Anterior cervical discectomy and fusion for radiculopathy and myelopathy has the complication of the development of adjacent segment degeneration. Furthermore, reoperations may be required to treat complications of fusion, such as non-union, graft collapse, or expulsion. Cervical disc arthroplasty lays claim to preserving cervical motion and reducing the risks of adjacent segment disease in the treatment of cervical radiculopathy. We performed a prospective study in order to evaluate the radiological and clinical outcomes of cervical disc arthroplasty for single or two level disc disease with associated radiculopathy. Our study included a total of 26 patients. Each patient had cervical radiculopathy from nerve root compression due to degenerative disc disease at one or two levels. Diagnosis was made preoperatively on clinical examination and by means of MRI scanning. Each patient also had preoperative flexion and extension cervical spine x-rays in order to assess pre-operative range of neck movement. The outcomes of surgery were assessed prospectively. Range of motion at final follow-up was measured by flexion and extension view x-rays of the cervical spine. Clinical outcome was assessed by means of VAS scores for pain, SF12 for mental and physical health and the neck disability index (NDI). All complications were recorded. 14 of the patients had a follow-up for two years and the remaining 12 patients had a follow-up for one year. A Discovery disc arthoplasty by Scient'X was the implant used in all patients. A standard anterior cervical approach was used to achieve decompression and for the implantation of the prosthesis. On follow-up all patients had either maintenance or an improvement in the range of movement. There was no evidence of progression of degeneration in the segments adjacent to the arthroplasty prosthesis. Improvements in SF12, VAS, and NDI scores were seen from preoperative levels in 25 of the 26 patients. Complications included one patient with a horse voice post-operatively and one patient with minimal improvement of radicular symptoms. Post-operative MRI scanning demonstrated adequate decompression with this procedure and showed no evidence of progression of adjacent segment disease. There were no cases of implant subsidence or dislocations. We have found cervical disc arthroplasty to produce good clinical outcomes when used for single or two level cervical radiculopathy whilst maintaining neck motion with an acceptable complication rate. A longer follow-up is needed to further assess the risk of development of adjacent segment disease but we did not discover the development of adjacent segment disease in our study with a follow-up of upto 2 years

Injury to the sciatic nerve is one of the more serious complications of acetabular fracture and traumatic dislocation of the hip, both in the short and long term. We have reviewed prospectively patients, treated in our unit, for acetabular fractures who had concomitant injury to the sciatic nerve, with the aim of predicting the functional outcome after these injuries.

Of 136 patients who underwent stabilisation of acetabular fractures, there were 27 (19.9%) with neurological injury. At initial presentation, 13 patients had a complete foot-drop, ten had weakness of the foot and four had burning pain and altered sensation over the dorsum of the foot. Serial electromyography (EMG) studies were performed and the degree of functional recovery was monitored using the grading system of the Medical Research Council. In nine patients with a foot-drop, there was evidence of a proximal acetabular (sciatic) and a distal knee (neck of fibula) nerve lesion, the double-crush syndrome.

At the final follow-up, clinical examination and EMG studies showed full recovery in five of the ten patients with initial muscle weakness, and complete resolution in all four patients with sensory symptoms (burning pain and hyperaesthesia). There was improvement of functional capacity (motor and sensory) in two patients who presented initially with complete foot-drop. In the remaining 11 with foot-drop at presentation, including all nine with the double-crush lesion, there was no improvement in function at a mean follow-up of 4.3 years.