Background. Low back pain is a common condition amongst Armed Services personnel and can have significant impact upon their ability to undertake military duties, including being deployed into austere environments. Methods and results. This was a qualitative study of 16 military physiotherapists exploring their attitudes and beliefs towards management of low back pain. Semi-structured interviews were conducted and transcribed. The transcripts were analysed using a method of thematic content analysis. Six themes were identified; military culture, occupational issues, continuing professional development, clinical reasoning, need for a cure and labelling the patient. The highly challenging occupational demands placed on military patients appeared to prompt physiotherapists to request radiological investigations at an earlier stage than recommended in current guidelines. Justification for early investigation was considered to be both in the patients' and the Armed Services best interests, for the patient to initiate treatment with minimum delay whilst also decreasing the number of personnel unable to deploy for medical reasons. Conclusion. Obtaining investigative procedures at an early stage of the patients' management was justified by reference to the highly demanding physical duties undertaken by service personnel. The military physiotherapists' were very well informed about occupational demands placed on their patients; in this instance results from radiological investigations were used to inform not only the clinical management but more significantly the occupational management. The military physiotherapists regard for the significance of occupational factors sets them apart from those in civilian practice where management is predominantly based on clinical features alone

Back pain is extremely common in soldiers undergoing training. 1. There is no data worldwide with regards to incidence, prevalence and impact of back pain in a deployed military population. This study was undertaken to evaluate these issues. 1000 back pain questionnaire were distributed over a period of four days at the main military base in Basrah in February 2009 in different locations. The filling out was anonymous and completely voluntary. UK military personnel. Information was obtained about age, BMI, length of service, rank, incidence, prevalence, onset, admission rate, treatment, aero-medical evacuation, operational effectiveness, pain killers and VAS. 768 (77%, 26% of population at risk) questionnaires were returned Prevalence of back pain was 33.4% (257). A greater prevalence occurred in the combat arms (41.7%, p=0.01) and those of over 12 years service (44%, p=0.004). No statistical difference was found with rank, or BMI. 74 people (9.6%) had developed new onset back pain since deploying. Recurrent pain occurred in 38.9% of the whole sample. VAS showed a normal distribution. 35% of those affected were discharging their duty with mild difficulty but around 6% were having great difficulty. 25% were on regular analgesics. Back pain constituted 23% (137/583) of the physiotherapy dept caseload, 6.6%, (25/378) of ward admissions and 0.04% (5/119) of aero-med patients. Back pain is a major problem among deployed personnel. However with adequate resources the vast majority can be managed in the field thus reducing attrition rates. 2. and maintaining operational effectiveness. Further studies should be undertaken to assess if back pain persists after deployment

Introduction. Missile injuries are very serious injuries particularly in the cervical region. They are classified into high and low missile injuries when it involves the cervical spine. In modern guerrilla warfare, one must be aware of ballistic pathology with bullets as well as from explosives. In particular, improvised explosive devices commonly known as IED's play a new and important pathophysiology whether they are suicided vests or roadside bombs. They usually produce severe or lethal injuries and serious neurovascular deficit is frequent. We present the details of 40 patients with local experience on how to handle serious penetrating cervical missile injuries. Methods. All cases were collected from the record of Basrah University Hospital, Iraq. Healthy military gentlemen with ages ranging between 20–35 years were included. Results. 11 patients had bullet injuries and 29patients had fragments of shell injuries. The sites of injuries were 9: C2–C3, 12: C5–C6, 12: C4–C5 and 7: C7-T1. Bullet entrance was anterior in 23 patients, posterior in 7 patients and lateral in 10 patients. The cervical vertebrae were injured in 37 patients at body or lamina level while in 3 patients it was only neural tissue injuries. Missiles were retained in 13 patients. All injuries showed some degree of neurological deficit with quadriplegia in 26 patients. 9 patients presented with very serious injuries. No relation was found between the size of the missile and the extent of damage. Outcome of treatment in all patients was poor. Conclusion. Gunshot wounds only account for approximately one third of penetrating missile injuries in patients who survive and are well enough to receive medical treatment. 62% of patients' cohort were from explosive devices, consistent with data from 2010, where 58% of fatalities were from IED's occurring in foreign soldiers in Afghanistan. We discuss the importance of general supportive measures, generous wound excision, removal of the retained missiles and heavy cover of antibiotics

Aims

The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment.

Aims

The aim of this study was to explore the prognostic factors for postoperative neurological recovery and survival in patients with complete paralysis due to neoplastic epidural spinal cord compression.

The aim of this study was to evaluate the feasibility of using the intact S1 nerve root as a donor nerve to repair an avulsion of the contralateral lumbosacral plexus. Two cohorts of patients were recruited. In cohort 1, the L4–S4 nerve roots of 15 patients with a unilateral fracture of the sacrum and sacral nerve injury were stimulated during surgery to establish the precise functional distribution of the S1 nerve root and its proportional contribution to individual muscles. In cohort 2, the contralateral uninjured S1 nerve root of six patients with a unilateral lumbosacral plexus avulsion was transected extradurally and used with a 25 cm segment of the common peroneal nerve from the injured leg to reconstruct the avulsed plexus.

The results from cohort 1 showed that the innervation of S1 in each muscle can be compensated for by L4, L5, S2 and S3. Numbness in the toes and a reduction in strength were found after surgery in cohort 2, but these symptoms gradually disappeared and strength recovered. The results of electrophysiological studies of the donor limb were generally normal.

Severing the S1 nerve root does not appear to damage the healthy limb as far as clinical assessment and electrophysiological testing can determine. Consequently, the S1 nerve can be considered to be a suitable donor nerve for reconstruction of an avulsed contralateral lumbosacral plexus.

Cite this article: Bone Joint J 2015; 97-B:358–65.