Background: To assess the clinical and radiological results of motion-segment sparing anterior cervical partial discectomy and foraminotomy surgery in patients with at least 1 year of follow-up.

Methods: The study is a prospective, non-randomized, observational study. The patients all had symptoms of intrusive nerve root irritation with or without motor symptoms, refractory to conservative management for greater than 6 weeks duration. Patients were asked to complete questionnaires capturing) VAS (visual analogue) pain scores, NDI (neck disability index) and European myelopathy scores, patient satisfaction, and return to work details. Radiographic assessments were collected preoperatively, at 4 weeks, 3 months, 6 months, 1 and 2 years postoperatively.

Results: 58 patients have been assessed with at least 1year follow-up. The mean duration of symptoms prior to surgery was 24 weeks (6–20 weeks). 55 patients had single level surgeries (C5/C6-15, C6/C7-38, C7-T1-2), 3 patients had two level surgeries (C4/C5& C5/C6-1, C5/C6& C6/C7-2). In 34 patients sugery was for soft disc prolapse, in 12 patients surgery was for hard osteophytes and in 12 patients both pathologies contributed equally. Operation time ranged from 50–85 minutes. Average in patient stay was 2.6 days. There were no complications apart from 1 patient who had to return early to theatre for evacuation of haematoma and then made a full recovery. All patients reported pain intensity reductions. Pain decreased from 6.7 to 1.4 for arm pain on a 10-point scale. NDI scores improved from a preop mean of 42 to 16 on a 100 point score at 6 months post-surgery. All patients returned to their usual occupations with the exception of 2 patients who are involved in litigation against an employer or third party. No patient required repeat surgeries. Radiographic analysis at 1 year shows preservation of segmental motion in 75% patients, preservation of interbody height in 60% patients, spontaneous fusion in 12% patients.

Conclusion: A clinical success rate of 90% was achieved (clinical success being defined as a patient rating of very satisfied or satisfied on a 5-point patient self-scoring outcome scale). 56 out of 58 patients would undergo the same procedure again and recommend it to friend.

Aim: The pelvis is a rare location for osteochondromas and differentiation from chondrosarcomas can be difficult. We aim to aid this differentiation using tends and demographics of treated cases.

Methods and Results: Patients referred to a supra-regional bone tumour centre with pelvic tumours, consequently diagnosed as osteochondromas were studied to determine the clinico-pathological features that differentiate them from chondrosarcoma. Treatment outcome was also reviewed.

30 patients were studied with a mean follow-up of 32 months. The mean age at diagnosis was 34yrs (range 19–79). The male to female ratio was 1:1. The most common location was the ilium (19 patients), with the pubis and ischium accounting for a third of patients. Only 1 patient had an acetabular osteochondroma. Median duration of symptoms prior to referral was 6 months (1–79). Pain without a lump was the main presenting symptom (16 patients), followed by lump with pain (6), and lump alone (6). Two patients presented with obstructive labour requiring emergency procedures. The lesions were solitary in 24 and associated with hereditary multiple exostosis (HME) in 6 patients. 1 patient had a radiation induced lesion.

The lesions showed increased uptake on bone scans and the cartilage cap was less than 10mm in all but 2 patients. Treatment was surgical excision in 21 patients and observation with serial radiographs in 9. Histological examination confirmed osteochondroma in all patients, however 1 patient with HME had areas of Grade I malignancy. Significant surgical complications occurred in 1 patient who developed pulmonary embolism.

Conclusion: We conclude that symptoms from osteochondromas of the pelvis are similar to those with chondrosarcomas and increased uptake on bone scans is seen in both. However, a tumour with a cartilage cap larger than 10mm or arising from the acetabulum is unlikely to be an osteochondroma.

Objective To describe the initial clinical and radiological results of a minimally invasive technique of lumbar fusion

Study Design Prospective review of 16 consecutive patients with degenerative lumbar disease who underwent a mini posterior lumbar interbody fusion using the operating microscope and B- twin expandable cages and titanium facet screws and facet fusion .

Subjects 16 patients with degenerative lumbar disease, average age 41(33–48) 5 male 11 female. This was the primary procedure in 11 patients , 5 had previously had a microdiscectomy . 14 patients L5/S1 level 2 patients 2 level L4/L5 L5/S1

Outcome Measures Oswestry disability index and VAS of back and leg pain were perfomed pre-operatively and at 3/12, 6/12, 12/12 Average follow up was 8.1 months (3–17).

Results 1 patient had persistent bone graft donor site pain ,no other complications. Preoperative mean ODI 55 (40–76) Post operative ODI 33 (2–64) Pre op back pain 7.1 (0–8) post op at last follow up 3.7(0–6) Pre op leg 3.9 (0–8) 1.6(0–5) All patients who had reached 12 months follow up had evidence of bone formation at the level in question. All patients improved in terms back pain and leg pain scores and all but 1 patient had a significantly improved ODI score.

Conclusions This has proved to be a safe method of achieving a 360degree stabilisation and probable fusion. It maximally preserves the paraspinal muscles and their innervation in contrast to posterolateral fusion and conventional PLIF using pedicle screws .The small diameter of the implant prior to expansion minimises the degree of neural retraction required .