Aims

Gram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre.

Background and objectives. Numerous approaches are recommended for the management of non-specific neck pain (NS-NP). However, the extent to which approaches are used is unclear. This survey investigated current UK physiotherapists' measurement and management of patients with NS-NP. Methods and results. Physiotherapists were invited to participate in an online survey if they were practicing in the UK and had experience of managing NS-NP. 2101 responses were received. Analysis of the results indicated the overall popularity of active treatment approaches with 84% and 61% of respondents employing exercise and patient education respectively. 48% of respondents reported using a multimodal approach (that is, combination of exercise and manual therapy with/without patient education). Over a third of respondents reported not using outcome measures (OMs) for NS-NP. Of the two-thirds who reported using OMs, the majority reported using pain and range of motion measures. Physical and functional limitations, psychological distress, and quality of life constructs, which are frequently associated with NS-NP, were rarely measured. Conclusion. The active interventions most frequently used in the management of NS-NP were supported by moderate to strong evidence but a variety of other commonly used approaches have limited, unclear or no evidence of efficacy. Multimodal treatment approaches that are supported by strong evidence of efficacy are less commonly used. Physiotherapists in the UK are inadequately evaluating NS-NP. Research and guidelines are needed to reduce the use of ineffective interventions, promote the use of multimodal care and develop high quality outcome measures that are relevant and feasible for use in clinical practice. Keywords. Health, survey, neck pain, non-specific, rehabilitation. Conflicts of interest: None. Sources of funding: None

Background. Previous research in people with musculoskeletal low back pain (MLBP) in primary care shows that a reliable and valid measure of consultation-based reassurance enables testing reassurance against patient' outcomes. Little is known about the role of reassurance in people with MLBP consulting spinal surgeons, especially in cases where surgeons recommend not to have surgery. There might be several reasons to exclude surgery as a treatment option, that range from positive messages about symptoms resolving to negative messages, suggesting that all reasonable avenue of treatment have been exhausted. AIM to explore patient's experience of consultation-based reassurance in people with MLBP who have been recently advised not to have surgery. Methods. Semi-structured interviews were conducted with 30 low back pain patients who had recently consulted for spinal surgery and were advised that surgery is not indicated. Interview were audio recorded and transcribed, and then coded using NVIVO qualitative software and analysed using the Framework Analysis. Results. Most patients reported feeling dismissed and discouraged. They considered that consultants were better in relationship building and data gathering than in providing cognitive and generic reassurance. Major emerging themes included the complexity and confusion of their NHS journey, lack of continuity-of-care, lack of information for their condition and a sense of dismissal. Patients reported that they needed reassurance through clear explanations and discussion of pain management, but instead were discharged into a void. Conclusion. Effective communication with patients attending surgical settings to consult about their back pain is important, especially when no active treatment is being offered. No conflict of interest. Funded by a grant from EuroSpine awarded to Professor Tamar Pincus and carried out within the NHS

AO Spine Reference Centre & Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. Traumatic spinal cord injury (SCI) is a devastating condition with no curative therapy. Pro-inflammatory therapy has been suggested recently to try and reduce the inhibitory glial scar and promote neural regeneration and healing. The aim of this study is to investigate the potential of sustained delivery of angiogenic/pro-inflammatory growth factors to reduce the secondary degeneration after spinal cord injury. Adult male Wistar Kyoto rats (200-300g; 12-16weeks old) were subjected to cord hemisections via a T10 laminectomy. Animals were randomised to treatment or control groups after the spinal cord injury had been induced. Treatment consisted of implantation of a mini-osmotic pump capable of delivering 5 micrograms vascular endothelial growth factor (VEGF) and 5 micrograms platelet-derived growth factor (PDGF), via a catheter, to the site of the lesion, over 7 days(n=6). Control animals were subjected to either cord lesion only (n=6) or lesion plus mini-pump delivering PBS (phosphate-buffered saline) solution (n=6). Rats were sacrificed at one month and the spinal cords were harvested and examined by immunohistology, using anti-neurofilament-200 and anti-Glial Acidic Fibrillary Acidic Protein (GFAP) antibodies. RESULTS: Active treatment spinal cords showed a higher level with aboration of the axonal filament through the defect and more dense neurofilament-200 staining at the lesion site compared to both control groups. The treatment also showed the elevated presence of activated microglia in the lesion, whilst distal to the lesion the microglia and astrocytes retained an unreactive phenotype. Pro-inflammatory therapy in the rat spinal cord-injury model showed favourable histological findings after sustained delivery of PDGF and VEGF

We report a series of 15 children, six male and nine female, of average age 20 months, seen at a paediatric orthopaedic clinic with torticollis. Orthopaedic examination revealed a normal range of neck movement in all cases but in seven there was palpable tightness in the absence of true shortening or contracture of the sternomastoid muscle. The patients were prospectively referred for ocular examination. In five of the 15 an ocular cause for the torticollis was detected with underaction of the superior oblique muscle in three, paresis of the lateral rectus muscle in one and nystagmus in one. Another two patients were found to have an abnormal ocular examination which was thought to be unrelated to their torticollis. Three of the patients with ocular torticollis required extra-ocular muscle surgery to abolish the head tilt and one of these had a tight sternomastoid muscle. Two of the non-ocular group had surgical release of the sternomastoid muscle; in the rest, the condition either resolved with physiotherapy or required no active treatment. We recommend that all patients with torticollis and no clear orthopaedic cause are referred for ocular assessment since it is not possible clinically to distinguish ocular from non-ocular causes