Purpose and background. Static plain radiographs at the end of uncontrolled bending are the current standard of care for measuring translatory slip in back pain patients. Quantitative fluoroscopy systems (QF) that employ standardised bending protocols have been found to improve precision and reduce dose, but comparative data are lacking. We compared 4 QF methods with static radiographs in a control population, calculating ranges, population variation and measurement errors over 6 weeks. Methods. Fifty-four healthy controls (F=22, M=23) received passive recumbent and active weight bearing QF screenings during controlled motion, plus still fluoro imaging in neutral, flexion and extension. The translatory slip of all levels from L2-S1 was determined for each condition using bespoke image tracking codes (Matlab) and pooled to provide means and ranges of variation (+/-1.96SD). The pooled measurement error, or minimal detectable change (MDC. 95. ), reflecting the intra subject repeatability over 6 weeks was calculated. Ranges of translation for each level (L2-S1), for each type of motion were also calculated. Results. Static radiographs at the end of uncontrolled flexion gave the greatest variation and the worst repeatability, while QF recumbent passive and active weight bearing motion with flexion recorded during the motion had ¼ less variation and twice the repeatability. For individual levels, L2-3 had significantly higher flexion ranges in controlled motion than uncontrolled motion, whereas the converse was true at L4-5 (P<0.001). Conclusion. Dynamic QF measurement of flexion translatory slip gives ¼ less population variation and half the measurement error of static radiographs when measured in the same participants. No conflicts of interest. No funding obtained

Purpose and Background:. The spread of upright MRi scanning is a relatively new development in the UK. However, there is a lack of information about whether weight bearing scans confer any additional useful information for low back conditions. Methods and Results:. Forty-five patient referrals to the upright MRI Department at the AECC for weight bearing lumbar spine scans between November 1. st. 2014 and June 30. th. 2015, and the resulting radiologists' reports were reviewed. Age, gender, clinical history, summary of findings, type of weight bearing scanning performed (sitting, standing, flexion, extension) were abstracted. All patients were scanned in a 0.5T Paramed MRopen scanner and all also received supine lumbar spine sagittal and axial scans. The patients comprised 18 females and 27 males, mean age 52 years, (SD 15.5). Thirty had leg pain, 6 of which was bilateral. In 15, a stenotic lesion was suspected. Other reasons for referral were; possible malignancy (1), effects of degenerative change (4), spondylolisthesis (2), fracture, (1), previous surgery (3), trauma (1), sacroiliitis (1) and instability (3). In 12/45 cases, reportable findings were more prominent, and sometimes only identifiable, on weight bearing scans, while in a further 4, the reverse was true. All but one of these involved disruption of the spinal or root canals. Eight of them also involved positional alignment. Conclusion:. In this case series nearly a third of referred patients had reportable findings relating to the spinal or nerve root canals that were differentiated by upright MRI scans

Aims

To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod.

Aims

Magnetically controlled growing rods (MCGR) have been gaining popularity in the management of early-onset scoliosis (EOS) over the past decade. We present our experience with the first 44 MCGR consecutive cases treated at our institution.

Purpose and Background. This pilot study aimed to determine the accuracy of lumbar spine combined movement (CM) testing for diagnosing facet joint mediated pain, by comparing CM to medial branch blocks (MBB) - the gold standard in the diagnosis of facet joint pain. A regular compression pattern of CM combines active extension and lateral flexion, which is believed to compress the facet joints greater than physiological uni-planar movements. Method and Results. 96 patients attending a pain clinic day case unit for diagnostic MBB were recruited. Patients' pain responses to CMs were measured prior to and thirty minutes following MBB. The effect of weight bearing and recumbence, RMDQ, EQ-5D and MYMOP were also measured. The regular compression CM test had 80% sensitivity (95%CI: 71% to 89%) and 50% specificity (95%CI: 28% to 71%). The regular compression CM group had the largest pre-post VAS difference (median 4 points). The patients whose pain was not relieved in recumbence (n=15) showed a significant VAS difference of 6 points p=0.001). There was a significant positive correlation between the pre and post pain scores, p<0.001. There was no association between MBB response and RMDQ, EQ-5D, MYMOP scores, duration of symptoms or standing as a provoking activity. Conclusion. Regular compression CM testing can be used as a diagnostic tool to identify patients with facet joint mediated pain, particularly when associated with high pain scores. Low back pain (LBP) provoked by standing and relieved with recumbence are common features in the LBP population but are not indicators of facet joint pathology, contrary to many clinicians' beliefs

To investigate whether restoration of mechanical function and spinal load-sharing following vertebroplasty depends upon cement distribution. Fifteen pairs of cadaver motion segments (51-91 yr) were loaded to induce fracture. One from each pair underwent vertebroplasty with PMMA, the other with a resin (Cortoss). Various mechanical parameters were measured before and after vertebroplasty. Micro-CT was used to determine volumetric cement fill, and plane radiographs (sagittal, frontal, and axial) to determine areal fill, for the whole vertebral body and for several specific regions. Correlations between volumetric fill and areal fill for the whole vertebral body, and between regional volumetric fill and changes in mechanical parameters following vertebroplasty, were assessed using linear regression. For Cortoss, areal and volumetric fills were significantly correlated (R=0.58-0.84) but cement distribution had no significant effect on any mechanical parameters following vertebroplasty. For PMMA, areal fills showed no correlation with volumetric fill, suggesting a non-uniform distribution of cement that influenced mechanical outcome. Increased filling of the vertebral body adjacent to the disc was associated with increased intradiscal pressure (R=0.56, p<0.05) in flexed posture, and reduced neural arch load bearing (F. N. ) in extended posture (R=0.76, p<0.01). Increased filling of the anterior vertebral body was associated with increased bending stiffness (R=0.55, p<0.05). Cortoss tends to spread evenly within the vertebral body, and its distribution has little influence on the mechanical outcome of vertebroplasty. PMMA spreads less evenly, and its mechanical benefits are increased when cement is concentrated in the anterior vertebral body and adjacent to the intervertebral disc

Aims

The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events.

Objectives

Many studies have investigated the kinematics of the lumbar spine and the morphological features of the lumbar discs. However, the segment-dependent immediate changes of the lumbar intervertebral space height during flexion-extension motion are still unclear. This study examined the changes of intervertebral space height during flexion-extension motion of lumbar specimens.

Aims

The authors present the results of a cohort study of 60 adult patients presenting sequentially over a period of 15 years from 1997 to 2012 to our hospital for treatment of thoracic and/or lumbar vertebral burst fractures, but without neurological deficit.

The purpose of this study was to evaluate whether concerns about the release of metal ions in metal-on-metal total hip replacements (THR) should be extended to patients with metal-bearing total disc replacements (TDR).

Cobalt and chromium levels in whole blood and serum were measured in ten patients with a single-level TDR after a mean follow-up of 34.5 months (13 to 61) using inductively-coupled plasma mass spectrometry. These metal ion levels were compared with pre-operative control levels in 81 patients and with metal ion levels 12 months after metal-on-metal THR (n = 21) and resurfacing hip replacement (n = 36). Flexion-extension radiographs were used to verify movement of the TDR.

Cobalt levels in whole blood and serum were significantly lower in the TDR group than in either the THR (p = 0.007) or the resurfacing group (p < 0.001). Both chromium levels were also significantly lower after TDR versus hip resurfacing (p < 0.001), whereas compared with THR this difference was only significant for serum levels (p = 0.008). All metal ion levels in the THR and resurfacing groups were significantly higher than in the control group (p < 0.001). In the TDR group only cobalt in whole blood appeared to be significantly higher (p < 0.001). The median range of movement of the TDR was 15.5° (10° to 22°).

These results suggest that there is minimal cause for concern about high metal ion concentrations after TDR, as the levels appear to be only moderately elevated. However, spinal surgeons using a metal-on-metal TDR should still be aware of concerns expressed in the hip replacement literature about toxicity from elevated metal ion levels, and inform their patients appropriately.

Between 1993 and 2008, 41 patients underwent total coccygectomy for coccydynia which had failed to respond to six months of conservative management. Of these, 40 patients were available for clinical review and 39 completed a questionnaire giving their evaluation of the effect of the operation. Excellent or good results were obtained in 33 of the 41 patients, comprising 18 of the 21 patients with coccydynia due to trauma, five of the eight patients with symptoms following childbirth and ten of 12 idiopathic onset. In eight patients the results were moderate or poor, although none described worse pain after the operation. The only post-operative complication was superficial wound infection which occurred in five patients and which settled fully with antibiotic treatment. One patient required re-operation for excision of the distal cornua of the sacrum.

Total coccygectomy offered satisfactory relief of pain in the majority of patients regardless of the cause of their symptoms.

Between January 1990 and December 2000 we carried out 226 SB Charité III disc replacements for lumbar disc degeneration in 160 patients. They were reviewed at a mean follow-up of 79 months (31 to 161) to determine the clinical and radiological outcome. The clinical results were collected by an independent observer, who was not involved in patient selection, treatment or follow-up, using a combination of outcome measures, including the Oswestry Disability Index. Pain was recorded using a visual analogue score, and the most recent radiographs were reviewed.

Survival of the device was analysed by the Kaplan-Meier method and showed a cumulative survival of 35% at 156 months when radiological failure was taken as the endpoint. The mean improvement in the Oswestry disability index scores after disc replacement was 14% (6% to 21%) and the mean improvement in the pain score was 1.6 (0.46 to 2.73), both falling below the clinically significant threshold. Removal of the implant was required in 12 patients, four because of implant failure.

These poor results indicate that further use of this implant is not justified.