Abstract. MAGnetic Expansion Control (MAGEC) rods are used in the surgical treatment of children with early onset scoliosis. The magnetically controlled lengthening mechanism enables rod distractions without the need for repeated invasive surgery. The CE certification of these devices was suspended in March 2021 due, primarily, to performance evidence gaps in the documents provided by the manufacturer to regulators and notified bodies. MAGEC rods are therefore not permitted for use in countries requiring CE marking. This was a survey of 18 MAGEC rod surgeons in the UK about their perception of the impact of the CE suspension on the clinical management of their patients. Unsurprisingly, virtually all perceived a negative impact, reflecting the complexity of this patient group. Reassuringly, these surgeons are highly experienced in alternative treatment methods. Cite this article: Bone Jt Open 2022;3(2):155–157

Purpose of study and background. Spinal surgery is a high-risk surgical speciality, a patient's understanding of surgical interventions, alternative treatment options, and the benefits and risks must be ascertained to gain informed consent. This pilot study aims to evaluate if the provision of a digital recording of a patient's consultation enhances patient satisfaction, improves recall of clinical diagnosis, recall of treatment options and the risks and benefits of Spinal Surgery. Methodology and results. A coalition team was identified. A safe and secure process for recording and storage identified. Both qualitative and quantitative data was collected via questionnaires. 62 patients were invited to participate in the pilot, 12 declined. Data was collected immediately post consultation, and two weeks following the consultation via telephone. Comparison was made of the relative increase or decrease in patient recall of the clinical diagnosis, treatment options, and the benefits and the risks of spinal surgery. Patient satisfaction was measured pre- and post- consultation. 50 patients (81%) participated. 32 participants (52%) responded to follow up questionnaire at 2 weeks. Recall of risk for surgical intervention increased by 37%, and of benefit by 36%. Patient satisfaction was rated excellent or very satisfied in 93% at initial consultation and at 2 week follow up all participant's rated satisfaction as excellent or very satisfied. Conclusion. This pilot study was small. COVID delayed further recruitment. Initial outcomes demonstrated high levels of patient satisfaction and appear to demonstrate improved recall. Significant technological issues were identified. Further collaborative work needs to be undertaken. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Purpose. To determine, for the first time, how back pain is portrayed in the United Kingdom press. Methods and Results. LexisNexisTM Professional search engine was utilised to retrieve articles from all national newspapers over a six months containing the terms “back pain/backpain/back ache/backache” from May to October 2009. 284 relevant articles were retrieved. Of these tabloids accounted for 62% and broadsheets for 38%. Back pain was the sole topic in 7%, a main topic in 18% and mentioned in passing in 75%. 15% were essentially case reports and the tone was neutral in 95%, positive in 2.5% and negative in 2.5%. The cause of back pain was mentioned in 11% of articles- trauma accounted for 50% and disc disease and spinal deformity for 20% each. Only 0.3% of articles discussed litigation. Articles mentioned new physiotherapy regimes in 7%, new forms of alternative therapy in 7%, new surgical techniques/technologies in 2% and new medications in 1%. They were significantly more likely to mention new non-surgical techniques- Fishers' Exact Test p=0.01. Articles were alternative therapy related in 3%, physiotherapist related in 2%, surgeon related in 1% and pain specialist related in 1%. 10% of papers included a quote from an “expert” of which 23% were Spine Surgeons, 16% GP's, 13% Sports Physicians, 13% alternative therapists, 10% pain specialists and 7% physiotherapists. Overall, 98% of articles were of a neutral tone and 1% were of a positive tone or negative tone. Articles concerning physiotherapists or new surgical techniques/technologies were significantly more likely to be of a positive overall tone than the other articles- Fishers' Exact Test p=0.04. Conclusions. Back pain receives a considerable amount of attention in the United Kingdom press. Much of this currently concentrates on isolated case reports, the aetiology of back pain is poorly represented, quoted “experts” are frequently non-medical and new surgical treatments receive significantly less attention than new non-surgical treatments. The press play an important role in educating and informing the general public. The stories they cover ad how they cover them have a powerful influence on public perceptions. We need to do more to engage with the press and positively influence their reportage

This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae. However, with an ever-advancing technology and deeper understanding of the damaged spinal cord, this appears increasingly conceivable. A brief synopsis of the most prominent challenges facing both clinicians and research scientists in developing functional treatments for a progressively complex injury are presented. Moreover, the multiple mechanisms by which damage propagates many months after the original injury requires a multifaceted approach to ameliorate the human spinal cord. We discuss potential methods to protect the spinal cord from damage, and to manipulate the inherent inhibition of the spinal cord to regeneration and repair. Although acute and chronic SCI share common final pathways resulting in cell death and neurological deficits, the underlying putative mechanisms of chronic SCI and the treatments are not covered in this review.

Introduction. Due to co-morbidities in elderly like atherosclerosis and approach-related risks, anterior lumbar surgery is mainly recommended for younger patients. We reviewed approach-related complications in anterior lumbar surgery in senior patients for complex reconstructions. Materials and Methods. Retrospective review of 12 patients (8 female and 4 male), mean age 65.5±4.9 years, treated with anterior fusion mainly for degenerative scoliosis and lumbar kyphosis in between 2007-10. 9(75%) patients had multilevel procedures. Most common co-morbidities were atherosclerosis (CT-proven in 7 patients), coronary heart disease and COPD. Renal impairment was present preoperatively in 3 patients. Results. Mean duration of surgery was 260±120.8 min and mean blood loss 403.3±348.0 ml in the whole group (157±49.1 min and 240.0±162.0 ml in single ALIF; 334.0±100.0 min and 520.0±408.0 ml in multilevel procedures). Retractor related ischaemia occurred in 8 patients (27.3±29.1 min); perfusion of the leg returned immediately after release (confirmed via pulse-oxymetry). 2 patients had a direct vessel suture (2 common iliac veins); hypotension during surgery occurred in 1 patient due to anaesthetic problems. 5 patients needed ICU support after the procedure. Superficial wound infection was reported in one patient. One case of incisional hernia and one case of lymphocele was noticed. Conclusion. In this retrospective review, no specific complications concerning age or co-morbidities occurred in senior patients. In this group, atherosclerosis was the most common co-morbidity. However, no arterial embolism or perfusion deficit occurred. In the future, more and more elderly are to be treated by spinal surgeons. Anterior lumbar surgery is an alternative treatment option even for complex cases in the elderly. This limited group of patients need further investigations and prospective studies regarding anterior lumbar surgery

Introduction. Lumbar spinal pain can be a consequence of discogenic pain. After failure of conservative management, lumbar fusions are popular and considered the gold standard. However, these techniques are associated with significant morbidity. A percutaneous trans-sacral technique may address these for L4/L5 and/or L5/S1 alone spinal fusions. Our unit has adopted this technique and presents our initial experience of 51 patients and preliminary results. Method. Patients with a confirmed clinical and radiological evidence of degenerate intervertebral disc with or without prior surgical intervention were selected. Patients with a history of pelvic surgery/radiotherapy were excluded. Data was collected prospectively using the Global Patient Outcome Scoring System and Oswestry Disability Index (ODI) scores at clinical follow-up. Results. 51 patients received the procedure and 30 achieving a minimum of 6 months follow-up. Patients had a median age of 46(range 20-78) and included 19 male and 32 females with on average 40 months of pain. The mean ODI score improved after surgery from pre-operative levels 52.9(SEM 3.0) to 6 month scores of 38.4(SEM 3.9), t(29)=4.2, p<0.0002 . This difference remained statistically significant at 12 month follow-up with a mean ODI scores 34.3 (SEM 5.2), t(18)=4.37, P<0.0004 (Mean difference of 21.1 SEM 4.8). A sub-analysis of confounding factors identified patients with previous surgery, claiming state benefits, pursuing litigation, mainly leg pain and requiring pedicular fusion failed to achieve statistical significance. Patients receiving a 360 degree fusion with facet screws alone improved sooner and achieving a mean difference in ODI score of 27.6(SEM 8.2). Conclusion. Our initial results confirm this to be an effective alternative treatment modality for lumbar spine fusion in the management of primary discogenic back pain. Patients receiving 360 degree fusion and not claiming state benefits or pursuing litigation appear to have a better outcome

Aims

The aim of this study was to compare the effect of a percutaneous radiofrequency heat lesion at the medial branch of the primary dorsal ramus with a sham procedure, for the treatment of lumbar facet joint pain.