‘Free From Pain’ is a drug-free, injection injection-free, lifestyle-based musculoskeletal pain management programme for seniors. The programme empowers Seniors with relevant information and inspirational metaphors whilst providing them with validated exercises. The programme is also available as a published book (ISBN-0995676941). This pilot study aimed to assess the suitability and safety of the programme's exercises and the usefulness of the book before considering a larger study. Participants used 5-point Likert scales to evaluate the exercises. A rating of three or below on a Likert scale denoted non-agreement to a positive statement regarding the exercises. A rating of four or above denoted agreement. The Usefulness Scale for Patient Information Material (USE) was utilised to assess the book.Abstract
Background
Methods
BANDAIDE aka Back and Neck Discomfort relief with Altered behaviour, Intelligent Postures, Dynamic movement and Exercises (ISBN - 0995676933) is a concise self-help booklet containing strengthening exercises and illustrated information to enable patients self-manage their back and neck pain. The aim of this preliminary audit was to determine patient opinion on BANDAIDE. Institutional audit approval was obtained – No. 8429. BANDAIDE was distributed to 40 patients, who were asked to evaluate the booklet using the Usefulness Scale for Patient Information Material (USE). USE consists of nine positive statements which are subdivided into three sub-domains; cognition, emotional and behavioural. The cognition sub-domain assesses the knowledge obtained from the material, the emotional sub-domain evaluates the effects of the material on an individual's ability to cope with the illness and the behavioural sub-domain assesses ability to self-manage. Responders were required to rate the extent to which they agreed with each of the nine statements on a scale of 0 to 10, where 0 denotes ‘completely disagree’ and 10 denotes ‘completely agree’. Each subsection is on a scale of 0–30, with a higher score suggesting better usefulness. 23 participants provided their opinions of BANDAIDE through the USE. For the three sub-domains, the mean ratings for cognition, emotional and behavioural were 27.2, 24.7, and 26.4 respectively.Background
Methods and Results
Free From Pain (aka Fear Reduction, Exercise Early with Food from plants, Rest and relaxation, Organisation and Motivation to decrease Pain from Arthritis and Increase Natural Strength) is a functional rehabilitation programme to combat sarcopenia and musculoskeletal pain in seniors. It is also published as a book (ISBN-0995676941). The aim of this audit was to evaluate the safety and suitability of the exercises and the usefulness of the exercise book. Participants were volunteers who paid to attend the Free From Pain Exercise programme. Participants evaluated the exercises using a 5-point Likert scale and the Exercise Book using the Usefulness Scale for Patient Information Material (USE). 30 participants attended the Free From Pain programme. 26 participants completed the questionnaire. This included 20 females and 6 males, with a mean age of 76 years. The mean scores on the 0 to 5 Likert scales were A) Exercises were suitable? 4.69; B) Exercises were safe? 4.58; C) Absence of any injury or medical event whilst exercising? 4.58; D) Covered all body parts? 4.38; E) Easy to do at home? 4.42; F) Encouraged to do more exercise? 4.42; G) Recommend to family and friends? 4.50. The mean scores of the cognitive, emotional, and behavioural sub domains of the USE scale, scored 0 to 30, were 25.23, 23.73 and 23.69, respectively.Background
Methods and Results
To capture the views of various members of the healthcare system with regards to whiplash injuries and in particular, the cumulative effects of whiplash on a patient seeking compensation. A questionnaire was set up on “Surveymonkey” which consisted of three scenarios outlining 1. single whiplash injury 2. Past history of neck pain with new whiplash injury 3. Chronic history of neck pain with a new whiplash injury seeking long term compensation and early retirement. The respondents were asked whether or not they agreed or disagreed with fictional expert opinions for each scenario. The questionnaire was distributed to orthopaedic surgeons, accident & emergency doctors, general practitioners and physiotherapists.Aims
Method
Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment, which can lead to devastating outcome on patients. The aim of this study was to assess health care professionals knowledge with regards to the urinary symptoms of CES and the timeframe in which treatment should be offered. To assess health care professionals knowledge with regards to urinary symptoms of CES and when treatment should be offered.Background
Objectives
Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment, which can lead to devastating outcome on patients. The aim of this study was to assess health care professionals knowledge with regards to the urinary symptoms of CES and the timeframe in which treatment should be offered. To assess health care professionals knowledge with regards to urinary symptoms of CES and when treatment should be offered. A 4-part questionnaire established profession and number of cases seen per week. The participant was asked to rank 15 urinary symptoms, 7 of these symptoms were not related to CES. The participants were asked the ideal time to surgical intervention for Complete CES and Incomplete CES. Primary and Secondary Care 60 questionnaires were complete. Participants had to successfully complete the first three parts of the questionnaire (n = 44). Any who failed to complete section four were excluded from analysis from that part only (n = 41). A total of 44 questionnaires were analysed. Both doctors and physiotherapists ranked the CES symptoms on average significantly higher than then the non-CES symptoms. The physiotherapists rated the CES symptoms significantly higher than the doctors (P = 0.05) and on average rated the non-CES symptoms significantly lower than doctors (P < 0.05). 87.8% thought that complete CES should be treated < 24 hours and 9.76% thought that complete CES should be treated from 24-48 hours. 46.34% thought that CESI should be treated < 24 hours and 43.9% thought that CESI should be treated from 24-48 hours. These results demonstrate that physiotherapists are better than Doctors at identifying the urinary symptoms in CES. The majority of health care professional who took part in this study stated that they would offer surgical intervention for both Complete and Incomplete CES within 24 hours. The gap in knowledge highlights the need for education to all medical professionals in the symptoms of CES and also the timing of treatment.
A recent audit in our institution showed that 40% of Lumbar spine X-rays ordered by General Practitioners were outside the Royal College of Radiology guidelines. Little in 1998 had commented that GPs requested Lumber Spine X-rays for psychosocial reasons. An online survey was conducted on Purpose of study
Methods
The Royal College of Radiology (RCR) provides guideline criteria to order lumbar spine X-rays for back pain. An audit was undertaken in our hospital to see compliance with this guideline. 200 lumbar spine radiology requests received in the hospital radiology department from General Practitioners over a 12 month period were identified. These 200 requests and their corresponding radiology reports were retrospectively analyzed.Purpose of study
Methods
To assess health care professional's knowledge with regards to the urinary symptoms of CES and when treatment should be offered. Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment.Objectives
Background
“Spine Class” was organised at Southport Hospitals NHS Trust. The course was awarded 6 CPD (Continuing Professional Development) points. We propose a new method for assessing the effectiveness of educational courses by pre and post testing and participant satisfaction. The course was attended by 64 delegates (49 Allied Health Professionals e.g. Physiotherapists and 15 Physicians). 21 lectures were planned for the day. The lecturers were asked to submit 2 True/False questions (TFQs), a total of 42 questions. Questions were answered prior to the course and immediately after. The lectures were evaluated on a scale of 1 to 5.Introduction:
Materials and Methods
We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural rupture during surgery and CSF hypovolemia are thought to be the main contributing factors, one can postulate on the effects of anti-psychiatirc medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and therefore should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases were the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible eplieptogenic medication.
Multiple treatments of Sacro-iliac joint (SIJ) dysfunction have been adopted by various disciplines that treat low back pain. The aim of this audit is to evaluate the effect of steroids and Local anaesthetic injection (LA) in the management of SIJ dysfunction and to determine the relation between road traffic accident and low back pain (LBP). We retrospectively reviewed 31 patients who were diagnosed as having SIJ dysfunction. All patients had steroids and LA injection under x-ray control. Based on previous history of road traffic accident patients were divided into RTA and non-RTA group. Through a postal questionnaire the severity of LBP and leg pain (pre and post injection) were assessed using visual analogue scale (VAS). Functional level was evaluated through the Oswestery disability Index (ODI). All patients showed improvements in LBP and leg pain post injection with mean improvement in VAS of 2.95 (SD 3.0, p-value <
.0001) for LBP and mean improvement of 3.3 (SD 3.3, p-value <
0.001) for leg pain. Similarly the ODI showed mean improvement of 15.0 (SD 17.0, p-value <
0.0001). Patients in the RTA group showed greater improvement than the non RTA group, however this did not reach statistical significance. We conclude that steroids and LA injection is an effective method in management of SIJ dysfunction. Also our study suggests that RTA can be a potential cause of back pain by causing SIJ dysfunction. We accept that our sample size is small and needed to be confirmed through a prospective randomised controlled trial which is currently taking place in our institution.
Sarcoidosis is a multisystem syndrome characterized by the development of non-caseating granulomata. The lesion disrupts the architecture and function of the tissue in which they reside. Sarcoidosis in and around the spine is very rare affecting less than 1% of patients with the disease. It can affect various parts of the craniospinal axis: intramedullary, intradural, extramedullary, intraspinal epidural spaces and in vertebral bodies. In this report we present a rare case of sarcoidosis in the intervertebral disc causing diagnostic dilemma. To our knowledge this has never been reported before. Our patient has had aggressive systemic sracoidosis, however the first presentation of the disease was in his spine in the form of intractable low back and leg pain resistant to treatment. X-ray and MRI showed Listhesis at L4/5. Posterior Fusion was performed. Pain became worse and accordingly anterior fusion was attempted, which was aborted because of excessive bleeding. Patient then developed subcutaneous nodules. Biopsy from the nodules showed features of non-caseating granulomatous lesion. In view of the persistence of his symptoms biopsy from L4/5 disc was performed and showed similar histological features. CT chest and abdomen confirmed the diagnosis of sarcoidosis. The patient was commenced on steroids and Methotrexate. In this report we highlight the approach to diagnosis and management and present a review of the literature. Our main aim is to make the clinicians more aware of this rare condition and raise the index of suspicion, particularly if the first presentation of this multi-system granulomatous disorder is in the spine.
A 48-year old man presented with back pain that was resistant to treatment. An MR scan showed spondylolisthesis at L4-5 and narrowing of the exit foraminae. He had a posterior fusion which did not relieve his symptoms. He continued to have back pain and developed subcutaneous nodules in both forearms. Biopsy from the skin revealed cutaneous sarcoidosis, and one from the lumbar spine showed sarcoidosis granuloma between the bone trabeculae. A CT scan of the abdomen and chest revealed axillary lymphadenopathy, mediastinal enlarged nodes, apical nodular nodes and splenomegaly. The patient was started on large doses of methotrexate and steroids. His angiotensin-converting enzyme and calcium levels returned to normal and the back pain resolved.
INTRODUCTION: To audit the workload of an Orthopaedic Surgeon sent on deployment to the Middle East. The cases seen and treated are discussed. The audit was to determine the lessons for the future. DISCUSSION: 86 in patient admissions occurred between 12.01.2002 and 10.04.2002. A break up of speciality was a follows: Orthopaedic 38, Medical 27, General Surgical 16 and Psychiatric 5. A breakdown of the Orthopaedic cases were as follows: Ankle Injury 5, Arthralgia 3, Closed Fracture 4, Elbow Injury 1, Knee Injury 5, Low Back Pain 5, Multiple Soft Tissue Injury 3, Open Injury 3, Sciatica 1, Shoulder Injury 2, Soft Tissue Injury 3, and Stress Fracture 3. The 3 suspected stress fractures and the 2 gun shot wounds required special mention. 31 of 38 Orthopaedic patients were sent back to the UK through the Aeromedical chain. These patients were subclassified according to the requirement of evacuation through the Aeromedical chain. Seventeen patients, though not fit for theatre were able to undertake their own flight back. A trial of sending them back on unaccompanied flights failed. All patients were then evacuated through the Aeromedical chain. On average this meant one medical attendant per 2 patients. If civilian flights were taken this would have meant an extra expenditure of £4,800 (£600 x 8). Illness behaviour was noted in 10 of the 38 Orthopaedic patients. All these patients were evacuated to the UK. Malingering as tested by the Burns bench test, modified Schobers test, Hoover test and Inappropriate Waddells signs were positive in 4 of these patients whose initial complaint was of low back pain. CONCLUSION: It is proposed that the category of patients who are unfit for theatre but fit to fly unaccompanied should be recognised. It is also proposed that patients potentially deployable but showing illness behaviour should be discharged from the services earlier as it causes unnecessary expenditure and enforces extra work on other sincere and fit personnel.
This study was designed to determine the point prevalence of musculoskeletal pain among deployed personnel. 150 questionnaires were randomly distributed through the cashier and the mess at RAF Thumrait. 112 questionnaires were returned. The questionnaire, although a general musculoskeletal one, focused mainly on spine pain and also contained the Short Form 36. 107 males and 5 females responded. 85 (75.89%) personnel reported presence of some pain either in their spine and/ or limbs. There was no difference in the report of pain between the various age groups mentioned (p=0.76). There were significant differences among the different occupational branches (p=0.0023). There was no correlation however between spinal pain and lifting (p=0.79), standing (p=0.28), sitting (p=0.98), or running / jumping/ climbing (p=0.77). Though the 22 smokers reported higher pain than non-smokers this did not show statistical significance. There was negative correlation between the VAS report of pain and the Physical Component of Health (p=0.0001) and between stress at work and the Mental Component of Health (p=0.001) and between stress at work and the Mental component of health (p=0.001). 85 (75.9%) of the 112 personnel who had completed the questionnaire had some pain either in the spine or limbs. The lower back was the single anatomical region where pain was reported (n=68,60.7%) most frequently. It is interesting to note that all these personnel were on active duty in the armed forces and considered medically fit to deploy. It only shows to reinforce that low back pain in particular and musculoskeletal pain in general is common and normal and does not always imply disease and disability.
Recent years have seen the popularization of minimally invasive approaches to the spine. However, the use of the balloon assisted retroperitoneal approach has not been widely described, moreover there has been no direct comparison between this mini-ALIF (anterior lumbar interbody fusion) and the conventional open method in the literature. Comparison of peri and intra-operative parameters between the rnini-ALIF (using the balloon assisted dissector and Synframe retractor system) and the open midline approach for single and double level anterior lumbar interbody fusions in order to assess the efficacy of this procedure. An independent retrospective evaluation of 35 patients who underwent single or double level ALIF under the care of the senior author at the University Hospital, Nottingham during the period from 1997 to 2000. The patients were split between those undergoing a mini-ALIF (balloon assisted retroperitoneal dissection) or the conventional approach via a larger midline incision. The groups were matched for age, sex and number of levels. Data was collated from the medical notes with regards to intra-operative blood loss, operative time, intra-operative complications, PCA requirements, time to mobilisation and length of hospital stay. A statistically significant (p=0. 01) reduction in time to mobilisation (mean 2. 1 days vs 3. 9 days) and operative time (mean 175mins vs 265mins) was found for the single level mini-ALIF. This reflects the greater number of L5/SI fusions in this group. The number of vascular injuries was also greater in the approach to L4/5. No difference was found between the two groups for double level procedures. The immediate advantages of a less invasive approach both to the patient and hospital do not appear to be borne out by this study. Cosmesis was not assessed and the long term functional outcome awaits later confirmation.
Conclusion: The immediate advantages of a less invasive approach both to the patient and the hospital do not appear to be borne out by this study. Cosmesis was not assessed and long term functional outcome awaits later review.
Advances in laparoscopic technology have popularised minimally invasive approaches to the anterior lumbar spine. The use of the balloon assisted retroperitoneal approach however has not been widely described; moreover there has been no direct comparison between this mini anterior lumbar interbody fusion (ALIF) and the conventional open method in the literature. Comparison of peri and intra-operative parameters between the mini-ALIF (using the balloon assisted dissector) and the open midline approach for single and double level anterior lumbar interbody fusions in order to assess the efficacy of this procedure. An independent retrospective evaluation of 35 patients who underwent single or double level ALIF. A single surgeon at the University Hospital, Nottingham, performed the procedures during the period from 1997 to 2000. The patients were split between those undergoing a mini-ALIF (balloon assisted retroperitoneal dissection) and the conventional approach via a larger midline incision. The groups were matched for age, sex and number of levels. Data was collated from the medical notes with regards to intra-operative blood loss, operative time, intra-operative complications, Patient Controlled Analgesic (PCA) requirements, time to mobilisation and length of hospital stay. A statistically significant reduction in operative time (mean 178mins Vs 255mins) and time to mobilisation (mean 2.2 days Vs 3.7days) was found for the single level mini-ALIF. No other significant difference was detected for the other criteria between the two groups for either single or double level procedures. Complications in the form of vascular injuries were almost equal in both groups. Although operating time was significantly shortened using the balloon-assisted dissector other perioperative parameters were not. The question of cosmesis of the surgical scar was not explored in this study, this may have been more favorable in the mini-ALIF group but given the above results one must question whether the added expense of this innovative device is justified when there was no detected difference in all other measured criteria.
To determine the current practice and to review the literature regarding administration of high dose Methylprednisolone for acute spinal cord injury (SCI). Administration of high dose Methylprednisolone for Acute Spinal Cord Injury has been widely practised following the publication of the three National Acute Spinal Cord Injury Studies (NASCIS). NASCIS recommends a bolus intravenous dose of 30mg/kg of Methylprednisolone in 15 minutes, followed by a 45 min pause and then followed by a maintenance dose of 5.4 mg / kg / hr for 23 hours. This regime has been recommended by the Advanced Trauma Life Support. The Cochrane reviews also extol the three NASCIS randomised controlled trials. The mechanism of neuroprotection by Methylprednisolone is based on its inhibition of lipid peroxidation. Three hundred questionnaires were sent to Consultants practising Spinal surgery, Neurosurgery and Accident &
Emergency to determine the popular thought regarding the use of Methylprednisolone for Acute SCI. A thorough review of current medical literature was also performed. The literature search showed contradictory evidence regarding the use of high dose Methylprednisolone. The current popular thought, the diversity of responses between the three groups, the results of the 3 NASCIS trials and a recent review of literature is presented.