a trauma centre has affected the management of patients with open tibial fractures.

Introduction: Achilles tendinopathy is a source of significant pain and disability. While many patients respond to non-operative treatment, a proportion will require operative treatment. Both open decompression and percutaneous longitudinal tenotomy have been described. We describe a new technique and present the results of percutaneous circumferential decompression of the tendon, dividing adhesions between the paratenon and the tendon.

Methods: We followed up 10 patients for a mean of 10 months (5–19) post operatively. They were scored pre and post operatively using the tegner activity score, the puddu score and an analogue pain score. The functional result was also assessed with the SF12 questionnaire.

Results: All patients reported significant improvements in pain (p=0.007), tegner (p=0.007) and puddu (p=0.005) scores. They would all undergo the procedure again. The SF12 scores were not significantly different from a normal population.

Discussion: We believe that this technique addresses the underlying pathology, giving excellent results without the potential complications of an open decompression.