The use of nerve root blocks is common in the management of radicular pain due to lumbar disc prolapse. However, most papers reporting their use do not necessarily specify the position or level at which the needle is positioned with respect to the level of pathology. We therefore set out to investigate this. We performed a survey of medical practitioners across the UK with an interest or involvement in the management of radicular pain secondary to lumbar disc prolapse The survey depicted the clinical scenario of a patient with radicular pain from an L4/5 disc prolapse and a number of questions were asked in relation to the use of nerve root blocks.

Questionnaires were sent to 319 practitioners. We received 153 responses of which, 120 (37.6%) were sufficiently complete to be analysed. Of those who responded, 83% used a combination of local anaesthetic and steroids together with or without contrast. There were variations across the respondents in terms of the level injected with 22.5% injecting at the level of the L4/5 foramen, while 45% injected at the level of the L5/1 foramen. Differences were also noted when respondents were subgrouped according to their speciality. Of those who worked in pain management, 34.1% injected at the L4/5 foramen while 31.8% injected at the L5/1 foramen. For spine surgeons the respective figures were 20.5% and 43.2% and for radiologists 9.4% and 65.6%.

In the treatment of radicular leg pain, there are apparent variations in the use and positioning of root blocks for a given level of disc pathology. This suggests that caution is necessary when considering the validity of published studies on the use of root blocks relative to an individual clinician's practice.

Only 0.8% of arthroplasties registered on the National Joint Registry in 2006 are patello-femoral. The Leicester patello-femoral replacement (Corin) has been in use for over 10 years with satisfactory initial results. The indication for use is isolated patello-femoral osteoarthritis with the theoretical benefits of bone preservation, maintenance of normal knee mechanics and easy revision. The implant was only available in one size and the femoral component was uncemented.

We reviewed 49 patients managed with this prosthesis with a median follow up of 10 years (range 4-16). The mean age of the patients at time of surgery was 64. 62 arthroplasties were performed.51 were in females and 11 in males giving a 5:1 ratio. Thirteen patients had bilateral procedures. Thirty-nine revisions (62.9%) were performed for progressive tibio-femoral arthritis or prosthetic failure. Mean time to revision was 5 years 3 months. The knees were revised to total knee replacements without the need for stems, wedges or constraint. The unrevised knees had a mean survivorship of 8 years 6 months with a range of 4-14 years. The mean Oxford score for these surviving implants was 22.5.

Results of other implants from the literature included the Avon prosthesis with 80% satisfaction rate at 5 years and the Lubinus with 45% satisfaction rate at 7.5 years. The Leicester device showed a pattern of progressive failure with up to 40% revision at 5 years. However those with surviving implants were reasonably happy as shown by the Oxford scores.

We concluded that patello-femoral replacement has a role though this is not as well defined as TKR or even UKR. We posed the question as to whether these results were due to poor patient selection or design failings of the Leicester prosthesis. This prosthesis has been successful at reducing pain and improving function and may have been more successful with more sizes of implant, better instrumentation and more rigid patient selection.

Purpose: A descriptive cohort study of the surgical treatment of spinal tuberculosis in a single unit in the United Kingdom

Tuberculosis is a common disorder and may be increasing in prevalence. 83 cases of spinal involvement with TB occurred and of these 40 patients had a total of 61 interventional procedures.

Indications for intervention were:

Progressive neurological deterioration

Results: The age range was from 12 to 73. Sixteen patients had 17 closed biopsies to assist in establishing the diagnosis, of these four went on require further surgical procedures. There were five intermediate level procedures such as application of halo or removal of hardware.

Two patients were Caucasian with no predisposing factors and delays occurred in the initial diagnosis. Diabetes was a significant associated co-morbidity particularly in Asian patients.

Multiple procedures were required usually for staged stabilisation after anterior decompression. 2 patients had four procedures, 2 had three procedures and 10 had two procedures 27 had a single procedure.

Nine patients that underwent anterior decompression and strut grafting for neurological deterioration went on to have a second stage extra focal fixation and became ambulant. One death occurred from mesenteric infarction at 4 months post op in this group. Significant neurological recovery occurred after surgery in the neurologically impaired patients.

Two revision procedures were required in the cervical spine for inadequate primary stabilisation.

Conclusion: About half of the spinal TB cases come to interventional procedures.

Surgery when required is often a complex decompression and staged reconstruction

Background: The safest and most effective method of early spine clearance in unconscious patients is the subject of intense debate.

Hypothesis: Helical CT is a sufficiently sensitive investigation to render dynamic screening of the cervical spine redundant.

Protocol: Our protocol for cervical spinal clearance in the unconscious patient since April 1994 involves the use of plain radiographs, CT scan (helical CT since 1997) and dynamic screening (DS).

Method: Over a ten-year period, April 1994 to September 2004, 839 patients were admitted to intensive care under the orthopaedic surgeons. 35 patients were excluded because of incomplete records.

Results:

Demographics: The mechanism of injury was a road traffic accident in 80% and the mean ISS was 24.1. There were 95 patients (10.9%) with a cervical spine fracture, 96 (10.8%) with a fracture in either / both thoracic and lumbar regions.

Conclusion: DS is a safe procedure but has no real advantage over helical CT. Power’s ratio calculation is essential to reduce the chance of a missing an upper cervical injury. The cervical spine can be reliably cleared using helical CT alone.

Aims: To assess the value of hip arthrography in planning definitive treatment for children with DDH and Perthes’ disease.

Background: It is sometimes unclear whether children with DDH and Perthes’ disease need an operation. Surgeons are guided by the clinical symptoms and signs together with the radiographic appearances of the affected hip. In our Unit children on whom an operation is considered undergo an examination under anaesthetic (EUA) and a hip arthrogram. This prospective study was developed to assess whether treatment was modified by the arthrogram.

Methods: All patients who underwent an EUA and hip arthrogram for DDH or Perthes’ disease over a 10 month period were entered into this prospective study. Prior to arthrography a Consultant Children’s Orthopaedic Surgeon formulated a treatment plan. A standard arthrogram was performed which included anteroposterior, frog lateral, Von Rosen and oblique views. Traction axial loading views were taken to assess stability. Following EUA and arthrogram the Consultant Surgeon formulated a definitive treatment plan. Three Children’s Consultants were then invited subsequently to review the preoperative and arthrographic appearances blindly to monitor reproducibility. Twenty-one patients with DDH and 19 with Perthes’ disease were entered into the study.

Results: In the DDH group of patients the treatment plan was modified in 12 of the 21 patients as a consequence of the arthrogram. Six of the 19 patients (31.6 %) of the Perthes’ affected patients had their treatment modified. When it was felt likely prior to EUA a conservative treatment was indicated. The correlation of intra-observer Consultant agreement was high but inter-observer Consultant agreement was moderate only. In both groups of patients the range of hip motion was significantly greater under anaesthesia.

Conclusion: Static and dynamic arthrography helps decision making in patients with DDH and Perthes’ disease.

Study Design: Retrospective cohort study.

Objectives: The aim of the study was to determine the incidence, sex distribution, age at diagnosis and any relationship this may have to handedness in 10–16 year olds with idiopathic scoliosis.

Design: A total of 611 patients with scoliosis were reviewed.

Subjects: 344 patients were diagnosed as having idiopathic idiopathic scoliosis. Those between the ages of 10–16, with a Bunnell angle greater than 5 degrees were included in the study.

Outcome Measures: Incidence in females was 0.69 % and 0.15 % in males. The female:male ratio was 5:1.

Results: Age at diagnosis was earlier in females, and typically occurred eighteen months following menarche. The incidence of left-handedness in 10–16 year olds in the general population was found to be 10%. This was the same in the scoliotic group.

Conclusions: The data showed that there was no significant relationship between handedness and the typical idiopathic pattern. However, there was a significant relationship between left handed individuals and the atypical curves (p= 0.0003, CI 1.56–6.63)