The study was designed to observe the patients emotional and physical response to total disc replacement surgery in the cervical spine.

A prospective cohort study of patients undergoing Cervical total disc replacement (TDR) surgery at our institution. Surgery was carried for radicular and or axial neck pain. The Activ-C TDR (Aesculap) was used. Pre and post operative data was collected using validated questionnaires.

13 Consecutive patients from Nov 2007 to Aug 2008 were studied. All patients were planned for surgical intervention for symptomatic degenerative cervical disc disease at single or multiple levels. 7 male, 6 female.

The Centre for Epidemiological Studies Depression Scale (CES-D) was used to assess the psychological impact. The Neck Disability Index (NDI) and a visual analogue scale (VAS) were used to assess the physical impact of the surgery.

NDI shows a significant improvement at 6 and 12 months (p= 0.002 and p=0.02 respectively). The VAS also shows significant improvement at 6 and 12 months (p=0.004 and 0.008 respectively) The CES-D improved but failed to show any significant improvement at either interval.

In our patient population surgical intervention with TDR for degenerative disc disease offers significant physical benefit over the short term. This does not correlate with an improvement in their emotional state.

Lumbar spinal surgery may be associated with considerable pain in the early postoperative period. This often leads to a delay in patient mobilisation and a consequent increase in the risk of developing perioperative complications. Several studies have demonstrated the efficacy of intrathecal opioids for analgesia following spinal surgery.^1–3 Morphine has been the most widely studied opioid and although improved analgesia has been reported with its use the risk of serious side effects such as respiratory depression has resulted in patients having to be nursed postoperatively in a high dependency unit.² Intrathecal diamorphine has been widely used for analgesia following lower limb joint replacement where it is an effective analgesic agent with a good safety profile.^4–5 Its use for analgesia following lumbar spinal surgery has never been reported.

We present our experience of using intrathecal diamorphine for analgesia following lumbar spinal surgery. Data were collected on all patients undergoing surgery who received intrathecal diamorphine and stored on a database (Microsoft Access).

Results: 194 patients received intrathecal diamorphine following spinal surgery over a 30 month period. All patients underwent lower lumbosacral decompressive and/or fusion surgery. Mean dose of diamorphine administered was 1.6mg (range 1–4mg or 20–50mcg/kg). In all cases intrathecal diamorphine was administered by the anaesthetist once the patient was anaesthetised. Only 9% of patients had a pain score of 2 or greater within the first 24 hours (using a verbal rating scale 0–10). No patients required rescue analgesia with intravenous opiates. All patients except one were nursed on a regular orthopaedic ward. Side effects were rare. Respiratory depression occurred in one patient necessitating supplemental oxygen and monitoring in a high dependency unit for 12 hours. Hypotension was an infrequent finding (3.5%) but was most common upon return to the ward and in the following 24 hours. It was easily treated with the administration of intravenous fluids and vasopressors were never required. Sedation occurred in 4 of the patients whilst in the recovery ward but the incidence was nil once patients had been discharged to the orthopaedic ward. The most common complication recorded was pruritis, occurring in 9% of patients within the first 12 hours.

Conclusion: Intrathecal diamorphine is an effective and safe method of providing analgesia following lumbar spinal surgery. High Dependency nursing care is not required as the incidence of serious side effects is low.

Introduction: Radiation dose exposure to patients in a main X-ray department in a hospital is well documented and controlled. Few studies report the radiation exposure to patients undergoing spinal surgery received from an image intensifier. There are no recommended doses published when using the image intensifier

Methods: We reviewed the radiation doses and exposure times from computer and radiation log records of all the patients who underwent trauma & orthopaedic surgery which required an image intensifier between January and September 2005. The Dose-Area-Product (Gray/cm2) and screening time was recorded.

Results: More than 600 patients underwent trauma & orthopaedic surgery that required an image intensifier at the time of surgery. The mean screening Dose Area Product of the patients undergoing spinal surgery and other common procedures are shown (Gray/cm2):- Lumbar fusion – 23. Disc replacement – 10. Discogram – 4.9. Foraminal injection – 4.4. DHS – 1.86. IMHS – 1.33. ORIF Ankle – 0.89. MUA k-wire wrist – 0.04. The four surgical procedures which required the most radiation were spinal procedures. The maximum radiation is given to patients undergoing lumbar spinal fusion.

Conclusion: Patients undergoing spinal surgery can receive as much radiation exposure as those undergoing procedures such as barium swallow or standard lumbar spine films. Efforts should be made to reduce radiation exposure to orthopaedic patients, and operating surgeons especially those undergoing spinal surgery. By publishing our radiation exposure doses, we can begin to establish guidelines for recommended patient doses.