To review the accuracy of our systematic process in preventing wrong level lumbar microdiscectomy. X-ray is used to identify the correct level for the skin incision to be made, x-ray is again used if the surgeon is in doubt prior performing the flavotomy. Following a lumbar microdiscectomy a Watson Chane is inserted into the empty disc space and an intra-operative x-ray is taken to confirm the level the discectomy has occurred. Observers A and B independently reviewed intra-operative x-ray in patients undergoing lumbar microdiscectomies and correlated the accuracy of the x-ray in determining correct level surgery against the pre-operative MRI scan and the preposed level of surgery. 123 patients, 66 males and 57 females underwent 127 lumbar microdiscectomy procedures between 2007 and 2009. The levels where surgery occurred are;- L2/3 -1 patient, L3/4–8 patients, L4/5–53 patients and L5/S1-65 patients. Kappa coefficient was used to determine inter-observer and Pearson Correlation coefficient was used to determine the X-ray and MRI relationship. Percentage of patients who required a pre-flavotomy x-ray level check are:- L2/3–100%, L3/4-63%, L4/5–45%, and L5/S1–40%. Pearson's correlation in confirming the level lumbar microdiscectomy was performed using final x-ray and the pre-operative MRI scan was 1. Kappa coefficient between observer A and B was 1. This process of using intra-operative x-ray in determining the exact level where lumbar microdiscectomy was performed is 100% accurate. This is our standard process in preventing wrong level surgery for lumbar microdiscectomy

Introduction. The Odom's criteria are, since 1958, a widely used 4-point rating scale for assessing the clinical outcome after cervical spine surgery. Surprisingly, the Odom's criteria have never been validated. The aim of this study was to investigate the reliability and validity of the Odom's criteria for the evaluation of surgical procedures of the cervical spine. Methods. Patients with degenerative cervical spine disease were included and divided into two groups, based on their most predominant symptom: myelopathy or radiculopathy. Reliability was assessed with inter-rater and test-retest design using a quadratic weighted Kappa coefficient. Construct validity was assessed by means of hypothesis testing with related constructs. To evaluate if the Odom's criteria could act as a global perceived effect (GPE) scale, we assessed concurrent validity by comparing the areas under the curves (AUCs) of the receiver operating characteristic curves (ROCs) with both the Odom's criteria, as the GPE as an anchor. Results. A total of 110 patients were included in the study. Overall inter-rater reliability was k=0.77 and the test-retest reliability k=0.93. Inter-rater reliability for the radiculopathy patients was κ=0.81 and for myelopathy patients κ=0.68. More than 75% of the hypotheses were met. The AUCs showed similar characteristics between the Odom's criteria and GPE. Conclusion. The Odom's criteria meet the predefined criteria for reliability and validity. Therefore, the Odom's criteria may be used to measure surgical outcome after a cervical spine procedure. Results of previous studies that have been deemed less trustworthy, because of the use of the Odom's criteria, should be reconsidered. No conflicts of interests. No funding obtained

Purpose of the study. We propose a simple classification for adolescent idiopathic scoliosis (AIS) based on two components which include the curve type and shoulder level and suggest a treatment algorithm for AIS. Introduction. Few Classification systems for adolescent idiopathic scoliosis (AIS) have helped in communicating, understanding and selecting a treatment for this condition; however, most of these classifications are complex and include many subtypes, making it difficult for the orthopaedic surgeon to use them in clinical practice. The variable reliability and reproducibility of these studies make recommendations and comparisons between various operative treatments a difficult task. Furthermore, none of these classifications has taken the shoulder imbalance into account, despite its importance as a clinical parameter and outcome measure. Methods. We developed a classification system with two components: curve type (I through III) and shoulder level (A or B). The curve types are divided into type I: Primary lumbar-thoracolumbar +/− secondary dorsal; type II: Primary dorsal secondary lumbar and type III: Dorsal. Each curve pattern is subdivided into type A or B depending on the shoulder level. In type A, the lower shoulder is ipsilateral to the concavity of the primary curve. In type B, the shoulders are level or the lower shoulder is on the convexity of the primary curve. This classification was tested for interobserver reliability and intraobserver reproducibility by six surgeons using radiographs of 28 patients. We performed a retrospective analysis of the radiographs of 232 consecutive AIS cases to assess the prevalence of curve types and tested the surgical treatment against the proposed treatment algorithm. Results. Three major types and six subtypes were identified, of which type I accounted for 30%, type II 28% and type III 42%. The kappa coefficient for interobserver reliability was 0.943, while the kappa value for intraobserver reproducibility was 0.964. There was a complete concordance with the shoulder level component. Of the 232 cases reviewed, with a minimum two-year follow-up, only three patients developed a decompensation distal to the instrumentation requiring fusion extension. Conclusion. This classification is the first of its kind to specifically address shoulder imbalance in the surgical decision-making process. The high interobserver reliability and intraobserver reproducibility is due in part to the simplicity of this classification, which makes it an invaluable tool to describe scoliosis curves and offers a potential treatment algorithm in correcting scoliosis

Aims

To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so.

Background. Pain with radiation to the leg is a common presentation in back pain patients. Radiating leg pain is either referred pain or radicular, commonly described as sciatica. Clinically distinguishing between these types of leg pain is recognized as difficult but important for management purposes. The aim of this study was to investigate inter-therapist agreement when diagnosing referred or radicular pain. Methods. Thirty-six primary care consulters with low back-related leg pain were assessed and diagnosed as referred or radicular leg pain by one of six trained experienced musculoskeletal physiotherapists. Assessments were videoed, excluding any diagnosis discourse, and viewed by a second physiotherapist who made an independent diagnosis. Therapists rated their confidence with diagnosis and reasons for their decision. Data was summarized using percentage agreements and kappa (K) coefficients with two sided 95% confidence intervals (CI). Results. The therapists assessing and therapists watching the video both diagnosed radicular pain in 25 of the 36 patients. Agreement was 72% with fair inter-rater reliability (K = 0.35, 95% CI 0.07, 0.63, p<0.05). Mean confidence in diagnosis was 87% for radicular pain and 83% for referred pain. In the subgroup of patients where therapists' confidence in diagnosis was ≥ 80% (n=28), agreement was 86% with substantial reliability (K = 0.65, 95% CI 0.37, 0.93 p<0.001). Conclusion. Reliability was fair among therapists when diagnosing back-related leg pain. This concurs with current opinion that differentiating between types of back-related leg pain can be difficult. However, when confidence in clinical diagnosis is high, levels of agreement and reliability indices improve substantially

Aims

Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems.

Aims

The aims of this study were to evaluate the clinical and radiological outcomes of instrumented posterolateral fusion (PLF) performed in patients with rheumatoid arthritis (RA).

Aims

The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level.

Aims

To clarify the asymmetrical ossification of the epiphyseal ring between the convex and concave sides in patients with adolescent idiopathic scoliosis (AIS).

This study evaluates factors related to myelopathic symptoms in patients with ossification of the posterior longitudinal ligament (OPLL). A total of 87 patients with OPLL were included. Of these, 53 (Group I) had no symptoms or presented with neck pain and radiculopathy and 34 (Group II) had myelopathic symptoms. Gender, age, and history of trauma were evaluated in the two groups. The range of movement of the cervical spine was measured using plain radiographs. The number of involved segments, type of OPLL, and maximal compression ratio were analysed using CT and signal change in the spinal cord was evaluated using MRI.

The patients’ age was found to be significant (p = 0.001). No difference was found between gender and the range of movement in the two groups. The maximum compression of the spinal canal showed a difference (p = 0.03). The signal change of the spinal cord was different between the two groups. In patients with OPLL of the cervical spine, myelopathic symptoms are not related to the range of movement or the number of involved segments.

Low back injuries account for the greatest loss of playing time for professional fast bowlers in cricket. Previous radiological studies have shown a high prevalence of degeneration of the lumbar discs and stress injuries of the pars interarticularis in elite junior fast bowlers. We have examined MRI appearance of the lumbar spines of 36 asymptomatic professional fast bowlers and 17 active control subjects. The fast bowlers had a relatively high prevalence of multi-level degeneration of the lumbar discs and a unique pattern of stress lesions of the pars interarticularis on the non-dominant side. The systems which have been used to classify the MR appearance of the lumbar discs and pars were found to be reliable. However, the relationship between the radiological findings, pain and dysfunction remains unclear.