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Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease.

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To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation.

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Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD.

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To determine the value of scoliosis surgery, it is necessary to evaluate outcomes in domains that matter to patients. Since randomized trials on adolescent idiopathic scoliosis (AIS) are scarce, prospective cohort studies with comparable outcome measures are important. To enhance comparison, a core set of patient-related outcome measures is available. The aim of this study was to evaluate the outcomes of AIS fusion surgery at two-year follow-up using the core outcomes set.

We studied MR images of the spine in a consecutive series of 100 patients with acute compression of the spinal cord due to metastases. All patients had documented neurological deficit and histologically proven carcinoma. MRI was used to localise bony metastatic involvement and soft-tissue impingement of the cord. A systematic method of documenting metastatic involvement is described. A total of 43 patients had compression at multiple levels; 160 vertebral levels were studied. In 120 vertebrae (75%), anterior, lateral and posterior bony elements were involved. Soft-tissue impingement of the spinal cord often involved more than one quadrant of its circumference. In 69 vertebrae (43%) there was concomitant anterior and posterior compression. Isolated involvement of a vertebral body was observed in only six vertebrae (3.8%). We have shown that in most cases of acute compression of the spinal cord due to metastases there is coexisting involvement of both anterior and posterior structures

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To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach.

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This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases.

Objective:. The aim of this study was to define a method to identify the location of the great vessel bifurcation (GVB) in relation to the L5/S1 disc and measure the lumbo-sacral angle (LSA) at L5/S1 using routine lumbar spine MRI images on standard PACS software. The information can be used for surgical planning of anterior lumbar interbody fusion (ALIF) at L5/S1 with a plate and cage. Method:. Axial and sagittal T2 sections of 192 lumbar spine MRI scans were viewed simultaneously to classify the position of the GVB and the LSA. A further 75 scans were assessed independently by 2 examiners (E1/E2) utilizing the same classification to record the GVB position (High (H), Middle (M), Low (L)) and size of the LSA using standard radiology software. Twenty five images were randomly selected for repeat measurements one month later. Results:. Inter and Intra-observer agreements were excellent for LSA (0.92, R1=0.92, R2=0.94) and moderate for GVB (0.76, R1=0.85, R2=0.75). Reduced GVB correlation was primarily observed in the high (E1=64% vs E2=50.7%, =57.3%) and Middle (E1=25.3% vs E2=40%, =32.7%) categories. LSA was most prevalent between 121–130° in both assessors (E1= 57.3% vs E20=61.3%, =59.5%). Conclusion:. MRI assessment of GVB height and LSA is feasible and can aid surgical planning of L5/S1 ALIF and permit selection of the implants that best suit the patient's specific anatomy. The results indicate that anterior plate placement, without impingement on the great vessels, would be possible in 90% of cases with a majority having an LSA of between 125° and 130°

Purpose and Background. Back pain impinges upon all aspects of life, has a reported UK lifetime prevalence as high as 84% and considering approximately a third of our lives are spent asleep the paucity of research into the effect a mattress has on back pain and sleep is surprising. Mood changes, effecting an increase in pain perception, due to sleep loss may also lead to a downward spiral of increasing back pain and greater sleep loss. A controllable factor in this spiral, affecting both aspects, is the mattress but to the authors' knowledge none currently available on the market have any robust, published research to objectively support any claims made and at best being ‘endorsed’ by experts. This may lead to possible misinterpretation of efficacy and leave professionals at a loss with what to advise when questioned. Methods and Data collection. Method:. A three month, randomised, controlled, double blind crossover field study is proposed to take place in the participants own homes, ensuring the most natural sleep environment. Data collection:. Three 28 day phases. 1 - Baseline data, participants sleeping on their own mattress. 2 - Random allocation of mattresses, half allocated test and half control. 3 - Crossover of test and control mattress. Subjective measures of back pain and sleep quality will be collected utilising a daily sleep diary and visual analogue scales. Objective measures of sleep quality using activity monitors during sleep. Conclusion. Minimal evidence is available suggesting the optimal sleep surface for people with back pain. This research hopes to generate evidence to help this group with mattress selection. To confirm: this abstract has not previously been published in whole or part nor has it been presented previously at a national meeting. Conflicts of interest: All mattresses will be designed in conjunction with and provided by Innovative Health Organisation Caerphilly. Sources of funding: This work is part-funded by the European Social Fund (ESF) through the European Union's Convergence programme administered by the Welsh Government and is in conjunction with the Knowledge Economy Skills Scholarship (KESS) project

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Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform.

Introduction. The use of thoracic pedicle screws for the treatment of adolescent idiopathic scoliosis (AIS) has gained widespread popularity. Many techniques has been described to increase the accuracy of free hand placement; however the placement of pedicle screws in the deformed spine poses unique challenges because of possible neurologic and vascular complications. We are describing a universal way of insertion of pedicle thoracic screws which has been applied in many pathologies including the deformed spine. Methods. Our technique includes exposure of the superior facet of the corresponding body to identify its lateral border border which together with the superior border of the TP denotes our entry point which is just lateral to this crossing, we make a short entry with a straight Lenke probe then continue the track with a strong ball probe to go safely through the cancellous bone of the body. This is retrospective review of radiographs and clinical notes of all the patients who underwent posterior thoracic instrumentation by pedicle screws using the same single technique by one surgeon between June 2008 and December 2009; 1653 screws in 167 consecutive patients (119 females and 48 males). There were 139 deformities, 130 scoliosis (AIS 80, Congenital 31, Neuromuscular 10 and Degenerative 9), 19 kyphosis and 18 other diagnoses (fractures 14, revision 3 and tumour 1). Results. The recorded complications for all the patients were: 1 patient had pain due to nerve impingement, 1 parasthesia and 1 CSF leak intraoperatively. There were no revision of any of the screws, no vascular complications. Conclusion. Thoracic pedicle screws can be inserted with a universal point of entry using the same technique in all the levels of the dorsal spine. This technique seems to be simple and safe. Ethics approval: None. Interest Statement: None

We measured the serum concentration of C-reactive protein (CRP) by a high-sensitive method in patients with lumbar disc herniation. There were 48 patients in the study group and 53 normal controls. The level and type of herniation were evaluated. The clinical data including the neurological findings, the angle of straight leg raising and post-operative recovery as measured by the Japanese Orthopaedic Association (JOA) score, were recorded. The high-sensitive CRP (hs-CRP) was measured by an ultrasensitive latex-enhanced immunoassay. The mean hs-CRP concentration was 0.056 ± 0.076 mg/dl in the patient group and 0.017 ± 0.021 mg/dl in the control group. The difference was statistically significant (p = 0.006). There was no other correlation between the hs-CRP concentration and the level and type of herniation, or the pre-operative clinical data. A positive correlation was found between the concentration of hs-CRP before operation and the JOA score after. Those with a higher concentration of hs-CRP before operation showed a poorer recovery after. The significantly high concentration of serum hs-CRP might indicate a systemic inflammatory response to impingement of the nerve root caused by disc herniation and might be a predictor of recovery after operation

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The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma.

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We present the results of correcting a double or triple curve adolescent idiopathic scoliosis using a convex segmental pedicle screw technique.

Objectives

To employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery.

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The purpose of this study was to investigate the prevalence of sarcopenia and to examine its impact on patients with degenerative lumbar spinal stenosis (DLSS).

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Clinical and radiological data were reviewed for all patients with mucopolysaccharidoses (MPS) with thoracolumbar kyphosis managed non-operatively or operatively in our institution.

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The aim of this study was to determine whether chilled irrigation saline decreases the incidence of clinical upper limb palsy (ULP; a reduction of one grade or more on manual muscle testing; MMT), based on the idea that ULP results from thermal damage to the nerve roots by heat generated by friction during bone drilling.

Few studies have examined the order in which a spinal osteotomy and total hip replacement (THR) are to be performed for patients with ankylosing spondylitis. We have retrospectively reviewed 28 consecutive patients with ankylosing spondylitis who underwent both a spinal osteotomy and a THR from September 2004 to November 2012. In the cohort 22 patients had a spinal osteotomy before a THR (group 1), and six patients had a THR before a spinal osteotomy (group 2). The mean duration of follow-up was 3.5 years (2 to 9). The spinal sagittal Cobb angle of the vertebral osteotomy segment was corrected from a pre-operative kyphosis angle of 32.4 (SD 15.5°) to a post-operative lordosis 29.6 (SD 11.2°) (p < 0.001). Significant improvements in pain, function and range of movement were observed following THR. In group 2, two of six patients had an early anterior dislocation. The spinal osteotomy was performed two weeks after the THR. At follow-up, no hip has required revision in either group. Although this non-comparative study only involved a small number of patients, given our experience, we believe a spinal osteotomy should be performed prior to a THR, unless the deformity is so severe that the procedure cannot be performed.

Cite this article: Bone Joint J 2014;96-B:360–5.