Background and aims

The EU-funded Back-UP project aims to develop a cloud computer platform to guide the treatment of low back and neck pain (LBNP) in first contact care and early rehabilitation. In order to identify evidence-based treatment options that can be recommended and are accessible to people with LBNP across Europe, we conducted a systematic review of recently published guidelines.

Introduction

Early intervention is advocated to prevent long-term work absence due to musculoskeletal (MSK) pain. The SWAP trial tested whether adding a vocational advice (VA) service to best current care led to fewer days work absence over 4 months.

Objective

Pyogenic spinal infection (PSI) is an increasingly common presentation to spinal units in the UK. Its investigation and diagnosis is often delayed. The purpose of this study was to determine the prognostic significance of the inflammatory marker levels on admission on achieving a positive microbiological diagnosis in patients with PSI.

Purpose

To report a retrospective study of 103 cases of primary spinal infection, the largest ever such series from the UK, analysing presenting symptoms, investigations, bacteriology and the results of treatment.

Pedicle screw fixation has become the norm for the surgical correction of adolescent idiopathic scoliosis (AIS), with much biomechanical research into different types of rod screw constructs. The senior authors have experience using a monoaxial screw only construct in the correction of AIS since 2003 and the polyaxial screw only construct since 2005.

We retrospectively reviewed our experience in the first ten patients with AIS using the polyaxial system and compared this against 18 patients who had been corrected using the monoaxial system. Table I shows our results, expressed as mean and ranges or means ± SD for the main thoracic and lumbar curves.

Our early results show that the polyaxial system produces similar correction of both the thoracic and lumbar curves as compared to the monoaxial system in the immediate post-operative period. Though the absolute values for the lumbar curves differ between the two groups the percentage correction shows no statistical difference.

We studied the long term outcome, using the Oswestry Disability Index (ODI), on patients who were managed at our institution between February, 1997, and August, 2004, with a diagnosis of a primary spinal infection, excluding TB or post-operative infection. Patients were identified from databases held within the Departments of Radiology, Orthopaedic Surgery, Neurosurgery and Microbiology. This identified 98 adult patients who fulfilled our inclusion criteria, of who ODIs were calculated on 66, with a mean follow-up of 5 years. There were initially 53 male and 45 female patients with a mean age of 60 years (range 21 0 86) at presentation and symptoms had been present on average for 72 days prior to admission. Back pain was the predominant symptom in 59 and neuropathy in 43. Our figures would suggest a mush higher incidence of primary spinal infection than previously quoted. 75% had significant co-morbidities and 85% of patients under 40 years of age were IV drug users. The causative organisms and their effect were noted. Admission WCC (mean 11.5 ± 8.6) and CRP (mean 128 ± 48) were obtained in the majority of patients (97/98 & 94/98). For those patients who were still available to f/u, the mean ODI was 32 ± 25.

Background: Most reports of sickness absence come either from company records, which are limited to specific workforces, or rely on self-report. Electronic recording of sickness certification in primary care medical records provides an alternative source of information.

Purpose: To investigate the validity of electronic sickness certification records in primary care.

Methods: Analysis included 292 primary care LBP consulters, who returned a questionnaire including self-reported work absence, and consented to medical record review. Sickness certification records for 2001–2 were downloaded. Self-reported sickness absence for the previous 2-weeks was matched with electronic records for the same time period. Records were considered to match if there was no reported absence and no certificate, if there was reported absence > =7 days and a certificate, or if reported absence was < 7 days and no certificate was issued.

Results: Overall, 84% of records matched; 87% of employed consulters and 90% of unemployed consulters. Among the employed, 100% of reports of no absence did not have a certificate, 49% of reported absences > =7 days were matched by a certificate for the same time period and lastly, 80% of reported absences of < 7 days did not have a certificate.

Conclusion: We have demonstrated that people with none or short self-reported work absences do not have sickness certificates in their records, but only a small proportion of people with longer self-reported absences appear to have certificates. Further work will investigate possible reasons for non-matching, these may include non-requirement of a certificate, recall errors or incomplete recording of sickness certificates.