Introduction. This study was performed to investigate the efficacy of steroid and local anaesthesia (LA) in reducing post-operative pain in lumbar discectomy. Materials and methods. The study was ethically approved. Patients undergoing primary single level lumbar discectomy were randomised by a closed envelope system into 4 groups, which were (Group 1) 10mg of adcortyl in 1ml and 1ml of 0.5% marcaine, (Group 2) 10mg of adcortyl and 1ml of normal saline, (Group 3) 1ml of 0.5% marcaine and 1ml of normal saline and (Group 4) 2mls of normal saline as control. Combinations of the above were applied topically over the nerve root prior to closure. Pre-operative, day 1 and eight weeks post-operative pain scores were recorded. 24 hours post-operative opiate analgesia requirements and duration of inpatient stay were recorded. Data were analysed using student t-test for statistical significance. Results. 100 patients were recruited into the study. There were no significant differences seen in the mean age, gender and the mean pre-operative pain score between all groups. Mean day one pain score in groups 1,2,3 and 4 was 0.9,2.5, 2.1 and 3.3 respectively. Mean 24 hours post-operative opiate requirement was 32.4mg, 54mg, 48.8mg and 56.4mg respectively. Mean inpatient stay was 2.2 days, 3.9 days, 4.62 days and 3.63 days respectively. A significant different (p<0.05) was noted in day one post-operative mean pain score, mean 24 opiate requirement and mean inpatient stay in the corticosteroid and LA group. At 8 weeks post-operatively, no significant differences were seen in the pain score in all groups. Conclusions. Significant early post-operative pain reduction was achieved in the steroid and local anaesthesia group compared with other groups (p<0.05). A significant reduction in the 24-post operative analgesia requirement (p<0.05) and in inpatient stay (p<0.05) was also observed

Background. Cauda equina syndrome (CES) is a physical process. There is compression of the cauda equina resulting in arrest of the electrochemical signal from the central nervous system. Previous studies have demonstrated that anthropomorphic features influence nerve conduction properties. Aim. We therefore sought to if there was an association between biophysical parameters and CES. Setting and design. Single centre retrospective comparative study. Method and materials. We analysed consecutive patients who had elective lumbar discectomy. Demographic data-including age, gender, height, weight and BMI were recorded. Identical information was collected in consecutive patients who underwent emergency lumbar discectomy for MRI-proven CES. Results. There were 40 patients who underwent emergency surgery for CES. There were 22 women and 18 men with a mean age of 38.6 years. 92 patients underwent elective lumbar discectomy. There were 45 men and 47 women with a mean age of 44 years. Patient undergoing emergency discectomy for CES were significantly heavier (p=0.001) and had a significantly higher BMI (p< 0.0005) compared to the elective surgery cohort. The mean difference in weight and BMI were 11.2 kg (95% confidence interval: 3.8–18.7) and 4.6kg/m2 (95% confidence interval: 2.4–6.9) respectively. The CES-group was also slightly younger (mean difference 5.4 years 95% CI: 1.7–9.8 p=0.01). There was no statistically significant difference between the heights of the two groups or the gender ratio. Multivariate binary logistic regression showed increasing weight to be associated with the increasing odds of CES (P< 0.0005). In contrast increasing height was correlated with a reducing likelihood of CES (P< 0.01). Increasing BMI was associated with increased odds of CES (p< 0.0005). Conclusion. This is the first study to relate anthropometric features to CES. Our study observed that increasing BMI is linked with the increased odds of CES syndrome as was increasing weight and decreasing height

Objective. To investigate, through a randomised, single blind, Quasi-experimental trial, whether immediate physiotherapy after lumbar micro-discectomy enables patients to become independently mobile more rapidly with no increase in risk of complications. Background data. Although studies have demonstrated the efficacy of rehabilitation after lumbar discectomy, nos have looked at physiotherapy commencing immediately post-operatively. Methods. Thirty patients were randomised to an immediate group commencing physiotherapy within two hours after surgery or a control group receiving physiotherapy on the first day after surgery. Outcome measures included the time taken for the patient to become independently mobile after surgery, Oswestry Disability Index and pain scores (VAS and short form McGill) collected pre-operatively and post-operatively at four weeks, and three months. Results. The results indicated significantly reduced time to independent mobility (p=0.009) and return to work (p=0.002) in the immediate group. In that group, 47% of patients achieved discharge criteria on the day of surgery compared with 33% in the control group. There was no significant difference in disability and pain scores at four weeks and three months between the groups. Early mobilisation did not result in increased complications at 18 months after surgery. Conclusions. Immediate physiotherapy following first time single level lumbar micro-discectomy enables patients to become independently mobile more rapidly and return to work sooner. Immediate physiotherapy may enable patients to experience earlier discharge with associated cost benefits to healthcare

Aims

The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic.