A statement of the purposes of the study and background. Lower back pain (LBP) is one of the ten leading causes of disease burden globally, producing significant detrimental effects on physical and emotional wellbeing whilst having a substantial economic burden for society. There is an inverse relationship between socio-economic status and pain prevalence. The effectiveness of a locally run ‘Back to Fitness Programme’ (6-week education and exercise programme) in the most deprived local authority area in England was evaluated. A summary of the methods used and the results. Patients at Blackpool Hospitals NHS Trust over a 6-month timeframe were included. Initial data were collected from 49 patients (mean age 53.4 years, 67% female). The amount of final data collected varied per outcome measure due to a range of factors. Participants reported the programme had helped with their understanding of pain (n=16, 100%), ability to move around and function (n=15, 94%), and level of pain (n=14, 88%). Looking at Roland Morris Disability Questionnaire scores (n=17), 88% (n=15) of patients indicated a reduction (n=12, 71%) or no change (n=3, 18%) in perceived disability. The Pain Self Efficacy Questionnaire (n=18) showed that 78% (n=14) of participants perceived an increase in their average level of confidence to move despite pain. There was an overall improvement in understanding of pain reflected by Revised Neurophysiology of Pain Questionnaire scores (n=44): 89% (n=39) improved (n=36, 82%) or did not change (n=3, 7%). Regarding lumbar flexion post-programme (n=17), 77% (n=13) of participants demonstrated an improvement (n=9, 53%) or no change (n=4, 24%). Conclusion. The majority of clinical outcomes improved following participation, predominantly in relation to understanding of pain. Conflicts of interest: No conflicts of interest. Sources of funding: This study is supported by The University of Central Lancashire in partnership with The Blackpool Teaching Hospitals NHS Foundation Trust

57 year old healthy woman, with a non-symptomatic aortic aneurysma after a traffic accident 30 years ago and a 70:ty degree thoracolumbar kyfo-scoliosis, was referred for treatment because of severe postural back-pain. The anticipated treatment was correction of spinal balance with an apical osteotomy, a long instrumentation and maximal number of atachments. A careful preoperative investigation, including DEXA, bending films, internal medical judgement and vascular surgery consultaion, was performed. The latter ended up in an aortic stent, because of the risks of rupture of the aneurysma, due to elongation of the spine and aorta. Correction was performed with an oblique 1,5 segment reduction osteotomy in L1 and L2. Blood loss 2 700 ml. Normal neurophysiology during and after the surgery. The patient could return back home after two weeks, protected by a soft brace. Six weeks after index surgery she became unconscious, got heart arrest and was acute transported to the regional hospital, after resuscitation. Great amounts of blood were found in the lungs and a CT scan demonstrated a severe elongation of aorta as well as a possible rift at the junction between normal and stented vessel. Two weeks later the patient died, still unconscious. Autopsy confirmed aortic rupture. CONCLUSION. What are the risks with aneurysma at spinal correction? Should the correction have been performed without the aortic stent?

Aim:. Recent guidelines have been published by the Association of Neurophysiological Scientists / British Society for Clinical Neurophysiology (ANS/BSCN) regarding the use of intra-operative neurophysiological monitoring (IOM) during spinal deformity procedures. We present our unit's experience with IOM and the compliance with national guidelines. Method:. All patients undergoing intra-operative spinal cord monitoring during adult and paediatric spinal deformity surgery between Jan 2009 and Dec 2012 were prospectively followed. The use of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) was recorded and monitoring outcomes were compared to post-operative clinical neurological outcomes. Compliance with the national ANS/BSCN guidelines was assessed. Results:. 333 patients were included in this study. IOM was successful in 312 patients (94%), with both MEPs and SSEPs obtained in 282 patients (85%). SEPs were achieved in 91% and MEPs in 87%. Aetiology was idiopathic in 199 cases, 53 neuromuscular, 28 degenerative, 16 congenital, 16 other. Nine patients had changes in IOM related to surgical activity; six had MEP changes only, three had MEPs and SSEPs changes. All but one of these changes returned to baseline following surgical action; the one remaining patient had a temporary postoperative neurological deficit. One patient had a post-operative single radiculopathy requiring surgical exploration, without change in initial IOM. Final IOM findings demonstrated a positive predictive value (PPV) of 1 and a negative predictive value (NPV) of 0.996. Discussion:. IOM is essential during spinal deformity surgery and, using MEPs, has a high PPV and NPV. Our unit meets guidelines for MEP use and frequently meets guidelines for SSEP use. Conflict Of Interest Statement: No conflict of interest

Introduction. One of the most complicated problems of orthopaedics is the treatment of scoliosis. More than 90% of cases are attributable to idiopathic deformation, the cause of which is unknown. We investigated the cause and pathogenesis of this disorder. Methods. At our institution, more than 6900 patients aged 1–89 years have undergone inpatient and outpatient treatment in connection with spinal pain syndrome and different neurological disorders associated with idiopathic scoliosis. This study was undertaken between February, 1996, and February, 2010. All patients had had clinical, radiographic, and laboratory examinations. Results. 29·6% of patients were aged 31–50 years; 60% were men and 40% women. While examining patients with scoliosis deformation we noted symptoms of body asymmetry–ie, different volumes of right and left halves of face, body, and limbs. These features were typical for all patients irrespective of sex, age, and ethnic origin. 83·2% of patients had underdevelopment of left part of the body, and only 16·8% the right side. Analysis of published work in anatomy, physiology, neurophysiology, and vertebrology, done simultaneously with analysis of clinical material, allowed us to make some conclusions. Conclusions. First, asymmetrical structure of human body is based on laws of nature and is linked with difference of sizes and activity of brain's hemispheres, particularly of right or left gyrus centralis anterior, which control the muscle's function and our movements. Second, asymmetrical tension of Erector spinae muscles leads to inclination of the pelvis on a side of weak muscles; thus initiating development of lateral spine curves. Since such a situation is typical for all people, this deformation is known as functional scoliosis. Third, further development of bodies of vertebrae, their arches, processes, intervertebral discs, ligaments, and other anatomical elements in position of deviation leads to one-sided underdevelopment of these structures. As a result, areas of instability appear in each segment of spine (neck, chest, lumbar, and sacral areas). Fourth, the muscles in a growing body misbalance and on the ground of rotating movement start rotatory dislocation of vertebrae in zones of instability in all parts of the spine. As a result, torsion of deformed wedge-shaped vertebrae leads to formation of structural scoliosis. Rotation of vertebrae, described above, does not depend on sex, age, and ethnic origin of a patient and has a character of natural development. Thus, from our point of view, the term idiopathic scoliosis must be changed to spinal muscle asymmetrical deformation of a reflex origin. Understanding of this rotation allowed us to establish an effective non-surgical method of treatment of scoliosis and spinal pain syndrome in patients of all ages